Medication List Nur 106 - Diabetes And Hypoglycemia

Front 1

Sulfonylureas

Back 1

Main action site: Pancreas

Stimulate pancreas to secrete more insulin

Front 2

Pioglitazone
(Thiozolidinediones)

Back 2

Main action site: muscle cells

Make muscle cells more sensitive to insulin; decrease liver production of glucose

Indications
Type 2 diabetes mellitus (with diet and exercise); may be used with metformin, sulfonylureas, or insulin

Action
• Improves sensitivity to insulin by acting as an agonist at receptor sites involved in insulin responsiveness and subsequent glucose production and utilization
• Requires insulin for activity

Therapeutic Effect(s):
Decreased insulin resistance, resulting in glycemic control without hypoglycemia

Adverse Reactions/Side Effects
CV: CHF, edema.
EENT: macular edema.
GI: hepatitis, ↑ liver enzymes.
Hemat: anemia.
Misc: fractures (arm, hand, foot) in female patients.

Front 3

Byetta

Back 3

Indications: Type 2 diabetes uncontrolled by metformin, a sulfonylurea, or a thiazolidinedione (or a combination of these agents)

Action: Mimics the action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucose-lowering

Therapeutic Effect(s):
Improved control of blood glucose

Adverse Reactions/Side Effects:
CV: dizziness, headache, jitteriness, weakness.
GI: PANCREATITIS, diarrhea, nausea, vomiting, dyspepsia, gastroinestinal reflux.
Derm: hyperhydrosis.
Metabolic: ↓ appetite, weight loss

Patient/Family Teaching
• Instruct patient to take exenatide as directed within 60 min before a meal. Do not take after a meal. If a dose is missed, skip the dose and take the next dose at the prescribed time. Do not take an extra dose or increase the amount of the next dose to make up for missed dose
• Advise patient to notify health care professional immediately if symptoms of pancreatitis (unexplained, persistent, severe abdominal pain which may or may not be accompanied by vomiting) occur

Front 4

Metformin
(Biguanides)

Back 4

Main action site: Liver

Keep liver from releasing excessive insulin; make muscle cells more sensitive to insulin

Indications
Management of type 2 diabetes mellitus; may be used with diet, insulin, or sulfonylurea oral hypoglycemics

Action
• Decreases hepatic glucose production
• Decreases intestinal glucose absorption
• Increases sensitivity to insulin

Therapeutic Effect(s):
Maintenance of blood glucose

Adverse Reactions/Side Effects
GI: abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste.
Endo: hypoglycemia.
F and E: LACTIC ACIDOSIS.
Misc: decreased vitamin B12 levels.

• Patients who have been well controlled on metformin who develop illness or laboratory abnormalities should be assessed for ketoacidosis or lactic acidosis. Assess serum electrolytes, ketones, glucose, and, if indicated, blood pH, lactate, pyruvate, and metformin levels. If either form of acidosis is present, discontinue metformin immediately and treat acidosis

Evaluation/Desired Outcomes

Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes. Control may be achieved within a few days, but full effect of therapy may be delayed for up to 2 wk. If patient has not responded to metformin after 4 wk of maximum dose therapy, an oral sulfonylurea may be added. If satisfactory results are not obtained with 1–3 months of concurrent therapy, oral agents may be discontinued and insulin therapy instituted



Teaching:
• Explain to patient the risk of lactic acidosis and the potential need for discontinuation of metformin therapy if a severe infection, dehydration, or severe or continuing diarrhea occurs or if medical tests or surgery is required. Symptoms of lactic acidosis (chills, diarrhea, dizziness, low blood pressure, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea, or weakness) should be reported to health care professional immediately

Front 5

Rapid Acting Insulin

Back 5

Exubera
NovoLog
Humalog
Apidra

Front 6

Short Acting Insulin

Back 6

Humulin R
Novolin R
Vesosulin BR

Front 7

Intermediate Acting

Back 7

NPH

Front 8

Long Acting

Back 8

Levemir

Lantus

Front 9

Combination Insulin

Back 9

Novolog Mix 70/30
Humalog Mix 75/25
Humulin 70/30
Novolin 70/30
Humulin 50/50