Week 10

Wednesday, October 16, 2019 1:42 PM

Drugs Administered for the Treatment of Diabetes Mellitus

Drug Class Prototype Other Drugs in the Class
Insulins Insulin (Humulin R, Novolin R) Short-acting insulins:
Insulin lispro (Humalog)
Insulin aspart (NovoLog)
Insulin glulisine (Apidra)
Intermediate-acting insulin:
Isophane insulin suspension (NPH Humulin
N, Novolin N)
Long-acting insulins:
Insulin glargine (Lantus)
Insulin detemir (Levemir)
Sulfonylureas Glyburide (DiaBeta, Glynase) Glimepiride (Amaryl)
Glipizide (Glucotrol, Glucotrol XL,
GlipiZIDE)
Chlorpropamide
Tolazamide
Tolbutamide
Alpha-glucosidase inhibitors Acarbose (Precose) Miglitol (Glyset)
Biguanide Metformin (Fortamet, Glucophage, Glucophage XR,
Glumetza, Riomet)
Thiazolidinediones Rosiglitazone (Avandia) Pioglitazone (Actos)
Meglitinides Repaglinide (Prandin) Nateglinide (Starlix)
Dipeptidyl peptidase 4 (DPP-4) Sitagliptin (Januvia) Alogliptin (Nesina)
inhibitor Linagliptin (Tradjenta)
Saxagliptin (Onglyza)
Incretin mimetics Exenatide (Bydureon, Byetta) Liraglutide (Victoza)
Amylin analogs Pramlintide (SymlinPen 120, SymlinPen 60) Albiglutide (Tanzeum)
Dulaglutide (Trulicity)
Angiotensin-converting enzyme Enalapril maleate (Vasotec) Benazepril hydrochloride (Lotensin)
inhibitors Captopril (Capoten)
Fosinopril (Monopril)
Lisinopril (Prinivil, Zestril)
Moexipril hydrochloride (Univasc)
Perindopril erbumine (Aceon, Coversyl)
Quinapril hydrochloride (Accupril)
Ramipril (Altace)
Trandolapril (Mavik, Gopten)
Angiotensin II receptor Losartan (Cozaar) Azilsartan medoxomil (Edarbi)
antagonists Candesartan cilexetil (Atacand)
Eprosartan mesylate (Teveten)
Irbesartan (Avapro)
Olmesartan medoxomil (Benicar)
HMG-CoA reductase inhibitors Simvastatin (Zocor) Atorvastatin calcium (Lipitor)
Fluvastatin (Lescol, Lescol SL)
Lovastatin (Altoprev, Mevacor)
Pitavastatin calcium (Livalo)
Pravastatin (Pravachol)

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 Rosuvastatin (Crestor)

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s03.xhtml>

Herbs That Increase the Risk of Hypoglycemia When Used With Antidiabetic Drugs

• Alfalfa
• Aloe
• Bilberry
• Bitter melon
• Burdock
• Celery
• Coriander
• Damiana
• Dandelion root
• Fenugreek
• Garcinia
• Garlic
• Ginseng
• Gymnema
• Juniper
• Karela
• Marshmallow
• Stinging nettle

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s03.xhtml>

Drugs That Increase the Effects of Insulin

• Angiotensin-converting enzyme inhibitors (e.g., captopril)
Increase the risk of hypoglycemia
• Alcohol
May promote increased hypoglycemia; inhibits gluconeogenesis (in people with or without diabetes).
• Antidiabetic drugs, oral
May alter blood glucose levels; increasingly being used with insulin in the treatment of type 2
diabetes. (The risks of hypoglycemia are greater with the combination.)
• Antimicrobials (sulfonamides, tetracyclines)
Increase the risk of hypoglycemia
• Beta-adrenergic blocking agents (e.g., propranolol)
Increase hypoglycemia by inhibiting the effects of catecholamines on gluconeogenesis and
glycogenolysis (effects that normally raise blood glucose levels in response to hypoglycemia); may
also mask signs and symptoms of hypoglycemia (e.g., tachycardia, tremors) that normally occur with
a hypoglycemia-induced activation of the sympathetic nervous system
Drugs That Decrease the Effects of Insulin
• Adrenergics (e.g., albuterol, epinephrine)
Increase insulin requirements
• Anabolic corticosteroids (e.g., prednisone)
Increase insulin requirements

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Increase insulin requirements
• Estrogens and oral contraceptives
Increase insulin requirements
• Glucagon
Raises blood glucose by converting liver glycogen to glucose
• Levothyroxine
Increases insulin requirements due to hyperglycemia
• Phenytoin
Raises blood sugar by inhibiting insulin secretion
• Thiazide diuretics (e.g., hydrochlorothiazide)
Increase risk of hyperglycemia due to change in glucose control

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s03.xhtml>

Drug Interactions: Glyburide

Drugs That Increase the Effects of Glyburide
• Acarbose, miglitol, metformin, pioglitazone, and rosiglitazone
Increase risk of hypoglycemia
• Alcohol (acute ingestion)
Causes hypoglycemia
• Cimetidine
May inhibit metabolism of sulfonylureas, thereby increasing and prolonging hypoglycemic effect
• Insulin
May cause hypoglycemia
Drugs That Decrease the Effects of Glyburide
• Alcohol (acute ingestion)
Accelerates metabolism of sulfonylureas, shortening their half-lives; may produce a flushing
response
• Beta-adrenergic blocking agents
Decrease hypoglycemic effects, possibly by decreasing release of insulin in the pancreas
• Corticosteroids, diuretics, epinephrine, estrogens, and oral contraceptives
Have hyperglycemic effects
• Glucagon
Raises blood glucose levels
• Nicotinic acid (large doses)
Has hyperglycemic effect
• Phenytoin
Inhibits insulin secretion and has hyperglycemic effects
• Rifampin
Increases the rate of metabolism of sulfonylureas by inducing liver metabolizing enzymes
• Thyroid preparations
Antagonize hypoglycemic effects of oral antidiabetic drugs

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s04.xhtml>

Drug Interactions: Acarbose

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 Drug Interactions: Acarbose
Drugs That Decrease the Effects of Acarbose
• Corticosteroids (systemic and inhaled)
Result in hyperglycemia
• Luteinizing hormone, somatotropin, and thiazide diuretics
Increase risk of hyperglycemia
Drugs That Increase the Effects of Acarbose
• Corticosteroids (inhaled)
May suppress the hypothalamic–pituitary–adrenal axis, leading to adrenal crisis, leading to hypoglycemia
• Pegvisomant
Increased risk of hypoglycemia

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s05.xhtml>

Drugs That Decrease the Effects of Metformin

• Corticosteroids (systemic and inhaled)
Result in hyperglycemia
• Luteinizing hormone, somatotropin, and thiazide diuretics
Increase risk of hyperglycemia
Drugs That Increase the Effects of Metformin
• Alcohol
Increases risk of hypoglycemia and lactic acidosis
• Cephalexin, cimetidine, dalfampridine, and glycopyrrolate
Interferes with metabolism and increases blood levels
• Corticosteroids (oral and inhaled)
May suppress the hypothalamic–pituitary–adrenal axis, leading to adrenal crisis, leading to hypoglycemia
• Furosemide
Increases blood levels
• Pegvisomant
Increases risk of hypoglycemia
• Sulfonylurea hypoglycemic agents
Increases risk of hypoglycemia

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s06.xhtml>

Drugs That Increase the Effects of Repaglinide

• Cimetidine, erythromycin, ketoconazole, and miconazole
Increase serum concentrations of repaglinide, leading to hypoglycemia
• Corticosteroids (oral or inhaled)
May suppress the hypothalamic–pituitary–adrenal axis, leading to adrenal crisis, leading to hypoglycemia
• Nonsteroidal anti-inflammatory drugs and other agents that are highly bound to plasma proteins
May displace drug from binding sites, increasing blood levels
• Pegvisomant
Increases the risk of hypoglycemia
• Sulfonamides
May inhibit hepatic metabolism, increasing blood levels
Drugs That Decrease the Effects of Repaglinide
• Adrenergics, corticosteroids, estrogens, niacin, oral contraceptives, and thiazide diuretics

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 • Adrenergics, corticosteroids, estrogens, niacin, oral contraceptives, and thiazide diuretics
Increase the risk of hyperglycemia
• Corticosteroids (systemic and inhaled)
Diminish the effect of acarbose, resulting in hyperglycemia
• Luteinizing hormone, somatotropin, and thiazide diuretics
Increase the risk of hyperglycemia
• Carbamazepine and rifampin
Induce drug-metabolizing enzymes in the liver, which leads to faster inactivation

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s08.xhtml>

8. The nurse is assessing a patient who has just begun taking glyburide. Which of the following is a
therapeutic outcome for this patient? (Select all that apply.)
1. a glycosylated hemoglobin (hemoglobin A1C) of 10%
2. a decrease in polyuria
3. a decrease in polyphagia
4. a fasting blood glucose of 108 mg/d
9. A patient with type 2 diabetes calls the nurse to report the following symptoms: blood glucose of 378
mg/dL, excessive urination, and feelings of becoming drowsier. To determine a possible diagnosis,
which of the following questions is most important?
1. “Has there been any change in diet?”
2. “Has there been any fever?”
3. “Have there been any ketones in the urine?”
4. “Have you increased the amount of fluid intake?”
10. A patient with type 2 diabetes is scheduled to have a cardiac catheterization in 1 week, and the
nurse makes a preprocedure phone call. The nurse instructs the patient to stop taking which
medication 2 days before the procedure?
1. sitagliptin
2. insulin
3. glyburide
4. metformin
11. A man with type 2 diabetes mellitus has a blood glucose of more than 500 mg/dL. He is complaining
of excessive urination, extreme thirst, and weakness, and he also notes recent weight loss. The
nurse would expect to find which diagnosis in his chart?
1. hypoglycemia
2. diabetic ketoacidosis
3. hyperglycemic hyperosmolar nonketotic syndrome
4. hypothyroidism
12. The nurse is monitoring a patient newly diagnosed with type 2 diabetes mellitus taking repaglinide
for complications. Which of the following, if exhibited by the patient, would indicate hypoglycemia
and require immediate treatment?
1. polyuria
2. diaphoresis
3. decreased heart rate
4. hypertension

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s08.xhtml>

• Use correct technique for injecting amylin analogs and incretin mimetics:
• Inject pramlintide (Symlin) subcutaneously into abdomen or thighs before meals. Do not mix in same
syringe with insulin. Insulin dosages may be reduced by 50% when taking pramlintide.

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syringe with insulin. Insulin dosages may be reduced by 50% when taking pramlintide.
• Inject exenatide (Byetta) subcutaneously into abdomen, thigh, or upper arm within 60 minutes before
morning and evening meal.
• Rotate injection site of pramlintide and do not give in same site where insulin is administered.

NCLEX Success
13. A patient with type 2 diabetes begins taking sitagliptin for the management of blood glucose
levels. Which statement by the patient indicates an understanding of this medication?
1. “I will take two doses in the morning if my blood sugar is high.”
2. “By taking this medication, I am able to eat more.”
3. “Now that I am taking this medication, I don’t have to exercise anymore.”
4. “I will take this medicine once a day.”
14. The nurse caring for a patient with diabetes mellitus has lipodystrophy of the abdomen. What
should the nurse assess?
1. Does the patient administer the injection at a 45-degree angle?
2. Does the patient aspirate for blood prior to giving the injection?
3. Does the patient pinch the skin appropriately?
4. Does the patient rotate sites for giving each injection?
15. Based on the action of pramlintide, which of the following is a primary nursing intervention?
1. Administer glucagon during the peak of action.
2. Assess blood sugar at 2.4 hours after medication administration.
3. Assess respiratory status for the onset of an upper respiratory infection.
4. Provide a meal immediately after the administration of the subcutaneous injection.

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s09.xhtml>

Drugs That Increase the Effects of Canagliflozin

• Alpha-lipoic acid, androgens, insulin, or antidiabetic agents (oral or subcutaneous, monoamine
oxidase inhibitors, pegvisomant, quinolone antibiotics, salicylates, selective serotonin reuptake
inhibitors)
Increase hypoglycemic effects
Drugs That Decrease the Effects of Canagliflozin
• Carbamazepine, efavirenz, fosphenytoin, phenobarbital, phenytoin, primidone, and ritonavir
Decreases the serum concentration of canagliflozin

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s12.xhtml>

Cotransporter 2 (SGLT2) Inhibitors

• Administer without regard to food with the first meal of the day.
• For patients with stable glycemic control, hemoglobin A1C should be monitored every six months.
• Maintain adequate hydration of 2000 to 3000 mL/d.
• Instruct on hypotension and syncope.
• Do not consume salt substitutes.

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s13.xhtml>

NCLEX Success
1. A patient who is newly diagnosed with diabetes mellitus demonstrates extreme anxiety. The
most appropriate intervention to decrease the patient’s anxiety would be to
2. convey empathy, trust, and respect toward the patient
3. administer an antianxiety medication
4. ensure that the patient knows the correct medical terminology to understand what is going on

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 4. ensure that the patient knows the correct medical terminology to understand what is going on
5. ignore the signs and symptoms of anxiety so they will disappear more quickly
6. The nurse is educating a patient about proper foot care. Which instruction does the nurse
include in the teaching plan?
7. Always use a pumice stone on callused areas of the feet.
8. Use a heavy moisturizing cream on the feet at all times.
9. Wash feet in cold water only.
10. Always have a podiatrist cut toenails.
11. A patient with DKA is admitted to the hospital. Which of the following does the nurse expect to
see?
12. increased pH and increased heart rate
13. increased respiratory rate and decrease in urine output
14. elevated potassium and increase in blood pressure
15. elevated blood glucose and decreased plasma bicarbonate
16. A 58-year-old woman with type 2 diabetes mellitus takes glyburide (DiaBeta) 5 mg by mouth
daily, and this drug controls her diabetes well. However, recently, her fasting blood glucose
has measured between 200 and 220 mg/dL. Which of the following medications may have
been added to the patient’s regimen?
17. atenolol
18. prednisone
19. enalapril maleate
20. levothyroxine sodium

From <https://jigsaw.vitalsource.com/books/978-1-4963-7960-3/epub/OEBPS/c41-s14.xhtml>

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