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SGLT-2 inhibitors are oral medications that lower blood glucose levels in adults with type 2 diabetes by promoting glucose excretion in the urine. They can also be added to the treatment regimen of clients who are overweight or have a risk of hypoglycemia. **Prototype: canagliflozin (Invokana) **...

SGLT-2 inhibitors are oral medications that lower blood glucose levels in adults with type 2 diabetes by promoting glucose excretion in the urine. They can also be added to the treatment regimen of clients who are overweight or have a risk of hypoglycemia. **Prototype: canagliflozin (Invokana) ** - **Category**: Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors (Oral Hypoglycemic Agent)  - **Primary Function**: SGLT-2 inhibitors lower blood glucose levels in adults with type 2 diabetes by promoting glucose excretion in the urine. They can also be added to the treatment regimen of clients who are overweight or have a risk of hypoglycemia.  - **Unique Features**: Glycosuria from SGLT-2 inhibitors can also cause weight loss.  Mechanism of Action - SGLT-2 inhibitors work by blocking the reabsorption of glucose in the kidneys. By targeting the SGLT-2 transporter in the kidneys, responsible for approximately 90% of glucose reabsorption, these inhibitors facilitate increased urinary glucose excretion, thereby improving glycemic control and offering the added benefit of weight loss due to caloric loss.  Indications and Therapeutic Uses - **Diabetes**: SGLT-2 inhibitors are utilized to improve glycemic control in clients with type 2 diabetes by increasing glucose excretion in the urine. Side Effects and Adverse Reactions **Side Effect** **Description** --------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- Urinary Tract Infections These infections are caused by increased glucose in the urine since certain bacteria thrive in those conditions. Genital Fungal Infections These infections can be complicated to treat and stem from increased glucose in the urine. Females are particularly affected. Orthostatic Hypotension This drop in blood pressure occurs with position change and can also involve dizziness, especially in older adults and when used with diuretics. Precautions and Contraindications **Precautions** - Caution is advised for clients with severe renal impairment or those on dialysis, as SGLT-2 inhibitors are less effective in individuals with impaired kidney function.  **Contraindications** - Contraindicated in individuals with an estimated glomerular filtration rate (GFR) below 45 mL/min/1.73 m2.  Drug Interactions - Administering SGLT-2 inhibitors with UDP-glucuronosyltransferase inducers (such as **\[rifampin, phenytoin, or phenobarbital\]**) may require increased doses of the SGLT-2 inhibitor.  - Since SGLT-2 inhibitors can cause a diuretic effect, co-administration with **\[thiazide and loop diuretics\]** can increase the risk of dehydration and hypotension.  Dosing, Administration, & Client Teaching **Dosing** - Dosing varies based on the condition, severity, and client response.  - Check drug dosing guidelines for individualized dosing.  - Oral dosing once per day before the first meal.  - Not recommended for clients with severely impaired kidney function.  - Dosing is based on glycemic control needs and renal function.  - These drugs can be added to the treatment regimen of clients who are overweight or have a risk of hypoglycemia.  - These medications can also be used in clients who also have a history of ASCVD, heart failure, or CKD.  **Administration** - PO administration.  **Client Teaching** - Clients should regularly monitor their blood glucose levels to avoid hypoglycemia.  - Clients should be educated on recognizing the signs and symptoms of hypoglycemia and how to manage it should it occur.  - Educate clients about hydration and monitoring for signs of infections or hypotension.  Labs to Monitor **Basic Metabolic Panel (BMP)** - Regular monitoring of kidney function and blood glucose levels is recommended to adjust dosing accordingly.  **Hemoglobin A1c** - Monitoring hemoglobin A1c will provide information on the effectiveness of the treatment regimen.