Medications (Separated)

somatropin therapeutic uses

growth deficiencies

AIDS wasting syndrome

pediatric growth failure

somatropin complications

hyperglycemia

inactivation

• may develop neutralizing antibodies that bind w/ growth hormones and render it inactive

somatropin contraindications/precautions

precautions: DM, hypothyroidism

contraindications: morbid obesity, severe respiratory impairments

somatropin interactions

glucocorticoids

• counteract growth-promoting effects

methimazole therapeutic uses

Graves disease

pre-operative therapy for thyroidectomy

radiation adjunct

emergency treatment of thyrotoxicosis

first-line therapy

methimazole complications

hypothyroidism

• drowsiness, depression, weight gain, edema, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia

agranulocytosis

• sore throat, fever

• monitor blood counts

methimazole contraindications/precautions

precautions: bone marrow suppression, immunosuppression, liver pathologies

methimazole interactions

anticoagulants: increase anticoagulation

digoxin: increase glycoside level

methimazole MoA

blocks the synthesis of thyroid hormones, prevents oxidation of iodine

propylthiouracil (PTU) therapeutic uses

Graves disease

pre-operative therapy for thyroidectomy

radiation adjunct

emergency treatment of thyrotoxicosis

propylthiouracil (PTU) complications

hypothyroidism

agranulocytosis

liver injury, hepatitis

• monitor for jaundice, dark urine, light-colored stools, LFTs

propylthiouracil (PTU) contraindications/precautions

does not cross placenta, can be used during 1st trimester

precautions: bone marrow suppression, immunosuppression, liver pathologies

propylthiouracil (PTU) interactions

anticoagulants: increase anticoagulation

digoxin: increase glycoside level

propylthiouracil (PTU) MoA

blocks conversion of Y₄ → T₃

radioactive iodine (I-131) therapeutic uses

hyperthyroidism

thyroid cancer

radioactive iodine (I-131) complications

radiation sickness: hematemesis, epistaxis, NV

bone marrow suppression: leukemia

hypothyroidism

radioactive iodine (I-131) contraindications/precautions

do not administer to young children

radioactive iodine (I-131) interactions

antithyroid agents: discontinue other agents for a week prior to therapy

radioactive iodine (I-131) education

maintain distance of 6 feet from others

do not prepare food for others

avoid close contact w/ young children and pregnant pts

increase fluid intake

dispose of body wastes as instructed

radioactive iodine (I-131) MoA

absorbed by the thyroid and destroys some of the thyroid hormone-producing cells

hydrocortisone therapeutic uses

acute and chronic therapy for adrenal insufficiency

cancer, inflammation, allergic reactions

hydrocortisone complications

glucose intolerance: hyperglycemia and glycosuria

fluid and electrolyte disturbances: sodium and water retention; potassium loss

osteoporosis

adrenal suppression

peptic ulcer

Cushing syndrome

hydrocortisone contraindications/precautions

contraindications: active infections w/o antibiotic use

precautions: recent MI, gastric ulcer, HTN, renal disorders, osteoporosis, CM, cirrhosis, hypothyroidism, MG

hydrocortisone interactions

oral antidiabetics: may require increased doses of oral antidiabetics

NSAIDs, acetaminophen, alcohol: increased risk for GI distress, GI bleed

potassium-wasting agents: hypokalemia (diuretics)

hydrocortisone MoA

mimics the effects of natural steroid hormones

lispro therapeutic uses

glycemic control

**lispro pharmacokinetics**

Onset: 15 - 30 min

Peak: 0.5 - 3 hr

Duration: 3 - 5 hr

lispro complications

Hypoglycemia

• Glucose < 70 mg/dL

Hypokalemia

Lipohypertrophy

• Rotate injection sites

lispro contraindications/precautions

“high risk” medication

lispro interactions

Sulfonylureas, meglitinides, beta blockers, alcohol

• Additive hypoglycemic effects

Thiazide diuretics, glucocorticoids

• Counteract effects of insulin

Beta blockers

• Mask SNS response to hypoglycemia

lispro MoA

Promotes cellular uptake of glucose

Convert glucose into glycogen and promotes energy storage

Moves potassium into cells (along w/ glucose)

lispro nursing administration considerations

DO NOT GIVE BEFORE THEY EAT

make sure that pt has at least a few bites before administration

regular insulin therapeutic uses

glycemic control

hyperkalemia

**regular insulin pharmacokinetics**

Onset: 0.5 - 1 hr

Peak: 1 - 5 hr

Duration: 6 - 10 hr

regular insulin complications

Hypoglycemia

• Glucose < 70 mg/dL

Hypokalemia

Lipohypertrophy

• Rotate injection sites

regular insulin contraindications/precautions

“high risk” medications

regular insulin interactions

Sulfonylureas, meglitinides, beta blockers, alcohol

• Additive hypoglycemic effects

Thiazide diuretics, glucocorticoids

• Counteract effects of insulin

Beta blockers

• Mask SNS response to hypoglycemia

NPH therapeutic uses

glycemic control

**NPH pharmacokinetics**

Onset: 1 - 2 hr

Peak: 4 - 14 hr

Duration: 14 - 24 hr

NPH complications

Hypoglycemia

• Glucose < 70 mg/dL

Hypokalemia

Lipohypertrophy

• Rotate injection sites

NPH contraindications/precautions

“high risk” medication

NPH interactions

Sulfonylureas, meglitinides, beta blockers, alcohol

• Additive hypoglycemic effects

Thiazide diuretics, glucocorticoids

• Counteract effects of insulin

Beta blockers

• Mask SNS response to hypoglycemia

NPH nursing administration considerations

Clear over cloudy

Only insulin that should be cloudy

glargine therapeutic uses

glycemic control

**glargine pharmacokinetics**

Onset: 1 - 4 hr

Peak: none

Duration: 24 hr

glargine complications

Hypoglycemia

• Glucose < 70 mg/dL

Hypokalemia

Lipohypertrophy

• Rotate injection sites

glargine contraindications/precautions

“high risk” medication

glargine interactions

Sulfonylureas, meglitinides, beta blockers, alcohol

• Additive hypoglycemic effects

Thiazide diuretics, glucocorticoids

• Counteract effects of insulin

Beta blockers

• Mask SNS response to hypoglycemia

glargine nursing administration considerations

do not need to worry about checking blood glucose at night since there is no peak

glipizide therapeutic uses

glycemic control (DM2)

glipizide complications

Hypoglycemia

Weight gain

glipizide contraindications/precautions

Precautions: renal failure, hepatic dysfunction, HF, alcohol use disorder

glipizide interactions

Alcohol

• Disulfiram-like reaction: intense NV, flushing, palpitations

NSAIDs, sulfonamide antibiotics, cimetidine

• Additive hypoglycemia effects

Beta blockers

• Mask SNS response to hypoglycemia

• Decrease effectiveness by inhibiting insulin release

glipizide nursing administration considerations

Best taken 30 min before breakfast

HOLD dose if NPO

glipizide MoA

insulin release from the pancreas; can increase tissue sensitivity to insulin over time

metformin therapeutic uses

glycemic control (DM2)

PCOS

• off-label

metformin complications

GI: anorexia, nausea, diarrhea

• Usually subside w/ use

Vit. B₁₂ and folic acid deficiency

Lactic acidosis

• Hyperventilation, myalgia, lethargy, somnolence

metformin contraindications/precautions

Contraindications: severe infection, shock, kidney, impairment, hypoxia, alcohol use disorder

metformin interactions

Alcohol, cimetidine

• Increases risk of lactic acidosis

Iodine-containing contrast media

• Acute kidney failure

• HOLD dose 24 - 48 hr prior to procedure…

metformin MoA

Reduces the production of glucose w/in the liver through suppression of gluconeogenesis

Increases glucose uptake and use in fat and skeletal muscles

Decreases glucose absorption in the GI tract

pioglitazone therapeutic uses

glycemic control (DM2)

pioglitazone complications

Fluid retention

Elevated LDL-C

Hepatotoxicity

Ovulation despite perimenopause

pioglitazone contraindications/precautions

Precautions: mild HF, older adults, perimenopausal females

Contraindications: severer HF, hx bladder CA, active hepatic disease

pioglitazone interactions

Insulin

• Fluid retention

Ketoconazole and CYP2C8 inhibitors

• Increased levels of medication

Rifampin, cimetidine

• Decreased levels of medication

pioglitazone MoA

Increases cellular response to insulin by decreasing insulin resistance

Increases glucose uptake and decreases glucose production

acarbose therapeutic uses

glycemic control (DM2)

acarbose complications

GI: abdominal distention, cramping, hyperactive bowel sounds, diarrhea, excessive gas

Anemia

• Decreased iron absorption

Hepatotoxicity w/ long-term use

Impaired breakdown of sucrose

acarbose contraindications/precautions

Precautions: renal impairments, hepatic dysfunctions

Contraindications: GI disorders (IBD, ulceration, obstruction)

acarbose interactions

Sulfonylureas, insulin

• Increases risk for hypoglycemia

acarbose nursing administration considerations

Take w/ first bite of food w/ each meal

acarbose MoA

Slows CHO absorption and digestion

sitagliptin therapeutic uses

glycemic control (DM2)

sitagliptin complications

• HA

• Nausea

• Joint pain

• Pancreatitis

  • HA

  • Nausea

  • Joint pain

  • Pancreatitis

    • Rare

sitagliptin contraindications/precautions

Precautions: renal impairments, hepatic dysfunction

sitagliptin interactions

Insulin, glyburide, glipizide, glimepiride

• Increases risk for hypoglycemia

sitagliptin MoA

Augments naturally occurring incretin hormones, which promote release of insulin and decrease secretion of glucagon

Lowers fasting and postprandial blood glucose levels

canagliflozin therapeutic uses

Glycemic control (DM2)

HFrEF GDMT

canagliflozin complications

GU: cystitis, candidiasis, polyuria

• Monitor for infections

Dizziness

canagliflozin contraindications/precautions

Precautions: older adults

Contraindications: renal failure and undergoing dialysis

canagliflozin interactions

Rifampin, phenytoin, phenobarbital

• Decreased effect

Thiazide and loop diuretics

• Increases the effects of diuretics

canagliflozin MoA

Limits the rise of postprandial glucose levels

Excretes glucose through the urine by preventing its reabsorption in the kidney

Promotes weight loss

semaglutide therapeutic uses

Glycemic control (DM2)

Weight management

semaglutide complications

Nausea

Loss of appetite

Pancreatitis

semaglutide contraindications/precautions

Precautions: renal impairments, hepatic dysfunction

Contraindications: DM1

semaglutide interactions

Insulin, sulfonylureas

• Increases the risk for hypoglycemia

semaglutide MoA

reduces the incretin hormone GLP-1 the body uses

glucagon therapeutic uses

Emergency management of hypoglycemia

Prior to radiological procedures of the stomach and intestines

Food bolus

glucagon complications

GI: NV

Hyperglycemia

glucagon contraindications/precautions

Precautions: CV disease

glucagon interactions

Insulin

• antagonistic effect

Glucose

• additive effect

glucagon MoA

increases blood glucose levels by increasing the breakdown of glycogen into glucose

levothyroxine therapeutic uses

Hypothyroidism

Myxedema coma

• IV

levothyroxine complications

Overmedication

• Thyrotoxicosis

Chronic overtreatment

• Atrial fibrillation

• Risk of fractures from accelerated bone loss

levothyroxine contraindications/precautions

Precautions: DM, older adults, cardiovascular comorbidities

Contraindications: thyrotoxicosis, adrenal insufficiency

levothyroxine interactions

Catecholamines

• Epinephrine, dopamine, dobutamine

  • Increases risk of dysrhythmias

Insulin and digoxin

• Increase requirements

Binding agents, antiulcer agents, Ca and Fe supplements, Mg salts, food

• Allow ≥ 4 hours between medication administration

Antiseizure agents and antidepressants

• Increase levothyroxine metabolism

Warfarin

• Increases effects of warfarin

levothyroxine MoA

synthetic form of thyroxine (T4), a form of liothyronine (T3), or a combination of both… increase metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temperature, blood volume, and growth processes