Create
Learn
Share

NURS 133 Sulfonylureas and Metformin

rename
jasmine's version from 2016-04-19 13:39

Section 1

Question Answer
Sulfonylureas Anti-diabetics; Control of blood glucose in type 2 diabetes mellitus when diet therapy fails; Require some pancreatic function
Sulfonylureas actions Lower blood glucose by stimulating the release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites; May also decrease hepatic glucose production
Sulfonylureas therapeutic uses Lowering of blood glucose in diabetic patients
Elimination/Excretion of SulfonylureasAll agents are mostly metabolized by the liver; Glimepiride-converted to a metabolite with some hypoglycemic activity; glyburide-primarily metabolized by CYP2C9 (primary enzyme responsible for metabolizing non-steroidal anti-inflammatory drugs [NSAIDS]), oral anti-diabetic agents, and angiotensin II receptor blockers (ARBs); also is major enzyme involved in disposition of warfarin)
Adverse/Side Effects of Sulfonylureas Photosensitivity; hypoglycemia; aplastic anemia
Contraindications of Sulfonylureas Hypersensitivity; Hypersensitivity with sulfonamides (cross-sensitivity may occur); Type I diabetes; Diabetic coma or ketoacidosis; Concurrent use of bosentan (glyburide only)
Drug/Food interactions of Sulfonylureas Increase risk of elevated liver enzymes when bosentan used with glyburide (avoid concurrent use); Effectiveness may be decreased by concurrent use of diuretics, corticosteroids, phenothiazines, oral contraceptives, estrogens, thyroid preparations, phenytoin, niacin, sympathomimetics, and isoniazid; Alcohol, androgens (testosterone), chloramphenicol, clarithromycin, fluoroquinolones, MAO inhibitors, NSAIDs, salicylates, sulfonamides, and warfarin may increase risk of hypoglycemia; Concurrent use with warfarin may alter the response to both agents (increase effects of both initially, then decrease activity)-close monitoring recommended during any changes in dose; Beta blockers may mask signs and symptoms of hypoglycemia
Medication administration of Sulfonylureas PO
Nursing interventions of Sulfonylureas Confirm patient has type 2 diabetes prior to administrating; observe for signs and symptoms of hypoglycemic reactions (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety); Assess patient for allergy to sulfonamides; Lab test considerations: monitor serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness of treatment; monitor CBC periodically during therapy, and report decrease in blood counts promptly
Client education of Sulfonylureas Instruct patient to take medication at same time each day and as directed; Explain medication controls hyperglycemia, and therapy is long term; Review signs of hypoglycemia and hyperglycemia with patient-advise a glass of orange juice with hypoglycemia or other, and notify health care professional; Encourage patient to follow prescribed diet and exercise regimen; Instruct patient in proper testing of serum glucose and ketones, including during episodes of stress or illness; Caution patient use of alcohol may cause a disulfiram-like reaction (abdominal cramps, nausea, flushing, headaches, and hypoglycemia); May occasionally cause dizziness or drowsiness, so caution patient to avoid driving or other activities requiring alertness until response to medication is known; Caution patient to use sunscreen and protective clothing; Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times; Advise patient to notify health care professional promptly if unusual weight gain, swelling of ankles, drowsiness, shortness of breath, muscle cramps, weakness, sore throat, rash, or unusual bleeding or bruising occurs; Counsel female patients to use a form of contraception other than oral contraceptives and to notify health care professional if pregnancy is planned or suspected; Emphasize the importance of follow up exams
Evaluation/Desired outcomes of Sulfonylureas Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes
Potential nursing diagnoses of Sulfonylureas Imbalanced nutrition: more than body requirements (indications); Non-compliance (patient/family teaching)
memorize

Section 2

Question Answer
Metformin Anti-diabetics: Management of type 2 diabetes mellitus; May be used with diet, insulin, or sulfonylurea oral hypoglycemics
Metformin actions Decreases hepatic glucose production; Decreases intestinal glucose absorption; Increases sensitivity to insulin
Metformin therapeutic uses Maintenance of blood glucose
Elimination/Excretion of Metformin Eliminated almost entirely unchanged by the kidneys
Adverse/Side Effects of Metformin Abdominal bloating, diarrhea, nausea, vomiting, lactic acidosis
Contraindications of Metformin Hypersensitivity; Metabolic acidosis; dehydration, sepsis, hypoxemia, hepatic impairment, excessive alcohol use (acute or chronic); renal dysfunction; Radiographic studies requiring IV iodinated contrast media (withhold metformin); HF; Safety not established in pregnancy, lactation, or children less than 10 years of age
Drug/Food interactions of Metformin Acute or chronic alcohol ingestion or iodinated contrast media increase risk of lactic acidosis; Amiloride, digoxin, morphine, procainamide, quinidine, ranitidine, triamterene, trimethoprim, calcium channel blockers, and vancomycin may compete for elimination pathways with metformin-altered responses may occur; cimetidine and furosemide may increase effects of metformin; Nifedipine increase absorption and effects; Glucosamine may worsen blood glucose control; Chromium and co-enzyme Q-10 may produce increase hypoglycemic effects
Medication administration of Metformin PO
Nursing interventions of Metformin When combined with oral sulfonylureas, observe for signs and symptoms of hypoglycemic reactions (abdominal pain, sweating, hunger, weakness, dizziness, headache, tremor, tachycardia, anxiety); 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; Lab test considerations: Monitor serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness; Assess renal function before initiating and at least annually during therapy; Discontinue metformin if renal impairment occurs; Monitor serum folic acid and vitamin B12 every 1-2 years in long-term therapy; Metformin may interfere with absorption; Withhold metformin before or at the time of studies requiring IV administration of iodinated contrast of media and for 48 hours after study
Client education of Metformin Instruct patient to take metformin at eh same time each day, and as directed; Explain to patient that metformin helps control hyperglycemia, and therapy is usually long term; Encourage patient to follow prescribed diet and exercise regimen to prevent hyperglycemic or hypoglycemic episodes; review signs of hypoglycemia and hyperglycemia with patient; If hypoglycemia occurs, advise patient to take a glass of orange juice or other and notify health care professional; Instruct patient in proper testing of blood glucose and urine ketones-these tests should be monitored closely during periods of stress or illness; 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 BP, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea, or weakness) should be reported to health care professional immediately; Inform patient that metformin may cause an unpleasant or metallic taste that usually resolves spontaneously; Inform patients taking XR tablets that inactive ingredients resembling XR tablet may appear in stools; Counsel female patients to use a form of contraception other than oral contraceptives and to notify health care professional promptly if pregnancy is planned or suspected, or if breast feeding; Advise patient to carry a form of sugar (sugar packets, candy) and identification describing disease process and medication regimen at all times; Emphasize the importance of routine follow up exams
Evaluation/Desired outcomes of Metformin Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes; Control may be achieved within a few days, yet full effect of therapy may be delayed for up to 2 weeks; If patient has not responded to metformin after 4 weeks 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
Potential nursing diagnoses of Metformin Imbalanced nutrition: more than body requirements (indications); Non-compliance (patient/family teaching)
memorize