Oral antidiabetic medications - Sulfonylureas and meglitinides: Nursing pharmacology

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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

Memory Anchors and Partner Content

Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)

Picmonic

Glyburide and Glipizide (2nd Generation Sulfonylureas)

Picmonic

Repaglinide and Nateglinide (Meglitinides)

Picmonic

Transcript

Content Reviewers

Antonella Melani, MD,Lisa Miklush, PhD, RNC, CNS,Gabrielle Proper, RN, BScN, MN

Contributors

Maria Emfietzoglou, MD,Evan Debevec-McKenney,Elijah Lee, MScBMC

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.

Sources

"Focus on Nursing Pharmacology" LWW (2019)

"Pharmacology" Elsevier Health Sciences (2014)

"Mosby's 2021 Nursing Drug Reference" Mosby (2020)

"Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)

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Oral antidiabetic medications - Sulfonylureas and meglitinides: Nursing pharmacology

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