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Unit 4 - Meds

Unit 4 - Medications

Classification for Metformin Biguanide
First line drug Metformin
Metformin indications Hyperglycemia Decrease intestinal absorption of glucose Does NOT cause hypoglycemia
Metformin administration PO
Metformin adverse effects GI problems: Bloating Anorexia Abdominal discomfort
Metformin nursing considerations Contraindicated in renal pts Lifestyle modifications Monitor BUN and creatinine Stop 48hrs before and after use of contrast agent
Classification of Glipizide, Glimepiride, Glyburide Sulfonylureas - second line drug - added to Metformin if it doesn’t work alone
Indications - Glipizide, Glimepiride, Glyburide Hyperglycemia Can be added to Metformin if HgbA1C is >7 Can cause hypoglycemia because it stimulates insulin release from beta cells type 2
Glipizide, Glimepiride, Glyburide Administration PO
Glipizide, Glimepiride, Glyburide - Adverse effects Hypoglycemia Nausea Weight gain GI distress
Glipizide, Glimepiride, Glyburide - considerations No alcohol - can cause hypoglycemia reaction
Classification of Exenatide Dulaglutide Liraglutide Alogliptin Linagliptin Saxagliptin Incretin Enhancers- TIDE or GLIPTIN
Indications for incretin enhancers Hyperglycemia Prevent breakdown of natural incretins and increases insulin secretion which lowers blood glucose
Action of incretin enhancers Incretins are hormones secreted by the mucosa of the small intestine following a meal, when blood glucose is elevated.
Action of incretin enhances Signal the pancreas to increase insulin production and signal the liver to decrease glucagon. Both of these actions lower blood glucose. Decrease food intake by increasing the feeling of satiety and slow gastric emptying which delays glucose absorption.
Administration of Exenatide Dulaglutide Liraglutide SubQ
Administration of Alogliptin Linagliptin Saxagliptin PO
Adverse Effects: Exenatide Dulaglutide Liraglutide • Does not usually cause hypoglycemia • High incidence of nausea, vomiting, and diarrhea • Pancreatitis
Adverse Effects: Alogliptin Linagliptin Saxagliptin • Fewer adverse effects (N, V, D) • Do not usually cause hypoglycemia • Pancreatitis
Nursing Considerations: Exenatide Dulaglutide Liraglutide Alogliptin Linagliptin Saxagliptin Assess for s/s pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, may be accompanied by vomiting) beginning of therapy and with dose increases. If suspected, promptly discontinue incretin enhancer and seek medical attention.
Nursing Considerations: Exenatide Dulaglutide Liraglutide Alogliptin Linagliptin Saxagliptin Monitor HgbA1c prior to and during therapy. The TIDES are approved by the FDA as alternatives to metformin in patient who have not achieved glycemic control with metformin. GLIPTINs have fewer adverse effects and work well with other antidiabetic agents
Name Rapid Acting Insulin Lispro (Humalog) Aspart (Novolog)
Rapid Acting Insulin - Indications Lispro and Aspart • Hyperglycemia • Lowers blood sugar as it rises after meals
Rapid Acting Insulin - Administration, Onset, Peak and Duration SQ Onset 15 minutes or less Peak 40-60 minutes Duration 3-5 h
Rapid Acting Insulin - Adverse Effects Lispro and Aspart • Hypoglycemia
Rapid Acting Insulin - Nursing Considerations Lispro and Aspart • Clear solution • “mealtime insulin” • Client should eat within 15 minutes of injection
Name Short Acting Insulin Regular (Humulin-R, Novolin-R)
Short Acting Insulin - Indications Regular (Humulin-R, Novolin-R) Hyperglycemia
Short Acting Insulin - Administration, Onset, Peak and Duration Regular (Humulin-R, Novolin-R) SQ or IV Onset 30-60 minutes Peak 2-3 hr Duration 4-6 hr
Short Acting Insulin - Adverse Effects Regular (Humulin-R, Novolin-R) Hypoglycemia
Short Acting Insulin - Nursing Considerations Regular (Humulin-R, Novolin-R) • Clear solution • Administer 20-30 minutes before meals • Can be given alone or mixed with other insulin
Name Intermediate Acting Insulin Isophane (NPH, Humulin-N, Novolin-N)
Intermediate Acting Insulin - Indications Isophane (NPH, Humulin-N, Novolin-N) • Hyperglycemia
Intermediate Acting Insulin - Administration, Onset, Peak and Duration Isophane (NPH, Humulin-N, Novolin-N) SQ Onset 2-4 hr Peak 6-8 Duration 12-16hr
Intermediate Acting Insulin - Nursing Considerations Isophane (NPH, Humulin-N, Novolin-N) • White and cloudy solution-has protein in it. • Usually taken after meals
Name Very Long Acting Insulin Glargine
Very Long Acting Insulin - Indications Glargine • Hyperglycemia • Keeps blood sugar stable between meals and overnight
Very Long Acting Insulin - Administration, Onset, Peak and Duration Glargine SQ Onset 2 hr Peak – none Duration 24 h
Very Long Acting Insulin - Adverse Effects Glargine Hypoglycemia
Very Long Acting Insulin - Nursing Considerations Glargine • Used for basal dose • Maintains blood glucose levels regardless of meals • Cannot be mixed with other insulins • Given at bedtime
Classification of Travoprost Latanoprost Prostaglandins “prost”- first line therapy
Indications for Travoprost Latanoprost • Increases ocular outflow through trabecular meshwork to decrease IOP, used to treat open angle glaucoma
Administration of Travoprost Latanoprost Optic - Eye
Adverse Effects of Travoprost Latanoprost • Local irritation and redness • Brown pigmentation of the iris • Lashes may grow longer
Nursing Considerations for Travoprost Latanoprost • Administered once daily at bedtime • Apply light pressure on lacrimal sac for 1 min following instillation
Classification of Timolol maleate Levobunolol Beta blockers “lol” or “olol”
Indications of Timolol maleate Levobunolol • Decrease production of aqueous humor and Reduces intraocular pressure in management of glaucoma • Beta blocker
Administration of Timolol maleate Levobunolol Optic – Eye
Adverse Effects of Timolol maleate Levobunolol • Eye irritation • Hypotension • Increased airway resistance
Nursing Considerations of Timolol maleate Levobunolol • Monitor BP and pulse • Apply light pressure on lacrimal sac for 1 min following instillation • Used in caution with clients already taking beta-blockers for HTN. • Contraindicated in clients with history of asthma
Classification of Meclizine Diphenhydramine Fexofenadine Loratidine Chlorpheniramine Anti-vertigo - Antihistamines
Indication of Meclizine • Vertigo
Indications of Diphenhydramine Fexofenadine Loratidine Chlorpheniramine • Treat allergic rhinitis, allergies, vertigo, cough, sneezing
Administration of Meclizine Diphenhydramine Fexofenadine Loratidine Chlorpheniramine PO
Adverse Effects of Meclizine • Headache • Vomiting • Dry mouth • Tiredness/drowsiness
Adverse Effects of Diphenhydramine Fexofenadine Loratidine Chlorpheniramine • Drowsiness, excitement, photosensitivity • Anticholinergic effects-dry mouth, urinary retention, constipation
Nursing Considerations of Meclizine • Avoid activities that require alertness
Nursing Considerations of Diphenhydramine Fexofenadine Loratidine Chlorpheniramine • Use cautiously in CVD, HTN, renal ds. May be given pre-blood to decrease allergic response, increase fluid intake
Classification of Promethazine Prochlorperazine Antiemetic
Indications for Promethazine Prochlorperazine • Vertigo • Nausea • Vomiting • Sedation
Administration of Promethazine Prochlorperazine PO, IV, PR
Adverse Effects of Promethazine Prochlorperazine • Drowsiness • Dizziness • Constipation • Urinary retention • Dry mouth
Nursing Considerations of Promethazine Prochlorperazine • If used for motion sickness, take ½ hr before traveling • Avoid activities that require alertness • Avoid alcohol/CNS depressants
Created by: PinkRN



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