Oral antidiabetic medications - Sulfonylureas and meglitinides: Nursing Pharmacology

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