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
