Drug
Action – Target
ADVERSE/se:
st
1 generation Stimulates
Hypoglycemia and weight gain, diarrhea, Take with
sulfonylureas: secretion of
constipation, dizziness, gas, anorexia, meals 100 –
Chlorpropami insulin –
headache, nausea, vomiting, abdominal 500 mg daily.
de
Pancreatic beta distress. Rare AD: resp difficulties in
Adult 250mg/d
(Diabinese) cells. Adjunct to cardiac and HF; sedation, muscle
Ger 100-125
P = 2-4
diet & exercise to cramping, seizures; edema, comatose, Max 750mg/d
D = 24-72
improve glycemic weakness, pruritus, jaundice, dark urine,
control in T2DM light colored stools, increased fatigue,
sore throat, increased temperature,
increased bleeding or bruising.
Nursing considerations: Increased risk of hypoglycemia in geriatric or malnourished
patients. Take with first meal of the day. Nausea, Avoid alcohol. Long duration of action
with potential for hypoglycemia avoid in older clients should not be used by women who
are pregnant or nursing, or by individuals allergic to sulfa drugs; sulfonylura interacts with
many other drugs.
Drug
Action – Target
ADVERSE/se:
2nd
Antidiabetic / Management of TYPE 2 APLASTIC ANEMIA
PO (adult) 5 mg /day
generation diabetes mellitus when diet therapy photosensitivity,
(geriatric 2.5mg/day)
sulfonylureas fails. Requires some pancreatic
hypoglycemia observed 3-4 initially may be ↑ by 2.5 -5
glipizide
function. Action: lower blood glucose hrs May increase or
mg/day at weekly intervals
(Glucatrol) by stimulating the release of insulin decrease appetite. Increased as needed (max 40
from the pancreas and increasing weight, dyspepsia, nausea, mg/day (immediateO = 15-30 the sensitivity to insulin at receptor constipation/diarrhea, avoid release), administered
min
sites. May also decrease hepatic
alcohol. Possible
glipizide 30 min before a
P = 1-2 hr glucose production.
hypoglycemia in geriatric or meal.
D = 24 hr
malnourished patients.
Nursing considerations: Take 30 minutes before first meal of the day. Hyperglycemia w/high doses of
nicotinic acid.
observe for s/s of hypoglycemic reactions. Assess for allergy to sulfonamides. Patients on beta blocker
therapy may have subtle signs of hypoglycemia. Lab Tests: serum glucose, glycosylated hemoglobin, May
cause an in AST, LDH, BUN, and serum creatinine. CBC Report ↓ in blood counts promptly
Toxicity: Overdose is manifested by s/s of hypoglycemia. Severe treated with IV D50W.
High Alert: Accidental administration of oral hypoglycemic agents to non-diabetic adults and children has
resulted in serious harm or death. Before administering, confirm that patient has T2DM.
Drug
Action – Target
ADVERSE/se:
Biguanides: Decrease hepatic LACTIC ACIDOSIS, nausea, PO: 500 mg once or
Metformin
glucose production vomiting, abdominal pain,
twice daily w/increases
(Glucophage) and intestinal
malaise, loss of appetite
q 2 weeks until
glucose absorption; difficulty, may lose weight, adequate response or
P = 2-3
improve insulin
breathing, diarrhea, muscle max dose (2550mg)
D = 12-24
sensitivity/ Target is weakness. Vit B12 deficiency Take with first main
liver, small intestine, or reduced absorption and meal SLOW onset of
and peripheral
folic acid, anorexia, metallic action not noted for 14
tissues
taste, rarely suitable for
days of initial therapy
adults > 80 yr of age.
Nursing Implications: Take with meals to decrease GI distress. May cause anorexia. Avoid
Alcohol. Avoid in renal failure because of risk of lactic acidosis. T2DM – contraindicated
w/renal insufficiency or uncontrolled HF.
Drug
Action – Target
ADVERSE/se:
Thiazolidinediones Improves insulin Actos: edema, HF, headache, Once or twice
(glitazones):
sensitivity – target myalgia, sinusitis, upper resp daily
Pioglitazone(Actos) activates genes infections.
Avandia - PO 4
P= 2
involved with fat Avandia: CHF, LACTIC
mg/daily or 2
D = 16-24
synthesis and
ACIDOSIS, possible liver
mg/twice daily.
rosiglitazone(Avan carbohydrate
damage, hepatotoxicity -rare. Peak in 1 hr.
dia)
metabolism
mild anemia, fluid retention,
Actos – PO 15 to
P = 1 (Davis UKN) Only for T2DM who weight gain, altered lipid levels. 45 mg once daily.
D = 12-24
can produce
Peak 2 hrs.
insulin.
Nursing Implications: Take once a day without regard to food. Increased weight. monitor
liver function, monitor for edema, weight gain, HF Fluids – HF requires careful monitoring.
Blood testing for liver functions should be performed before start of therapy q 2 months
during 1st year and periodically thereafter.
Drug
Meglitinides NonSulfonylureas:
repaglinide
(Prandin),
P = 1 hr
D = 4 hr
neteglide
(Starlix) P = 1
D= < 4hr
Action – Target
ADVERSE/se:
Stimulates HYPOGLYCEMIA and
Prandin: 0.5 – 4mg 3 times
secretion of weight gain; Repaglinide
daily before meals. Omit if
insulin
has a lightly increased risk client skips meals. Not to
Targetfor cardiac events,
exceed 16mg/day
Pancreatic headache, resp tract
Starlix: Dosed at 60 -120 mg
beta cells infection, altered liver
3 times/daily immediately
T2DM
function tests. Cardiac
before meals.pt approaching
May be used effects – hypotension, chest glycemic control may be
with
pain, cardiac dysrhythmias. started at 60 mg 3times
metformin, Starlix – back pain, flu like daily.Take with meals onset
rosigliazone, symp.
within 15-20 minutes RAPID
pioglitazone.
Nursing Implications: Take 15-30 min before meals. May increase weight, tooth disorders,
nausea/vomiting. Diarrhea/constipation. Limit alcohol. May increase risk of hypoglycemia
in malnutrition.
Drug
AlphaGlucosidase
Inhibitor:
acarbose
(Precose)
P = not
absorbed
D= 8 – 12
hrs.
Action – Target
ADVERSE/se:
Delays absorption of glucose from flatulence, PO 25 mg 3xdaily. not to
GI Tract / Target – Small intestine. diarrhea exceed 50 mg 3xdaily in
antidiabetic/ Management of TYPE (particularly patients < 60 kg or
2 diabetes in conjunction with
after high- 100 mg 3 x daily > 60 kg.
dietary therapy, may be used with carb meal) Administer w/first bite of
insulin or other hypoglycemic
abdominal each meal
agents. Lowers blood glucose by pain, may Must be taken with meals.
inhibiting the enzyme alphainterfere Omit if skipped meal.50-100
glucosidase in GI tract. Delays and with iron mg 3 times daily. Initiate
reduces glucose absorption
absorption dose slowly to reduce GI
adverse effects.
Nursing Implications: observe patient for hypoglycemia – sweating, hunger, weakness,
dizziness, tremor, tachycardia, anxiety. Lab Test Consider: serum glucose & glycosylated
hemoglobin. Monitor AST and ALT q 3 mo for 1st year. Take with first bite of main meal.
Limit alcohol. May decrease absorption of digoxin.
Drug
Action – Target
ADVERSE/se:
Glucogon
Indicated for treatment HYPERSENSITI IM, IV SQ 0.5 to 1mg
TO RAISE BLOOD SUGAR of severe
VITY
half-life 10 minutes.
IM-O:10 min P: 30
hypoglycemia in
REACTIONS, duration 1.5 hrs.
minD:60-90/12-27min
diabetes and adjunct ANAPHYLAXIS, repeated in 20
IV-O:1 min
P:5 min D: for GI radiography.
nausea,
minutes when
9-17min
Natural polypeptide
vomiting, allergic necessary.
SQ-O:10 min P: 30-45 min hormone secreted by reaction. no
D:60-90 min
pancreatic alpha cells significant drug
in response to
interactions.
hypoglycemia.
Drug
Adjunctive Therapies
Incretin mimetics
Action – Target
ADVERSE/se:
Exenatide (Byetta) for patients
Pramlintidide (Symlin)
taking metformin, a sulfonylura, or a synthetic form of hormone
combination of metformin and a
amylin. (normally
sulfonylura.
produced by beta cells in
Action: lowers blood glucose
the pancrease) Works
levels by increasing insulin
with insulin and glucagon
secretion in the presence of
to maintain normal blood
elevated blood glucose levels.
glucose levels taken
Good because it does not tend to w/meals. Improves HbA1c
increase risk of hypoglycemia.
levels by slowing gastric
emptying rate.