Ch 39 Drug Therapy For Diabetes Mellitus

Front 1

Blood glucose level

Back 1

blood sugar level in the body

Front 2

Blood glucose meter

Back 2

device that measures how much glucose is in the blood

Front 3

Diabetes mellitus

Back 3

chronic disease characterized by disordered metabolism of carbohydrates, fats, and protein, and hyperglycemia, due to a deficiency in the amount on action of insulin; the three main forms are type 1, type 2, and gestational

Front 4

Glucagon

Back 4

pancreatic hormone that raises blood glucose levels by stimulating the liver to convert glycogen into glucose; it opposes insulin

Front 5

Gluconeogenesis

Back 5

formation of glucose from noncarbohydrate sources such as fats and amino acids

Front 6

glucose

Back 6

sugar in the blood; major stimulus of insulin secretion

Front 7

Impaired fasting glucose

Back 7

fasting blood glucose level between 100 mg/dL to 125 mg/dL; also referred to as prediabetes

Front 8

insulin

Back 8

protein hormone secreted by beta cells in the pancreas; facilitates glucose utilization by cells. Absence of insulin results in diabetes mellitus

Front 9

insulin pump

Back 9

wearable delivery system for continuous subcutaneous insulin infusion; the insulin dosage is programmed into the pump, and the appropriate amount of insulin is injected through a needle into the adipose tissue

Front 10

ketoacidosis

Back 10

metabolic acidosis due to accumulation of ketone bodies formed by the breakdown of fatty acids and amino acids for energy in the absence of insulin

Front 11

Lancet

Back 11

sharp instrument used to prick the finger for a blood test

Front 12

hyperglycemia

Back 12

A major clinical manifestation of disordered metabolism is _____________, or fasting blood glucose levels exceeding 126 mg/dL.

Front 13

100 and 125 mg/dL

Back 13

A person with a fasting blood glucose level between _____&_____ mg/dL is said to have impaired fasting glucose (IFG), or prediabetes.

Front 14

diabetes

Back 14

Indicative blood glucose levels for most people diagnosed with __________ are approximately 80 to 120 mg/dL before a meal, 180 mg/dL or less after a meal, and between 100 and 140 mg/dL at bedtime.

Front 15

Macrovascular

Back 15

Vascular problems include atherosclerosis throughout the body. _____________ (moderate and large vessels) clinical manifestations include hypertension, myocardial infarction, stroke, and peripheral vascular disease.

Front 16

microvasculature

Back 16

Changes in small blood vessels (________________) especially affect the retina and kidney, resulting in retinopathy, blindness, and nephropathy.

Front 17

type 1 diabetes

Back 17

___________ is a common chronic disorder of childhood, results from an autoimmune disorder that destroys pancreatic beta cells. Although it may occur at any age, it usually appears after 4 years of age and peaks in incidence at 10 to 12 years for girls and 12 to 14 years for boys.

Front 18

Type 2 diabetes

Back 18

__________ is characterized by hyperglycemia and insulin resistance. The hyperglycemia results from increased production of glucose by the liver and decreased uptake of glucose in liver, muscle, and fat cells.

Front 19

beta

Back 19

__________ cells in the pancreas secrete insulin.

Front 20

insulin

Back 20

Several hormones raise blood glucose levels and stimulate _______ secretion, including cortisol, glucagon, growth hormone, epinephrine, estrogen, and progesterone.

Front 21

insulin

Back 21

_________ regulates glucose metabolism to produce energy for cellular functions. If excess glucose is present after this need is met, it is converted to glycogen and stored for future energy needs or converted to fat and stored. The excess glucose transported to liver cells is converted to fat only after glycogen stores are saturated. When _______ is absent or blood glucose levels are low, these stored forms of glucose can be reconverted. The liver is especially important in restoring blood sugar levels by breaking down glycogen or by forming new glucose.

Front 22

insulin

Back 22

Insulin promotes transport of glucose into fat cells, where it is broken down. One of the breakdown products is alpha-glycerophosphate, which combines with fatty acids to form triglycerides. This is the mechanism by which _______ promotes fat storage.

Front 23

insulin

Back 23

Lack of _______ causes protein breakdown into amino acids, which are released into the bloodstream and transported to the liver for energy or gluconeogenesis. The lost proteins are not replaced by synthesis of new proteins, and protein wasting causes abnormal functioning of many body organs, severe weakness, and weight loss.

Front 24

Hyperglycemia

Back 24

_____________ produces glucosuria, which, in turn, produces polydipsia, polyuria, dehydration, and polyphagia.

Front 25

Diabetes

Back 25

________ is a leading cause of myocardial infarction, stroke, blindness, leg amputation, and kidney failure. These complications result from hyperglycemia and other metabolic abnormalities that accompany a lack of effective insulin. The metabolic abnormalities associated with hyperglycemia can cause early, acute complications, such as DKA or hyperosmolar hyperglycemic nonketotic coma

Front 26

Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC)

Back 26

____ is another type of diabetic coma that is potentially life threatening. It is relatively rare and carries a high mortality rate. The term hyperosmolar refers to an excessive amount of glucose, electrolytes, and other solutes in the blood in relation to the amount of water.

Front 27

HHNC

Back 27

__________ is characterized by hyperglycemia, which leads to osmotic diuresis and resultant thirst, polyuria, dehydration, and electrolyte losses, as well as neurologic signs ranging from drowsiness to stupor to coma. Additional clinical problems may include hypovolemic shock, thrombosis, renal problems, or stroke.

Front 28

hyperosmolar hyperglycemic nonketonic coma

Back 28

Treatment of _____is similar to that of DKA in that insulin, IV fluids, and potassium supplements are major components.

Front 29

Metabolic syndrome

Back 29

___________ is usually characterized by additional weight in the abdominal area, as well as an increase in BP, total cholesterol, and low-density lipoprotein cholesterol, impaired glucose values, and abdominal obesity.

Front 30

Insulin (Humulin R, Novolin R)

Back 30

Insulin prototype

Front 31

insulin other drugs in class:

short-acting insulin

Back 31

Insulin lispro (Humalog)

Insulin aspart (NovoLog)

Insulin glulisine (Apidra)

Front 32

insulin other drugs in class:

intermediate-acting insulin

Back 32

Isophane insulin suspension (NPH Humulin N, Novolin N)

Front 33

insulin other drugs in class:

long - acting insulin

Back 33

Insulin glargine (Lantus)

Insulin levemir (Detemir)

Front 34

Glyburide (DiaBeta)

Back 34

Sulfonylureas prototype

Front 35

sulfonylureas other drugs in class

Back 35

Glimepiride (Amaryl)

Glipizide (Glucotrol, Glucotrol XL)

Front 36

acarbose (Precose)

Back 36

Alpha-glucosidase inhibitors prototype

Front 37

Alpha-glucosidase inhibitors other drugs in class

Back 37

Miglitol (Glyset)

Front 38

Metformin (Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet)

Back 38

Biguanide prototype

Front 39

Short-acting insulins

Back 39

____________ insulins have a rapid onset (15 minutes or less) and a short duration of action (4–8 hours). Short-acting products include insulin lispro (Humalog), insulin aspart (NovoLog), and insulin glulisine (Apidra).

Front 40

Intermediate-acting insulin

Back 40

____________-acting insulin preparations such as isophane (NPH) suspension possess zinc insulin crystals that have been modified by protamine in a neural buffer. The addition of zinc assists in slowing the absorption and thus prolongs the duration of action.

Front 41

Long-acting insulin

Back 41

___________ -acting insulin preparations include insulin glargine and insulin detemir. Health care providers use them to provide a basal amount of insulin through 24 hours, similar to normal, endogenous insulin secretion.

Front 42

Herbs That Increase the Risk of Hypoglycemia When Used With Antidiabetic Drugs

Back 42

Alfalfa

Aloe

Bilberry

Bitter melon

Burdock

Celery

Coriander

Damiana

Dandelion root

Fenugreek

Garcinia

Garlic

Ginseng

Gymnema

Juniper

Karela

Marshmallow

Stinging nettle

Front 43

insulin

Back 43

After subcutaneous injection,________ is absorbed most rapidly from the abdomen, followed by the upper arm, thigh, and buttocks. Absorption is delayed or decreased by injection into subcutaneous tissue with lipodystrophy or other lesions, by circulatory problems such as edema or hypotension, by insulin-binding antibodies (which develop after 2 or 3 months of insulin administration), and by injecting cold (i.e., refrigerated) ________. Absorption may also be increased when administered in an extremity before the patient engages in a sport that requires use of the specific extremity (i.e., swimming, tennis, or jogging).

Front 44

Regular

Back 44

* ________ insulin (insulin injection) has a rapid onset of action and can be given intravenously. Therefore, it is the insulin of choice during acute situations, such as DKA, severe infection or other illness, and surgical procedures.

Front 45

Isophane insulin (NPH)

Back 45

________ is often used for long-term insulin therapy. For many patients, a combination of NPH and short-acting insulin provides more consistent control of blood glucose levels.

Front 46

glargine; detemir

Back 46

Insulin ________ or insulin________ may be used to provide a basal amount of insulin over 24 hours, with a short-acting insulin or short-acting insulin analog at meal times.

Front 47

Regular insulin

Back 47

________ ________ is rapidly absorbed after IV, intramuscular (IM), and subcutaneous administration. It is considered to be of short duration with a slow action. It is primarily metabolized in the liver, and a small amount is metabolized in the kidneys. Less than 2% of the drug is excreted in the urine.

Front 48

insulin action

Back 48

The ________ lower blood glucose levels by increasing glucose uptake by body cells, especially skeletal muscle and fat cells, and by decreasing glucose production in the liver.

Front 49

increase

Back 49

Factors that________ insulin requirements include weight gain, increased caloric intake, pregnancy, decreased activity, acute infections, hyperadrenocorticism (Cushing's disease), primary hyperparathyroidism, acromegaly, hypokalemia, and drugs such as corticosteroids, epinephrine, levothyroxine, and thiazide diuretics. Patients who are obese may require 2 units/kg/d because of resistance to insulin in peripheral tissues.

Front 50

decrease

Back 50

Factors that________ insulin requirements include weight reduction; decreased caloric intake; increased physical activity; development of renal insufficiency; stopping administration of corticosteroids, epinephrine, levothyroxine, and diuretics; hypothyroidism; hypopituitarism; recovery from hyperthyroidism; recovery from acute infections; and the “honeymoon period,” which may occur with type 1 diabetes.

Front 51

hypoglycemic

Back 51

The Conscious Patient

Treatment of _____________ reactions consists of immediate administration of a rapidly absorbed carbohydrate. For the conscious patient who is able to swallow, the carbohydrate is given orally. Foods and fluids that provide approximately 15 g of carbohydrate include:

Liquids or fruit juices

4 teaspoons of sugar

Commercial glucose products (e.g., Glutose, B-D Glucose). These products must be swallowed to be effective.

Front 52

Unconscious

Back 52

The ________ Patient: hypoglycemia

In the health care facility, administer 25% to 50% dextrose solution

In home or elsewhere, give Sub-Q or IM glucagon 0.5 to 1 mg if available, and there is someone to inject it.

Glucagon. If the patient does not respond to one or two doses of glucagon within 20 minutes, IV glucose is indicated.

Front 53

insulin

Back 53

Risks of diabetic complications are increased because the stress of surgery increases________ requirements and may precipitate diabetic ketoacidosis. Metabolic responses to stress include increased secretion of catecholamines, cortisol, glucagon, and growth hormone, all of which increase blood glucose levels.

Front 54

hypoglycemia

Back 54

The only clear-cut contraindication to the use of insulin is________ , because of the risk of brain damage

Front 55

Oral administration

Back 55

________ administration ofinsulins is not effective because the proteins are destroyed by proteolytic enzymes in the GI tract. Sub-Q administration is fine, and for regular insulin, the IV route may be appropriate.

Front 56

30 to 45 minutes

Back 56

With regular insulin before meals, it is very important that the medication be injected ________ to ________ minutes before meals so that the insulin is available when blood sugar increases after meals.

Front 57

15 minutes

Back 57

With insulin lispro, aspart, or glulisine before meals, it is important to inject the medication about ________ minutes before eating.

Front 58

bedtime

Back 58

Insulin glargine or detemir is most commonly given at ________ .

Front 59

Drugs That Increase the Effects of Insulin

Back 59

Angiotensin-converting enzyme inhibitors (e.g., captopril)
Increase the risk of hypoglycemia

Alcohol
May promote increased hypoglycemia; inhibits gluconeogenesis (in people with or without diabetes).

Antidiabetic drugs, oral
May alter blood glucose levels; increasingly being used with insulin in the treatment of type 2 diabetes. (The risks of hypoglycemia are greater with the combination.)

Antimicrobials (sulfonamides, tetracyclines)
Increase the risk of hypoglycemia

Beta-adrenergic blocking agents (e.g., propranolol)

Front 60

Drugs That Decrease the Effects of Insulin

Back 60

Adrenergics (e.g., albuterol, epinephrine)
Increase insulin requirements

Anabolic corticosteroids (e.g., prednisone)
Increase insulin requirements

Estrogens and oral contraceptives
Increase insulin requirements

Glucagon
Raises blood glucose by converting liver glycogen to glucose

Levothyroxine
Increases insulin requirements due to hyperglycemia

Phenytoin
Raises blood sugar by inhibiting insulin secretion

Thiazide diuretics (e.g., hydrochlorothiazide)
Increase risk of hyperglycemia due to change in glucose control

Front 61

peak

Back 61

Patients receiving insulin need food at the ________ action time of the insulin and at bedtime. They usually take the food as a between-meal and a bedtime snack. These snacks help prevent hypoglycemic reactions between meals and at night. When hypoglycemia occurs during sleep, there may be a delay in recognition and treatment, which may allow the reaction to become more severe.

Front 62

hypoglycemia

Back 62

Assessing for signs and symptoms of ________ is essential . It is necessary to assess for tachycardia, palpitations, nervousness, weakness, confusion, hunger, and sweating. A decrease in blood glucose activates the sympathetic nervous system to produce a stress response. The nurse also assesses for such central nervous system effects as mental confusion, incoherent speech, visual changes, convulsions, and coma. In addition, he or she assesses the skin and subcutaneous fat for dimpling, atrophy, or hypertrophy of the injection sites. These effects are indicative of lipodystrophy that prevents proper absorption of insulin.

Front 63

glargine

Back 63

Insulin ________is the only insulin not available for use in a continuous insulin pump becaue its pharmacokinetics does not match that of the human body. This insulin has a delayed absorption and a prolonged duration of action. This form of insulin is used solely for injectible use only.

Front 64

high blood sugar (hyperglycemia)

Back 64

know the signs and symptoms of________ : increased blood glucose and excessive thirst, hunger, and urine output. Persistent ________ may indicate a need to change some aspect of the treatment program, such as diet or medication.

Front 65

low blood sugar (hypoglycemia)

Back 65

know the symptoms of________ : sweating, nervousness, hunger, weakness, tremors, and mental confusion.

Front 66

Hypoglycemia

Back 66

Treatment of _____________ is a rapidly absorbed source of sugar, which usually reverses symptoms within 10 to 20 minutes. If you are alert and able to swallow, take 4 ounces of fruit juice, 4 to 6 ounces of a sugar-containing soft drink, a piece of fruit or 1/3 cup of raisins, two to three glucose tablets (5 g each), a tube of glucose gel, 1 cup of skim milk, tea, or coffee with 2 teaspoons of sugar, or eight Lifesaver candies. Avoid taking so much sugar that hyperglycemia occurs.

Front 67

glucagon

Back 67

If you take acarbose (Precose) or miglitol (Glyset) along with insulin, glimepiride (Amaryl), glipizide (Glucotrol), or glyburide (DiaBeta, Glynase, Micronase) and a hypoglycemic reaction occurs, you must take some form of glucose (or________ ) for treatment. Sucrose (table sugar) and other oral carbohydrates do not relieve hypoglycemia because the presence of acarbose or miglitol prevents their digestion and absorption from the gastrointestinal (GI) tract.

Front 68

Reduce

Back 68

________ insulin dosage or eat extra food if you expect to exercise more than usual. Specific recommendations should be individualized and worked out with health care providers in relation to the type of exercise.

Front 69

diabetic ketoacidosis

Back 69

Understand that an illness is a stress response and can increase or decrease your blood glucose. The body will have increased secretions of glucagon, epinephrine, growth hormone, cortisol, and hormones that raise blood glucose levels, and this will require an increase in medication to lower blood sugar. If you are unable to eat, hypoglycemia will result. Illnesses that lower blood sugar include viral infections, nausea, and vomiting. These conditions can result in dehydration and changes in fluids and electrolytes, leading to________ .

Front 70

sulfonylureas

Back 70

The________ are the oldest and largest group of oral agents. Second-generation sulfonylureas have largely replaced first-generation sulfonylureas (e.g., acetohexamide, chlorpropamide, tolazamide, tolbutamide)

Front 71

Glyburide

Back 71

________ lowers blood glucose mainly by increasing secretion of insulin. It may also increase peripheral use of glucose, decrease production of glucose in the liver, increase the number of insulin receptors, and alter postreceptor actions to increase tissue responsiveness to insulin. Because the drug stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present.

Front 72

110 mg/dL or less

Back 72

Health care professionals use glyburide in combination with diet to lower blood sugar in patients with type 2 diabetes mellitus. It is usually necessary to start with a low dosage and increase it gradually until the fasting blood glucose level is________ mg/dL or less. The lowest dose that achieves normal fasting and postprandial blood sugar levels is recommended

Front 73

glyburide

Back 73

The main adverse effectof this drug is hypoglycemia.

Front 74

glyburide

Back 74

In the event of high stress such as infections, surgery, or trauma, a change to insulin therapy may be warranted. In the event of severe hypoglycemia, it is necessary to administer IV glucose.

Front 75

glyburide

Back 75

Patients should take________ before breakfast in the morning or in divided doses before meals if the patient experiences gastric distress.

Front 76

Drugs That Increase the Effects of Glyburide

Back 76

Acarbose, miglitol, metformin, pioglitazone, rosiglitazone
Increase risk of hypoglycemia

Alcohol (acute ingestion)
Causes hypoglycemia

Cimetidine
May inhibit metabolism of sulfonylureas, thereby increasing and prolonging hypoglycemic effect

Insulin
May cause hypoglycemia

Front 77

Drugs That Decrease the Effects of Glyburide

Back 77

Alcohol (acute ingestion)
Accelerates metabolism of sulfonylureas, shortening their half-lives; may produce a flushing response

Beta-blocking agents
Decrease hypoglycemic effects, possibly by decreasing release of insulin in the pancreas

Corticosteroids, diuretics, epinephrine, estrogens, and oral contraceptives
Have hyperglycemic effects

Glucagon
Raises blood glucose levels

Nicotinic acid (large doses)
Has hyperglycemic effect

Phenytoin
Inhibits insulin secretion and has hyperglycemic effects

Rifampin
Increases the rate of metabolism of sulfonylureas by inducing liver-metabolizing enzymes

Thyroid preparations
Antagonize hypoglycemic effects of oral antidiabetic drugs

Front 78

30 minutes

Back 78

Take glipizide or glyburide approximately________ minutes before meals; take glimepiride with breakfast or the first main meal. Take Glucotrol XL with breakfast.

Front 79

acarbose

Back 79

Take ________ or miglitol with the first bite of each main meal. The drugs need to be in the gastrointestinal tract with food because they act by decreasing absorption of sugar in the food. Starting with a small dose and increasing it gradually helps to prevent bloating, “gas pains,” and diarrhea.

Front 80

metformin

Back 80

Take________ (Glucophage) with meals to decrease stomach upset.

Take Glucophage XR with the evening meal.

If a diagnostic test is ordered requiring a contrast media with iodine, stop________ 48 hours before the test and do not begin taking it again until 48 hours after the test.

Front 81

acarbose and metformin

Back 81

________ & ________ do not cause hypoglycemia when taken alone.

Front 82

exercise

Back 82

If you________ vigorously, you may need to decrease your dose of antidiabetic drug or eat more. Ask for specific instructions related to the type and frequency of the exercise. Follow the recommended diet and exercise program as ordered by the health care provider.

Front 83

Glipizide (Glucotrol, Glucotrol XL)

Back 83

________ also stimulates the release of insulin from functioning beta cells in the pancreas and improves binding between insulin and the insulin receptors; in addition, it may increase the number of insulin receptors.

Front 84

30 minutes

Back 84

People should take the drug ________ minutes before breakfast to provide the greatest reduction in blood glucose.

Front 85

Glipizide

Back 85

________ is associated with an increased risk of cardiovascular mortality and hematologic adverse effects such as leukopenia, thrombocytopenia, and anemia. As with the previous second-generation sulfonylureas, dosage reduction is warranted with impaired liver function.

Front 86

Alpha-glucosidase inhibitors

Back 86

________ inhibit alpha-glucosidase enzymes (e.g., sucrase, maltase, amylase) in the GI tract, thereby delaying digestion of complex carbohydrates into glucose and other simple sugars.

Front 87

acarbose

Back 87

The drug is obtained through the fermentation process of microorganisms. Because________ does not enhance insulin, it works best when given with a sulfonylurea to control blood glucose levels.

Front 88

Acarbose

Back 88

________ has a rapid onset of action and peaks in 1 hour. The drug is metabolized by the digestive enzymes and intestinal bacteria in the GI tract. It is minimally distributed and excreted in the urine and feces.

Front 89

acarbose

Back 89

There are no serious adverse effects of________ . However, it can cause gastric upset because the drug is metabolized in the GI tract. It also has the potential to produce leukopenia, thrombocytopenia, and anemia.

Front 90

acarbose

Back 90

Contraindications to ________ include hypersensitivity, DKA, hepatic cirrhosis, inflammatory or malabsorptive intestinal disorders, and severe renal impairment.

Front 91

Drugs That Decrease the Effects of Acarbose

Back 91

Corticosteroids (systemic and inhaled)
Result in hyperglycemia

Luteinizing hormone, somatotropin, thiazide diuretics
Increase risk of hyperglycemia

Front 92

Drugs That Increase the Effects of Acarbose

Back 92

Corticosteroids (inhaled)
May suppress the hypothalamic–pituitary–adrenal axis, leading to adrenal crisis, leading to hypoglycemia

Pegvisomant
Increased risk of hypoglycemia

Front 93

acarbose

Back 93

________ can decrease digoxin levels, and thus patients taking digoxin require close monitoring.

Front 94

acarbose

Back 94

People should take ________ at the beginning of each meal so that it is present in the GI tract with food and able to delay digestion of carbohydrates.

Front 95

acarbose adverse effects

Back 95

The nurse also assesses for GI effects such as diarrhea, abdominal pain, and flatulence. He or she should assess the complete blood (cell) count for leukopenia, thrombocytopenia, and anemia when using this drug.

Front 96

Biguanides

Back 96

The only drug available in this class is the prototype metformin (Glucophage).

Front 97

Biguanides:

metformin

Back 97

Experts prefer to call it an antihyperglycemic rather than a hypoglycemic because it does not cause hypoglycemia, even in large doses, when used alone.

Front 98

metformin

Back 98

Absorption of________ occurs in the small intestine, and it circulates without binding to plasma proteins. The drug has a serum half-life of 1.3 to 4.5 hours. It is not metabolized in the liver and is excreted unchanged in the urine.

Front 99

Metformin

Back 99

________ reduces the production of glucose by the liver. It also decreases the intestinal absorption of glucose to increase insulin sensitivity. This action increases the uptake of glucose, thus enhancing its utilization to produce energy.

Front 100

Biguanides: metformin

Back 100

Prescribers widely order it as the initial drug in obese patients with newly diagnosed type 2 diabetes, mainly because it does not cause the weight gain associated with most other oral agents.

Front 101

metformin

Back 101

Contraindications to use of ________ in older adults often include cardiovascular disorders that increase risks of fluid retention and congestive heart failure. A BLACK BOX WARNING ♦ for this drug states that patients 80 years of age or older should not take the drug because of the risk of lactic acidosis.

Front 102

metformin

Back 102

It is important to discontinue metformin at least 48 hours before diagnostic tests are performed with these materials and resume the drug at least 48 hours after the tests are done and tests indicate that renal function is normal.

Front 103

hepatic

Back 103

Metformin is not recommended for use in patients with clinical or laboratory evidence of________ impairment because risks of lactic acidosis may be increased.

Front 104

metformin

Back 104

The primary adverse effect of________ is lactic acidosis. Other adverse effects include hypersensitivity reactions, dizziness, nausea, vomiting, abdominal discomfort or cramping, malabsorption of amino acids, and diarrhea.

Front 105

metformin

Back 105

Patients should take ________ with meals. They should swallow the extended-release formulation whole and take it with the evening meal. They should discontinue the drug immediately if they are diagnosed with a myocardial infarction.

Front 106

Drugs That Decrease the Effects of Metformin

Back 106

Corticosteroids (systemic and inhaled)
Result in hyperglycemia

Luteinizing hormone, somatotropin, thiazide diuretics
Increase risk of hyperglycemia

Front 107

Drugs That Increase the Effects of Metformin

Back 107

Alcohol
Increases risk of hypoglycemia and lactic acidosis

Cephalexin, cimetidine, dalfampridine, glycopyrrolate
Interferes with metabolism and increases blood levels

Corticosteroids (oral and inhaled)
May suppress the hypothalamic–pituitary–adrenal axis, leading to adrenal crisis, leading to hypoglycemia

Furosemide
Increases blood levels

Pegvisomant
Increases risk of hypoglycemia

Sulfonylurea hypoglycemic agents
Increases risk of hypoglycemia

Front 108

metformin

Back 108

The nurse assesses fasting, preprandial, and postprandial blood glucose for normal or near-normal levels. Also, the nurse assesses for improvement in hemoglobin A1C levels when using this drug.

Front 109

lactic acidosis.

Back 109

The nurse assesses the skin for eczema, pruritus, erythema, and urticaria. All of these symptoms are indicative of a hypersensitivity reaction. It is also necessary to assess the GI response to the medication. In addition, the nurse assesses for abdominal pain, nausea, vomiting, and diarrhea. It is essential to check the liver function to determine the onset of ________.

Front 110

lactic acidosis

Back 110

Symptoms and signs of ________ may include drowsiness, malaise, respiratory distress, bradycardia, and hypotension.