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PAT 20A/B Chapter Notes - Chapter N/A: American Diabetes Association, Aplastic Anemia, Guanethidine


Department
Pathotherapeutics
Course Code
PAT 20A/B
Professor
Audrey Kenmir
Chapter
N/A

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(2)PAT20 Winter Week 3-4 Drug Classifications (Diabetes Mellitus)
1. Anti-Diabetics
a) Insulin *Metabolic Agent* (Anti-hyperglycemia)
Insulin drugs: R- insulin lispro (Humalog), S- regular insulin (Humulin-R), I- NPH:
neutral protamine hagedone (Novolin-N), L- insulin gargine (Lantus), Premixed
regular insulin (Humulin-R and NPH 30/70)
Action: insulin lowers blood glucose by stimulating glucose uptake in skeletal muscle
and fat, inhibiting hepatic glucose production, lipolysis and proteolysis and enhances
protein synthesis.
Uses: control of hyperglycemia in patients with type 1 or type 2 diabetes mellitus,
treats of diabetic ketoacidosis, patients requiring temporary insulin therapy during
pregnancy, treats hyperkalemia (regular insulin only).
Pharmacokinetics (Rapid, Short, Intermediate & Long Acting Insulin):
Onset- R: less than 0.5 hr; 30-60 min; I: 1-2 hrs; L: 3-4 hrs
Peak- R: 0.5-1.5 hrs; S: 2-4 hrs; I: 4-12 hrs; L: none
Duration- R: less than 8 hrs; S: 5-7 hrs; I: 18-24 hrs; L: 24 hrs
Side/Adverse Effects:
DERM: localized urticarial lesions (usually disappear), lipodystrophy of
subcutaneous fat, pruritus
ENDO: hypoglycemia due to excess; insulin resistance
OTHER: hypersensitivity reactions, including anaphylactic shock, antineurotic
edema
Contraindications/Precautions:
Hypersensitivity or allergy to particular insulin, preservatives, or other additives, use
cautiously in patients with stress and infection (may increase insulin requirement),
kidney or liver impairment (may decrease insulin requirement), pregnancy may
require higher dosages of insulin, safety in pediatric patients less than 6 y/o has not
been established.
Interactions:
-Beta-blocker, clonidine, and reserpine may mask signs and symptoms of
hypoglycemia.
-Corticosteroids, estrogens, niacin, phenothiazines, rifampin, and thyroid hormone
replacement drugs may increase insulin requirements.
-Concurrent use of ACE-Is, alcohol, guanethidine, MAO-Is, octreotide, oral
antidiabetic drugs, propranolol, and salicylates may decrease insulin requirements
and intensify hypoglycemic effects of insulin.
Dosages (Rapid, Short, Intermediate & Long Acting Insulin):

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Injection: 100, 500 units/mL (concentrated); prefilled cartridges and pens: 100
units/mL
Nursing Management Priorities:
Assess: history of hypersensitivity, hypo/hyperglycemic reactions, hepatic and renal
function.
Dietary management: avoid use with alcohol, American Diabetes Association diet
(decreased carbohydrate and fat)); calorie restriction.
Lab test evaluation: FBS, blood glucose.

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b) Alpha-Glucosidase Inhibitor *Metabolic Agent* (Anti-GI tract hyperglycemia)
Alpha-glucosidase inhibitor drugs: acarbose (Precose), miglitol (Glyset),
Action: local inhibition of ingested carbohydrate digestion within GI tract.
Uses: manages type 2 diabetes that cannot be controlled by diet and lifestyle changes
alone.
Pharmacokinetics (Acarbose):
Onset- PO: sec-mins
Peak- PO: 1hr
Duration- PO: unknown
Side/Adverse Effects:
DERM: erythema, morbilliform/maculopapular eruptions, photosensitivity
GI: nausea, epigastric fullness, heartburn
HEM: aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, pancytopenia,
thrombocytopenia
MET: hypoglycemia
Contraindications/Precautions:
Hypersensitivity, diabetic ketoacidosis with or without coma.
Interactions:
-Use with alcohol, beta blocker MAO-is, phenylbutazones significantly increases
hypoglycemic effects.
-Use with anabolic steroids, chloramphenicol, guanethidine, oral anticoagulants,
probenecid, salicylates, sulfinpyrazone, sulfonamides increases hypoglycemic
effects.
-Use with adrenergics, corticosteroids, phenytoin, thiazides, thyroid preparations
decrease hypoglycemic effects.
Dosages (Acarbose):
Tablets = 25, 50, 100 mg
Nursing Management Priorities:
Assess: history of hypersensitivity, hypo/hyperglycemia reactions, hepatic and renal
function.
Dietary management: avoid alcohol, American Diabetes Association diet (decrease
carbohydrate and fat), calorie restriction
Lab test: FBS
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