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Oral antidiabetic medications - Sulfonylureas and 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
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)