Lardizabal, Rafael Joseph P.

11/21/20
NDA4

DM

DRUG MODE OF ACTION INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING

CONSIDERATIONS

GENERIC NAME: Oral hypoglycemic Adjunct to diet and Hypersensitivity to repaglinide; Body as a Whole: -Monitor carefully for S&S of
REPAGLINIDE agent that lowers exercise in type 2 insulin-dependent diabetes, Arthralgia, back pain, hypoglycemia especially
blood glucose levels diabetes. May also diabetic ketoacidosis, paresthesia, allergy. during the 1-wk period
BRAND NAME:  by stimulating be used in hypoglycemia; severe renal CNS: Headache.  following transfer from a
PRANDIN release of insulin combination with dysfunction; pregnancy (category CV: Chest pain, longer-acting sulfonylurea
from the pancreatic metformin. C), lactation. such as chlorpropamide.
angina. 
CLASSIFICATION: islets. -Take only with meals to
GI: Nausea, diarrhea,
ANTIDIABETIC lessen the chance of
constipation,
AGENT; hypoglycemia. If a meal is
vomiting, dyspepsia. skipped, skip a dose; if a meal
MEGLITINIDE
Respiratory: URI, is added, add a dose.
ROUTE AND sinusitis, rhinitis, -Start repaglinide the morning
DOSAGE: bronchitis.  after the other agent is
PO: 0.5 mg 15–30 Metabolic: stopped when changing from
min a.c. Hypoglycemia. another oral hypoglycemic
drug.
-Do not breast feed while
taking this drug.

DRUG MODE OF ACTION INDICATIONS CONTRA ADVERSE EFFECTS NURSING

INDICATIONS CONSIDERATION

GENERIC NAME: Biguanide oral Treatment of type 2 Hypersensitivity to metformin; CNS: Headache, Lab tests: Obtain baseline
METFORMIN hypoglycemic agent. diabetes mellitus in hepatic or cardiopulmonary dizziness, agitation, and periodic kidney and
 Unlike sulfonylureas, patients not insufficiency; alcoholism; fatigue. Metabolic: Lactic liver function tests; drug
BRAND NAME: biguanides do not controlled with diet concurrent infection; acute MI, acidosis. GI: Nausea, contraindicated in the
FORTEMET stimulate the release of alone. May be used cardiogenic shock; diabetic vomiting, abdominal pain, presence of renal or
insulin from the beta with an oral ketoacidosis; hypoxemia, lactic bitter or metallic taste, hepatic insufficiency. 
CLASSIFICATION: cells of the pancreas. sulfonylurea. acidosis; radiographic contrast diarrhea, bloatedness,
ANTIDIABETIC Mechanism of action is administration; renal disease, anorexia; malabsorption Monitor blood glucose and
AGENT thought to be due to renal failure, renal impairment; of amino acids, vitamin HbA1C, and lipid profile
both increasing the sepsis; surgery; children <10 y, B12, and folic acid periodically.
ROUTE AND binding of insulin to its lactation. possible. Monitor known or
DOSAGE: receptor and suspected alcoholics
500 mg q.d. to t.i.d. or potentiating insulin carefully for decreased
850 mg q.d. to b.i.d. action. liver function.
with meals
Monitor cardiopulmonary
status throughout the
course of therapy;
cardiopulmonary
insufficiency may
predispose to lactic
acidosis.

Be aware that
hypoglycemia is not a risk
when a drug is taken in
recommended therapeutic
doses unless combined
with other drugs which
lower blood glucose.

Report to the physician

immediately S&S of
infection, which increases
the risk of lactic acidosis
(e.g., abdominal pains,
nausea, and vomiting,
anorexia).

DRUG MODE OF ACTION
GENERIC NAME: Short-acting, clear,
Insulin (Regular) colorless solution of
exogenous unmodified
BRAND NAME: insulin extracted from beta
Humulin R cells in pork pancreas or
synthesized by
CLASSIFICATION: recombinant DNA
Antidiabetic Agent technology (human).
Enhances transmembrane
ROUTE AND passage of glucose across
DOSAGE: cell membranes of most
SC 5–10 U 15–30 body cells and by unknown
min a.c. and h.s. mechanism may itself enter
(dose adjustments the cell to activate selected
based on blood intermediary metabolic
glucose processes. Promotes
Do not breast feed while
taking this drug without
consulting a physician.
INDICATIONS CONTRAINDICATIONS ADVERSE EFFECT NURSING
DIAGNOSIS
Emergency treatment of Hypersensitivity to Body as a Whole: Most -Note: Frequency of
diabetic ketoacidosis or insulin animal protein. adverse effects are related to blood glucose
coma, to initiate therapy in hypoglycemia; anaphylaxis monitoring is
patients with insulin- (rare), hyperinsulinemia determined by the
dependent diabetes [Profuse sweating, hunger, type of insulin
mellitus, and in headache, nausea, regimen and health
combination with tremulousness, tremors, status of the
intermediate-acting or palpitation, tachycardia, patient.
long-acting insulin to weakness, fatigue, -Lab tests: Periodic
provide better control of nystagmus, circumoral pallor; postprandial blood
blood glucose numb mouth, tongue, and glucose, and HbA1C.
concentrations in the other paresthesias; visual Test urine for
diabetic patient. Used IV disturbances (diplopia, ketones in new,
to stimulate growth blurred vision, mydriasis), unstable, and type 1
hormone secretion staring expression, confusion, diabetes;
(glucose counter personality changes, ataxia, -Notify physician
determinations) conversion of glucose to regulatory hormone) to incoherent speech,
glycogen. evaluate pituitary growth apprehension, irritability,
hormone reserve in inability to concentrate,
patients with known or personality changes,
suspected growth uncontrolled yawning, loss of
hormone deficiency.  consciousness, delirium,
hypothermia, convulsions,
Babinski reflex, coma. (Urine
glucose tests will be
negatives).
 CNS: With overdose, psychic
disturbances (i.e., aphasia,
personality changes,
maniacal behavior).
Metabolic:
Posthypoglycemia or rebound
hyperglycemia (Somogyi
effect), lipoatrophy and
lipohypertrophy of injection
sites; insulin resistance.  -Inject insulin into
Skin: Localized allergic
reactions at injection site;
generalized urticaria or
bullae, lymphadenopathy.
promptly for
presence of
acetone with sugar
in the urine; may
indicate onset of
ketoacidosis.
Acetone without
sugar in the urine
usually signifies
insufficient
carbohydrate
intake.
-Check BP, I&O
ratio, and blood
glucose and
ketones every hour
during treatment for
ketoacidosis with
IV insulin.
the abdomen rather
than a near muscle
that will be heavily
taxed, if engaged in
active sports.
-Notify physicians
of local reactions at
injection site;