Type 2 DM Meds - Type 2 DM meds chart PDF

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Summary

Type 2 DM meds chart...

Description

ORAL DIABETIC MEDS

Drugs in Class

Biguanine

Sulfonylureas

Glinides

Metformin

Glipizide (Glucotrol) Glyburide (Diabeta) Glimiperide (Amaryl)

Repaglinide (Prandin) Neteglinide (Starlix)

MOA

Decreases glucose production by liver. Also may decrease absorption of glucose in intestine= increased periph. glucose uptake & use & decreased production of triglycerides & cholesterol

Therapeutic Effects/ Indications

1st line tx type 2 DM Pre diabetes

Precautions/ AE/ contra-

Contra-renal disease creat > 1.4-1.5 (excreted by kidneysaccumulates in pts with RF since they can’t clear it= increased risk lactic acidosis); alcoholism, metabolic acidosis, hepatic disease, HF, liver disease, alcoholism, cardiopulmonary disease AE-GI-n/d, bloating, cramping-less if titrated dose & taken w/ food; metallic taste, reduced B12 after long term use, hypoglycemia, lactic acidosis

Bind to specific receptors on Beta cells in pancreas to stimulate insulin release. Secondarily decrease secretion of glucagon,

Type 2 DM

Increase insulin secretion from pancreas

Type 2 DM

Contra-elderly, conditions that predispose pts to hypoglycemia, pt is NPO, allergy, ETOH use Possible cross sensitivity with sulfa allergies. AE-hypoglycemia, wt gain, rash, nausea, epigastric fullness, heartburn

Contra-similiar to sulfonylureas

Nursing ImplicationsKnow clinical signs of lab abnormalities Metformin must be d/c’d day of test if pt needs iodine contrast & held at least 48 hours after.

Interactions

S

Iodine contrast, hypoglycemia drugs, cimetidine, diuretics, corticosteroids,

N g h w U p

Monitor for AE. Pt teaching about BG monitoring, medication, s/s hypoglycemia, Need to monitor BG & follow up for appt. Monitor for AE. Pt teaching about BG monitoring, medication, s/s hypoglycemia, Need to monitor BG & follow up for appt. Same as above

N a ca (N

B blockers, cimetidine, Emycin, fluconazole, sulfa abx , DPP4 inhibitors, garlic, ginger, ginseng, carbamazepine, phenobarbital, Dilantin,rifampin similiar to sulfonylureas

AE-hypoglycemia, wt gain Thiazolidineiones (Glitazones)

Alpha-glucosidase inhibitors

Pioglitazone (actos) Rosiglitazone (avandia)

Acarbose (precose) Miglitol (Glyset)

Insulin sensitizing drugsdecrease insulin resistance by enhancing sensitivity of receptorsstim periph uptake of glucose & storage & inhibits glucose & trigycerides in liver

Type 2 DM

Reversibly inhibit enzyme in small intesting that is

Tx type 2 DM

Contraindicated w/ HF-class 3 or 4; Caution-use with liver/kidney disease AE-Black Box warning-can cause/ exacerbate HF; not recommended for use in symptomatic HF Periph. edema, wt gain, increase in adipose tissue, decreased bone density; increased risk fractures

Contra-not to be used w/inflammatory bowel disease, malabsorption syndrome, intestinal obstruction, DKA,

Same as above.

Metabolized partly by cytoP450-levels may be increased if taken with other drug that inhibits same enzyme in CytoP450 system-ex. Emycin, ketoconazole Digozin, ranitidine, propanolol

N a ca (N G co w S a g m S a ta

U ca

ORAL DIABETIC MEDS

responsible for converting types of saccharides to glucose= delayed glucose absorption

DPP 4 inhibitors

Sitagliptin (Januvia) Linagliptin (Onglyza) Linagliptin (tradjenta) Aloglipin (Nesina)

Delay breakdown of incretin hormones by inhibiting DPP 4 enzymeincrease insulin synthesis and lower glucagon secretion= reduced fasting glucose & post prandial (after eating) glucose concentrations

h w ra h n co ca d b o

cirrhosis, inflammatory bowel disease, colonic ulceration, intestinal obstruction or chronic disease AE-flatulence, diarrhea, abd pain, elevated LFT’s Same as above, Monitor LFT’s

Tx type 2 DM

Contra-allergy AE-URI, h/a, diarrhea, hypoglycemia, pancreatitis

Same as above Monitor for pancreatitis

Sitagliptin (Januvia) May increase Digoxin levels & metabolism may be inhibited by CytoP450 inhibitors Possible hypoglycemia w/ insulin, sulfonylureas Rifampin

Amylin Agonist (Injectable antidiabetic drug)

Incretin Mimetics

SGLT2 inhibitors

Pramlinitide (Symlin)

Liraglutide (Victoza) Exenatide (Byetta,) Dulaglutide (Trulicity)

Canagliflozin (Invokana)

1-slows gastric emptying 2-suppresses glucagon secretion & hepatic glucose production 3-increases satiety

Type 1 or 2 DM who fail to be controlled with insulin

Enhance glucose dependant secretion, suppress elevated glucagon secretion & slow gastric emptying

Type 2 DM

Inhibiit glucose reabsorption, may increase insulin sensitivity & glucose uptake in cells & decrease gluconeogenesis

Type 2 DM

Contra-gastroparesis & GI motility issues

Monitor for hypoglycemia.

AE-n/v, anorexia, h/a Pt teaching.

Contra-sensitivity to drug, h/o family medically thyroid ca or personal history of same, pts with endocrine neoplasia

Monitor for hypoglycemia.

AE-Black box warning-developing Thyroid C cell tumorsn/v/d, hemorrhagic or necrotizing pancreatitis, wt loss

Pt teaching. Monitor pancreas labs Monitor for hypoglycemia.

Contra-DKA, mod to severe renal impairment AE- genital yeast infections, UTI’s, increased urination, hypotn, hypovolemia, hyperkalemia, may increase LDL FDA warning-risk of ketoacidosis

Treatment for hypoglycemia- oral glucose (tablets, gel); D50W (50% dextrose in water); Glucagon

Pt teaching. Monitor VS, K, LDL

If taken w/ rapid or short acting insulininsulin need to be reduced by 50% Delays absorption of any drug taken at same time. Can delay other PO meds by slowing gastic emptying.

Rifampin Hypoglycemia w/ other DM meds

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