Oral antidiabetic medications - DPP-4 inhibitors: Nursing pharmacology

Dipeptidyl peptidase-4 inhibitors, or DPP4 inhibitors for short, are medications used to treat type 2 diabetes mellitus.

Type 2 diabetes mellitus is characterized by insulin resistance, which is when tissue cells have trouble responding to insulin in order to use glucose from the blood.

As a result, tissue cells starve for energy despite having high blood glucose levels, which is called hyperglycemia. Now, commonly used DPP4 inhibitors are sitagliptin, saxagliptin, linagliptin, and alogliptin.

All of them end with the suffix -gliptin, which makes them easy to recognize!DPP4 inhibitors are taken orally. Once administered, these medications inhibit the enzyme DPP4, which normally destroys the hormone incretin.

As a result, DPP4 inhibitors increase the levels of incretin, which in turn increases insulin secretion and decreases glucagon secretion.

The end result is a reduction in glucose production by the liver, and thus a reduction in blood glucose levels.Now, the most common side effects of DPP4 inhibitors include headaches, nausea, vomiting, and diarrhea or constipation, as well as mild infections of the upper respiratory or urinary tract.

In addition, they can increase the risk of hypoglycemia, pancreatitis, and acute renal failure. Less frequently, DPP4 inhibitors can cause life-threatening side effects, such as anaphylaxis, angioedema or Stevens Johnson syndrome.As far as contraindications go, DPP4 inhibitors should not be used in clients with a history of pancreatitis, hypoglycemia, and angioedema.

They should also be avoided in clients with a history of diabetic ketoacidosis, or DKA for short, which is an acute life-threatening complication of diabetes.

Finally, precautions should be taken during pregnancy and breastfeeding, as well as in elderly clients, and those with other endocrine, hepatic, or renal disorders.Now, if a client with type 2 diabetes is prescribed a DPP4 inhibitor like sitagliptin, be sure to review their most recent laboratory test results, including blood glucose, hemoglobin A1c, as well as their renal and hepatic function.

Next, explain how the medication works to lower their blood glucose level. Be sure to remind them that the medication is most effective when combined with an antidiabetic regimen, which includes following a low-carbohydrate and high-fiber diet, regular physical activity, and frequent blood glucose monitoring.

Next, teach your client to take their medication once daily, with or without food. Be sure to review with them the symptoms of hyperglycemia, such as fatigue, blurred vision, increased thirst, appetite, and urination, and advise them to check their blood glucose level and contact their healthcare provider immediately.

Also review symptoms of hypoglycemia, including hunger, fatigue, tremors, headache, dizziness, and confusion; if these occur, remind them to check their blood glucose level, followed by taking about a half cup of fruit juice, three glucose tablets, or approximately 15 grams of sugar; and to check their blood glucose again after 15 minutes.Also teach your client to recognize potentially serious side effects that should be reported right away.

Symptoms like severe abdominal or back pain could be indicative of pancreatitis. On the other hand, weight gain, swelling, blood in the urine, or changes in the amount of urine they are producing could be symptoms of renal problems.

Lastly, painful, blistered, peeling skin could indicate a serious hypersensitivity reaction like Stevens Johnson syndrome.

Finally, during treatment with a DPP4 inhibitor, be sure to monitor for side effects and the therapeutic response to the medication by regularly checking your client’s blood glucose levels, hemoglobin A1c, and renal function tests.

Alright, as a quick recap … DPP4 inhibitors are medications used to treat type 2 diabetes mellitus. They lower blood glucose levels by inhibiting the enzyme DPP4, increasing the levels of incretin, which in turn increases insulin secretion and decreases glucagon secretion.

Important side effects include hypoglycemia, and upper respiratory infections, as well as pancreatitis, renal failure, and Stevens Johnson syndrome.

Nursing considerations for clients taking DPP4 inhibitors include performing a baseline assessment, as well as monitoring for side effects and for the therapeutic effect of improved blood glucose control.

Client teaching is focused on safe self-administration, actions to take for both hypo- and hyperglycemia, and recognizing potentially serious side effects that should be reported