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Oral antidiabetic medications - Sulfonylureas & meglitinides: Nursing Pharmacology

Notes

Notes

SULFONYLUREAS & MEGLITINIDES
DRUG NAME
First generation: tolbutamide, tolazamide, chlorpropamide
Second generation: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Glynase)
*High Alert Medications*

repaglinide, nateglinide
*High Alert Medications*

CLASS
Sulfonylureas
Meglitinides
MECHANISM OF ACTION
Inhibit ATP-sensitive K+ channels on pancreatic beta cells → increase insulin secretion → decrease blood glucose levels
INDICATIONS
Type 2 diabetes mellitus
ROUTE(S) OF ADMINISTRATION
PO
SIDE EFFECTS
  • Hypoglycemia
  • Headaches, dizziness, fatigue
  • Weight gain
  • Gastrointestinal disturbances
  • Back pain, arthralgias
  • Skin rash, pruritus
  • Allergic or anaphylactic reactions
  • Second generation sulfonylureas: hepatotoxicity, hematologic side effects (anemia, leukopenia, thrombocytopenia)
CONTRAINDICATIONS AND CAUTIONS
  • Type 1 diabetes mellitus
  • Diabetic ketoacidosis (DKA)
  • Pregnancy and breastfeeding
  • Children or elderly clients
  • Thyroid, cardiac, hepatic, or renal disease
NURSING CONSIDERATIONS: SULFONYLUREAS & MEGLITINIDES
ASSESSMENT AND MONITORING
Sulfonylureas and meglitinides
Assess
  • Laboratory test results, including CBC, blood glucose, hemoglobin A1c, electrolytes, renal and hepatic function

Monitor
  • Side effects and therapeutic response: blood glucose, hemoglobin A1c levels, CBC, liver and renal function tests
CLIENT EDUCATION
Sulfonylureas and meglitinides
  • Purpose of medication: lowers blood glucose levels by increasing insulin release from pancreas
  • Continue antidiabetic regimen: low-carbohydrate and high-fiber diet, regular physical activity, frequent blood glucose monitoring
  • Timing of medication administration with meals
    • Glipizide: take 30 minutes before the first meal of the day
    • Repaglinide: take within 30 minutes of each meal; do not take if a meal is skipped
  • Recognize side effects
    • Nausea, vomiting, headaches, joint pain
    • Hyperglycemia: fatigue, blurred vision; increased thirst, appetite, and urination
      • Check glucose level
      • Contact healthcare provider
    • Hypoglycemia: hunger, headache, fatigue, tremors, dizziness, confusion
      • Check blood glucose level
      • Consume a source of glucose; e.g., half a cup of orange juice, three glucose tablets, or approximately 15 grams of sugar
      • Check blood glucose after 15 minutes
    • Lactic acidosis: hyperventilation, muscle pain, and changes in their level of consciousness
      • Contact healthcare provider
      • Avoid alcohol
Transcript

Sulfonylureas and meglitinides are medications used to treat type 2 diabetes mellitus. Type 2 diabetes 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, sulfonylureas can be classified into first and second generation, and are easy to recognize because they all have the suffix -ide.

First generation sulfonylureas include tolbutamide, which is short-acting, tolazamide, which is intermediate-acting, and chlorpropamide, which is long-acting; while second generation sulfonylureas include glimepiride, glipizide and glyburide

On the other hand, meglitinides have the suffix -glinide, and the most commonly used ones include repaglinide and nateglinide.

Okay, now both sulfonylureas and meglitinides are given orally and once administered, they both act on the pancreas by inhibiting ATP-sensitive potassium channels on the membrane of pancreatic beta cells.

As a result, these medications initiate a cascade of events that stimulate the pancreatic beta cells to secrete more insulin, ultimately leading to a decrease in blood glucose levels.

Unfortunately, both classes of medications can lead to side effects like hypoglycemia, as well as headaches, dizziness, fatigue. Additionally, clients report weight gain and gastrointestinal disturbances, such as nausea and vomiting.

Some clients may also experience back pain or arthralgias, and can develop a skin rash, pruritus, and even allergic or anaphylactic reactions.

Finally, second generation sulfonylureas can cause hepatotoxicity; as well as hematologic side effects, such as anemia, leukopenia and thrombocytopenia.

As far as contraindications go, both sulfonylureas and meglitinides should not be used in clients with type 1 diabetes mellitus, or those experiencing diabetic ketoacidosis or DKA.

In addition, some of these medications should be used with caution during pregnancy and breastfeeding, as well as in children or elderly clients. Final precautions for these medications include thyroid, cardiac, hepatic, or renal disease.

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)