SCF Level 2 Exam 3 Drugs
Metformin Biguanide Adverse Effects - lactic acidosis; most are minor & GI related: N/V/D,
abdominal pain, metallic taste, headache. Monitor fasting & postprandial glucose, HbA1c, Hepatic &
renal failure Black Box: has been associated w/potentially fatal lactic acidosis
Regular insulin (Humulin R, Novolin R) Uses - Short acting, Clear solution, given 15 min before a
meal, Parenteral drug for DM; Also emergency management of ketoacidosis
Regular insulin (Humulin R, Novolin R) Adverse Effects - Hypoglycemia, irritation of injection sites,
lipohypertrophy-accumulation of extra fat at the SQ site
Regular insulin (Humulin R, Novolin R) Contraindications - renal or hepatic impairment, thyroid
disease, older adults. Pregnancy, hypokalemia
Regular insulin (Humulin R, Novolin R) Drug/Drug Interactions - ETOH, MAOI, salicylates,
corticosteroids, thyroid hormone, Beta Blockers, Furosemide, Hydrochlorothiazide (HCTZ), Oral Anti-
diabetics, garlic, ginseng (everything but cortisol will increase the effects of insulin
Regular insulin (Humulin R, Novolin R) Special Comments - Do not inject cold insulin, Monitor:
Fasting & postprandial glucose, HbA1C, Carry some form of fast acting carbohydrate, "Only type of given
via IV"
Regular insulin (Humulin R, Novolin R, ReliOn N) Action/Onset/Peak/Duration - Onset 30-60 min,
Peak 2-4 h. Duration 5-7 h. Metabolized Liver <2% excreted in urine; Excreted: Kidney.
Glyburide MOA - (Sulfonylureas) Stimulate the release of insulin from pancreatic islet cells.
Increases the sensitivity of insulin receptors on target cells. Used in Type II. 1st oral hypoglycemic agent
available. NOT for TYPE I
Glyburide Adverse Effects - (Sulfonylureas) Most common hypoglycemia, heartburn, N/V, Pruritus-
itching, Weight gain, blurred vision, hepatoxicity. Alcohol, Oral anticoagulants, MAOI's, clarithromycin,
thiazides, garlic, ginseng
, Glyburide Contraindications - (Sulfonylureas) DM Type 1, renal or hepatic impairment, thyroid
disease, elderly, children, pregnancy, allergy to sulfonamides, major surgery/severe infection
Glyburide Action/Onset/Peak/Duration - (Sulfonylureas) Metabolized in Liver, Excreted in Urine &
Feces Onset: 15-60 min. Peak 1-2 h. Duration up to 24 h. so WATCH BS the entire day. Dose is 2.5 mg
daily, titrate up to max dose of 20 mg/day divided into 10 mg am & 10 mg pm
Metformin Biguanide Use - Treat DM Type 2 to reduce blood glucose, can be used in children, also
comes in extended=XR, it helps the body use its own insulin better. Off label, use is polycystic ovarian
syndrome
Regular insulin (Humulin R, Novolin R) MOA - Lowers blood glucose by stimulating peripheral
glucose uptake by skeletal muscle & fat & inhibiting glucose production by the liver. Short-acting insulin
to quickly decrease blood glucose
Metformin Biguanide Doses - Adults start at 500 mg PO daily, titrate to max dose of 2550 mg/daily
in divided doses. Check labs every 3 mo. an A1C and fasting glucose level.
Metformin Biguanide Contraindications - Acute MI, diabetic ketoacidosis, renal or liver
impairment, sepsis, dehydration, pregnancy, hold for 48 h. before & after the contrast dye administration
Metformin Biguanide Drug/Drug - ETOH, Captopril, Lasix, nifedipine, vancomycin, digoxin,
morphine, decreases b12 & folic acid,
Sitagliptin MOA - Slows the breakdown of incretins-(this is a hormone secreted in the small
intestine in response to elevated BG levels it signals the pancreas to secrete insulin & the liver to stop
production of glucagon, incretin potentiates the feeling of fullness, slows gastric emptying). (e.g. GLP-1
by inhibiting DPP-4) (Incretin Enhancer DPP-4 inhibitor)
Sitagliptin Contraindications - DMI, renal impairment, elderly, history of pancreatitis, pregnancy,
kids. Give PO without regards to meals. (Incretin Enhancer DPP-4 inhibitor)
