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DRUG STUDY
Name of Drug
Generic Name: Regular Insulin rand Name: Humulin R Novolin R Classification: Hormone and Synthetic substitute; anti diabetic agent Dosage! Route " #re$uenc%: D ! Adult:S" #$1% U 1#$&% min a'c' and h's' (dose ad)ustments based on blood glucose determinations* +etoacidosis!

Mechanism of Action
Short,actingclear- colorless solution o. e/ogenous unmodi.ied insulin e/tracted .rom beta cells in 0or1 0ancreas or synthesi2ed by recombinant DN3 technology (human*' 4nhances transmembrane 0assage o. glucose across cell membranes o. most body cells and by un1no5n mechanism may itsel. enter the cell to activate selected intermediary metabolic 0rocesses'

Indications
4mergency treatment o. diabetic 1etoacidosis or coma- to initiate thera0y in 0atient 5ith insulin, de0endent diabetes mellitusand in combination 5ith intermediate, acting or long,acting insulin to 0rovide better control o. blood glucose concentrations in the diabetic 0atient' Used I6 to stimulate gro5th hormone secretion (glucose counter regulatory hormone* to evaluate 0ituitary gro5th hormone reserve in 0atient 5ith 1no5n or sus0ected gro5th

Contraindications
Hy0ersensiti vity to insulin animal 0rotein'

Adverse Effect
Signs o. an allergic reaction- such as! , , , , ,

Nursing Responsibilities
Note! 8re9uency o. blood glucose monitoring is determined by the ty0e o. insulin regimen and health status o. the 0atient' :ab tests! ;eriodic 0ost0randial blood glucose- and Hb31"' Test urine .or 1etones in ne5unstable- and ty0e 1 diabetes; i. 0atient has lost 5eight- e/ercises vigorously- or has an illness; 5henever blood glucose is substantially elevated' Noti.y 0hysician 0rom0tly .or 0resence o. acetone 5ith sugar in the urine; may indicate onset o. 1etoacidosis' 3cetone 5ithout sugar in the urine usually signi.ies insu..icient carbohydrate inta1e'

Itching 3n une/0lained rash Hives S5elling o. the mouth or throat 7hee2ing or other di..iculty breathing

Sym0toms o. lo5 blood sugar- such as! , , , , , "old s5eats Sha1iness Di..iculty s0ea1ing S5eating Di22iness

< Adult:I6 <'=$>'< U loading dose.ollo5ed by <'=$ >'< U?h continuous in.usion ;romotes conversion o. glucose to glycogen' hormone de.iciency' , "hanges in behaviorsuch as irritability or mood s5ings :oss o. coordination 4/treme hunger @lurry vision "on.usion Sei2ures Unconscious ness'

, , , , , ,

onitor .or hy0oglycaemia at time o. 0ea1 action o. insulin' Anset o. hy0oglycemia (blood sugar! #%$=% mg?d:* may be ra0id and sudden' "hec1 @;- IBA ratioand blood glucose and 1etones every hour during treatment .or 1etoacidosis 5ith I6 insulin' Give 0atients 5ith severe hy0oglycemia glucagon- e0ine0hrine- or I6 glucose 1%C$#%C' 3s soon as 0atient is .ully conscious- give oral carbohydrate (e'g'- dilute corn syru0 or orange )uice 5ith sugar- Gatorade- or ;edialyte* to 0revent secondary hy0oglycemia'

Name of Drug

Mechanism of Action

Indications

Contraindications

Adverse Effect

Nursing Responsibilities

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Generic Name: et.ormin Classification: 3ntidiabetic; biguanides Dosage! Route " #re$uenc%: ;'A! #%%mg @ID- TID

@iguanide oral hy0oglycemic agent' Unli1e sul.onylureasbiguanides do not stimulate the release o. insulin .rom the beta cells o. the 0ancreas' echan ism o. action is thought to be due to both increasing the binding o. insulin to its rece0tor and 0otentiating insulin action'

Treatment o. ty0e < diabetes mellitus in 0atients not controlled 5ith diet alone' ay be used 5ith an oral sul.onylurea'

Hy0ersensiti vity to met.ormin; renalhe0atic- or cardio 0ulmonary insu..iciency; alcoholism; concurrent in.ection'

"NS! Headachedi22iness- agitation.atigue'

Assessment " Drug Effects :ab tests! Abtain baseline and 0eriodic 1idney and liver .unction tests; drug contraindicated in the 0resence o. renal or he0atic insu..iciency' onitor blood glucose and Hb31"- and li0id 0ro.ile 0eriodically' onitor 1no5n or sus0ected alcoholics care.ully .or decreased liver .unction' onitor cardio0ulmonary status throughout course o. thera0y; cardio0ulmonary insu..iciency may 0redis0ose to lactic acidosis' &atient " #amil% Education @e a5are that hy0oglycemia is not a ris1 5hen drug is ta1en in recommended thera0eutic doses

= unless combined 5ith other drugs 5hich lo5er blood glucose' Re0ort to 0hysician immediately SBS o. in.ection- 5hich increase the ris1 o. lactic acidosis (e'g'-abdominal 0ains- nausea and vomiting anore/ia*' Do not breast .eed 5hile ta1ing this drug 5ithout consulting 0hysician'

Name of Drug
Generic Name: Gli0i2ide Classification: 3ntidiabeticSul.onylurea (second

Mechanism of Action
Gli0i2ide a00ears to lo5er blood glucose acutely by stimulating the release o. insulin .rom the 0ancreas- an e..ect de0endent

Indications
, 3d)unct to diet and e/ercise to lo5er blood glucose 5ith ty0e < diabetes mellitus , 3d)unct to insulin thera0y in the

Contraindications
Hy0ersensiti vity' Ty0e 1 D ; 1etoacidosis; severe renal or he0atic insu..iciency' ;regnancy-

Adverse Effect
GI u0setsdiarrhoea- nausea; allergic s1in reactionsleuco0eniathrombocyto0eniaagranulocytosishy0onatraemia;

Nursing Responsibilities
Assessment History! 3llergy to sul.onylureas; diabetes 5ith com0lications; ty0e 1 diabetes- serious he0atic or renal im0airment- uremiathyroid or endocrine

# generation* Dosage! Route " #re$uenc%: TabletsD#- 1% mg; 4R tabletsD <'#- #- 1% mg Dosages ! Give a00ro/imately &% min be.ore brea1.ast to achieve greatest reduction in 0ost0randial hy0erglycemia' 3DU:TS Initial therapy: # mg ;A be.ore brea1.ast' 3d)ust dosage in increments o. <'#$# mg as determined by blood glucose res0onse' 3t least several days should ela0se bet5een ad)ustments' u0on .unctioning beta cells in the 0ancreatic islets' 4/tra0ancreatic e..ects also may 0lay a 0art in the mechanism o. action o. oral sul.onylurea hy0oglycemic drugs' T5o e/tra0ancreatic e..ects sho5n to be im0ortant in the action o. gli0i2ide are an increase in insulin sensitivity and a decrease in he0atic glucose 0roduction' Ho5ever- the mechanism by 5hich gli0i2ide lo5ers blood glucose during long,term administration has not been clearly established' Stimulation o. insulin secretion by gli0i2ide in res0onse to a stabili2ation o. certain cases o. ty0e 1 diabetes- reducing the insulin re9uirement and decreasing the chance o. hy0oglycemic reactions lactation' )aundice; haemolytic anaemia0ancyto0enia' ;otentially 8atal! Hy0oglycaemia in 0resence o. renal or he0atic damage and alcohol'

im0airmentglycosuriahy0erglycemia associated 5ith 0rimary renal disease; 0regnancy Physical! S1in colorlesions; T; orientationre.le/es- 0eri0heral sensation; Radventitious sounds; liver evaluationbo5el sounds; urinalysis- @UNserum creatinine:8Ts- blood glucose"@"

Interventions Give drug &% min be.ore brea1.ast; i. severe GI u0set occurs or more than 1# mg?day is re9uired- dose may be divided and given be.ore meals' onitor urine or serum glucose levels .re9uently to determine drug e..ectiveness and dosage' 73RNING! Trans.er to

E meal is o. ma)or im0ortance'

a/imum once,daily dose should not e/ceed 1# mg; above 1# mg- divide dose- and administer be.ore meals' Do not e/ceed =% mg?day' 4R tablets! # mg?day' 3d)ust dosage in #, mg increments every & mo; ma/imum doseD<% mg?day' Maintenance therapy: Total daily doses above 1# mg ;A should be divided; total daily doses above &% mg are given in divided doses bid' Extended

insulin thera0y during 0eriods o. high stress (eg- in.ectionssurgery- trauma*' 73RNING! Use I6 glucose i. severe hy0oglycemia occurs as a result o. overdose'

'eaching points Ta1e this drug &% minutes be.ore brea1.ast .or best results' Do not discontinue this drug 5ithout consulting your health care 0rovider' onitor urine or blood .or glucose and 1etones' I. ta1ing 4R tabletss5allo5 them 5hole; do not crush- che5- or divide tablets' The em0ty tablet may a00ear in your stool' Do not use this drug during 0regnancy; consult health care 0rovider' 3void alcohol 5hile using this drug'

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release: # mg?day 5ith brea1.ast- may be increased to 1% mg?day a.ter & mo i. indicated'

Re0ort .ever- sore throat- unusual bleeding or bruisingrash- dar1 urine- light, colored stoolshy0oglycemic or hy0erglycemic reactions'

Name of Drug

Mechanism of Action

Indications

Contraindications

Adverse Effect

Nursing Responsibilities

F Instruct to re0ort to the doctor or nurse as soon as 0ossible i. any o. the .ollo5ing side e..ects occur!

Generic Name: Glicla2ide Classification: Aral hy0oglycemic (anti,diabetic drug* and is classi.ied as a sul.onylurea Dosage! Route " #re$uenc%:
There is no .i/ed dosage regimen .or the management o. diabetes mellitus 5ith glicla2ide or any other hy0oglycemic agent' Determination o. the 0ro0er dosage .or glicla2ide .or each 0atient should be made on the basis o. .re9uent determinations o. blood glucose during dose titration and throughout maintenance' The recommended daily dosage is F%

The hy0oglycemic action o. glicla2ide is related to an im0rovement in insulin secretion .rom the .unctioning beta cells o. the 0ancreas' It 0otentates the insulin releaseim0roves the dynamics o. insulin.

This medication is an oral hy0oglycemic (anti, diabetic drug*0rescribed .or ty0e < diabetes' It stimulates the 0ancreas- 5hich hel0s in more insulin secretion'

"ontraindicat ed in 0atients 5ith diabetic, 1etoacidosissevere liver and 1idney im0airmentand hy0ersensitiv ity'

GI disturbancess1in reactiondecrease in blood cell counts)aundice- vomitingdiarrhea and stomach in.lammation'

de0ression high blood 0ressure s1in rash or hives s5elling o. the legs or une/0ected 5eight gain sym0toms caused by lo5 blood sugar! o an/iousness o blurred vision o cold s5eats o con.usion o di..iculty concentrating o dro5siness o .ast heart rate o .eeling drun1 o headache o hunger o nausea o nervousness o nightmares o sha1iness o slurred s0eech o unusual tiredness sym0toms o. liver 0roblems- e'g'! o dar1 urine

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to &<% mg' Dosage o. 1E% mg and above should be divided into < e9ual 0arts .or t5ice a day administration' Glicla2ide should be ta1en 0re.erentially 5ith meals'

light stools yello5ing o. s1in or eyes unusual bleeding or bruising

o o

Sto0 ta1ing the medication and see1 immediate medical attention if any of the follo(ing occur:

chest 0ain or 0ressure and?or shortness o. breath sei2ures sym0toms o. a serious allergic reaction- e'g'! o di..iculty breathing or shortness o. breath o hives o s5elling o. the .ace- li0s- or throat unconsciousness

Name of Drug

Mechanism of Action

Indications

Contraindi cations

Adverse Effect

Nursing Responsibilities

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Generic Name: Simvastatin Classification: 3nti, hy0erli0idemic 3gent Dosage! Route " #re$uenc%: The recommended dose range o. simvastatin is 1% mg to =% mg- and it is administered once daily in the evening 5ith or 5ithout .ood' Thera0y usually is initiated 5ith 1% or <% mg dailybut individuals 5ho have a high ris1 o. heart disease can be started on =% mg daily'

Inhibits H G,"o3 reductase- the en2yme that cataly2es the .irst ste0 in the cholesterol synthesis 0ath5ay- resulting in a decrease in serum cholesterolserum :D:s- and either an increase or no change in serum HD:s'

3d)unct to diet in the treatment o. elevated total cholesterol and :D: cholesterol 5ith 0rimary hy0ercholesterolemi a in those unres0onsive to dietary restriction o. saturated .at and cholesterol and other non0harmacologic measures' Treatment o. 0atients 5ith isolated hy0er triglyceridemia'

"ontraindicat ed 5ith allergy to simvastatin.ungal by0roducts0regnancylactation' &recautions : H ;ast liver diseasealcoholismsevere acute in.ectionstrauma- severe metabolic disorderselectrolyte imbalanceselderly- renal disease'

CN): Headache- astheniaslee0 disturbances GI: 8latulencediarrhea- abdominal 0aincram0s- consti0atio n- nauseadys0e0siaheartburn- liver .ailure Respirator%: Sinusitis- 0haryngitis *ther: Rhabdomyolysisacute renal .ailure arthralgia- myalgia

4nsure that 0atient has tried a cholesterol,lo5ering diet regimen .or &,E mo be.ore beginning thera0y' 3ssess nutrition! .at0rotein- carbohydrates Give in the evening; highest rates o. cholesterol synthesis are bet5een midnight and # 3 ' 3dvise not to drin1 gra0e.ruit 5hile using this drug' onitor bo5el 0attern daily onitor triglyceridescholesterol baseline throughout treatment'

Name of Drug

Mechanism

Indications

Contraindi

Adverse Effect

Nursing

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of Action
Generic Name: "e.uro/ime Classification: 3ntibiotic"e0halos0orin (second generation* Dosage! Route " #re$uenc%: Ty0ical adult oral doses are <#% or #%% mg t5ice daily .or >,<% days de0ending on the ty0e and severity o. the in.ection' The usual adult dosage range .or ce.uro/ime (ce.uro/ime in)ection* is >#% mg to 1'# grams every F hoursusually .or # to 1% days' @actericidal! inhibits synthesis o. bacterial cell 5all- causing cell death' It is e..ective .or the treatment o. 0enicillinase, 0roducing Neisseria gonorrhoea (;;NG*' 4..ectively treats bone and )oint in.ectionsbronchitismeningitisgonorrhea- otitis media0haryngitis?tonsillitis - sinusitis- lo5er res0iratory tract in.ections- s1in and so.t tissue in.ections- urinary tract in.ections- and is used .or surgical 0ro0hyla/isreducing or eliminating in.ection'

cations
3llergy to ce0halos0ori ns or 0enicillinsrenal .ailurelactation0regnancy Headachedi22inesslethargy- 0aresthesi asNausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembran ous colitis! liver to/icity- Ne0hroto/i citybone marro( depression! decre ased 7@"decreased 0lateletsdecreased Hct- Ran ging from rash to fever to anaph%la+is! seru m sic1ness reaction- Pain, absc ess at in)ection site- phlebitis,in.la mmation at I6 site'

Responsibilities
Determine history o. hy0ersensitivity reactions to ce0halos0orins0enicillins- and history o. allergies0articularly to drugsbe.ore thera0y is initiated' Ins0ect I and I6 in)ection sites .re9uently .or signs o. 0hlebitis' Give oral drug 5ith .ood to decrease GI u0set and enhance absor0tion' Re0ort onset o. loose stools or diarrhea' onitor IBA rates and 0attern! 4s0ecially im0ortant in severely ill 0atients receiving high doses' Re0ort any signi.icant changes'

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Submitted by!

ARCENAS, GARNET RNHeals A;D $ D "linic