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ANTI-DIABETIC DRUGS (ACARBOSE (MECHANISM OF ACTION (In diabetic patients,…
ANTI-DIABETIC DRUGS
ACARBOSE
SIDE EFFECTS
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Gas, or abdominal discomfort/pain
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CONTRA-INDICATIONS
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Type 1 diabetes. These patients do not have functioning beta cells and would have no benefit from the drug.
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MECHANISM OF ACTION
In diabetic patients, the short-term effect of these drug therapies is to decrease current blood glucose levels; the long-term effect is a reduction in HbA1c level.
This reduction averages an absolute decrease of 0.7%, which is a decrease of about 10% in typical HbA1c values in diabetes studies.
Inhibition of these enzyme systems reduces the rate of digestion of complex carbohydrates. Less glucose is absorbed because the carbohydrates are not broken down into glucose molecules
whereas the membrane-bound intestinal alpha-glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides to glucose and other monosaccharides in the small intestine.
Pancreatic alpha-amylase hydrolyzes complex starches to oligosaccharides in the lumen of the small intestine,
specifically, alpha-glucosidase enzymes in the brush border of the small intestines, and pancreatic alpha-amylase.
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METFORMIN
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CONTRA INDICATIONS
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Type 1 diabetes. These patients do not have functioning beta cells and would have no benefit from the drug.
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SIDE EFFECTS
Common adverse effects include hypoglycemia, lactic acidosis, GI upset, nausea, anorexia, diarrhea, heartburn, and allergic skin reaction.
Pioglitazone is strongly linked with an increased risk of bladder cancer if it is used for over 1 year.
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STORAGE
Store in a dry cool place, away from the sun
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THIAZOLIDENEDIONES
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CONTRAINDICATIONS
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Type 1 diabetes. These patients do not have functioning beta cells and would have no benefit from the drug.
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SIDE EFFECTS
Common adverse effects include hypoglycemia, lactic acidosis, GI upset, nausea, anorexia, diarrhea, heartburn, and allergic skin reaction.
Pioglitazone is strongly linked with an increased risk of bladder cancer if it is used for over 1 year.
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NURSING CONSIDERATIONS
NURSING ASSESSMENT
Assess for contraindications or cautions (e.g. history of allergy to the drugs, pregnancy and lactation status, severe renal or hepatic dysfunction,)
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Investigate nutritional intake, noting any problems with intake and adherence to prescribed diet,
Assess activity level, including amount and degree of exercise
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Monitor results of laboratory tests, including urinalysis
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INSULIN
MECHANISM OF ACTION
It is the only parenteral antidiabetic agent available for exogenous replacement of low levels of insulin
It reacts with the receptors of the cells to facilitate transport of various metabolites and ions across cell membranes
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and stimulates the synthesis of glycogen from glucose, of fats from lipids, and of proteins from amino acids.
Indications
INDICATIONS
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Management of diabetic ketoacidosis, hyperkalemia, and marked insulin resistance
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CONTRAINDICATIONS
However, close monitoring is needed among pregnant and lactating women to adjust the dose accordingly
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Insulin does enter breast milk but it is destroyed in the GI tract and does not affect the nursing infant.
Insulin-dependent mothers may have inhibited milk production because of insulin’s effects on fat and protein metabolism.
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NURSING CONSIDERATIONS
NURSING ASSESSMENT
Assess for contraindications or cautions (e.g. history of allergy, pregnancy, etc.)
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Assess skin lesions; orientation and reflexes; blood pressure, pulse, respiration and adventitious breath sounds
Inspect skin areas that will be used for injection; note any areas that are bruised, thickened, or scarred,
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Assess activity level, including amount and degree of exercise which can alter serum glucose levels and need for these drugs.
Monitor the results of laboratory tests, including urinalysis, for evidence of glucosuria.
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NURSING IMPLEMENTATION
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Gently rotate the vial containing the agent and avoid vigorous shaking to ensure uniform suspension of insulin.
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Use caution when mixing types of insulin; administer mixtures of regular and NPH insulins within 15 minutes after combining them
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Provide good skin care and foot care, to prevent the development of serious infections and changes in therapeutic insulin doses.
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EVALUATION
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Monitor for adverse effects (hypoglycemia, ketoacidosis, injection-site irritation).
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