Oral Hypoglycemics
Sulfonylureas:
Glipizine (Glucotrol)
Action: Promotes the release of insulin from the pancreas
Risk: Risk of hypoglycemia in clients with renal, hepatic or adrenal disorders. Usually caused by
taking too much medication or not eating enough food.
Give 30 mins before morning meal
Meglitinides:
Repaglinide (Prandin)
Action: Stimulates beta cells to release insulin
Risk: Short acting (2-4 hours); administer before each meal; risk of hypoglycemia
Biguanides:
Metformin (Gulcophage)
Action: Reduces gluconeogenesis; makes muscle tissue more sensitive to insulin
Does not promote insulin release from pancreas
Risk: Withhold 48 hours and 48 after a test with contrast media. Contraindicated for clients with
severe infections.
Monitor for Lactic Acidosis
Thiazolidinediones:
Rosiglitazone (Avandia)
Action: Decreases cellular insulin resistance; Make take 3-4 months of therapy
Risk: Exacerbation of heart Failure (Fluid retention, headache, weight gain) DO NOT USE
WITH PT WITH HEART FAILURE, DUE TO FLUID RETENTION
,Alpha- Glucosidase Inhibitors:
Acarbose (Precose)
Action: Slows carbohydrate absorption and digestion
Risk: Contraindicated in clients with intestinal disease due to increase gas formation
Take with the first bite of each meal 3x a day
Gliptins:
Sitagliptin (Januvia)
Actions: Promotes release of insulin, lowers glucagon secretion and slows gastric emptying
Risk: Caution with impair renal function- dose will be reduced
Injectable Hypoglycemics
Insulin:
Rapid: Lispro (HumaLOG): Onset (15-30 mins) Peak (0.5- 2.5 hours) Duration (3-6 hrs)
Short: Regular (HumuLIN): Onset (0.5-1 hrs) Peak (1-5hrs) Duration (6-10hrs)
Intermediate: NPH (Humulin N): Onset (1-2 hrs) Peak (6-14 hrs) Duration (16-24 hrs)
Long: Glargine(Lantus): Onset(70mins) Peak (None) Duration (24hrs)
***Mixing regular and NPH= Regular 1st & then Nph
*** Administer Long acting ad bedtime
*** Only regular insulin can be given IV with normal saline
Side effects: Hypoglycemia/Hyperglycemia
Nursing interventions: Roll vial; do not shake
, Thyroid Replacement
Levothyroxine T4 (Synthroid)
Action: Stimulates metabolism of all body systems by accelerating the rate of cellular
oxygenation
Therapeutic use: HYPOthyroidism
Precautions: Overmedication can result in Hyperthyroidism
Side effects: Tachycardia
Weight loss
Diarrhea
Weight loss
Decreased bone density
Heat intolerance
Insomnia
Nursing Interventions: Monitor cardiac system
Monitor T4 and TSH levels
Take early in the morning
Monitor for fatigue, slow speech, hoarseness or slow pulse; May indicate under medication
Anti-Thyroid Drugs
Propylthiouracil:
Propylthiouracil (PTU)
Actions: Interferes with synthesis of T3 used for rapid improvement
Use: Hyperthyroidism
Adverse effects: Rash and Leucopenia (Most common) Significant Bradycardia
*** Administer at the same time everyday preferably in the morning to decrease the potential of
insomnia
, Radioactive Iodine:
Iodine-131 (131l, Iodotope)
Action: At high dose: Hyperthyroidism
Thyroid cancer
Clients who have not responded to anti-thyroid treatment
At low dose: Thyroid function studies
Complications: Monitor for radiation sickness, monitor for Anemia
Nursing Considerations: -Maintain distance of 6ft from others do not prepare food for other or
share utensils
-Instruct the client to increase fluid intake
-Give with fruit juice to dilute the unpleasant taste
-Ask about iodine salt and shell fish intake
-Assess for irregular bleeding
Drug therapy for peptic ulcers
Histamine2-receptor antagonists:
Ranitidine hydrochloride (Zantac)
Action: Blocks H2-receptors in stomach to decrease acid production/secretion of acids
Side effects: Headache is the most common severe reduction of WBC, RBC, Platelets is
possible. In high doses may cause impotence or loss of libido in men.
Nursing Considerations: Administer after meals and monitor liver and renal function. Tell the
patient that smoking decreases the effectiveness of the medication.
Proton pump inhibitors:
Omeprazole (Prilosec)
Action: Reduces acid secretion in stomach
Side Effects: Headache, nausea, diarrhea, rash, abdominal pain
Nursing Interventions: Give at breakfast on empty stomach, Gingko and St. Johns
contraindicated Zollinger- Ellison drug of choice
Sulfonylureas:
Glipizine (Glucotrol)
Action: Promotes the release of insulin from the pancreas
Risk: Risk of hypoglycemia in clients with renal, hepatic or adrenal disorders. Usually caused by
taking too much medication or not eating enough food.
Give 30 mins before morning meal
Meglitinides:
Repaglinide (Prandin)
Action: Stimulates beta cells to release insulin
Risk: Short acting (2-4 hours); administer before each meal; risk of hypoglycemia
Biguanides:
Metformin (Gulcophage)
Action: Reduces gluconeogenesis; makes muscle tissue more sensitive to insulin
Does not promote insulin release from pancreas
Risk: Withhold 48 hours and 48 after a test with contrast media. Contraindicated for clients with
severe infections.
Monitor for Lactic Acidosis
Thiazolidinediones:
Rosiglitazone (Avandia)
Action: Decreases cellular insulin resistance; Make take 3-4 months of therapy
Risk: Exacerbation of heart Failure (Fluid retention, headache, weight gain) DO NOT USE
WITH PT WITH HEART FAILURE, DUE TO FLUID RETENTION
,Alpha- Glucosidase Inhibitors:
Acarbose (Precose)
Action: Slows carbohydrate absorption and digestion
Risk: Contraindicated in clients with intestinal disease due to increase gas formation
Take with the first bite of each meal 3x a day
Gliptins:
Sitagliptin (Januvia)
Actions: Promotes release of insulin, lowers glucagon secretion and slows gastric emptying
Risk: Caution with impair renal function- dose will be reduced
Injectable Hypoglycemics
Insulin:
Rapid: Lispro (HumaLOG): Onset (15-30 mins) Peak (0.5- 2.5 hours) Duration (3-6 hrs)
Short: Regular (HumuLIN): Onset (0.5-1 hrs) Peak (1-5hrs) Duration (6-10hrs)
Intermediate: NPH (Humulin N): Onset (1-2 hrs) Peak (6-14 hrs) Duration (16-24 hrs)
Long: Glargine(Lantus): Onset(70mins) Peak (None) Duration (24hrs)
***Mixing regular and NPH= Regular 1st & then Nph
*** Administer Long acting ad bedtime
*** Only regular insulin can be given IV with normal saline
Side effects: Hypoglycemia/Hyperglycemia
Nursing interventions: Roll vial; do not shake
, Thyroid Replacement
Levothyroxine T4 (Synthroid)
Action: Stimulates metabolism of all body systems by accelerating the rate of cellular
oxygenation
Therapeutic use: HYPOthyroidism
Precautions: Overmedication can result in Hyperthyroidism
Side effects: Tachycardia
Weight loss
Diarrhea
Weight loss
Decreased bone density
Heat intolerance
Insomnia
Nursing Interventions: Monitor cardiac system
Monitor T4 and TSH levels
Take early in the morning
Monitor for fatigue, slow speech, hoarseness or slow pulse; May indicate under medication
Anti-Thyroid Drugs
Propylthiouracil:
Propylthiouracil (PTU)
Actions: Interferes with synthesis of T3 used for rapid improvement
Use: Hyperthyroidism
Adverse effects: Rash and Leucopenia (Most common) Significant Bradycardia
*** Administer at the same time everyday preferably in the morning to decrease the potential of
insomnia
, Radioactive Iodine:
Iodine-131 (131l, Iodotope)
Action: At high dose: Hyperthyroidism
Thyroid cancer
Clients who have not responded to anti-thyroid treatment
At low dose: Thyroid function studies
Complications: Monitor for radiation sickness, monitor for Anemia
Nursing Considerations: -Maintain distance of 6ft from others do not prepare food for other or
share utensils
-Instruct the client to increase fluid intake
-Give with fruit juice to dilute the unpleasant taste
-Ask about iodine salt and shell fish intake
-Assess for irregular bleeding
Drug therapy for peptic ulcers
Histamine2-receptor antagonists:
Ranitidine hydrochloride (Zantac)
Action: Blocks H2-receptors in stomach to decrease acid production/secretion of acids
Side effects: Headache is the most common severe reduction of WBC, RBC, Platelets is
possible. In high doses may cause impotence or loss of libido in men.
Nursing Considerations: Administer after meals and monitor liver and renal function. Tell the
patient that smoking decreases the effectiveness of the medication.
Proton pump inhibitors:
Omeprazole (Prilosec)
Action: Reduces acid secretion in stomach
Side Effects: Headache, nausea, diarrhea, rash, abdominal pain
Nursing Interventions: Give at breakfast on empty stomach, Gingko and St. Johns
contraindicated Zollinger- Ellison drug of choice
