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25 Cards in this Set

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  • Back
What is the prototype drug in the sulfonylurea class?
Glipizide
What is the site of action for glipizide (glucotrol XL, a sulfonylurea)?
Pancreas
What is the MOA for glipizide (glucotrol XL)? (sulfonylureas)
Targets the beta cells of the pancreas and stimulates the release of insulin
does this by binding to the K+ channels causing an influx of Ca++ which causes a release of insulin.
Release of insulin is glucose dependent
What are the pharmacotherapeutic actions of glipizide (glucatrol XL)? (sulfonylureas)
increases peripheral use of glucose
decreases production of glucose in the liver (hepatoneogenesis)
increases the number of insulin receptors
increases tissue response to insulin (lock and key effect btw glucose and insulin)
What are the nursing considerations with glipizide (glucatrol XL)? (sulfonylureas)
assess renal (excretion via), hepatic (metabolism) and thyroid
do not give if allergic to sulfa
hypoglycemia is BIG
What are the s/e of glipizide (glucatrol XL)? (sulfonylureaa)
hypoglycemia
weight gain (not for use with HTN or CHF)
not used during pregnancy or lactation
What is the prototype drug for biguanides?
Metformin (glucophage)
What is the MOA for metformin (glucophage, a biguanide)?
Decreases production of glucose in liver
increases glucose uptake and utilization by the muscle
increases insulin sensitivity peripherally
lowers postprandial and basal glucose levels
What is the site of action for metformin (glucophage, a biguanide)?
liver and peripheral tissues
What is the difference in the MOA for sulfonureas vs biguanides?
sulfonureas target beta cells of pancreas to increase insulin release
biguanides lower hepatoneogenesis of glucose
What are adverse effects of metformin (glucophage, a biguanide)?
GI - decreased appetite, nausea, diarrhea (lose weight)
decreased absorption of B12 and folic acid
lactic acidosis (occurs with renal dysfunction, very important to run BUN Creatinine before giving)
Anemia - abnormal RBC maturation
Alcohol interaction
What are the pharmacotherapeutic actions of metformin (glucophage, a biguinide)?
decreases A1C
decreases fasting plasma and postprandial glucose
decreases triglycerides
decreases total cholesterol
increases HDL
What is the prototype drug for T-diones?
Pioglitazone (actos)
What is the site of action for pioglitazone (actos, a T-dione)?
the liver and peripheral tissues
What is the MOA for poglitazone (actos, a T-dione)?
regulates expression of genes required for insulin action by binding to PPAR receptors, which sensitizes the cell to insulin
increases glucose uptake by skeletal muscles (lock and key effect)
What are the pharmacotherapeutic actions of pioglitazone (actos, a T-dione)?
inhibits gluconeogenesis
decreases insulin resistance
enhances glucose utilization
What are the adverse effects of pioglitazone (actos, a T-dione)?
Weight gain
edema
increased LDL
never give with liver (hepatically), cardio or renal disease
increases risk of bladder cancer
no alcohol
new concerns with worsening heart disease, cautious use
What is the prototype drug of the alpha glucosidase inhibitors?
Acarbose (precose)
What is the site of action of acarbose (precose, an alpha glucosidase inhibitor)?
the small intestine
What is the MOA of acarbose (precose, an alpha glucosidase inhibitor)?
retards the digestion of CHO and fats by inhibiting alpha glucosidase; reduces rise in postprandial plasma glucose; helps patients avoid insulin therapy
metabolized in liver, excreted in the feces
What are the adverse effects of acarbose (precose, an alpha glucosidase inhibitor)?
gas, diarrhea and abdominal pain (never give to pts with IBD, obstructions, cirrhosis, renal issues)
elevated liver enzymes
increased hypoglycemia with other agents
be careful combining with metformin due to GI effects
What is the prototype drug for the incretin mimetic class?
byetta (exenatide)
injectible; from the saliva of the gila monster
pancreatitis alert
What are GLP -1 and GIP?
incretin hormones released by gut when you eat (normally), which increase insulin secretion from beta cells and decrease glucagon secretions from alpha cells (which turns off hepatic gluconeogenesis)
What is the MOA of januvia (sitagliptin)?
stops deactivation of incretin hormones by DPP-4, which does the inhibiting
preserves and forms new beta cells
pancreatitis alert
What is the drug for hyperthyroidism?
methimazole (tapazole)