Endocrine Medications: How much do you know?

A patient newly diagnosed with Diabetes Mellitus type 2 has been prescribed metformin. Which of the following items, if noted within the patient history, would be a cause for concern?

• Elevated blood pressure readinge

• alcohol use disorder

• heart failure

• bladder cancer

Answer explanation

Metformin is contraindicated for those clients with alcohol use disorder.

pioglitazone is contraindicated in those with heart failure and bladder cancer.

Concurrent use of thiazide diuretics and glucocorticoids can:

• raise blood sugar.

• lower blood sugar.

Answer explanation

Thiazide diuretics and glucocorticoids can raise blood sugar- decreasing the effectiveness of insulin.

Assessing your medication administration knowledge! Which of the following is True?

• Sitagliptin can be taken with or without food

• repaglinide should be taken within 1-2 hours of a regularly scheduled meal

• glipizide can be taken at any time

Answer explanation

Glipizide is best taken 30 minutes before breakfast

sitagliptin can be taken with or without food

repaglinide needs to be taken within 30 minutes of meal time

NSAIDS, sulfonamide antibiotics, ranitidine and cimetidine when used concurrently with glipizide can:

• create a disulfiram-like reaction (N/V, flushing, palpitations).

• decrease the effectiveness of glipizide.

• increase the hypoglycemic effect.

• lead to fluid retention.

Answer explanation

glipizide, when used concurrently with NSAIDS, sulfonamide antibiotics, ranitidine, and cimetidine have additive hypoglycemic effect- the dosage may need to be changed.

Which medication is used in emergency management of hypoglycemic reactions?

• glucagon

• incretin mimetics

• rapid acting insulin

• glipizide

Answer explanation

glucagon can be given IM or IV, and is used in those with hypoglycemic reactions

Sitagliptin is effective in the treatment of DKA

• True

• False

Answer explanation

All oral antidiabetic medications are contraindicated in the treatment of DKA.

Which of the following are complications of Pioglitazone ?

Select all that apply.

• Fluid retention

• Decrease in LDL

• Folic Acid deficiency

• Fluid Loss

• Hepatoxicity

Answer explanation

Complications from Pioglitazone are:

1. fluid retention

2. Elevations in low density lipoproteins (LDL)

3. Hepatotoxicity

Folic acid deficiency occurs with the use of metformin

Assessment: Which of the following is a guideline that clients must meet before being prescribed oral antidiabetic therapy?

• The client must have an onset of diabetes mellitus at age 30 years or older

• They must have normal blood pressure readings

• The cannot be underweight

• Must have tried insulin first.

Answer explanation

The guidelines are as follows:

•The client must have an onset of diabetes mellitus at age 40 years or older

•The diagnosis of diabetes must be made for less than 5 years

•The client is not underweight

•Their fasting blood glucose is equal to or less than 200 mg/dL

•IF they need insulin, less than 40 units are required per day

•They must have normal renal and hepatic function

Which of the following is not considered an oral antidiabetic?

• Glipizide

• Metformin

• Repaglinide

• Exenatide

Answer explanation

Exenatide is an Incretin mimetic (a non-insulin injectable antidiabetic)- mimics the effects of naturally occurring glucagon that promotes the release of insulin

Your patient's blood sugar reading is 50 mg/dL per bedside glucose monitor. The patient is unconscious. Which of the following medications will you expect to administer?

• regular Insulin

• metformin

• glipizide

• glucagon

Answer explanation

glucagon can be given IM, IV or SubQ. Since the patient is unconscious, you would not give an oral medication. Additionally, metformin and glipizide will further decrease the blood sugar.

Insulin, decreases the blood sugar. The patient is already hypoglycemic (less than 70 mg/dL)