Pharm Agents to Control Blood Glucose Levels, Thyroid

Insulin

know there is rapid-acting, short-acting (only one given IV), intermediate-acting, long-acting

used to treat type 1 diabetes and type 2 in adults who have no response to diet, exercise and other agents

adverse: hypoglycemia, injection site reactions (lipodystrophy or lipohypertrophy)

drug/drug: beta blockers mask manifestations or hypoglycemia, many other drug/drug 

draw SHORT-ACTING before LONG-ACTING

do not mix glargine with any other insulin

lowers serum potassium

wear a medical alert bracelet

ABRUPT HYPOGLYCEMIA: tachycardia, palpitations, diaphoresis, shakiness

GRADUAL HYPOGLYCEMIA: headache, tremors, weakness

don’t inject cold insulin

Nursing interventions for hypoglycemia

1. check blood glucose first

2. if conscious: 4 oz orange juice or 2-3 tbsp honey/sugar/corn syrup in water or glucose tablets

3. if unconscious: IV D50W or glucagon IM/SC

4. recheck every 15-20 minutes stable 

Biguanide metformin

first line treatment for people with type 2 diabetes

adverse: lactic acidosis - rare, but potentially fatal (weakness, fatigue, lethargy, hyperventilation), metallic taste, vitamin B12 and folic acid deficiency

contraindications: DKA

interventions: monitor for signs of lactic acidosis - stop and notify provider if occurs, recommend vitamin B12 and folic acid supplements if needed, monitor renal function

avoid alcohol (lactic acidosis)

sulfonylureas glipizide

treats type 2 diabetes

adverse: hypoglycemia, BMS (CBC)

contraindications: DKA

give orally 30 minutes before a meal

hypoglycemia interventions

Alpha-glucose inhibitors acarbose

treats type 2 diabetes

adverse: significant GI effects, liver dysfunction, anemia, hypoglycemia

administration: give with first bite of food (skipped meal = skipped dose)

interventions: monitor GI, liver, manifestations of anemia

warn to expect gastric effects and adhere to diet regimen

car sick

DPP-4 Inhibitors sitagliptin

treats type 2 diabetes

adverse: pancreatitis, SJS, anaphylaxis, angioedema, upper respiratory infections

reduced dosage to clients with severe renal impairment 

report persistent or unrelieved headaches

Meglitinides repaglinide

treats type 2 diabetes 

adverse: hypoglycemia

administration: 30 minutes before meals

interventions: hypoglycemia interventions, CBC

SGLT-2 Inhibitors empagliflozin

treats type 2 diabetes; also used in HF and CV disease

glucose gets lost in urine

adverse: DKA, hypoglycemia (quicker than others), dehydration, hypotension, increased risk of UTI, acute kidney injury

risk increased with reduced caloric intake, fasting

Thiazolidinediones pioglitazone

treats type 2 diabetes

adverse: fluid retention, edema, HF, hepatotoxocity

monitor for signs of HF

expect periodic cholesterol testing

Amylin Mimetics pramlintide

treats type 1 and 2 as a supplement to insulin

adverse: severe hypoglycemia

contraindications: gastroparesis and medications affecting GI motility

do NOT mix with insulin in the same syringe 

peak action 20 minutes after dose

hypoglycemia interventions 

GLP-1 Agonists semaglutide

adverse: GI effects (loss of appetite), pancreatitis, boxed warning: thyroid c-cell tumors in animals

contraindications: type 1 diabetes

slows absorption of oral medications

Glucose-elevating Agent glucagon

treats hypoglycemia

adverse: GI upset

Thyroid Hormones levothyroxine

treats hypothyroidism

adverse: hyperthyroidism symptoms

give on empty stomach 30-60 minutes before breakfast

formulations NOT interchangeable

Antithyroid agents - thionamides propylthiouracil (PTU)

treats hyperthyroidism

adverse: hepatotoxicity, agranulocytosis (fever, sore throat → STOP), hypothyroidism symptoms

monitor CBC (WBC) and LFT

give orally at regular intervals

Radiopharmaceuticals radioactive iodine

treats hyperthyroidism and thyroid cancer

destroys thyroid hormone-producing cells

adverse: hypothyroidism, BMS, radiation sickness

must have negative pregnancy test prior to starting

may get radiation sickness (bloody vomit/nosebleeds)