ATI Pharmacology FINAL (endocrine)

glipizide drug class

oral hypoglycemic: second gen Sulfonylurea

glipizide therepeutic uses

DM2

glipizide complications

mild hypoglycemia (mainly in those with decreased liver/kidney function)

NV

glipizide contraindications/precautions

• pregnancy

• lactation

• diabetic ketoacidosis

• caution with liver, kidney, adrenal, or pituitary dysfunction

glipizide interactions

• alchol (produces disulfiram like reaction)

• sulfonamide antibiotics, NSAIDs, oral anticoagulants, salicylates, monoamine oxidase inhibitors, and cimetidine increase hypoglycemic effects

• thiazides counteract the hypoglycemic effects

• Beta blockers can mask some of the manifestations of hypoglycemia, such as tachycardia. 

glipizide interventions

• monitor for hypoglycemia (diaphoresis, tachycardia, fatigue, excessive hunger, and tremors)

• If any of these manifestations occur, and the client is conscious, administer carbohydrates, such as 2 to 3 tsp of sugar, 4 oz of orange juice, or honey, or corn syrup dissolved in water.

• Check the client’s blood glucose every 15 to 20 min

glipizide administration

Give glipizide orally 30 min before a selected meal,

glipizide client education

• signs of hypoglycemia

• 4 oz of orange juice; 2 to 3 tsp of sugar, honey, or corn syrup dissolved in water

• Reinforce the need to always carry a carbohydrate snack

Metformin therepeutic uses

DM2

Metformin complications

• nausea, diarrhea, vomiting,

• metallic taste in the mouth

• vitamin B12 and folic acid deficiency

• lactic acidosis

metformin should only be prescribed for clients who have

healthy renal function bc of risk for lactic acidosis

metformin nursing interventions

• monitor for signs of lactic acidosis (weakness, fatigue, lethargy, muscle pain, and hyperventilation)

• Monitor fluid intake and output and for potential gastrointestinal effects

metformin administration

orally twice a day with the morning and evening meal

metformin client instructions

• avoid alchol

• taking with food can reduce metallic taste

• stop taking if manifestations of lactic acidosis develop

metformin contraindications

diabetic ketoacidosis, cardiopulmonary, hepatic, or renal insufficiency, alcoholism, heart failure, severe infection, shock, acute myocardial infarction, hypoxemia, and lactic acidosis

metformin interactions

• alchol and cimetidine

• iodine based contrast media

• nifedipine, furosemide, ranitidine, morphie, and antifungals. 

Pioglitazone therepeutic uses

DM2

Pioglitazone complications

• fluid retention

• liver injury

• Increased risk for bladder cancer and ovulation

• upper respiratory tract infections, headaches, and myalgia

• elevations in both high- and low-density lipoproteins and triglycerides

  • (dangerous bc elevated lipid levels combined with hyperglycemia can lead to cardiovascular disorders)

pioglitazone interventions

• monitor ALT

• Obtain the client’s baseline liver function values and then every 3 to 6 months

• Watch clients’ serum lipid levels for increases in triglycerides and lipoproteins

  • HDL is desirable

  • an elevated level of LDL is not and is a risk factor for cardiovascular disease. 

pioglitazone client instructions

• expect some swelling and edema but report significant swelling, weight gain, or shortness of breath immediately

• report signs of bladder cancer like hematuria and dysuria

• get cholesterol testing

pioglitazone contraindications/precautions

• cardiovascular disease

• hypertension, heart failure, or active hepatic disease.

• Clients who have T1DM should not be given glitazones

•  diabetic ketoacidosis.

• Caution should also be used in clients who have a history of bladder cancer.

pioglitazone interactions

Using insulin and pioglitazone together increases the risk of heart failure and edema

Giving pioglitazone concurrently with gemfibrozil, also called Lopid, or ketoconazole, will increase the hypoglycemic effects of pioglitazone. Pioglitazone may reduce the effectiveness of contraceptives.