Antidiabetic Agents Study Guide

Key Concepts

• Antidiabetic drugs are used to manage blood glucose levels in patients with diabetes.
• These drugs are often used in combination with insulin or other medications like sulfonylureas.

Types of Antidiabetic Agents

• Alpha-glucosidase inhibitors: e.g., acarbose, miglitol (Precose, Glyset)
• Biguanides: e.g., metformin (Glucophage)
• Dipeptidyl peptidase-4 inhibitors: e.g., linagliptin (Tradjenta), saxagliptin (Onglyza), sitagliptin (Januvia)
• Human amylin: e.g., pramlintide acetate (Symlin)
• Incretin mimetics: e.g., exanatide (Baraclude), liraglutide (Victoza)
• Meglitinides: e.g., nateglinide (Starlix), repaglinide (Prandin)
• Thiazolidinediones: e.g., pioglitazone (Actos), rosiglitazone (Avandia)

Therapeutic Actions

• Alpha-glucosidase inhibitors: Delay glucose absorption; mild effect with potential severe GI distress.
• Biguanides (Metformin): Reduce glucose production and increase uptake; associated with lactic acidosis and GI distress.
• Meglitinides: Increase insulin release.
• Human Amylin: Modulates gastric emptying and regulates postmeal glucose levels.
• Incretin Mimetics: Enhance insulin secretion and slow gastric emptying.
• DPP-4 Inhibitors: Prolong insulin secretion effects and slow GI emptying.
• Thiazolidinediones: Decrease insulin resistance.

Indications

• Metformin: Approved for children 10+ years; used for polycystic ovarian syndrome (PCOS).
• Meglitinides: Used for rapid-acting glucose control before meals.
• Thiazolidinediones: Used with insulin or other agents in insulin-resistant patients.

Pharmacokinetics

• Route: Oral
• Onset: Slow
• Peak: 2-2.5 hours
• Duration: 10-16 hours
• Metabolism: Liver
• Excretion: Urine

Contraindications and Cautions

• Allergy to antidiabetic agents.
• Type 1 diabetes (ineffective due to non-functioning beta cells).
• Pregnancy and lactation.

Adverse Effects

• Common: Hypoglycemia, lactic acidosis, GI upset, nausea, anorexia, diarrhea, heartburn.
• Pioglitazone: Increased risk of bladder cancer if used long-term.
• Rosiglitazone: Cardiovascular risks.

Interactions

• Decreased excretion with drugs that acidify urine.

Nursing Considerations

• Similar to those for sulfonylureas.

Resources

• Recommended books and resources for further reading on nursing pharmacology and antidiabetic agents.

This guide can be used to understand the different types of antidiabetic agents, their actions, indications, pharmacokinetics, contraindications, adverse effects, and nursing considerations.