Skip to content

Oral antidiabetic medications - DPP4 inhibitors: Nursing Pharmacology

Notes

Notes

DPP4 INHIBITORS
DRUG NAME
sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina, Vipidia)
(Suffix: -gliptin)

CLASS
DPP4 inhibitors
MECHANISM OF ACTION
Increase the level of incretin hormones → increase insulin secretion, decrease glucagon secretion → reduce glucose production by the liver
INDICATIONS
Type 2 diabetes mellitus
ROUTE(S) OF ADMINISTRATION
PO
SIDE EFFECTS
  • Headaches
  • Nausea, vomiting, diarrhea, constipation
  • Mild urinary and respiratory infections
  • Hypoglycemia
  • Pancreatitis
  • Acute renal failure
  • Anaphylaxis
  • Angioedema
  • Stevens-Johnson syndrome
CONTRAINDICATIONS AND CAUTIONS
  • Pancreatitis
  • Hypoglycemia
  • Angioedema
  • Diabetic ketoacidosis (DKA)
  • Pregnancy and breastfeeding
  • Elderly clients
  • Other endocrine disorders
  • Hepatic or renal disorders
NURSING CONSIDERATIONS: DPP4 INHIBITORS
ASSESSMENT AND MONITORING
Assess
  • Laboratory test results: blood glucose, hemoglobin A1c, renal and hepatic function

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

Evaluate
  • Therapeutic response: improved glucose control
CLIENT EDUCATION
  • Purpose of medication: lower blood glucose level
  • Take medication once daily, with or without food
  • Continue antidiabetic regimen: low-carbohydrate and high-fiber diet, regular physical activity, frequent blood glucose monitoring
  • 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 about a half cup fruit juice, three glucose tablets, or approximately 15 grams of glucose or table sugar
    • Check blood sugar again after 15 minutes
  • Recognize serious side effects
    • Pancreatitis: severe abdominal or back pain
    • Renal failure: changes in urine produced, weight gain, swelling, blood in the urine
    • Stevens-Johnson syndrome: severe joint pain, blistered, peeling skin
Transcript

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.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology: A patient-centered nursing process approach" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2021)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2020)
  5. "Goodman & Gilman's: The Pharmacological Basis of Therapeutics (13e)" McGraw-Hill Education (2018)
  6. "Lehne's Pharmacology for Nursing Care" Saunders (2019)