Pharm, part 32: Endocrine Medications - Oral Antidiabetics: Sulfonylureas, Meglitinides, Biguanides

by Cathy Parkes September 06, 2021 Updated: September 09, 2021

Full Transcript

Hi. I'm Cathy with LevelUp RN. In this video, I am going to cover some oral antidiabetic agents. And if you have our pharmacology second edition flashcards, definitely pull those out so you can follow along with me. And at the end of the video, I'm going to provide a little quiz to test your knowledge of some of the key points that I'll be covering in this video. So definitely stay tuned for that.

Also, it is very likely there will be a blooper reel at the end of this video because I will be pronouncing some of the oral antidiabetic medication class names, which are exceptionally challenging for me. So thank you for your patience. And if you are in need of a good laugh, then definitely stay tuned for those bloopers at the end of the video.

Okay, a couple of other things I want to mention before I get into specific classes is that oral antidiabetic agents are just for type 2 diabetes. So if a patient has type 1 diabetes, they are insulin-dependent, so they will just get insulin. For patients with type 2 diabetes, they can be given insulin or oral antidiabetic agents. So that's definitely important to know. The other thing I wanted to mention is that with a lot of these oral antidiabetic agents, a key side effect of these medications will be hypoglycemia. So just like with blood pressure medications, if the dose is too high, that blood pressure can come down too low. We can end up with hypotension. With these oral antidiabetic medications, their job is to bring blood sugar levels down. If they do their job too well, or we give the patient too high of a dose, we can end up with hypoglycemia, which definitely makes sense.

All right, so the first drug class I want to talk about here are sulfonylureas. And medications that fall within this class include glipizide and glyburide. These medications help to bring a patient's blood sugar levels down by increasing the release of insulin from the pancreas. A contraindication of this drug class would be a sulfa allergy. And side effects of this drug class include hypoglycemia, like we talked about. So signs and symptoms of hypoglycemia include tachycardia, diaphoresis, shakiness, headache, and weakness. Other side effects can include photosensitivity and GI upset. In terms of patient teaching, we want to advise our patient to take this medication 30 minutes before a meal. They should not use alcohol. And they definitely need to wear sunscreen when they go outside because of that side effect of photosensitivity.

So our cool chicken hint for this card, which you can find here at the top of the card, is when you look at the drug names glipizide and glyburide, it makes me think of riding or sliding down a slide. So that helps me to remember that you're going down the slide, and blood sugar levels are coming down with you. Also, slides are often in playgrounds outside. So when I think about being outside, I think about the sun being above me, and that helps me to remember photosensitivity as a side effect of this medication cause as well.

Next up, we have our meglitinides. And a key medication that falls within this class is repaglinide. This medication class has essentially the same mode of action as the sulfonylureas. So they help to increase insulin release from the pancreas. Side effects include hypoglycemia again, as well as angina. And then in terms of patient teaching, you want to advise your patient to take this medication three times a day, and eat within 30 minutes of taking the medication. So the way I remember this medication, if you look at the drug name repaglinide, that pag, P-A-G, reminds me of a pageant. So I think of a woman who is about to compete in a pageant, and she's about to go out on stage, but she has like chest pain, and she's feeling dizzy. She has diaphoresis and is weak. And she's attributing all of these signs and symptoms to being nervous about going on stage for this pageant. But in reality, she just started taking repaglinide, and it's actually her medication that is causing that angina, as well as the symptoms of hypoglycemia.

All right. Next, we have our biguanides, which includes a medication metformin. This medication class works by decreasing glucose production in the liver, and increasing the uptake of glucose by the body cells. Side effects can include GI upset, a metallic taste, as well as lactic acidosis. And the signs and symptoms of lactic acidosis include diarrhea, dizziness, hypotension, weakness, and bradycardia. In terms of patient teaching that you need to provide for a patient who takes metformin, they should take this medication with a meal. They should not use alcohol. And if they are scheduled for a procedure that will require them to be NPO or a procedure that requires contrast dye, we need to discontinue metformin 48 hours prior to that procedure.

So my little cool chicken hint for remembering some of the key side effects of metformin, is if you look at the word metformin, you got formin as part of that. So I imagine a foreman going to a construction site with his metal thermos. And as he's drinking from his thermos, he has like a metallic taste. He's like, oh, this doesn't taste good. And suddenly he feels really bad too. He has diarrhea. He feels weak. He feels dizzy. And he's chalking it up to this new thermos that he bought, when in actuality it is his metformin medication that he just started taking for type 2 diabetes that is causing that metallic taste, and causing those signs and symptoms of lactic acidosis, which include GI upset, diarrhea, weakness, and dizziness.

Okay. Time for quiz. I have three questions for you. First question, oral antidiabetics can be used with both type 1 and type 2 diabetes, true or false? The answer is false. So oral antidiabetic agents should only be used with patients with type 2 diabetes. Patients with type 1 diabetes will require insulin. Second question, what is a key side effect of many oral antidiabetic agents? If you said hypoglycemia, you are correct. Third question, what oral antidiabetic agent carries a risk for lactic acidosis? The answer is metformin.

Okay. I hope this quiz has been helpful. If you would like to see more quizzes at the end of my videos, definitely leave me a comment, and be sure to like this video as well. Take care and good luck studying. 

Blooper Reel: Next up, we have our gluta-- I'm sorry. Has essentially the same mode of action as the sulfonylureas. Essentially the same mode of action as the sulfonylureas.

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