| Question | Answer |
| Classification for Metformin | Biguanide |
| First line drug | Metformin |
| Metformin indications | Hyperglycemia
Decrease intestinal absorption of glucose
Does NOT cause hypoglycemia |
| Metformin administration | PO |
| Metformin adverse effects | GI problems:
Bloating
Anorexia
Abdominal discomfort |
| Metformin nursing considerations | Contraindicated in renal pts
Lifestyle modifications
Monitor BUN and creatinine
Stop 48hrs before and after use of contrast agent |
| Classification of Glipizide, Glimepiride, Glyburide | Sulfonylureas - second line drug - added to Metformin if it doesn’t work alone |
| Indications - Glipizide, Glimepiride, Glyburide | Hyperglycemia
Can be added to Metformin if HgbA1C is >7
Can cause hypoglycemia because it stimulates insulin release from beta cells type 2 |
| Glipizide, Glimepiride, Glyburide Administration | PO |
| Glipizide, Glimepiride, Glyburide - Adverse effects | Hypoglycemia
Nausea
Weight gain
GI distress |
| Glipizide, Glimepiride, Glyburide - considerations | No alcohol - can cause hypoglycemia reaction |
| Classification of
Exenatide
Dulaglutide
Liraglutide
Alogliptin
Linagliptin
Saxagliptin | Incretin Enhancers- TIDE or GLIPTIN |
| Indications for incretin enhancers | Hyperglycemia
Prevent breakdown of natural incretins and increases insulin secretion which lowers blood glucose |
| Action of incretin enhancers | Incretins are hormones secreted by the mucosa of the small intestine following a meal, when blood glucose is elevated. |
| Action of incretin enhances | Signal the pancreas to increase insulin production and signal the liver to decrease glucagon. Both of these actions lower blood glucose.
Decrease food intake by increasing the feeling of satiety and slow gastric emptying which delays glucose absorption. |
| Administration of
Exenatide
Dulaglutide
Liraglutide | SubQ |
| Administration of
Alogliptin
Linagliptin
Saxagliptin | PO |
| Adverse Effects:
Exenatide
Dulaglutide
Liraglutide | • Does not usually cause hypoglycemia
• High incidence of nausea, vomiting, and diarrhea
• Pancreatitis |
| Adverse Effects:
Alogliptin
Linagliptin
Saxagliptin | • Fewer adverse effects (N, V, D)
• Do not usually cause hypoglycemia
• Pancreatitis |
| Nursing Considerations:
Exenatide
Dulaglutide
Liraglutide
Alogliptin
Linagliptin
Saxagliptin | Assess for s/s pancreatitis (persistent severe abdominal pain, sometimes radiating to the back, may be accompanied by vomiting) beginning of therapy and with dose increases. If suspected, promptly discontinue incretin enhancer and seek medical attention. |
| Nursing Considerations:
Exenatide
Dulaglutide
Liraglutide
Alogliptin
Linagliptin
Saxagliptin | Monitor HgbA1c prior to and during therapy.
The TIDES are approved by the FDA as alternatives to metformin in patient who have not achieved glycemic control with metformin.
GLIPTINs have fewer adverse effects and work well with other antidiabetic agents |
| Name Rapid Acting Insulin | Lispro
(Humalog)
Aspart
(Novolog) |
| Rapid Acting Insulin - Indications
Lispro and Aspart | • Hyperglycemia
• Lowers blood sugar as it rises after meals |
| Rapid Acting Insulin - Administration, Onset, Peak and Duration | SQ
Onset 15 minutes or less
Peak 40-60 minutes
Duration 3-5 h |
| Rapid Acting Insulin - Adverse Effects
Lispro and Aspart | • Hypoglycemia |
| Rapid Acting Insulin - Nursing Considerations
Lispro and Aspart | • Clear solution
• “mealtime insulin”
• Client should eat within 15 minutes of injection |
| Name Short Acting Insulin | Regular
(Humulin-R, Novolin-R) |
| Short Acting Insulin - Indications
Regular
(Humulin-R, Novolin-R) | Hyperglycemia |
| Short Acting Insulin - Administration, Onset, Peak and Duration
Regular
(Humulin-R, Novolin-R) | SQ or IV
Onset 30-60 minutes
Peak 2-3 hr
Duration 4-6 hr |
| Short Acting Insulin - Adverse Effects
Regular
(Humulin-R, Novolin-R) | Hypoglycemia |
| Short Acting Insulin - Nursing Considerations
Regular
(Humulin-R, Novolin-R) | • Clear solution
• Administer 20-30 minutes before meals
• Can be given alone or mixed with other insulin |
| Name Intermediate Acting Insulin | Isophane
(NPH, Humulin-N, Novolin-N) |
| Intermediate Acting Insulin - Indications
Isophane
(NPH, Humulin-N, Novolin-N) | • Hyperglycemia |
| Intermediate Acting Insulin - Administration, Onset, Peak and Duration
Isophane
(NPH, Humulin-N, Novolin-N) | SQ
Onset 2-4 hr
Peak 6-8
Duration 12-16hr |
| Intermediate Acting Insulin - Nursing Considerations
Isophane
(NPH, Humulin-N, Novolin-N) | • White and cloudy solution-has protein in it.
• Usually taken after meals |
| Name Very Long Acting Insulin | Glargine |
| Very Long Acting Insulin - Indications
Glargine | • Hyperglycemia
• Keeps blood sugar stable between meals and overnight |
| Very Long Acting Insulin - Administration, Onset, Peak and Duration
Glargine | SQ
Onset 2 hr
Peak – none
Duration 24 h |
| Very Long Acting Insulin - Adverse Effects
Glargine | Hypoglycemia |
| Very Long Acting Insulin - Nursing Considerations
Glargine | • Used for basal dose
• Maintains blood glucose levels regardless of meals
• Cannot be mixed with other insulins
• Given at bedtime |
| Classification of
Travoprost
Latanoprost | Prostaglandins “prost”- first line therapy |
| Indications for
Travoprost
Latanoprost | • Increases ocular outflow through trabecular meshwork to decrease IOP, used to treat open angle glaucoma |
| Administration of
Travoprost
Latanoprost | Optic - Eye |
| Adverse Effects of
Travoprost
Latanoprost | • Local irritation and redness
• Brown pigmentation of the iris
• Lashes may grow longer |
| Nursing Considerations for
Travoprost
Latanoprost | • Administered once daily at bedtime
• Apply light pressure on lacrimal sac for 1 min following instillation |
| Classification of
Timolol maleate
Levobunolol | Beta blockers “lol” or “olol” |
| Indications of
Timolol maleate
Levobunolol | • Decrease production of aqueous humor and Reduces intraocular pressure in management of glaucoma
• Beta blocker |
| Administration of
Timolol maleate
Levobunolol | Optic – Eye |
| Adverse Effects of
Timolol maleate
Levobunolol | • Eye irritation
• Hypotension
• Increased airway resistance |
| Nursing Considerations of
Timolol maleate
Levobunolol | • Monitor BP and pulse
• Apply light pressure on lacrimal sac for 1 min following instillation
• Used in caution with clients already taking beta-blockers for HTN.
• Contraindicated in clients with history of asthma |
| Classification of
Meclizine
Diphenhydramine
Fexofenadine
Loratidine
Chlorpheniramine | Anti-vertigo - Antihistamines |
| Indication of Meclizine | • Vertigo |
| Indications of
Diphenhydramine
Fexofenadine
Loratidine
Chlorpheniramine | • Treat allergic rhinitis, allergies, vertigo, cough, sneezing |
| Administration of
Meclizine
Diphenhydramine
Fexofenadine
Loratidine
Chlorpheniramine | PO |
| Adverse Effects of
Meclizine | • Headache
• Vomiting
• Dry mouth
• Tiredness/drowsiness |
| Adverse Effects of
Diphenhydramine
Fexofenadine
Loratidine
Chlorpheniramine | • Drowsiness, excitement, photosensitivity
• Anticholinergic effects-dry mouth, urinary retention, constipation |
| Nursing Considerations of
Meclizine | • Avoid activities that require alertness |
| Nursing Considerations of
Diphenhydramine
Fexofenadine
Loratidine
Chlorpheniramine | • Use cautiously in CVD, HTN, renal ds. May be given pre-blood to decrease allergic response, increase fluid intake |
| Classification of
Promethazine
Prochlorperazine | Antiemetic |
| Indications for
Promethazine
Prochlorperazine | • Vertigo
• Nausea
• Vomiting
• Sedation |
| Administration of
Promethazine
Prochlorperazine | PO, IV, PR |
| Adverse Effects of
Promethazine
Prochlorperazine | • Drowsiness
• Dizziness
• Constipation
• Urinary retention
• Dry mouth |
| Nursing Considerations of
Promethazine
Prochlorperazine | • If used for motion sickness, take ½ hr before traveling
• Avoid activities that require alertness
• Avoid alcohol/CNS depressants |
