Question

Assignment chapter 38, Agents to control blood glucose levels

Group Assignment 1. As a group, construct a table that compares and contrasts Learning O the prototype drugs insulin, chlorpropamide, glyburide, and metformin with other antidiabetic and glucose-elevating agents. Discuss similarities and differences among drugs in each classi fication and across classifications.

Answer 1

#. CHLORPROPAMIDE/GLYBURIDE-

Classification

Sulfonylureas

-CHLORPROPAMIDE/GLYBURIDE-

Therapeutic Actions/Indications

Stimulates insulin release from the beta cells in the pancreas, improves insulin binding to insulin receptors, adjunct to diet and exercise to lower BG in type 2 DM.

-CHLORPROPAMIDE/GLYBURIDE-

Drug Interactions

Beta-blockers (masks the S/S of hypoglycemia), alcohol, and herbal therapies.

-CHLORPROPAMIDE/GLYBURIDE-

Contraindications/Cautions

Fever, severe infection/trauma, major surgery, ketoacidosis, severe renal/hepatic disease, pregnancy/lactation, type 1 diabetes.

-CHLORPROPAMIDE/GLYBURIDE-

Adverse Effects

Hypoglycemia, GI distress, allergic skin reactions

-CHLORPROPAMIDE/GLYBURIDE-

Nursing Considerations

Monitor nutritional status, monitor liver enzymes, monitor pt's during times of trauma, pregnancy, or severe stress, and arrange to switch to insulin coverage as needed.

#. Glucophage (metformin)

- Class

Antidiabetic

- Action

Decrase hepatic gluclose production and intestinal glucose absorption

- Indication

Managemenf of type two diabetes

- Side effects (DANHL)

Decrease B12 levels

Abdominal bloating

Diarrhea

Hypoglycemia

Lactic Acidosis

- Drug interactions (DAMN)

Digoxin

Alcohol

Morphine

Nifedine ranitidine

- Food interactions

Glucosamine

Chromium

Coenzyme

- Pt teaching

- take med at the same time everyday

- does not cure diabetes just helps control hyperglycemia

- take with meals

- Learn how to take bs the right way

- if hypoglycemic: glass of ok or 2-3 tsp of sugar

- risk for lactic acidosis and potential need to stop med if severe infection, dehydration, or continuing diarrhea occurs

Glucophage (metformin)

Nursing Implications

- observe for signs and symptoms of lactic acidosis:

-chills, diarrhea , dizziness, decreased Bp, decrease heart rate

- monitor bs

-observe for signs of hypoglycemia

3. Glipizide :-

- Action of Glipizide

• Directly stimulates functioning pancreatic beta cells to secrete insulin, leading to acute drop in blood glucose. Improves postprandial (post meal) glycemic control

- Uses:

• Adjunct to diet for control of hyperglycemia in patient with type 2 DM

- Contraindications of Glipizide

• Hypersensitivity to sulfonylureas; diabetic ketoacidosis; lactation

- Side effects of glipizide

• Nausea, Gi distress with heartburn, dizziness, headache, drowsiness

• HYPOGLYCEMIA (MOST COMMON), coma

- Drug to drug interactions of glipizide

• Alcohol produces disulfram-like reaction in some patients;

- oral anticoagulants, chloramphenicol, clofibrate, phenylbutazone, MAOIs, salicylates, probenecid, and sulfonamides may potentiate hypoglycemia actions;

- Thiazides may antagonize hypoglycemic effects, cimetidinemay increase glipizide levels and cause hypoglycemia.

Herbal/food

• Ginseng, garlic may increase hypoglycemic effects.

- Nursing implications of Glipizide

• Observe response to the initial dose, esp in older adults or debilitated patients; early signs of hypoglycemia are easily overlooked.

• Patients transferred from sulfonylurea with long half lifes should be made aware of the potential for hypoglycemic responses for 1-2 wk because of potential overlapping of drug effect.

• NOTE: First signs of hypoglycemia may be hard to detect in patients receiving concurrent beta-blockers or older adults.

• Monitor Labs: periodic fasting, postprandial BG, and HgBA1C. Periodic LFT's, serum electrolytes, and serum osmolarity.

- Pregnancy category C

4. Insulin (INSULIN)

Indications: Type 1 Diabetes, Type 2 (can't control by others)

Action: Replace endogenous insulin

Adverse: Hypoglycemia and ketoacidosis

5. Glucose-Elevating Agents (GLUCAGON)

Indications: Type 1 Diabetes, Blood Glucose <40 mg/dL

Actions: Increase blood glucose

Adverse effect - hyperglycemia above normal