Pharmacology Made Easy: Medication Information

Pharmacology Made Easy: Medication Information Table

Alpha-Glucosidase Inhibitors – Acarbose

Category Information

Therapeutic Use

Used for Type 2 diabetes mellitus, can be prescribed with or without medication therapy that includes insulin, sulfonylureas, or metformin.

Adverse Drug Reactions

Gastrointestinal effects: distention, flatus, hyperactive bowel sounds, diarrhea.
Hypoglycemia, especially when used in combination therapy with insulin or a sulfonylurea.
Liver dysfunction.
Anemia.

Nursing Interventions

Monitor for hyperactive bowel sounds, abdominal distention, and diarrhea.
Report any persistent gastric distress.
Watch for signs of hypoglycemia: diaphoresis, tachycardia, fatigue, excessive hunger, tremors.
Measure liver enzymes at baseline, every 3 months for the first year of therapy, and periodically thereafter.
Discontinue medication upon indications of liver injury.
Monitor CBC (Complete Blood Count).
Watch for anemia symptoms: pallor, fatigue, shortness of breath.
Recommend foods rich in iron and appropriate supplements.

Administration

Administer with the first bite of food, three times daily.
Instruct clients who skip a meal to also skip the corresponding dose and only take the next dose at the subsequent meal.

Client Instructions

Advise clients regarding possible gastric side effects.
Follow the dietary regimen provided by the healthcare provider.
Wear a medical alert bracelet.
Monitor for signs of hypoglycemia: test blood glucose to confirm, consume oral glucose tablets if necessary, and retest in 15 minutes, repeating if levels remain low.
Keep glucose tablets on hand at all times.
Report symptoms such as dark urine, abdominal pain, vomiting, or fatigue.
Report signs of anemia: pallor, fatigue, or shortness of breath.

Contraindications

Patients with gastrointestinal disorders (e.g., inflammatory bowel disease), obstruction, or ulceration.

Precautions

Caution in patients with hepatic impairment and gastrointestinal distress.
Not typically used in the U.S.

Interactions

Concurrent use of insulin and sulfonylureas increases the risk of hypoglycemia.

Amylin Mimetics – Pramlintide

Category Information

Therapeutic Use

Used in Type 1 and Type 2 diabetes mellitus as a supplement to insulin or other hypoglycemic medications.

Adverse Drug Reactions

Severe hypoglycemia when combined with insulin.
Nausea.
Injection site reactions.

Nursing Interventions

Recommend reducing the insulin dosage when initiating pramlintide therapy.
Monitor for hypoglycemia manifesting typically within 3 hours post-dosing.
Gradually titrate doses as appropriate.
Monitor for persistent nausea and vomiting, noted to be more common in individuals with Type 1 diabetes compared to Type 2.
Ensure proper injection techniques is used.

Administration

Do not mix pramlintide with insulin in the same syringe.
Administer subcutaneously in the thigh or abdomen before meals that contain at least 30 grams of carbohydrates.
Rotate injection sites.
Anticipate peak action in about 20 minutes post-administration.
Refrigerate unopened vials until expiration; in-use vials can be kept at room temperature for up to 28 days.

Client Instructions

Advise using a medical alert bracelet.
Monitor and report signs of hypoglycemia, especially within three hours after dosing.
Test blood glucose levels to confirm hypoglycemia, consume carbohydrate snacks, and retest.
Lie down if feeling nauseated.
Instruct on proper injection technique.

Contraindications

Patients with poor adherence to an insulin regimen.
Gastroparesis or medications affecting gastrointestinal motility.

Precautions

Use with caution in individuals with visual or dexterity impairments.

Interactions

Insulin increases the risk of hypoglycemia.
Absorption of oral medications is slowed; these should be taken 1 hour before or 2 hours after pramlintide.
Medications that slow gastric emptying, such as opioids or acarbose, further slow this process.

Antidiuretic Hormone – Desmopressin

Category Information

Therapeutic Use

Treatment of diabetes insipidus.
Note: For use in treating hemophilia, refer to the Hematologic System module.

Adverse Drug Reactions

Fluid retention, leading to water intoxication.
Hyponatremia.
Vasoconstriction (with vasopressin, not desmopressin).
Seizures.

Nursing Interventions

Monitor for symptoms indicating water intoxication: headache, confusion.
Monitor fluid intake and output.
Monitor serum sodium levels.
Restrict fluid intake when indicated.
Recommend diuretic therapy for moderate to severe fluid retention.

Administration

Administered orally, intranasally, subcutaneously, sublingually, or via IV.
Administer nasal spray high into the nasal cavity, avoiding the throat.
Monitor blood pressure, intake and output, urine and plasma osmolality, and creatinine clearance.
With IV vasopressin, monitor the IV insertion site to prevent complications like gangrene.

Client Instructions

Report symptoms such as pounding headache, sleepiness, fluid retention, weight gain, and edema.
Limit fluid intake during therapy.
Maintain daily record of fluid intake and output.
Report chest pain or pressure.

Contraindications

Vasopressin.
Coronary artery disease.
Poor peripheral circulation.
Chronic nephritis.
Electrolyte imbalances (oral form).
Renal failure.
Nephrogenic diabetes insipidus.

Precautions

Caution in older adults, individuals with cardiovascular disease, hypertension, history of hyponatremia, severe heart failure, or history of thromboembolic events.

Interactions

Carbamazepine and chlorpropamide enhance antidiuretic action.
Other vasopressors and lithium diminish antidiuretic action.
Loop diuretics.
Glucocorticoids.
SSRIs, NSAIDs, thiazide diuretics.

Radioactive Iodine – Iodine-131

Category Information

Therapeutic Use

Treatment for hyperthyroidism (Graves’ disease) and thyroid cancer.

Adverse Drug Reactions

Hypothyroidism, which is generally expected yet requires management.
Bone marrow depression (rare).
Radiation sickness (rare).

Nursing Interventions

Monitor thyroid function.
Watch for signs of thyroid dysfunction: drowsiness, depression, weight gain, edema, loss of appetite, cold intolerance, dry skin, menorrhagia.
Assess CBC and platelet count baselines and periodically thereafter.
Monitor for anemia, leukopenia, and thrombocytopenia.
Observe for signs of radiation sickness: hematemesis, epistaxis, severe nausea, and vomiting.

Administration

Administer orally.
Require a negative pregnancy test prior to administration.
Measure baseline vitals and weight before and monitor throughout treatment.
Dosages for thyroid disorders are minuscule compared to those for thyroid cancer.
Initiate radiation precautions for large doses: limit contact, increase fluid intake, and follow specific waste disposal protocols.

Client Instructions

Watch for signs of anxiety, drowsiness, depression, weight gain, facial swelling, appetite loss, cold intolerance, dry skin.
Report fever, sore throat, weakness, fatigue, and bleeding.

Contraindications

Pregnancy due to teratogenic effects.
Lactation.

Precautions

Children prior to puberty.

Interactions

Other antithyroid medications may diminish iodine uptake.

Biguanides – Metformin

Category Information

Therapeutic Use

Primarily prescribed for Type 2 diabetes mellitus.

Adverse Drug Reactions

Lactic acidosis (rare, yet potentially fatal).
Nausea, diarrhea, vomiting.
An unpleasant metallic taste.
Potential vitamin deficiencies (B12, folic acid).

Nursing Interventions

Monitor signs of lactic acidosis.
If symptoms of lactic acidosis arise, immediately discontinue the medication.
Severe cases of lactic acidosis may necessitate hemodialysis.
Monitor for persistent gastrointestinal issues.
Ensure appropriate fluid intake and output monitoring.
Look for signs of vitamin B12 or folic acid deficiency, recommending supplements if needed.
Check renal function at the onset of therapy and annually thereafter.

Administration

Administer orally either twice a day with the morning and evening meals (immediate-release) or once a day with the evening meal (extended-release).
Ensure clients swallow extended-release form whole without crushing or chewing.

Client Instructions

Avoid alcohol consumption.
Report any weakness, fatigue, lethargy, or hyperventilation and seek medical help if these occur.
These symptoms may subside as treatment progresses.
Lie down if nausea occurs.
Maintain adequate carbohydrate and fluid intake.
Keep the provider informed about symptoms like weakness, fatigue, pallor, or reddening of the tongue.

Contraindications

Diabetic ketoacidosis.
Cardiopulmonary, hepatic, or renal insufficiency.
Alcoholism.
Heart failure.
Severe infections.
Shock.
Recent myocardial infarction.
Hypoxemia.
History of lactic acidosis.

Precautions

Patients with diarrhea, dehydration, anemia, pituitary insufficiency, gastroparesis, gastrointestinal obstruction, hyperthyroidism, and older adults should be monitored closely.

Interactions

Alcohol and cimetidine can raise the risk of lactic acidosis.
Iodine-based contrast mediums may incur acute renal failure risk, exacerbating lactic acidosis.
Other medications such as nifedipine, furosemide, morphine, antifungals may elevate hypoglycemic effects.

Dipeptidyl Peptidase 4 (DPP-4) Inhibitors – Sitagliptin

Category Information

Therapeutic Use

Designed for treating type 2 diabetes alone or in conjunction with other antidiabetic medications.

Adverse Drug Reactions

Upper respiratory tract infections or inflamed nasal passages.
Headaches.
Pancreatitis.
Stevens-Johnson syndrome.
Anaphylaxis and angioedema.

Nursing Interventions

Monitor upper respiratory symptoms.
Take temperature during respiratory manifestations.
Monitor for headaches and administer analgesics as necessary.
Watch for gastrointestinal symptoms potentially signaling pancreatitis.
If pancreatitis is suspected, verify with blood amylase levels.
Check skin for Stevens-Johnson syndrome symptoms.
Be vigilant for signs of acute renal failure.

Administration

Administer orally, either as monotherapy or alongside metformin.
Sitagliptin may be taken with or without food.
For patients with renal impairment and low creatinine clearance, reduce the dosage accordingly.

Client Instructions

Instruct clients to report continual respiratory symptoms or fever.
Report persistent headaches or upper abdominal pains that may radiate to the back and be associated with nausea and vomiting.
Follow prescribed medication regimen and address missed doses promptly.
Educate clients on proper technique for obtaining routine blood glucose levels.

Contraindications

Hypersensitivity to the drug or its constituents.
In patients with Type 1 diabetes or diabetic ketoacidosis.

Precautions

Use caution in hemodialysis patients and those with moderate to severe renal dysfunction or past history of pancreatitis.

Interactions

Sitagliptin may elevate digoxin levels.
Concurrent use with other antidiabetics raises hypoglycemia risk.

Glucocorticoids – Hydrocortisone

Category Information

Therapeutic Use

Prescribed for replacement therapy in acute and chronic adrenocortical insufficiency, such as Addison’s disease.
For detailed information about glucocorticoids that treat asthma or pain and inflammation, consultants are referred to respective modules.

Adverse Drug Reactions

Few effects at low therapeutic doses.
Multiple adverse effects at higher doses necessary to suppress inflammation and the immune system.
Possible adrenal insufficiency.
Rarely, Cushing's syndrome.

Nursing Interventions

Monitor patients for signs of adrenal insufficiency that can manifest as weight loss, hypotension, weakness, anorexia, nausea, vomiting, confusion, and lethargy.

Administration

Administer orally (with meals) for chronic adrenal insufficiency, ideally in the morning upon waking or in divided doses with two-thirds in the morning and one-third in the early afternoon.
Administer IV in emergencies.
Obtain periodic CBCs, electrolytes, glucose, and glucocorticoid levels at baseline and follow-up.

Client Instructions
Increased stress might necessitate higher dosages, usually three times the normal dose for three days; encourage patients to report such situations.
Advise avoiding live vaccines.
Monitor for weight gain, swelling, or changes in vision.
Encourage a diet high in protein, potassium, calcium, and low in sodium and carbohydrates.

Contraindications

No issues when given in low doses.
In large doses: contraindicated in severe infections or if a live vaccine is involved.

Precautions

Monitor closely at both low and high doses for potential complications.

Interactions

At low doses, no known significant interactions.
At higher doses: oral contraceptives, phenytoin, phenobarbital, and rifampin may reduce efficacy.

Growth Hormone – Somatropin

Category Information

Therapeutic Use

Used in cases of growth hormone deficiencies, such as Turner’s syndrome, as well as adult growth hormone deficiency to increase lean muscle mass and combat AIDS wasting syndrome.

Adverse Drug Reactions

Hyperglycemia.
Risk of fatal outcomes for clients with Prader-Willi Syndrome (PWS).
Development of neutralizing antibodies.

Nursing Interventions

Monitor blood glucose levels closely.

Administration

Administered IM or subcutaneously, with dosing based on weight.
Frequency can be daily or several times a week, noting that the medication is costly.
For pediatric clients, establish baseline height, weight, thyroid function, and growth hormone levels with monthly monitoring; assess yearly with x-rays of long bones.

Client Instructions
Rotate injection sites to avoid tissue damage.

Contraindications

Severe obesity.
Severe respiratory compromise.
Closed epiphyses in children.
Critical illness.

Precautions

Caution in cases of diabetes mellitus, PWS, hypothyroidism, or chronic renal failure.

Interactions

Glucocorticoids and ACTH may antagonize growth-stimulating effects.
Thyroid hormones, estrogens, and androgens precipitate epiphyseal closure.

Hyperglycemics – Glucagon

Category Information

Therapeutic Use

Administered for hypoglycemia resulting from an insulin overdose.

Adverse Drug Reactions

Gastrointestinal effects such as nausea and vomiting.
Hypotension.
Risk of anaphylaxis.

Nursing Interventions

Position unconscious clients laterally to prevent aspiration from vomiting.
Monitor for ongoing nausea and vomiting and fluid/carbohydrate intake.
Regularly assess neurologic status during treatment and monitor for hypoglycemia signs during treatment.

Administration

Administered IV, IM, or subcutaneously.
Expect regaining consciousness about 20 minutes after IV administration.
Provide food post-recovery when the client can safely swallow.
Be aware that IV dextrose (D50W) is faster acting than glucagon.

Client Instructions

Inform clients that vomiting is a common occurrence following glucagon administration.
Emphasize keeping the client positioned on their side until full consciousness is regained.
Encourage oral intake once tolerated to reduce reoccurrence of hypoglycemia.
Educate on hypoglycemia symptoms and prevention, advising carrying sugar packets or candy for emergencies.

Contraindications

Not indicated for hypoglycemia due to starvation (as glycogen stores are insufficient).
Pheochromocytoma or hypersensitivity.

Precautions

Caution in those with cardiovascular disorders or adrenal insufficiency.

Interactions

Increases the effects of oral anticoagulants (such as warfarin).
Counteracts insulin effects.
Phenytoin inhibits glucagon activity.

Incretin Mimetics – Exenatide

Category Information

Therapeutic Use

Prescribed for Type 2 diabetes as an adjunct to sulfonylureas or metformin.

Adverse Drug Reactions

Causes hypoglycemia, nausea, vomiting, diarrhea.
Risks of pancreatitis, renal failure, and severe hypersensitivity reactions.

Nursing Interventions

Recommend reducing oral hypoglycemic dosage when therapy starts.
Monitor for signs of hypoglycemia.
Track persistent gastrointestinal issues and fluid intake.
Watch for pancreatitis signs and discontinue medication if needed.

Administration

Administered subcutaneously in the thigh, abdomen, or upper arm up to 60 minutes before morning and evening meals, not following meals.
Rotate injection sites and expect peak action around 2 hours post-dosing.

Client Instructions

Monitor and report hypoglycemia symptoms.
Test blood glucose to confirm and consume carbohydrate snacks.
Wear a medical alert bracelet.
Consume adequate calorie intake and lie down if nausea present.
Report severe or persistent abdominal pain and stop taking exenatide if this develops.

Contraindications

Patients with renal impairment, Type 1 diabetes, diabetic ketoacidosis, severe gastrointestinal diseases, pregnancy due to teratogenic effects, and children.

Precautions

Caution with thyroid disease or carcinoma, moderate renal dysfunction, pancreatitis histories, and concurrent insulin use.

Interactions

Sulfonylureas heighten hypoglycemia risk.
Slows oral medication absorption; therefore, instruct taking them 1 hour before or 2 hours after administering exenatide.

Insulin – Lispro (Rapid-Acting), Regular (Short-Acting), NPH (Intermediate-Acting), Glargine (Long-Acting)

Category Information

Therapeutic Use

Indicated for diabetes mellitus (Type 1, Type 2, gestational).

Adverse Drug Reactions

Can cause hypoglycemia and injection site reactions (lipodystrophy or lipohypertrophy).
Possible hypersensitivity or allergic response.

Nursing Interventions

Monitor for hypoglycemia symptoms (tachycardia, palpitations, diaphoresis, shakiness with abrupt onset; headache, tremors, weakness with gradual onset).
Confirm blood glucose levels and treat low values as needed with sugar or juice; for unconscious patients, administer glucagon parenterally.
Observe for subcutaneous fat accumulation and check potassium levels.
Review ECG readings and signs of hypokalemia.

Administration

Administer subcutaneously (insulin syringe) or IV.
Ensure proper needle size for subq injections and avoid discolored insulins.
Educate clients on the proper way to self-administer injections.

Client Instructions

Wear a medical alert bracelet and monitor for hypoglycemia symptoms.
Systematically rotate injection sites while maintaining a distance of 1 inch apart.
Do not store insulin with needles attached and check for symptoms of weakness, nausea or palpitations.

Contraindications

Known hypersensitivity to insulin.

Precautions

Monitor closely in older adults, during infections or periods of stress, and dietary alterations.

Interactions

Certain drugs may potentiate hypoglycemic effects: sulfonylureas, meglitinides, beta blockers, and salicylates.
Others, like thiazide and loop diuretics, may counteract these effects and increase blood glucose levels.

Meglitinides – Repaglinide

Category Information

Therapeutic Use

Used for Type 2 diabetes mellitus.

Adverse Drug Reactions

Hypoglycemia, nausea, vomiting.

Nursing Interventions

Monitor for hypoglycemia signs (diaphoresis, tachycardia, fatigue, excessive hunger, tremors).
For conscious clients, treat hypoglycemia with oral glucose; if not conscious, provide IV dextrose or glucagon.
Check the patient’s blood glucose every 15 to 20 min and continue treatment until levels stabilize.

Administration

Administer orally no more than 30 minutes before meals, typically three times per day; allow clients to skip doses if meals are missed while allowing additional doses for added meals.

Client Instructions

Advise wearing a medical alert bracelet and monitoring hypoglycemia.
Report symptoms and symptoms of nausea promptly, and ensure adequate carbohydrate intake.

Contraindications

Patients with diabetic ketoacidosis, liver, kidney, and endocrine disorders.

Precautions

Use caution in patients with renal or hepatic dysfunction, systemic infections, and older adults.

Interactions

Some drugs, like gemfibrozil, erythromycin, and chloramphenicol, may increase hypoglycemic effects, while others like alcohol, corticosteroids, and rifampin could diminish these effects.

Mineralocorticoids – Fludrocortisone

Category Information

Therapeutic Use

Used for replacement therapy in acute and chronic adrenocortical insufficiency (e.g., Addison’s disease), often in conjunction with hydrocortisone.

Adverse Drug Reactions

Few at low therapeutic doses, but at higher levels, can cause significant fluid/electrolyte imbalances, hypertension, edema, and hypokalemia.

Nursing Interventions

Watch for signs of inappropriate dosing: weight gain, fluid retention, elevated blood pressure, and low potassium levels.

Administration

Administer orally, daily or three times a week.
Check CBCs and electrolyte levels at baseline and periodically.
Advise clients to wear a medical alert band.

Client Instructions

Report weight gain or swelling immediately, as well as weakness or heart palpitations from low potassium levels.
Regular blood pressure checks should be encouraged, as well as a diet high in potassium.

Contraindications

Hypersensitivity to the medication.

Precautions

Caution in heart failure and during pregnancy.

Interactions

Rifampin and phenobarbital decline levels, while potassium-depleting diuretics may increase hypokalemia risks.

Antithyroid Medications – Propylthiouracil

Category Information

Therapeutic Use

Events include treating hyperthyroidism (Graves’ disease), thyrotoxic crises, and suppressing thyroid hormone production before thyroidectomy.

Adverse Drug Reactions

Can include hypothyroidism, agranulocytosis, hepatotoxicity, aplastic anemia, rash, arthralgia, and general malaise.

Nursing Interventions

Monitor thyroid function and look for signs of hypothyroidism (fatigue, weight gain, intolerance to cold, and dryness).
Adjust dosages as needed and check CBC regularly for leukocyte levels and other signs of blood disorders.

Administration

Administered orally at prescribed intervals (e.g., every 8 hours).
Check vital signs and weight at baseline and periodically thereafter.

Client Instructions

Be observant and report hyperthyroidism and hypothyroidism manifestations, including fever and sore throat.

Contraindications

Known hypersensitivity and precautions should be in place for those with immunosuppression or liver dysfunction.

Interactions

Risk of bone marrow depression may increase with antineoplastics or radiation therapy, and concurrent use of lithium affects antithyroid actions negatively.

Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i) – Empagliflozin

Category Information

Therapeutic Use

Prescribed for Type 2 diabetes mellitus, heart failure, and cardiovascular health.

Adverse Drug Reactions

Risks of diabetic ketoacidosis, hypoglycemia, dehydration, hypotension, fractures, and acute kidney injury.

Nursing Interventions

Monitor blood glucose, lipid levels, kidney function, and signs of dehydration while also assessing for diabetic ketoacidosis symptoms and UTIs.

Administration

Administered orally, usually once daily, can be taken with or without food.

Client Instructions

Urge immediate notification to the provider for adverse effects, regular blood pressure, and blood glucose monitoring, as well as maintaining proper hydration.

Contraindications

Not for use with Type 1 diabetes mellitus or renal failure.

Precautions

Possible risk for diabetic ketoacidosis and caution regarding caloric intake and hypotension.

Interactions

Watch for combined use with diuretics and other antiviral medications.