Anti-diabetics

Pharm Exam 4 (part 2)

Insulin lispro

Drug Action:

• RAPID ACTING

• allows glucose in the blood to enter cells, stimulates the liver to uptake & store glucose, thereby lowering blood glucose

Side Effects:

• Endo: hypoglycemia

Insulin lispro pt 2

Assess:

• blood glucose level

• s/s hypoglycemia

Teaching:

• s/s hypo & hyperglycemia

• monitor blood glucose levels

• diet

• effects of exercise on glucose

• long term effects of hyperglycemia

Interventions:

• have food available, be sure patient can eat

• rotate inject sites

• use INSULIN syringe

Insulin Glargine

Drug Action:

• LONG DURATION

• allows glucose in blood to enter cells, stimulates live to uptake & store glucose, thereby lowering blood glucose

Side Effects:

• Endo: hypoglycemia

Insulin Glargine part 2

Assess:

• blood glucose level

• s/s hypoglycemia

Teaching:

• s/s hypo & hyperglycemia

• monitor blood glucose levels

• diet

• effects of exercise on glucose

• long term effects of hyperglycemia

Interventions:

• use INSULIN syringe

• rotate sites

• give @ same time everyday

Regular Insulin

Drug Action:

• SHORT ACTING

• allows glucose in blood to enter cells, stimulates live to uptake & store glucose, thereby lowering blood glucose

Side Effects:

• Endo: hypoglycemia

Regular Insulin part 2

Assess:

• blood glucose level

• s/s hypoglycemia

Teaching:

• s/s hypo & hyperglycemia

• monitor blood glucose levels

• diet

• effects of exercise on glucose

• long term effects of hyperglycemia

Interventions:

• use INSULIN syringe

• rotate sites

NPH Insulin

Drug Action:

• INTERMEDIATE DURATION

• allows glucose in blood to enter cells, stimulates live to uptake & store glucose, thereby lowering blood glucose

Side Effects:

• Endo: hypoglycemia

NPH Insulin part 2

Assess:

• blood glucose level

• s/s hypoglycemia

Teaching:

• s/s hypo & hyperglycemia

• monitor blood glucose levels

• diet

• effects of exercise on glucose

• long term effects of hyperglycemia

Interventions:

• use INSULIN syringe

• rotate sites

Glucagon (hyperglycemic)

Drug Action:

• increases glucose & used to treat severe hypoglycemia when pt is unable to swallow

Side Effects:

• EENT: itchy, watery eyes & nose

• GI: N/V

• CNS: HA

Glucagon (hyperglycemic) part 2

Assess:

• blood glucose→if hypoglycemic… is pt unable to eat or drink?

Teaching:

• s/s hypoglycemia

• how to administer

• after dose, provide foods that maintain blood glucose level

Interventions:

• admin. as directed for route

Glipizide (oral sulfonylureas)(glucotrol)

Drug Action:

• stimulates insulin release & increase sensitivity to insulin at receptors→lowers blood glucose

Side Effects:

• Endo: hypoglycemia

• Derm: severe rash, photosensitivity

Glipizide (oral sulfonylureas)(glucotrol) part 2

Assess:

• monitor blood glucose

• s/s hypoglycemia

Teaching:

• diet

• s/s hypo & hyperglycemia

• monitor blood glucose

• effects of exercise

• long term effects of hyperglycemia

• LOSE WEIGHT

Metformin, hydrochloride (biguanides)(glucophage)

Drug Action:

• minimizes increase in blood sugar by:

  • increasing sensitivity of insulin receptors on the cells.

  • Inhibits glucose production by liver & decreases intestinal absorption of glucose→OK to skip meal

Side Effects:

• GI: bloating, diarrhea, N/V

• F&E: lactic acidosis

Metformin, hydrochloride (biguanides)(glucophage) part 2

Assess:

• monitor blood glucose

• s/s hypoglycemia

Teaching:

• diet

• s/s hypo & hyperglycemia

• monitor blood glucose

• effects of exercise

• long term effects of hyperglycemia

• LOSE WEIGHT

• avoid alcohol

• OK to skip meal

Interventions:

• give with meals to decrease GI effects

Sitagliptin (Januvia)(DPP-IV Inhibitor)

Drug Action:

• increase insulin release & decrease glucagon levels→ decrease blood glucose levels

Side Effects:

• Derm: severe skin reactions

• GI: pancreatitis

• MS: rhabdomyolysis

• Misc: hypersensitivity reactions

Sitagliptin (Januvia)(DPP-IV Inhibitor) part 2

Assess:

• monitor blood glucose

• s/s hypoglycemia

Teaching:

• s/s pancreatitis

• s/s hypo & hyperglycemia

• monitor blood glucose

• effects of exercise

• long term effects of hyperglycemia

• LOSE WEIGHT

• avoid alcohol

• diet

Potassium (KCI)

Drug Action:

• used to treat or prevent potassium depletion

Side Effects:

• CV: cardiac arrythmias

• GI: abd. pain, diarrhea, gas, N/V

Potassium (KCI) part 2

Assess:

• K+ levels

• monitor pulse, BP, EKG if giving IV

Teaching:

• s/s hypo & hyperkalemia

• avoid salt substitute

• avoid alcohol

Intervention:

• EXTREME CAUTION w/ IV infusion of higher doses→ monitor EKG

Iron (ferrous sulfate)

Drug Action:

• used to prevent &/or treat iron deficiency

Side Effects:

• GI: nausea, constipation, dk stools, diarrhea, epigastric pain

Iron (ferrous sulfate) part 2

Assess:

• hemoglobin level

• monitor for constipation

Teaching:

• avoid alcohol

• liquid preparation can stain teeth

• DO NOT open or chew capsules, tablets

• can cause constipation &/or black stools

Anti-neoplastics

Drug Action:

• targets highly proliferative cells (cells that x quickly)

Side Effects:

• bone marrow suppression→low WBC→inability to fight infection

• decreased platelet count→increase risk for bleeding

• decrease RBC→anemia

• GI: anorexia, N/V, diarrhea, stomatitis

Anti-neoplastics part 2

Assess:

• s/s infection (ie. temp, chills, shore throat), lung sounds, urine color & odor, sputum

• ecchymosis, bleeding gums, oozing injec. site,

• report epitaxis, hematuria, hematemesis, tarry stools

• fatigue, SOB, increased HR, RR, cyanosis

• loss of appetite

• measure emesis

• monitor #, consistency of stools

• asses oral mucosa

Anti-neoplastics part 3

Teaching:

• increase risk of infection, avoid people who are sick, report s/s infection

• avoid injury, report signs of internal or excessive bleeding

• plan rest periods

• minimize odors

• eat foods that bulk up stool

• frequent mouth rinses

Anti-neoplastics part 4

Intervention:

• hand hygiene, reverse isolation, limit visitors, avoid meds that mask fever

• protect from injury, electric razor, soft bristle tooth brush, avoid meds that promote bleeding→ aspirin

• elevate HOB, apply o2 as needed

• small, frequent, high calorie meals

• admin. antiemetics

• admin. anti-diarrheal meds

• pain meds, anti-fungal rinse