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Endocrine Day 3

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.

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Endocrine Day 3

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  1. Endocrine Day 3 Part 1

  2. Oral Hypoglycemic Agents SulfonylureaCholpropamide (Diabanese) Glipizide (Glucotrol) Glimepride (Amaryl) Glyburide (Diabeta, Micronase)

  3. Oral Hypoglycemic Agents Biguanides Metformin (Glucophage) Glucovance Sulfonyurea+Biguanide

  4. Oral Hypoglycemic Agents Alpha-Glucosidase Inhibitor Thiazolidinediones

  5. 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

  6. 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

  7. Sulfonylureas • Sulfonylureas work primarily by hthe 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

  8. 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

  9. Sulfonylurea • Side-effects of Sulfonylurea • Hypoglycemia • GI upset

  10. 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

  11. Biguanides • Major side effects of Metformin are: • Anorexia/ wt. Loss • Metformin is contraindicated in patients with Renal impairment

  12. Alpha Glucosidase Inhibitors • These act by delaying the absorption of glucose in the intestine • Side effects: diarrhea & flatulence • Take immediately before meals

  13. 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

  14. Thiazolidinediones • Indications of altered liver function • Yellow skin tone • Nausea • Abdominal pain • Dark urine

  15. 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

  16. Drug Interactions

  17. Drug Interactions

  18. Drug interactions

  19. Drug interactions

  20. 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?

  21. 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?

  22. Small Group Questions • What side-effects would you warm Mrs. Murdock about with these medications?

  23. 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?

  24. 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? • NSAIDS • Potassium-losing diuretics • Asprin • Digotoxin

  25. Small Group Questions Mrs. Connor is a type 1 diabetic. Which of the following medications might cause her to experience hypoglycemia? • Propranolol • Dilantin • Sulfonamide • Acetaminophen

  26. 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? • Clofibrate • Corticosteroids • MAO inhibitors • Digitoxin

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