The pathophysiology of DMII

The nurse understands the pathophysiology of DMII and the agents that are available to patients, and Match the drug class with the correct description. sitagliptin-Dipeptidyl peptidase 4 Inhibitors A. MOA- Simulate release of insulin from beta cells of the pancreas and diminish glucose production and metabolism of insulin by the liver. In general, this medication should not be given to patients with a Sulfa allergy. Dulaglutide/Glucagon- Like Peptide-1 Agonist B. MOA – works with the incretin hormones (prolonging their beneficial effects by inhibiting rapid metabolism) which reduces hyperglycemia. Can be used as an adjunct or monotherapy.

One positive benefit is that it will enhance insulin secretion only in the presence of hyperglycemia (making hypoglycemia less of a risk, especially If used as a monotherapy). v canagliflozin C. MOA – SGLT2 reabsorbs glucose back Into the circulation via the glomerulus. In Type II DM SGL2 is oversecreted, therefore (gliflozins )/Sodium- aggravating hyperglycemia. Inhibitors to SGLT2 will allow more glucose to be excreted (in the urine). Can be used as mono Glucose Cotransporter 2 therapy. Counsel patients regarding the risk for UTI. Inhibitors (SGLT2) Acarbose/Alpha- D. MOA – Increases insulin sensitivity and reduces hepatic gluconeogenesis.

Though not Indicated as initial therapy for DM II, Glucosidase Inhibitor can be a monotherapy. May take 4-6 weeks for full therapeutic effects. Contraindicated with severe heart failure. agents – Rosiglitazone/Thiazolidin E. MOA – Enhances insulin secretion only in the presence of hyperglycemia, Is not a monotherapy Is an injection. edition (TZDs) – Repaglinide/Meglitinides F. MOA- Increases insulin sensitivity, reduces the absorption of glucose in the small intestine, and reduces hepatic glucose production. Can be used as a monotherapy and does not cause weight gain, and may have a favorable effect on lipids. Must have an adequate glomerular filtration rate, and special care is taken to protect kidneys if radiopaque IV dyes are needed for imaging diagnostics. – > Glipizide/Sulfonylurea G. MOA-Stimulate the release of insulin from beta cells of the pancreas. Can be used as a monotherapy. The short duration of action requires frequent dosing (risk of compliance). Given preprandial, and dose should be held if meals are skipped. – Metformin/Biguanides H. MOA-Inhibits enzymes used in the digestion of sugars, delaying glucose absorption with meals, thus lowering postprandial hypoglycemia. If used as a monotherapy, makes hypoglycemia is very unlikely, but if occurs must use dextrose, not sucrose (table sugar) to treat it.

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