NCLEX Meds Endocrine System Part 2 Oral Hypoglycemics

NCLEX Meds Endocrine System Part 2 Oral Hypoglycemics

NCLEX Meds Endocrine System Insulin here.

Sulfonylureas

Expected Action:

Promote insulin release from the pancreas

Example: 1^st – tolbutamide / 2^nd – glipizide

Others: 1^st – chlorpropamide, 2^nd – glyburide

Therapeutic Uses: With diet/exercise, control blood GLC in type 2 diabetes

Adverse Effects: Hypoglycemia (abrupt’SNS / slow’CNS symptoms)

Contraindications/Precautions:

Pregnancy (C), Diabetic ketoacidosis, Pregnancy/lactation, Caution Renal/liver dysfunction

Interactions:

EtOH: disulfiram-like reaction

EtOH, NSAIDs, sulfonamides, ranitidine, cimetidine leads to additive hypoglycemic

Concurrent use of β-blockers may mask awareness of hypoglycemic, specifically SNS symptoms of tachycardia, palpitations, and diaphoresis.

Education:

GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%

Meglitinides

Expected Action: Promote insulin release from pancreas

Example: repaglinide (Prandin) — Others: nateglinide (Starlix)

Therapeutic Uses: Type 2 diabetes, with diet and exercise, Often use with metformin

Adverse Effects: Hypoglycemia

Contraindications/Precautions: Pregnancy (C), Diabetic ketoacidosis, Caution with Hepatic dysfunction

Interactions: Gemfibrozil (Lopid) leads to inhibition of repaglinide metabolism

Education: GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%

Biguanides

Expected Action: Inhibit gluconeogenesis in liver, increase muscular uptake and use of glucose

Example: Metformin (Glucophage)

Therapeutic Uses: Type 2 diabetes, Polycystic ovarian syndrome (PCOS)

Adverse Effects: GI effects (nausea, vomiting, weight loss 6-8 lb), Vitamin B₁₂ and folate deficiency d/t altered absorption, Lactic acidosis (hyperventilation, myalgia, sluggishness) – 50% mortality

Contraindications/Precautions: ♀ (B), Diabetic ketoacidosis, Renal, hepatic, cardiac failure, Severe infection, shock, hypoxia

Interactions: EtOH – increases risk lactic acidosis with concurrent use

Education: GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%

Thiazolidinediones

Expected Action: Increased cellular response to insulin by decreased insulin resistance

Proto: rosiglitazone (Avandia) — Others: pioglitazone (Actos)

Therapeutic Uses: Type 2 diabetes with diet and exercise

Adverse Effects: Fluid retention, increased LDL, Hepatotoxicity

Contraindications/Precautions: Pregnancy (C), DKA & heart failure, Caution Mild heart failure d/t fluid retention effects

Interactions: Insulin leads to increased risk for hypoglycemia, Gemfibrozil (Lopid) leads to V metabolism of rosiglitazone leads to increased hypoglycemia

Education: GLC 90-130 mg/dL preprandial, < 180 mg/dL postprandial. HgA1c < 7%

α-Glucosidase Inhibitor

Expected Action: Slow carbohydrate absorption and digestion

Example: acarbose (Precose) — Others: miglitol (Glyset)

Therapeutic Uses: Control postprandial blood sugar in type 2 diabetes

Adverse Effects:

Risk for anemia d/t decreased iron absorption

Hepatotoxicity with long-term use

Intestinal effects (abdominal distention, cramping, hyperactive bowel sounds, diarrhea, flatulence)

Contraindications/Precautions: Pregnancy (B), Diabetic ketoacidosis, GI disorders (inflammatory disease, ulceration, obstruction)

Interactions:
Insulin, sulfonylureas leads to increased risk of hypoglycemia
Metformin leads to Additive GI effects and risk for hypoglycemia with concurrent use.

Education:

Take medication with first bite
Postprandial blood glucose < 180 mg/dL
HgA1c < 7%