DRUG STUDY
DRUG DATA CLASSIFICATION
Generic Name: -Metformin is classified
METFORMIN as a biguanide, a group
of anti-diabetic drugs that
Trade/Brand Name: lowers blood sugar.
Glucophage, -Biguanides originate
Glucophage XR, from a lilac bush
Fortamet, and preparation that has long
Glumetza been used in herbal
medicine.
Patient Dose: 500 mg -In 1957, a French doctor
orally, BID named one biguanide
'Glucophage,' which
means 'glucose eater.'
-Today we know that
biguanides, and thus
metformin, do not eat
glucose to lower blood
sugar.
-Metformin slows the
release of glucose from
the liver, slows blood
glucose uptake from the
intestine, and increases
insulin sensitivity.
MECHANISM
OF ACTIONS
-Metformin is an anti-
hyperglycemic agent,
which improves glucose
tolerance in patients with
type 2 diabetes, lowering
both basal and
postprandial plasma
glucose.
-Its pharmacologic
mechanisms of action are
different from other
classes of oral anti-
hyperglycemic agents.
-Metformin decreases
hepatic glucose
production, decreases
intestinal absorption of
glucose, and improves
insulin sensitivity by
increasing peripheral
glucose uptake and
utilization.
-Unlike sulfonylureas,
metformin does not
produce hypoglycemia in
either patients with type 2
diabetes or normal
subjects (except in special
circumstances) and does
not cause
hyperinsulinemia.
INDICATIONS CONTRAINDICATIONS ADVERSE NURSING
REACTIONS RESPONSIBILITIES
-Metformin is primarily Conditions: -Asthenia
suited for the treatment -Diarrhea Assessment
of subjects with non-  infection -Flatulence
insulin-dependent  low blood sugar -Weakness  History: Allergy
diabetes mellitus.  pituitary hormone -Myalgia to metformin;
-Compared to other deficiency -Upper respiratory tract diabetes
antidiabetic agents, it has  decreased function infection complicated by
the advantages of of the adrenal -Hypoglycemia fever, severe
lowering rather than gland -GI complaints infections, severe
increasing body weight,  inadequate vitamin -Lactic acidosis (rare) trauma, major
of not causing B12 -Low serum vitamin B- surgery, ketosis,
hypoglycemia, and of  excess body acid 12 acidosis, coma;
entailing a reduction of  extreme loss of -Nausea/vomiting type 1 diabetes,
triglycerides and LDL- body water -Chest discomfort serious hepatic or
cholesterol levels.  alcoholism -Chills renal impairment,
-Metformin is therefore  alcohol -Dizziness uremia, thyroid
recommended in single intoxication -Abdominal distention or endocrine
drug therapy especially  heart attack -Constipation impairment,
for obese subjects. In the  suddenly serious -Heartburn glycosuria,
majority of the treated symptoms of heart -Dyspepsia hyperglycemia
subjects, a lowering of failure associated with
blood glucose levels by  liver problems primary renal
at least 25% is achieved  fever disease, CHF,
-Metformin can also be  Shock pregnancy,
combined with other  Severe Vomiting lactation
antidiabetic agents. It  Severe Diarrhea  Physical: Skin
can thus e.g. be used  Serious Lack of color, lesions; T,
when there is secondary Oxygen in the orientation,
failure with Blood reflexes,
sulfonylureas. -  Weakened Patient peripheral
Occasionally a small  Sepsis sensation; R,
VENTURANZA, Aira Mae
BSN II-B
-With metformin therapy, dose of metformin  chronic kidney adventitious
insulin secretion remains combined with a disease stage 3B sounds; liver
unchanged while fasting sulfonylurea is sufficient (moderate) evaluation, bowel
insulin levels and daylong to restore an adequate  chronic kidney sounds;
plasma insulin response diabetic control. In disease stage 4 urinalysis, BUN,
may actually decrease. carefully selected cases, a (severe) serum creatinine,
combination with insulin  chronic kidney LFTs, blood
can also be sensible — disease stage 5 glucose, CBC
particularly for obese (failure)
subjects with relative  kidney disease Interventions
insulin resistance. with likely
-Proof that the drug has reduction in kidney  Monitor urine or
an advantageous effect function serum glucose
on the prognosis of levels frequently
diabetes (complications, Allergies: to determine
mortality) does not exist. effectiveness of
 Biguanides drug and dosage.
 WARNING:
Arrange for
transfer to insulin
therapy during
periods of high
stress (infections,
surgery, trauma).
 WARNING: Use
IV glucose if
severe
hypoglycemia
occurs as a result
of overdose.

Teaching points

 Do not
discontinue this
medication
without
consulting your
VENTURANZA, Aira Mae
BSN II-B
 health care
provider.
 Monitor urine or
blood for glucose
and ketones as
prescribed.
 Swallow
extended-release
tablets whole; do
not cut, crush, or
chew.
 Do not use this
drug during
pregnancy; if you
become pregnant,
consult with your
health care
provider for
appropriate
therapy.
 Avoid using
alcohol while
taking this drug.
 Report fever,
sore throat,
unusual bleeding
or bruising, rash,
dark urine, light-
colored stools,
hypo- or
hyperglycemic
reactions.

Generic Name: -Citicoline (INN), also -As a medicine, it is -Patients with hypertonia Citicoline was well  Instruct patient
Citicoline known as cytidine Neuroprotective effects taken by mouth as a of the parasympathetic tolerated in clinical trials. to take the
diphosphate-choline The neuroprotective supplement or given by nervous system. Adverse effects may medication as
Trade/Brand Name: (CDP-Choline) or effects exhibited by IV or as a shot. - -Hypersensitivity include GI disturbances,
citicoline may be due to its
prescribed.
Cebroton, Ceraxon, cytidine 5'- Citicoline is used for transient headaches,  Teach the
VENTURANZA, Aira Mae
BSN II-B
Cidilin, Citifar, Cognizin,
Difosfocin, Hipercol,
NeurAxon, Nicholin,
Sinkron, Somazina,
Synapsine, Startonyl,
Trausan, Xerenoos, etc
Patient Dose: 1 g, QD
diphosphocholine is an preservation of cardiolipin Alzheimer's disease and hypotension, tachycardia, patient that
intermediate in the and sphingomyelin, other types of dementia, bradycardia, and citicoline may
generation of preservation of head trauma, restlessness. be taken with or
phosphatidylcholine from arachidonic acid content cerebrovascular disease without food.
choline, a common of phosphatidylcholine such as stroke, age-  Monitor for
biochemical process in and related memory loss,
adverse effects;
cell membranes. phosphatidylethanolamine, Parkinson's disease,
-Citicoline is naturally partial restoration of attention deficit- instruct patient
to report
occurring in the cells of phosphatidylcholine hyperactive disorder
human and animal tissue, levels, and stimulation of (ADHD), and glaucoma. immediately if
in particular the organs. glutathione synthesis and he/she develops
glutathione reductase chest tightness,
activity. tingling in
mouth and
Neuronal membrane
throat,
The brain preferentially
uses choline to synthesize
headache,
acetylcholine. This limits diarrhea and
the amount of choline blurring of
available to synthesize vision.
phosphatidylcholine.
When the availability of
choline is low or the need
for acetylcholine
increases, phospholipids
containing choline can be
catabolized from neuronal
membranes. This can
lower levels of hydroxyl
radicals produced after an
ischemia and prevent
cardiolipin from being
catabolized by
phospholipase A2. It can
also work to restore
cardiolipin levels in the
inner mitochondrial
membrane.
VENTURANZA, Aira Mae
BSN II-B
Cell signaling
Citicoline enhances
cellular communication by
increasing the availability
of neurotransmitters,
including acetylcholine,
norepinephrine, and
dopamine.[23]

Glutamate transport
Citicoline lowers
increased glutamate
concentrations and raises
decreased ATP
concentrations induced by
ischemia. Citicoline also
increases glutamate uptake
by increasing expression
of EAAT2, a glutamate
transporter, in vitro in rat
astrocytes.

VENTURANZA, Aira Mae

BSN II-B
VENTURANZA, Aira Mae

Px’s Name: Raquepo, Macedonia

Age: 75

Diagnosis: t/c Acute Myocardial Infarction

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

“Marigatan nak nga aganges,”
as verbalized by the Px

VENTURANZA, Aira Mae

BSN II-B