Endocrine- DM

  1. The nurse is caring for a client with a history of heart failure just diagnosed with type 2 diabetes mellitus. The health care provider prescribes an oral hypoglycemic for the client. Which oral hypoglycemic medication prescribed for this client should the nurse question?
    An adverse effect of pioglitazone is heart failure secondary to renal retention of fluid. For most clients, fluid retention is not clinically significant. However, for clients with heart failure, especially severe or uncompensated heart failure, increased fluid retention can make heart failure worse. Accordingly, pioglitazone should be used with caution in clients with mild heart failure and should be avoided by those with severe failure. Thus, option 4 is the correct option. Options 1, 2, and 3 do not have any side effects and adverse effects related to heart failure.
  2. Pramlintide
    Pramlintide is used for clients with types 1 and 2 diabetes mellitus who use insulin. It is administered subcutaneously before meals to lower blood glucose level after meals, leading to less fluctuation during the day and better long-term glucose control. Because pramlintide delays gastric emptying, oral medications should be given 1 hour before or 2 hours after an injection of pramlintide; therefore, instructing the client to take his or her pills 1 hour before or 2 hours after the injection is correct. Pramlintide should not be taken at the same time as other medications. Pramlintide is given immediately before the meal in order to control postprandial rise in blood glucose, not necessarily to prevent stomach upset. It is incorrect to instruct the client to take the medication after eating, as it will not achieve its full therapeutic effect.
  3. Metformin
    acts by decreasing hepatic production of glucose. Metformin should be used with caution in clients with kidney or liver disease, heart failure, chronic lung disease, or a history of heavy alcohol consumption.
  4. Metformin
    Metformin is classified as a biguanide and is the most commonly used medication for type 2 diabetes mellitus initially. It is also often used as a preventive medication for those at high risk for developing diabetes mellitus. When used alone, metformin lowers the blood sugar after meal intake as well as fasting blood glucose levels. Metformin does not stimulate insulin release and therefore poses little risk for hypoglycemia. For this reason, metformin is well suited for clients who skip meals. Unusual somnolence, as well as hyperventilation, myalgia, and malaise, are early signs of lactic acidosis, a toxic effect associated with metformin. If any of these signs or symptoms occur, the client should inform the health care provider immediately. While it is best to avoid consumption of alcohol, it is not always realistic or feasible for clients to quit drinking altogether; for this reason, clients should be informed that excessive alcohol intake can cause an adverse reaction with metformin.
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Endocrine- DM