5. diabetes drug table PDF

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Summary

drug table from notes ...

Description

Drug class and prototype

MOA/dynamics

Advantages

Disadvantages and side effects

Contraindications

Teaching Impleme Consider

Group 1 Biguanide

stops the liver from making glucose when its not needed

cost weight loss, insulin sensitization, positive lipid effect,

GI side effects (nausea, metallic taste, flatulence, diarrhea)

diabetes complicated by fever, severe infections, severe trauma, major surgery, acidosis, or pregnancy

given wit breakfas morning doses be

prototype: metformin

mild hypotensive effect.

rare lactic acidosis (liver disease)

conditions that may increase production of lactate

low risk of hypoglycemia

Group 2A: sulfonylureas prototypes: 1st generation: chlorpropamide

increase insulin output from the pancreas [make extra insulin]

oral; low cost, fast reduction in fasting glucose

weight gain, skin rash,

stop 2 da procedur decrease perfusion surgery eczema, erythem urticaria

severe renal or hepatic impairment

take with

type 1 diabetes or patients with DKA [diabetic ketoacidosis]

take 15-3 before ea

strong risk of hypoglycemia

carry sou carbohyd

work in pancreas

2nd generation: glyburide and glipizide

Group 2B: glinides prototype: repaglinide, nateglinide (Starlix)

stimulate pancreas to release more insulin

Very short acting (acts directly on beta cell)

lower risk for hypoglycemia, short acting, meal adjust dosing (flexible)

Cost: GI upset, upper respiratory congestion, hypoglycemia

short act side effe

Group 2C: incretin agents [two prototypes]

inhibits release of glucose from liver; stimulates insulin when glucose rises

gliptin [sitagliptin]

gliptin: inhibits glucose, PO

glutide: [liraglutide and glucagone-like peptide]

stimulates insulin, injection

Group 3: glitazones

inhibits release of glucose from liver)

prototypes: pioglitazone, rosiglitazone

helps body cells use insulin [address the core problem in type II diabetes—insulin resistance]

Group 4: starch blockers

lowered upper respiratory A1c, works well in infection, sore elderly, throat, diarrhea, headache, stuffy fewer side nose effects, take with other oral hypoglycemic agents

take without regard to means; decreases amount of insulin decrease risk of hypoglycemia, decrease in triglyceride level

slow digestion of decrease risk of starch hypoglycemia

prototypes: acarbose and miglitol

block renal glucose

given PO daily, weight loss, lower

production of ketones in the urine, end-stage renal disease, medication that cause hypoglycemia

monitor f effects risk of he DPP-4 in [gliptin] once dai without fo

cost; weight gain; don’t give with heart failure slow onset of [BBW] action (12 weeks); possible liver toxicity safety alert: risk of a heart attack liver injury and diarrhea, [MI] sinusitis, upper respiratory infection, rhinitis, and dyspnea.

monitor s transami

cost; potential to produce leukopenia, thrombocytopeni a, and anemia

contra: inflammatory bowel DKA, hepatic cirrhosis, and severe renal impairment

must be each me

don’t give with diuretics [can

monitor f itching (m

GI side effects (diarrhea, flatulence) SGLT2 Inhibitor (Gliflozin):

type 1 diabetes mellitus, insulin use,

same as contra and side effects

monitor b pressure presence before or minutes

Glucosuria prototype: canagliflozin, dapagliflozin

reabsorption

blood pressure

cause dehydration; possible reduced bone density; may cause ketoacidosis (high blood ketones)

promotes elimination of glucose

Type

name

Onset

Peak

Duration

Misc

Rapid-acting Insulin (analog)

lispro (Humalog) aspart (NovoLog) glulisine (Apidra)

about 15 (immediate)

30-1 hr

Effective SQ, IV, insulin Duration: 3-5 pump hours Ideal for bolus (mealtime and high glucose) 15 MINS FEELS LIKE AN HOUR DURING 3 RAPID RESPONSES

SHORT ACTING INSULIN

Intermediateacting Insulin

Regular: Humulin R , Novolin R, Actrapid

Humulin N, Novolin N (NPH)

Onset: 30-60 min

Onset: 2-4 hours

Peak 2-3 hours

Peak: 8-12 hours (hypoglycemia –

Duration: 5-7 hours

Effective duration 1824 hours

Clear/ give IV, SQ

SHORT STAFFED NURSES WENT FROM 30 PATIENTS TO (2) 8 patients Cloudy, Subq only **can be mixed with Regular

urinary tr infection

midafternoon)

Long-acting Insulin (analog)

glargine (Lantus) detemir (Levemir)

Onset: 3-4 hours

Peak: 8-16 hrs

18-20 hrs.

NURSES PLAY HEROES TO (2) EIGHT (8) 16 YEAR OLDS Adm Sq. (same time daily) Provides Basal THE THREE LONG NURSING SHIFTS NEVER PEAKED BUT LASTED 24 HOURS

Basal: glargine (long acting) any time, but usually at night (50% of total daily dose: TDD): keep basic metabolic functions even when not eating Nutritional (prandial or bolus) (50% of TDD): before meals Correctional (sliding scale): additional insulin depending on pt. condition to keep blood glucose within normal range...