NUR 635 Topic 7 DQ 1

Sample Answer for NUR 635 Topic 7 DQ 1 Included After Question

Based on the first letter of your last name, complete the discussion on the medication class to which you are assigned:

  • If your last name starts with A through D: GLP1s
  • If your last name starts with E through H: SGLT-2 Inhibitors
  • If your last name starts with I through L: DPP-IV
  • If your last name starts with M through O: Biguanides
  • If your last name starts with P through S: Sulfonylureas
  • If your last name starts with T through V: TZD
  • If your last name starts with W through Z: Insulin Preparations

Utilizing the guidelines from the American Diabetes Association website, in the topic Resources, share the mechanism of action of this medication class and hints for monitoring, side effects, and drug interactions, including interactions with CAM. Identify the medication class’s place in therapy according to the guidelines. Determine appropriate therapeutic options for a patient with diabetes mellitus. Discuss ethnic, cultural, and genetic considerations that must be considered for treatment. In addition, share a clinical trial that supports the use of this agent. Include the name of the medication in the subject line so that the medications can be followed.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education

This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2

A Sample Answer For the Assignment: NUR 635 Topic 7 DQ 1

Title: NUR 635 Topic 7 DQ 1

Medication Class: Biguanides (Metformin)

Mechanism of Action:

Metformin, an oral diabetic medication, is prescribed for treating type 2 diabetes. It predominantly decreases hepatic glucose production and increases peripheral tissue insulin sensitivity. By impeding the activity of mitochondrial glycerophosphate dehydrogenase, AMP-activated protein kinase is stimulated, and ATP production is reduced. Activation of this mechanism inhibits hepatic gluconeogenesis while increasing glucose uptake in muscle cells. Metformin exerts an impact on gut microbiota and hormones as well. When gestational diabetes is present, metformin is advised as a feasible substitute for insulin.

Due to the association between hyperglycemia and congenital malformations, metformin is utilized to mitigate elevated blood glucose levels throughout pregnancy. As per the findings of Facts and Comparisons, metformin was formerly classified as class B for pregnancy according to the previous FDA system. It is worth noting that the medication can traverse the placenta and is conceivably present in breast milk (Corcoran & Jacobs, 2023). 

Monitoring:

Monitoring oral antidiabetic agents entails routine evaluations of HbA1c, fasting, and postprandial blood glucose levels every three to six months. Additionally, clinicians should monitor renal function through the initial and periodic assessment of GFR. It is recommended that patients with a GFR ranging from 60 to 45 mL/min/1.73² undergo monitoring every three to six months. To assess their renal function, it is imperative to diligently monitor patients whose GFR is below 45 mL/min/1.73² every three months. Consistent surveillance is critical in preventing lactic acidosis, especially among the elderly (Corcoran & Jacobs, 2023). 

Occasional vitamin B12 deficiency may result from the prolonged use of metformin. As a result, the ADA recommends regularly monitoring vitamin B12 levels, particularly for patients with peripheral neuropathy or anemia. In addition, patients who are concurrently taking medications that increase the risk of lactic acidosis should be monitored frequently (Corcoran & Jacobs, 2023).  

 Side Effects:

Common side effects include gastrointestinal symptoms like nausea, diarrhea, and abdominal discomfort. These can be mitigated by starting with a low dose and gradually increasing it. Lactic acidosis is a rare but severe side effect, so metformin should be avoided in patients with kidney impairment (Wang et al., 2017). 

Drug Interactions:

Specific drug interactions can raise the risk of lactic acidosis, which involve medications such as bupropion, carbonic anhydrase inhibitors, cephalexin, cimetidine, dolutegravir, ethanol, glycopyrrolate, iodinated contrast agents, lamotrigine, ranolazine, and topiramate. Metformin may interact with medications that affect renal function, such as ACE inhibitors and NSAIDs (Corcoran & Jacobs, 2023). 

Alcohol consumption can increase the risk of lactic acidosis. In addition, other drug interactions can enhance the hypoglycemic effect of metformin. These drugs include androgens, alpha-lipoic acid, salicylates, selective serotonin reuptake inhibitors, quinolones, prothionamide, pegvisomant, and other antidiabetic agents. Therefore, it is advisable for clinicians to carefully monitor patients who are concurrently taking these medications along with metformin (Corcoran & Jacobs, 2023). 

Complementary and Alternative Medicine (CAM) Interactions:

Interactions with CAM should be assessed on a case-by-case basis. For example, some herbal supplements may impact glucose levels and interact with metformin (Corcoran & Jacobs, 2023). 

Guideline Recommendations:

Metformin has gained significant popularity as a treatment for type 2 diabetes mellitus (T2DM) since its approval in the United States in 1995. Dosages for this condition vary between 500 and 2,500 mg per day. Guidelines, including the American Diabetes Association (ADA), designate metformin as the initial-line treatment for type 2 diabetes (Wang et al., 2017). Due to its established efficacy, favorable safety profile, and prospective cardiovascular advantages, it is strongly advised. Metformin functions by inhibiting intestinal glucose absorption, enhancing peripheral glucose uptake, reducing fasting plasma insulin levels, and promoting insulin sensitivity. As a result, blood glucose concentrations are diminished without the manifestation of hypoglycemia (Wang et al., 2017). 

Ethnic, Cultural, and Genetic Considerations:

Some populations may require dosage adjustments due to variations in metformin’s pharmacokinetics. For example, certain Asian individuals may experience higher drug concentrations. Cultural factors can influence dietary habits, affecting blood glucose control. Healthcare providers should consider cultural dietary preferences when providing guidance. Genetic variations may impact metformin response. Pharmacogenomic testing can help identify individuals who may need tailored treatment. No dosage adjustment is necessary when the estimated glomerular filtration rate (eGFR) is above 60 mL/min per body surface area. Clinicians should monitor the renal function of their patients annually. No dosage adjustment is necessary for eGFR >45 and <60 mL/min per body surface area. Clinicians should monitor the renal function of their patients every 3 to 6 months (Corcoran & Jacobs, 2023). 

The initiation of therapy is not recommended for patients with an eGFR value between 30 and 45 mL/min per body surface area as per the manufacturer’s label. However, some researchers suggest a 500 mg daily metformin dose with an evening meal. Metformin therapy is contraindicated when the eGFR value is below 30 mL/min per body surface area (Corcoran & Jacobs, 2023). 

Clinical Trial Supporting Use:

An important trial that supports the use of metformin is the advantages of metformin in mitigating the likelihood of macrovascular complications among overweight individuals diagnosed with type 2 diabetes were established in this extended-term study. The inclusion of metformin as a first-line agent in numerous diabetes management guidelines was facilitated by this (Wang et al., 2017).

References

Corcoran C, Jacobs T. (2023). Metformin   Stat Pearls Publishing; Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK518983/

Wang, Y., He, S., Feng, X., Cheng, J., Luo, Y., Tian, L., & Huang, Q. (2017). Metformin: A review of its potential indications. Drug design, development, and therapy, 11, 2421–2429. https://doi.org/10.2147/DDDT.S141675   

A Sample Answer For the Assignment: NUR 635 Topic 7 DQ 1

Title: NUR 635 Topic 7 DQ 1                 

GLP1s

Mechanism of Action and Guidelines

GLP-1 receptor agonists, commonly referred to as GLP1s, are a class of medications used in the management of diabetes mellitus, as outlined by the American Diabetes Association (ADA) guidelines. The mechanism of action for GLP1s involves mimicking the action of glucagon-like peptide-1 (GLP-1), a hormone naturally produced in the gut. GLP-1 enhances glucose-dependent insulin secretion, suppresses glucagon release, slows gastric emptying, and promotes a feeling of satiety, leading to improved blood glucose control (Zheng et al., 2022).

Monitoring, Side Effects, and Drug Interactions

When administering GLP1s, close monitoring of patients is essential. Blood glucose levels, weight, and kidney function should be regularly assessed. GLP1s have various side effects, such as nausea, vomiting, and diarrhea, which tend to subside with continued use. More severe, albeit rare, side effects may include pancreatitis and thyroid tumors, warranting vigilant monitoring. Additionally, GLP1s may interact with certain medications, like oral contraceptives, and reduce their efficacy (D’Alessandro et al., 2022). Therefore, it is crucial to be aware of potential drug interactions when prescribing GLP1s. Furthermore, it is essential to consider potential interactions with complementary and alternative medicines (CAM) as some herbal supplements might affect blood glucose levels.

Place in Therapy According to ADA Guidelines

According to the ADA guidelines, GLP1 receptor agonists have a well-established place in the therapy of diabetes mellitus. They are recommended as an option for people with type 2 diabetes when other treatments, such as metformin, are insufficient to achieve glycemic control, or when weight management is a priority due to their potential for weight loss.

Ethnic, Cultural, and Genetic Considerations

In providing treatment, healthcare professionals must be sensitive to ethnic, cultural, and genetic factors. Various ethnic and cultural backgrounds may influence patients’ dietary habits, physical activity, and acceptance of certain medications, including GLP1s. Genetic considerations are also important, as individuals may respond differently to GLP1s due to genetic variations. For example, certain genetic factors can impact drug metabolism, which can affect the efficacy and side effect profile of GLP1s.

Clinical Trial Supporting GLP1 Receptor Agonists

One significant clinical trial supporting the use of GLP1 receptor agonists is the LEADER trial, which investigated the cardiovascular outcomes of liraglutide, a GLP1 agonist. This trial demonstrated that liraglutide reduced the risk of major adverse cardiovascular events in patients with type 2 diabetes who were at high cardiovascular risk. This finding emphasized the cardiovascular benefits of GLP1s, making them an attractive option for individuals with diabetes and cardiovascular concerns.

References

D’Alessandro, C., Benedetti, A., Di Paolo, A., Giannese, D., & Cupisti, A. (2022). Interactions between food and drugs, and nutritional status in renal patients: a narrative review. Nutrients14(1), 212.

Zheng, W., Li, L., & Li, H. (2022). Phytochemicals modulate pancreatic islet β cell function through glucagon-like peptide-1-related mechanisms. Biochemical Pharmacology197, 114817.