Oral Antidiabetic Drugs

Every question here, with the answer

1. A client who takes metformin is scheduled for a CT scan with contrast dye. The client's eGFR is below 30 mL/min. What should the nurse anticipate?

   1. Withhold metformin before and after the contrast dye.
   2. Switch metformin to the evening meal.
   3. Give metformin as usual on the day of the scan.
   4. Double the metformin dose after the scan.

   Answer: Withhold metformin before and after the contrast dye.

   Contrast dye raises the risk of lactic acidosis in clients on metformin with decreased renal function, so metformin is withheld 24 hours before and 48 hours after the dye when eGFR is below 30. Giving it as usual or increasing it adds to that risk.

2. A client takes glyburide and has just been prescribed a beta blocker. Which teaching point is most important?

   1. Early warning signs of low blood sugar, such as a fast heartbeat and tremors, may be hidden.
   2. Stop glyburide while taking the beta blocker.
   3. Take both drugs at bedtime to avoid side effects.
   4. Your blood sugar will rise, so check it more often for highs.

   Answer: Early warning signs of low blood sugar, such as a fast heartbeat and tremors, may be hidden.

   Beta blockers can mask early hypoglycemia symptoms such as tachycardia and tremors, and the combination can cause severe hypoglycemia. The risk is low blood sugar, not high, and stopping the diabetes drug is not what the section advises.

3. A client asks why a friend with type 1 diabetes cannot switch to oral diabetes pills. What is the nurse's best response?

   1. Oral drugs cause too much weight gain.
   2. Pills are only for older adults.
   3. Pills work only when taken with insulin.
   4. In type 1 diabetes the beta cells are not functioning, so oral drugs are ineffective.

   Answer: In type 1 diabetes the beta cells are not functioning, so oral drugs are ineffective.

   Oral diabetes drugs treat type 2 diabetes and are ineffective in type 1 because the beta cells are not functioning. Age and weight gain are not the reason given.

4. A client starts dapagliflozin, an SGLT2 drug. Which adverse effects should the nurse teach the client to watch for? Select all that apply.

   1. Dehydration
   2. Constipation from fluid retention
   3. Weight gain from fluid retention
   4. Increased urination
   5. Genital infections including UTIs

   Answer: Dehydration, Increased urination, Genital infections including UTIs

   Dapagliflozin removes glucose in the urine, and its listed adverse effects include increased urination, dehydration, hypotension and genital infections including UTIs. Constipation and fluid-retention weight gain are not listed for it.

5. The nurse is reviewing the history of a client with type 2 diabetes before a new oral diabetes drug is started. Which findings should the nurse report because they are contraindications? Select all that apply.

   1. Controlled hypertension
   2. A1c above target
   3. Hepatic insufficiency
   4. Severe kidney disorder
   5. Heart failure with fluid retention

   Answer: Hepatic insufficiency, Severe kidney disorder, Heart failure with fluid retention

   Most oral diabetes drugs are excreted in urine and metabolized by the liver, and they can add fluid retention, so severe kidney disorders, hepatic insufficiency and heart failure are contraindications. Hypertension is not listed, and a high A1c is the reason to treat.

6. A client is prescribed repaglinide. When should the nurse give it?

   1. Once a week on the same day
   2. Two hours after a meal
   3. 1–30 minutes before a meal
   4. At bedtime

   Answer: 1–30 minutes before a meal

   Meglitinides such as repaglinide have a rapid onset and short duration, so they are given 1–30 minutes before meals. Giving them at bedtime or long after a meal mismatches their short action with food intake.