Transcript Lecture 3A PowerPoint

Endocrine Day 3
Part 1
Oral Hypoglycemic Agents
Sulfonylurea
Cholpropamide (Diabanese)
Glipizide (Glucotrol)
Glimepride (Amaryl)
Glyburide (Diabeta, Micronase)
Oral Hypoglycemic Agents
Biguanides
Metformin (Glucophage)
Glucovance
Sulfonyurea+Biguanide
Oral Hypoglycemic Agents
Alpha-Glucosidase Inhibitor
Thiazolidinediones
Oral Hypoglycemic Agents
• Oral hypoglycemic meds are not Insulin
• Oral hypoglycemic meds require some production of
insulin
• Oral hypoglycemic agents are used in the treatment
of type ___DM
– Type 2
• Oral hypoglycemic meds are meant to supplement
diet and exercise, not replace them
Oral Hypoglycemic Agents
• Oral hypoglycemic meds cannot be used
during pregnancy
• Oral hypoglycemic meds may need to be
halted temporarily and insulin prescribed if BS
levels rise due to infection, trauma, stress,
surgery etc.
• Action vary so effect may be enhanced by use
of multiple meds
Sulfonylureas
• Sulfonylureas work primarily by h the
secretions of insulin by directly stimulating the
pancreas
• Sulfonylurea’s are to be taken with food
• **Except for Glucotrol/Glipizide which is to be
taken 30 minutes before meals
Sulfonylurea
• Sulfonylurea’s (esp. Diabinese) when taken
with alcohol can cause severe Disulfiram
reactions
• Disulfiram (antibus): a compound when used
with alcohol produces distressing symptoms
• Symptoms: Flushed skin, N/V, palpitations,
hyperventilation
Sulfonylurea
• Side-effects of Sulfonylurea
– Hypoglycemia
– GI upset
Biguanides
• Biguanides work primarily by aiding insulin’s
action on peripheral receptor sites
• Biguanides are NOT associated with episodes
of hypoglycemia
• Biguanides + sulfonylurea may h the glucose
lowering effect
Biguanides
• Major side effects of Metformin are:
– Anorexia/ wt. Loss
• Metformin is contraindicated in patients with
Renal impairment
Alpha Glucosidase Inhibitors
• These act by delaying the absorption of
glucose in the intestine
• Side effects: diarrhea & flatulence
• Take immediately before meals
Thiazolidinediones
• Used for patients with type 2 DM who take
insulin injections
• Acts by increasing insulin action at the
receptor site
• Affects liver function 
– liver function tests
Thiazolidinediones
• Indications of altered liver function
– Yellow skin tone
– Nausea
– Abdominal pain
– Dark urine
Can diabetes pills help me?
•
•
•
•
•
•
Type 2 only
Results vary
Effectiveness wears off
Insulin may still need to be taken occasionally
Pregnant…
No best pill
Drug Interactions
Directly interact with
Sulfonylurea and
increase risk of
hypoglycemia
Sulfonylurea+ * Med =
Hypoglycemia
Sulfonamides
NSAIDS

Drug Interactions
h blood glucose levels
Regardless of what
med you might also be
taking
Potassium-losing diuretics
Corticosteriods
Estrogen compounds
Phenytoin (Dilantin)
Salicylates (ASA)

Drug interactions
Meds that cause
Hypoglycemia
Without drug
interaction
Acetaminophen
Alcohol
Monoamine oxidase
inhibitors / MAO inhibitors

Drug interactions
Meds that can
MASK signs and
symptoms of
Hypoglycemia
Propranolol (Inderal)

Small Group Questions
1. A type 1 DM asks you “Why do I have to have insulin
injections, why can’t I just take the Insulin pills?”
How would you answer him?
2. Mr. Jones is a type 2 DM who is unable to control his
diabetes with diet and exercise alone. The doctor
prescribes Glucatrol 5 mg PO BID. When would you
advise Mr. Jones to take his medication?
Small Group Questions
3. What would you warn Mr. Jones about when taking
Glucatrol?
4. Mrs. Murdock is a Type 2 DM. She was taking
Glucatrol 20 mg BID. The MD changed her meds
today to Micronase 5 mg PO BID and Glucophage
500 mg PO BID. Mrs. Murdock asks you why she is
taking two medications now, instead of just
increasing the dose of Glucatrol?
Small Group Questions
5. What side-effects would you warm Mrs.
Murdock about with these medications?
Small Group Questions
6. Mrs. Henderson, a 51 yr old Type 1 DM is in
the gynecologists office C/O hot flashes, mood
swings & irritability. The doctor Dx these as
menopausal symptoms and prescribes estrogen
replacement. What nursing teaching would
you provide Mrs. Henderson regarding this
meds and her diabetes?
Small Group Questions
Mr. Bigfoot is a type 2 diabetic who takes
micronase/glyuride BID. Which of the following
medications would interact and possibly cause a
hypoglycemic event?
A. NSAIDS
B. Potassium-losing diuretics
C. Asprin
D. Digotoxin
Small Group Questions
Mrs. Connor is a type 1 diabetic. Which of the
following medications might cause her to
experience hypoglycemia?
A. Propranolol
B. Dilantin
C. Sulfonamide
D. Acetaminophen
Small group Questions
Ms. Knowitall is a type 2 DM who takes
glucotrol/Glipizide BID. Which of the
following meds might cause an increase in
her FSBS?
A. Clofibrate
B. Corticosteroids
C. MAO inhibitors
D. Digitoxin