Pharmacology, part 41: Endocrine Medications - Antidiabetic Agents, Glucagon


In this article, we cover two more oral antidiabetics: thiazolidinediones (pioglitazone), alpha glucose inhibitors (acarbose); these are prescribed for patients with Type 2 diabetes to help control hyperglycemia. Then we cover glucagon, which is given for HYPOglycemia when patients can't safely eat food.

The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

Thiazolidinediones - Pioglitazone (Actos)

Pioglitazone is an oral antidiabetic medication that belongs to the class thiazolidinediones; it's used to help patients with type 2 diabetes control blood sugar levels.

Pioglitazone mode of action

Pioglitazone and other thiazolidinediones help to decrease blood glucose by decreasing insulin resistance and glucose production and increasing glucose uptake in the body's cells.

Pioglitazone side effects

The side effects of pioglitazone include fluid retention, elevated LDL, and hepatotoxicity.

Cool Chicken If you eat too much junk food, you might end up in the “Pig zone” (with fluid retention, edema and elevated LDLs). These are the key side effects with pioglitazone.

Pioglitazone black box warning & contraindications

Pioglitazone carries a black box warning due to the risk of congestive heart failure, and it is contraindicated in patients with heart failure.

Heart failure is usually accompanied by fluid volume overload because the heart is not pumping effectively, and pioglitazone causes fluid retention. If a patient already has fluid volume overload and more retained fluid is introduced by taking this drug, this can overwhelm the heart and lead to heart failure for the patient.

Alpha Glucose Inhibitors - Acarbose (Precose)

Acarbose is an oral antidiabetic medication that belongs to the class alpha glucose inhibitors; it's used to help patients with type 2 diabetes control their blood sugar levels. It's usually taken 3 times a day with meals at the first bite of food.

Acarbose mode of action

Acarbose works to control blood sugar levels by inhibiting glucose absorption in the gastrointestinal tract.

Cool Chicken Acarbose will prevent absorption of carbs (i.e. glucose) in the GI tract.

Acarbose side effects

Possible side effects of acarbose include GI upset, hepatotoxicity, and anemia, as it may interfere with the body's intrinsic factor in the GI tract.

Acarbose contraindications

Acarbose is contraindicated for patients with gastrointestinal (GI) disorders. Acarbose's mode of action is in the GI tract, so if the GI tract is not functioning properly, the effectiveness of acarbose may be impaired.

Glycogenolytic Agent - Glucagon (GlucaGen)

Glucagon is a naturally-occurring hormone in the body that increases blood sugar levels. This hormone is covered in the Endocrine System section of our Medical-Surgical Nursing Flashcards which give an overview of the anatomy and physiology of each body system before diving into the diseases and disorders.

Artificial glucagon is a medication known as a glycogenolytic agent that is given via the subcutaneous, intramuscular, or IV route for severe hypoglycemia when a patient is unable to take oral glucose.

Hypoglycemia is a common complication seen in patients with diabetes wherein blood glucose levels drop below 70 mg/dL.

Normally, if a patient with hypoglycemia is conscious and able to safely swallow, they would be given 15g of a readily absorbable carbohydrate, like juice or milk. However, if a patient is not conscious or not able to safely swallow, they can be given glucagon via the subcutaneous, IM or IV route.

After administering glucagon, provide patients with food as soon as they are able to safely swallow.

Cool Chicken When the glucose is gone, take glucagon.

Glucagon is also sometimes used as a diagnostic aid to slow down the motion in the bowels for radiology so clear pictures can be taken.

Glucagon mode of action

Glucagon increases blood sugar in three ways.

  1. Glucagon kicks off a pathway called glycogenolysis in which glycogen in the liver is converted into glucose and then released into the bloodstream. The reason food is given after glucagon is so that a patient's body can replenish its glycogen stores.
  2. Glucagon stimulates gluconeogenesis, which is production of new glucose. If you break down the word into its medical terminology parts, "Gluco" means relating to glucose, "neo" means new, and "genesis" means formation. Like glycogenolysis (#1), gluconeogenesis (#2) happens primarily in the liver.
  3. Glucagon causes adipose tissue to break down fat for use as energy.

Glucagon side effects

The side effects of glucagon may include GI upset.

Full Transcript: Pharmacology, part 41: Endocrine Medications - Antidiabetic Agents, Glucagon

Hi. I'm Cathy with Level Up RN. In this video, I'm going to continue my coverage of oral antidiabetic medications. I'll also be covering a medication that is used for hypoglycemia as opposed to hyperglycemia. And at the end of the video, I'm going to provide you guys a little quiz, a little knowledge check to test your understanding of some of the key concepts I'll be covering in this video. So definitely stay tuned for that.

Also, there will very likely be a blooper reel at the end of this video because pronouncing antidiabetic medications is kind of my arch-nemesis so I'm going to do my best not to butcher these names. So thank you in advance for your patience.

All right. So let's first talk about thiazolidinediones, which includes pioglitazone.

So this medication class helps to decrease blood glucose levels by decreasing insulin resistance and glucose production. It also helps to increase uptake of glucose in the body's cells.

Key side effects include fluid retention, elevated LDL levels, hepatotoxicity, and this drug class also has a black box warning due to the risk of congestive heart failure. So heart failure will be a key contraindication when it comes to pioglitazone. And that makes sense, right?

Because with pioglitazone, we have fluid retention and with heart failure, we already likely have fluid volume overload because that heart is not pumping effectively. So if we overwhelm the heart even more with additional fluid retention, it is not going to be a good scenario for that patient.

All right. My way of remembering this drug and some of the key side effects of pioglitazone is when I look at the name pioglitazone, it kind of looks like Pig Zone. And when I think of Pig Zone, it helps me to remember fluid retention, edema, and increased LDL levels. So hopefully, my little trick here helps you to remember some of those side effects as well.

All right. Next up, we have an alpha glucose inhibitor, which is Acarbose.

So this medication works to decrease blood sugar levels by inhibiting glucose absorption in the GI tract.

Key side effects include GI, upset as well as hepatotoxicity.

So a key contraindication of Acarbose is a GI disorder. So if a patient has a gastrointestinal disorder, then we would advise them not to take this medication because the mode of action is in the GI tract.

So the way I remember this medication, if you look at the name Acarbose, and you break it down, A- means no or without, and then carbs, so no carbs will be absorbed with Acarbose.

And that's not fully accurate, right? We'll still absorb some carbohydrates, but it will decrease the absorption of carbohydrates which will help to control the patient's blood sugar levels. All right. So those are all of the oral antidiabetic agents that we're going to cover.

I'm now going to talk about a Glycogenolytic agent which is Glucagon.

So we would use Glucagon for severe hypoglycemia in a patient who is unconscious or somehow not able to take an oral glucose.

So normally, if a patient is conscious and able to safely swallow and they have hypoglycemia, we can give them 15 grams of a readily absorbable carbohydrate to help that situation.

However, if the patient is unconscious or unable to swallow safely, we need to give them Glucagon, and we can give this medication through the IV, IM, or subcutaneous route. Once we administer this medication and the patient is fully conscious and able to swallow safely again, then we want to provide them food afterwards.

So the way I remember this medication is if you look at Glucagon, it helps to remind me that when the glucose is all gone, then we give them Glucagon.

All right. Time for a quiz. I have three questions for you.

First question: What medication works by decreasing glucose absorption in the GI tract?

The answer is... Acarbose.

Question number two: Which medication causes fluid retention and is contraindicated for heart failure?

The answer is... Pioglitazone.

Question number three: What medication do you give an unconscious patient with hypoglycemia?

The answer is...Glucagon.

All right. I hope you all did great on that quiz. If you missed any questions, just go back and watch my video again, review the flashcards. It really takes repetition to learn all of this pharmacology information which is why flashcards work so well for this subject. So take care and good luck studying.

Blooper Reel: After you've provided them the Glucajohn-- Glucajohn, Glucajohn. Hopefully, you didn't give them any Glucajohn because that's not a thing.

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