Diabetes Drug Table PDF

INSULIN Drug Name and Class Use(s) and Route(s) Onset/Peak/Duration Nursing Implications RAPID ACTING INSULIN (ANALOG) lispro (Humalog) uses: - onset: about 15 mins (immediate) -food must be at...

INSULIN Drug Name and Class Use(s) and Route(s) Onset/Peak/Duration Nursing Implications RAPID ACTING INSULIN (ANALOG) lispro (Humalog) uses: - onset: about 15 mins (immediate) -food must be at bedside, the insulin is aspart (NovoLog) - ideal for bolus (meal time and high - peak: 30-90 mins rapid/acts fast! glulisine (Apidra) glucose) - duration: 3-5 hours routes: - SubQ - insulin pump Drug Name and Class Use(s) and Route(s) Onset/Peak/Duration Nursing Implications SHORT ACTING OR REGULAR INSULIN humulin R routes: - onset: 30-60 min -(only type of insulin given IV) novolin R - clear - peak: 2-3 hours actrapid - give SubQ or IV (only type of insulin - duration: 5-7 hours given IV) Drug Name and Class Use(s) and Route(s) Onset/Peak/Duration Nursing Implications INTERMEDIATE ACTING INSULIN humulin N routes: - onset: 1-1.5 hours - can be mixed with regular** novolin N (NPH) - subQ only - peak: 8-12 hours (hypoglycemia- - NPH= neutral protamine hagedorn - NO IV midafternoon) (protein + insulin) - duration: 18-24 hours - protein delays absorption of insulin - cloudy - give snack in midafternoon Drug Name and Class Use(s) and Route(s) Onset/Peak/Duration Nursing Implications LONG ACTING INSULIN (ANALOG) glargine (Lantus) uses: - onset: 1 hour - provides basal dose detemir (Levemir) - provides basal - peak: none routes: - duration: up to 24 hrs - SubQ (same time daily) - NO IV NON-INSULIN DRUGS Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications INSULIN SENSITIZER antihyperglycemic: biguanides prototype: metformin - make tissues more uses: advantages: - BBW for rare lactic - take with meals to (glucophage) sensitive to insulin - first line treatment for - insulin sensitization acidosis (liver disease) reduce GI effects - decreases intestinal type 2 diabetes* - low risk of - periodic test of renal glucose absorption routes: hypoglycemia function and liver - *addresses core issue of - oral - does not cause weight function insulin resistance gain - must hold drug at least 2 days before disadvantages: and 2 days after - GI side effect (nausea, procedures that metallic taste, require contrast flatulence, diarrhea) media - hold day of surgery - outcome: normalized blood glucose levels, improvement in HbA1c Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications INSULIN SENSITIZER Thiazolidinediones ‘glitazones’ prototype: rosiglitazone - inhibits release of uses: advantages: - BBW for heart failure - monitor BP, weight, (Avandia) glucose from liver - *not first line - take without regard to presence of edema therapy… may be last meals resort medicine - decrease risk of routes: hypoglycemia when - oral given alone disadvantages: - slow onset of action (12 weeks) - possible liver toxicity (monitor serum transaminase level) Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications INSULIN ‘STIMULATORS’ secretagogues, Sulfonylureas (SFU) prototype: stimulates the release of the routes: advantages: - take before breakfast second generation: body’s own insulin - oral - fast reduction in fasting - teach pt on s&s of glyburide (glynase) glucose hypoglycemia and instruct them to carry glypizide (glucotrol) disadvantages: a fast acting source of - sulfa drug allergy carbs for - strong risk of hypoglycemia hypoglycemia Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications INSULIN ‘STIMULATORS’ ‘Meglitinides’ -glinide prototype: repaglinide - similar to sulfonylureas routes: advantages: - teach pt on s&s of (Prandin) - stimulate beta cell by - oral - lower risk for hypoglycemia and closing K cells which hypoglycemia (risk it instruct them to carry opens calcium cells = still there though) a fast acting source of more insulin is released carbs for - not as commonly used, hypoglycemia wears out pancreas disadvantages: - hypoglycemia Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications ALPHA-GLUCOSIDASE INHIBITORS prototype: acarbose slows digestion of advantages: - inflammatory bowel - treat hypoglycemia (Precose) carbohydrates to prevent - decrease risk of disease, celiac with oral glucose not postprandial spikes in hypoglycemia when sucrose blood glucose used alone - works best with insulin or sulfonylurea disadvantages: - GI side effect (diarrhea, flatulence) Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications DPP-4 INHIBITORS prototype: sitagliptin - increases incretin routes: advantages: (Januvia) (GLP-1)= decreased - oral - oral drug glucose in blood - monotherapy or combined with other oral drugs - works only when blood glucose is elevated Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications INCRETIN ENHANCER: GLUCAGON LIKE PEPTIDE (GLP-1) prototypes: - lowers post meals routes: advantages: - BBW for c cell thyroid semaglutide (wegovy) glucose spikes - oral (semaglutide) - ‘helper hormone’ cancer Dulaglutide (trulicity) - others are injection weight loss disadvantages: - GI side effects: nausea, hypoglycemia, injection Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications AMYLIN ANALOG prototype: pramlintide - decreases glucose routes: advantages: - BBW for severe - take immediately (Symlin) appearance after meals - injection along with - regulates post- prandial hypoglycemia within 3 before meal (like - slows gastric emptying insulin blood glucose ‘spikes’ hours (bc blocks insulin) - suppresses glucagon type 1 and type 2 glucagon production) - do not take if meal - regulates food intake diabetes skipped (like insulin) through appetite - may be given at same disadvantages: time as insulin, but - subcutaneous injection not in same syringe Drug Name and Class Mechanism of Action Use(s) and Route(s) Advantage/Disadvantage Contraindications Nursing Implications SGLT2 INHIBITOR (GLIFOZIN) prototype: empagliflozin - blocks renal glucose disadvantages: not for pts with a GFR - monitor for burning, (Invokana) reabsorption = - don’t give diuretics =