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Oral antidiabetic medications - Alpha-glucosidase inhibitors: Nursing Pharmacology

Notes

Notes

ALPHA-GLUCOSIDASE INHIBITORS
DRUG NAME
acarbose (Precose), miglitol (Glyset)
CLASS
Alpha-glucosidase inhibitors
MECHANISM OF ACTION
Inhibit alpha-glucosidase enzyme in the small intestine → delay absorption of ingested carbohydrates → smaller rise in blood glucose
INDICATIONS
  • Type 2 diabetes mellitus
  • Unlabeled: type 1 diabetes mellitus (adjunct to insulin)
ROUTE(S) OF ADMINISTRATION
  • PO
SIDE EFFECTS
  • Gastrointestinal side effects: abdominal pain, flatulence, diarrhea
  • Acarbose: hepatic injury
  • Miglitol: skin rash
CONTRAINDICATIONS AND CAUTIONS
  • Gastrointestinal conditions: IBD, ileus, colonic ulceration, intestinal obstruction
  • DKA
  • Pregnancy and breastfeeding
  • Children
  • Renal or hepatic disease
NURSING CONSIDERATIONS: ALPHA-GLUCOSIDASE INHIBITORS
ASSESSMENT AND MONITORING
Assess
  •  Laboratory test results: blood glucose, hemoglobin A1c, renal and hepatic function tests

Monitor
  • Hemoglobin A1c, blood glucose levels, and hepatic function tests; side effects

Evaluate
  • Therapeutic response: improved glucose control
CLIENT EDUCATION
  • Purpose of medication: slow the rise in blood glucose
  • Continue antidiabetic regimen: low-carbohydrate, high-fiber diet, regular physical activity, frequent blood glucose monitoring
  • Take medication with first bite of their three main meals
  • Review the symptoms of hyperglycemia: fatigue, blurred vision, increased thirst, appetite, and urination
    • Check blood glucose level
    • Contact healthcare provider immediately
  • Review symptoms of hypoglycemia: hunger, headache, fatigue, tremors, dizziness, confusion
    • Check blood glucose level
    • Take only glucose (not sucrose) to restore blood glucose levels
    • Check blood sugar again after 15 minutes
  • Side effects
    • Abdominal pain, flatulence, diarrhea
    • Recognize signs of liver damage; e.g., fatigue, anorexia, nausea, dark urine, jaundice
Transcript

Alpha-glucosidase inhibitors are medications primarily used to treat type 2 diabetes mellitus, and have an unlabeled use for type 1 diabetes mellitus as an adjunct to insulin.

Now, type 2 diabetes mellitus is characterized by insulin resistance, which is when tissue cells have trouble responding to insulin to use glucose from the blood, while in type 1 diabetes mellitus, there’s no insulin at all.

As a result, tissue cells starve for energy despite having high blood glucose levels, which is called hyperglycemia.

Now, alpha-glucosidase inhibitors include medications like acarbose and miglitol, which can be taken orally.

Once administered, these medications act in the small intestine, where they inhibit the enzyme alpha-glucosidase, which helps digest complex carbohydrates into simple carbohydrates, such as glucose, that can be absorbed through the lining of the intestine and into the blood.

As a result, alpha-glucosidase inhibitors delay the absorption of ingested carbohydrates, ultimately leading to a smaller rise in blood glucose.

Unfortunately, the undigested carbohydrates remain within the intestines and are digested by intestinal bacteria.

Because of that, clients taking alpha-glucosidase can often present with gastrointestinal side effects, such as abdominal pain, flatulence, and diarrhea. In addition, acarbose may lead to hepatic injury, while clients on miglitol may develop a skin rash.

As far as contraindications go, alpha-glucosidase inhibitors should not be given to clients with gastrointestinal conditions like inflammatory bowel disease, or IBD for short, as well as ileus, colonic ulceration, or intestinal obstruction.

Alpha-glucosidase inhibitors are also contraindicated in clients experiencing diabetic ketoacidosis, or DKA for short.

In addition, these medications inhibitors should be avoided during pregnancy, unless strictly necessary, and are contraindicated while breastfeeding.

Finally, alpha-glucosidase inhibitors should be used with caution in children, as well as clients with renal or hepatic disease.

Now, if your client is prescribed an alpha-glucosidase inhibitor like acarbose, start by reviewing their most recent laboratory test results, such as blood glucose, hemoglobin A1c, as well as renal and hepatic function tests.

Next, explain how the medication works in their gastrointestinal system to slow the rise in their blood glucose level after a meal.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)