Week 5 Drugs

• Sulfonylureas


  glipizide (Glucotrol), glyburide, glimepiride
• Sulfonylureas glipizide (Glucotrol), glyburide, glimepiride MOA

  stimulates release of insulin of the isle cell of pancreas. lower blood glucose levels regardless of numbers, watch for Hypoglycemia
• therapeutic use of Sulfonylureas glipizide (Glucotrol), glyburide, glimepiride

  Type 2 DM
• Adv effects of Sulfonylureas glipizide (Glucotrol), glyburide, glimepiride

  Hypoglycemia
• Interventions for Sulfonylureas glipizide (Glucotrol), glyburide, glimepiride


  monitor for signs of hypoglycemia (diaphoreisis, tachycardia, fatigure, excessive hunger.

  
  

  if conscious, give glucose orally in pill form, 2-3 tsp of sugar, glass of orange juice, honey, corn syrup in dissolved water

  
  

  if unconscious, give IV glucose
• client education Sulfonylureas glipizide (Glucotrol), glyburide, glimepiride


  wear medical alert bracelet

  
  

  report symptoms of hypoglycemia and test blood glucose to confirm
• interactions Sulfonylureas glipizide (Glucotrol), glyburide, glimepiride

  beta blockers mask manifestations of hypoglycemia
• Biguanides


  Metformin (Glucophage)
• biguanides metform (glucophage) MOA

  decrease absorption of glucose from intestine, decreases synthesis of glucose by liver, decreases insulin resistance by increasing sensitivity of receptors of insulin
• therapeutic use biguanides metform (glucophage)

  Type 2 DM
• adverse effects biguanides metform (glucophage)

  lactic acidosis

  
  

  Nausea and vomitting

  
  

  Diarrhea

  
  

  metallic taste

  
  

  deficient in vitamin b12 and folic acid
• client education biguanides metform (glucophage)

  avoid drinking alcohol, report weakness, fatigue, lethargy, or hyperventilaton

  
  

  maintain adequate carb and fluid intake

  
  

  report pallor or reddened tongue
• contraindicaiton biguanides metform (glucophage)


  acut MI and lactic acidosis
• precautions biguanides metform (glucophage)


  hyperthyroidism and older adults
• interactions biguanides metform (glucophage)


  nifedipine (procardia), furosemide (lasix), morphine, antifungals, and many other drugs that increase hypoglycemic effects

  
  

  any contrast medium containing iodine increase the risk for acute renal failur
• Thyroid preparations

  Levothyroxine (Synthroid)
• Thyroid preparation Levothyroxine (Synthroid) MOA

  Synthetic form of T4 Thyroxine
• Thyroid preparation Levothyroxine (Synthroid) therapeutic use

  Hypothyroidism
• interventions Thyroid preparation Levothyroxine (Synthroid)


  monitor for indications of hyperthyroidism (anxiety, tachycardia, palpitations, tremors, altered appetite, heat intolerance, fever, diaphoresis, weight loss)
• client education Thyroid preparation Levothyroxine (Synthroid)

  watch for palpitations
• interactions Thyroid preparation Levothyroxine (Synthroid)

  food reduces absorption

  
  

  Anticoagulant effects of warfarin (Coumadin increase)
• adverse effects Thyroid preparation Levothyroxine (Synthroid)

  thyrotoxicosis, hyperthyroidism

  
  

  headache, irritability, insomina

  
  

  tachycardia, arryhthmia
• precautions Thyroid preparation Levothyroxine (Synthroid)


  cardiovascualr disorders and diabetes mellitus
• insulin


  lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus)
• insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus) MOA

  promotes reuptake of glucose

  
  

  promotes storage of glucose in liver and muscles

  
  

  promotes uptake of potassium in the cells as sodium is transported out, if given in excess hypokalemia)
• insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus) adv effects


  hypoglycemia, injection site reactions
• insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus) therapeutic use


  DM 1,2, gestational
• insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus interventions


  monitor for signs of hypokalemia (tachycardia, palpitations, diaphoresis, shakiness, headache, weakness, tremors)

  
  

  check blood glucose level to confirm, then give glass of OJ or 2-3 teaspons of sugar honey or corn syruo
• client education insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus


  wear medical alert bracelet, watch for symptoms of hypoglycemia

  
  

  rotate injection sites systemically and place 1 inch apart

  
  

  REport weakness, nausea, palpitations or paresthesia
• interactions insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus


  beta blockers mask manifestations of hypoglycemia (tachycardia, termors)
• adv effects insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus

  hypoglycemia, injection site reactions (lipodystrophy or lipohypertrophy)
• administration insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus


  give SubQ (insulin syringe) or IV (humulin R)

  
  

  when miing, draw short acting THEN long acting (clear then cloudy)

  
  

  do not mix glargine or detemir with any other insulin
• storage of insulin lispro (humalog), regular (humulin R), NPH (Humulin N), Glargine (Lantus


  refridgerate open vials until expiration date

  
  

  Expect dose administration in response to caloric intake, infection, exercise, stress, growth spurts, pregnancy
• Rapid acting Onset, peak and duration (Lispro (Humalog))

  <15 mins, 0.5-1.5 hr, 5 hr
• Short acting (regular insulin) onset peak and duration

  0.5-1 hr, 2-4 hours, 5-7 hours
• intermediate NPH Humulin N onset peak and duration

  1.5 hours, 4-12 hours, 16-24 hours
• intermediate NPH novolin N onset peak and duration

  1-4 hr, 14 hr, 10-24 hrs
• long acting lantus onset peak and duration

  2-4 hr, No peak, 24 hours
• mixtures (70 nph, 30 reg) onset peak and duration

  0.5-1 hr, 2-12 hr, 24 hours
• mixtures 50 nph 50 reg onset peak and duration

  0.5 hr, 3-5 hr, 24 hr