Transcript Roach: Introductory Clinical Pharmacology

Introduction to Clinical
Pharmacology
Chapter 42Antidiabetic Drugs
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Diabetes
• Risk factors for type 2 include:
– Obesity
– Older age
– Family Hx
– Hx of gestational diabetes
– Impaired glucose tolerance
– Minimal or no physical activity
– Race/ethnicity
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Insulin
• Hormone manufactured by beta cells of
pancreas
• Controls the storage and utilization of amino
acids and fatty acids
• Lowers blood glucose levels by inhibiting
glucose production by liver
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Insulin: Action and Uses
• *Activates a process that helps glucose
molecules enter the cells of striated muscle
and adipose tissue
• Promotes protein synthesis
• Properties of insulin: Onset, Peak, Duration
• Controls type 1 diabetes mellitus, type 2
diabetes, Severe diabetic ketoacidosis
• Treats hypokalemia in combination with
glucose
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Insulin: Adverse Reactions,
Contraindications, and Precautions
• Adverse reactions:
– Hypoglycemia; Hyperglycemia; Allergic
reaction
• Contraindicated in patients:
– With hypersensitivity, hypoglycemia
• Used cautiously in patients:
– With renal and hepatic impairment;
During pregnancy and lactation
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Display 42-1 Drugs that alter insulin
effectiveness
• Estrogens
• Methylprednisolone
• niacin
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Oral Antidiabetic Drugs
• Used to treat patients with type 2 diabetes
that is not controlled by diet and exercise
alone
• Not effective for treating type 1 diabetes
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Sulfonylureas
• Action
– Lower blood glucose by stimulating the B cells of the
pancreas to release insulin
– Not affective if B cells cannot release a sufficient
amount of insulin to meet the individuals needs
– *****Examples:
• Glucotrol-glipizide
• DiaBeta-glyburide
• glimpiride/Amaryl
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Nonsulfonylureas
• **A-glucosidase inhibitors
– Precose (acarbose) and Glyset (miglitol0
– Lower blood glucose levels by delaying the digestion
of CHO’s and absorption of CHO’s of the intestine
**Thiazolidinediones/glitazones
decrease insulin resistance and increase insulin
sensitivity by modifying several processes
Avandia/rosiglitazone and pioglitazone/Actos
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Adverse Reactions
• Sulfonylureas
– Hypoglycemia, anorexia, nausea, heartburn
• Nonsulfonylureas
– Lactic acidosis-buildup with metformin use
• s/s malaise, abdominal pain, rapid respirations,
shortness of breath and muscular pain
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Contraindications, precautions and
interactions
• **Sulfonylureas
– Oral antidiabetic drugs are contraindicated in
patients with known hypersensitivity to the drugs,
DKA (tx is insulin), severe infection, or severe
endocrine disease
– May have an increased hypoglycemic effect when
administered with anticoagulants
• Nonsulfonylureas
– Heart failure, renal disease
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Hormone Mimetic Agents
• Released in response to increases in glucose that occures
after eating
• Januvia/sitagliptin
– Lowers blood glucose level by enhancing the
secretion of endogenous incretin hormone
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Nursing Process: Assessment
• Preadministration assessment:
– Assess weight, blood pressure, pulse,
respiratory rate
– Assess skin, mucous membranes,
extremities, with special attention given
to sores or cuts that appear to be healing
poorly and ulcerations or other skin or
mucous membrane changes
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Nursing Process: Assessment
• Ongoing assessment:
– Monitor vital signs; Observe adverse drug
reactions
– *monitor q 2-4 hours for s/s of
hypoglycemia
– Notify primary health care provider if
adverse reaction occurs or if there is
significant weight gain or loss
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Nursing Process: Planning
• Expected outcomes:
– Optimal response to therapy
– Support of patient needs related to
management of adverse reactions
– Reduction in anxiety
– Improved ability in coping with diagnosis
– Understanding of and compliance with
prescribed therapeutic regimen
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Nursing Process: Implementation
• Promoting an optimal response to therapy
– Administer insulin, care must be taken to use
correct insulin
– Carefully read all drug labels before preparing any
insulin preparation
– Read label of the insulin bottle carefully for name,
source of insulin, number of units per milliliter
• U100 has 100 units in each milliliter
• *Those clients who are resistant to insulin may
require larger dose use the U500 concentration
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Nursing Process: Implementation
• Promoting an optimal response to therapy
– Mixing Insulins:
•Clarify with primary health care
provider if patient is to receive regular
insulin and NPH insulin, regular and
lente insulin
•*do not mix or dilute glargine
•Ask whether insulins were given
separately or together if patient had
been using insulin mixtures before
admission
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Nursing Process: Implementation
• Insulin administration
– Regular insulin is given 30-60 minutes before a meal
to achieve optimal results
– Lispro usually lowers the glucose level 1-2 hours
after meals
– Insulin glargine is given subcutaneously once daily at
bedtime
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Nursing Process: Implementation
• Promoting an optimal response to therapy
– Sulfonylureas: Give glipizide 30 minutes before meal
due to food delays
– Nonsulfonylureas: acarbose and miglitol are given three
times a day with the first bite of the meal, because food
increases absorption
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Nursing Process: Implementation
• Monitoring and managing patient needs
– Acute confusion:
•Immediately terminate hypoglycemic
reaction
•Notify primary health care provider if
episodes of hypoglycemia occur
– Deficient fluid volume:
•Notify health care provider if blood
glucose levels are elevated or if ketones
are present in urine
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Education
• Older adults taking oral antidiabetic drugs are more
susceptible to hypoglycemic reactions which may be
difficult to detect
• Teach to avoid ETOH, dieting, commercial weight loss
products and strenuous exercise
• Teach to perform finger stick on the side of a finger
where there are fewer nerve endings*
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Nursing Process: Evaluation
• Therapeutic drug effect is achieved; Normal or
near-normal blood glucose levels are
maintained
• Hypoglycemic reactions are identified, reported,
and managed successfully
• Anxiety is reduced
• Patient begins to demonstrate ability to cope
with disorder and its required treatment
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