1. Acarbose (Precose)
    • Classification: Alpha-glucosidase inhibitor
    • Action: delays absorption of carbohydrates and reduces the rise in blood glucose that occurs after meals. Acarbose inhibits the alpha-gluosidase enzyme. This action slows the digestion of carbohydrates, reducing the postprandial (after meals) rises in blood glucose
    • Uses:
    • type 2 diabetes mellitus not controlled by diet or exercise
    • in conjunction with insulin or a sulfonylurea
    • Contraindications and Precautions:
    • hepatic and renal problems
    • type 1 diabetes mellitus
    • hyperosmolar hyperglycemic nonketotic states
    • diabetic ketoscidosis
    • severe infections
    • major surgery
    • trauma
    • coma
    • intestinal problems
    • Side effects:
    • flatulence, cramps abdominal distention
    • borborymus (rumbling bowel sounds), diarrhea
    • liver dysfunction
    • decreased absorption of iron
    • Nursing implications:
    • liver function should be monitored every 3 months
    • monitor complete blood count and HbA1c
    • may cause hypoglycemia when combined with insulin and sulfonylurea (class of antidiabetic drugs that are used in the managment of diabetes mellitus type 2, they act by increasing insulin release from beta cells in the pancreas)
    • teach client to take the medication at the beginning of each meal
  2. Sulfonylureas
    First generation: Orinase, Dymelor, Diabinese, Tolinase
    Second generation: Glucotrol, DiaBeta, Amaryl
    • Classification: antidiabetic (sulfonylurea type)
    • Action: stimulates the beta cells of the pancreas to increase release of insulin. It also increases the sensitivity of periheral insulin receptors, which increase insulin binding in the peripheral tissues
    • Uses:
    • mild-to-moderate type 2 diabetes mellitus
    • when diet and exercise programs are unable to maintain glucose control
    • Contraindications:
    • diabetic ketoacidosis
    • type 1 diabetes mellitus
    • Precautions:
    • adrenal or pituitary insufficiency
    • severe hepatic or renal impairment
    • Side effects:
    • Hypoglycemia
    • Nursing implications:
    • instruct client to take the drug 15 to 30 minutes before meals, do not take medication and skip meals
    • monitor blood glucose levels daily
    • teach client to maintain weight and dietary restrictions along with medication
    • call the doctor for signs of hypoglycemia (fatigue, hunger, cool moist skin, increased anxiery, dizziness, palpitaitons)
  3. Corticosteroids
    • Classification:Adrenocorticosteroid, glucocorticoid
    • Action: suppresses the inflammatory and immune systems by inhibiting synthesis of chemical mediators (prostaglandins, leukotrienes, and histamine). Action is to decrease inflammation, which then resuces swelling, warmth, redness, and pain
    • Uses:
    • addison's disease, hormone replacement, cancer therapy
    • to decrease inflammation-systemic lupus erythematosus, rheumatioid arthritis, inflammatory bowel diaease, allergic conditions, asthma, chronic obstructive pulmonary disease, respiratory distress syndrome in infants
    • to suppress graft rejection
    • Contraindications:
    • systemic fungal infection
    • when receiving live virus vaccines
    • Precautions:
    • pediatric clients, pregancy, and breastfeeding
    • hypertension, heart failure, renal impairment
    • infections resistant to treatment
    • Side effects:
    • peptic ulcers, gastrointestinal bleeding, edema
    • osteoporosis, hyperglycemia, delayed wound healing
    • muscle wasting, fluid and electrolyte disturbance, cushing's syndrome
    • Nursing implications:
    • check fluid balance and potassium and glucose levels
    • warn client to take as prescribed and not to discontinue therapy suddenly
    • assess for underlying infection and decreased wound healing
    • daily doses need to increase during stress
    • assess for cushing symptoms
    • check stools for occult blood
  4. Levothyroxine Sodium (Synthroid)
    • Classification: Thyroid hormone
    • Action: increases basal metabolic rate, enhances gluconeogenesis, stimulates protein synthesis
    • Uses:
    • replacement in decreased or absent thyroid function
    • hypothyroidism
    • management of thyroid cancer
    • thyroid suppression test
    • Contraindications and Precautions:
    • thyrotoxicosis and myocardial infarction without hypothyroidism
    • treatment of obesity
    • hypersensitivity
    • older adult clients, clients with impaired cardiac function, hypertension
    • Side effects:
    • hyperthyroidism symptoms-irritability, insomnia, hyperthermia (increased body temp)
    • weight loss
    • palpitations
    • tachycardia, increased blood pressure, diaphoresis
    • If dose is too low watch for bradycardia, lethargy, constipation, excessive fatigue, excessive sleep
    • If dose is too high watch for irritability, hyperthermia, tachycardia, diarrhea, dysthythmias
    • Nursing implications:
    • monitor for increased pulse rate and rhythm
    • report abnormal vital signs and a pulse of >100 beats/min
    • replacement for hypothyroidism is lifelong do not discontinue
    • instruct client to have thyroid-stimulating hormone levels drawn periodically
    • takes about 1 month for the full effects of the medication to be seen
    • teach client to take the medication in the morning, preferably 30 minutes before meals
  5. Methimazole (Tapazole)
    • Classification: Antithyroid
    • Action: inhibits synthesis of thyroid hormone by interfering with iodine and tyrosine residue. does not destroy existing stores of thyroid
    • Uses:
    • suppresses production of thyroid hormone in hyperthyroidism
    • in preparation for thyroidectomy or radioactive iodine therapy
    • Contraindications and Precautions:
    • pregnancy and lactation; in clients over age 40
    • impaired liver function
    • in combination with agranulocytosis-inducing drugs
    • Side effects:
    • fever, rash and pruritus (itching, urge to itch)
    • dizziness, loss of taste, nausea and vomiting, peripheral paresthesia
    • toxic effects; agranulocytosis (leukopenia); toxic effect may occur as long as 4 months after therapy
    • Nursing implications:
    • obtain baseline vital signs and weight, monitor for changes in pulse rate
    • weight gain and decreased heart rate are indications of the development of hypothyroidism
    • monitor complete blood count for development of agranulocytosis-leukopenia
    • report any illness; sore throat and fever may be first indications of leukopenia
    • report any unusual bleeding or brusing immediatly; may be indicative of adverse affects on the liver
    • teach client to avoid seafood and iodine products teach client to schedule doses evenly throughout the day
  6. Ranitidine (Zantac)
    • Classification: H2 blockers
    • Action: Histamine H2-antagonists inhibit histamine action on H2-receptors, which are found on the gastric parietal cells and prevent gastrin secretions, thus decreasing acid production
    • Uses:
    • gastric and duodenal ulcer therapy
    • heartburn, acid indigestion, and gastroesophageal reflux disease
    • upper gastrointestinal bleeding
    • Contraindications and Precautions:
    • heptic and renal dysfunction
    • older adult clients
    • Side effects:
    • diarrhea
    • older adults: confusion, agitation
    • cimetidine-dysrhythmias, hypotension when given (IV)
    • cimetidine-may bind with androgens to cause gynecomastia (enlarged mammary glands, breast in males) and impotence
    • decrease in stomach acid may increase growth of candida (fungus) and bacteria in the stomach, pnuemonia
    • Nursing implications:
    • give oral drug before eating or with food
    • give at bedtime for adequate coverage
    • teach to avoid alcohol
    • smoking may decrease effectivness
  7. Psyllium (Metamucil)
    • Classification: Bulk-forming laxative
    • Action: Similar to dietary fiber. This medication is not digested or absorbed. After ingestion, it will swell to form a viscous solution or gel, softening the fecal mass and increasing the bulk. A fecal mass stretches the intestinal wall to stimulate peristalsis and passage of a soft-formed stool in 1 to 3 days
    • Uses:
    • treats constipation
    • prevents constipation and straining after myocardial infarction or rectal surgery
    • Contraindications:
    • bowel obstruction or undiagnosed acute abdominal pain
    • Precautions:
    • narrowing of the esophagus
    • intestinal ahesions, ulcers
    • Side effects:
    • abdominal discomfort
    • impaction and obstruction if not given with adequate liquids
    • Nursing implications:
    • if powder is mixed with water, mix at the bedside immediately before administration
    • instruct client to drink a full glass of water after administration
    • bowel movement should occur in 12 to 36 hours
  8. Metoclopramide Hydrochloride (Reglan)
    • Classification: peristaltic stimulant, antiemetic
    • Action: increases tone and accelerates intestinal transit and gastric emptying; suppresses emesis
    • Uses:
    • stimulates gastric emptying, intestinal transit
    • treatment of heartburn, delayed gastric emptying secondary to reflux esophagitis
    • suppresses vomiting in cancer therapy
    • Contraindications:
    • gastrointestinal obstruction or perforation
    • gastrointestinal hemorrhage
    • Precautions:
    • impaired renal function
    • congestive heart failure
    • cirrhosis
    • Side effects:
    • sedation and diarrhea
    • headache, dry mouth
    • extrapyramidal symptoms (toxic)
    • Nursing implications:
    • assess status of hydration
    • monitor for anxiety, restlessness, extrapyramidal symptoms
    • monitor for therapeutic response
    • give 30 minutes before meals and at bedtime
    • monitor renal function, blood pressure and heart rate
  9. Proton Pump Inhibitors
    Omeprazole (Prilosec)
    Esomeparazole (Nexium)
    Lansoprazole (Prevacid)
    Pantoprazole (Protonix)
    • Action: produces an irreversible block of the enzymes that gererate gastric acids. Blocks the final common path for gastric acid production. The effect will last until gastric enzymes are resynthesized
    • Uses:
    • short-term (4 to 8 weeks): duodenal ulcers, gastric ulcers, and gastroesophageal reflux disease
    • Long-term: hypersecretory conditions (hyper production of secreations)
    • Contraindications and Precautions:
    • pregnancy and lactation
    • Side effects:
    • headache
    • diarrhea
    • nausea and vomiting
    • Nursing implications:
    • instruct client to avoid opening , chewing or crushing capsules
    • instruct client to return for follow-up if symptoms are unresolved after 4 to 8 weeks of therapy
    • should be taken before meals
    • notice that the generic names end in zole
  10. Magnesium Hydroxide (milk of magnesia)
    In the PM for a B.M.in the AM
    • Classification: Osmotic laxative, Magnesium compound
    • Action: draws water into the intestine by osmotic action on the surrounding tissue. The increase in fluid in the intestine will dilute the stool, strech the bowel and increase peristalsis
    • Uses:
    • constipation
    • cleanse the gastrointestinal tract
    • flush ingested toxins out the gastrointestinal tract
    • Contraindications:
    • undiagnosed abdominal pain
    • renal impairment
    • Precautions:
    • rectal bleeding
    • bowel obstructions
    • colostomy or ileostomy
    • Side effects:
    • abdominal cramping
    • diarrhea, dehydration
    • hypermagnesemia
    • Nursing implications:
    • give with at least 8 ounces of water
    • will generally act within 6 to 12 hours
    • monitor bowel movement, hydration status, and electrolytes level
    • laxative abuse (laxative taken every day) decrease the defecatory reflex, leading to laxative dependence
    • teach client to eat foods high in fiber (brans, fruits), increase fluid intake
  11. Aluminum Hydroxide (Amphojel)
    • Classification: Phosphate-binding antacid, aluminum compound
    • Action: reduces acid concentration and pepsin activity by raising pH of gastric secretions. Binds with phosphate and helps prevent hyperphosphatemia. Decrease in serum phospherous may precipitate an increase in serum calcium.
    • Uses:
    • relief of hyperacidity related to gastritis and reflux
    • gastric and duodenal ulcers
    • may be used to treat hyperphosphatemia in renal insufficiency
    • Contraindications and Precautions:
    • clients who are dehydrated or fluid restricted
    • clients with renal disease or cardiac disease (or both)
    • undiagnosed abdominal pain
    • may reduce effects of tetracyclines, warfarin, and digoxin
    • use with caution in young children
    • clients on sodium restriction
    • Side effects:
    • constipation
    • hypophosphatemia
    • hypernatremia
    • Nursing implications:
    • monitor serum calcium, phosphate, magnesium and sodium levels
    • monitor for bone disease and neurologic impaiment associated with magnesium toxicity
    • do not administer antacids to cardiac clients complaining of dyspepsia; discomfort may be referred anginal pain
  12. Loperamide (Imodium)
    Diphenoxylate Hydrochloride (Lomotil)
    • Classification: antidiarrheals
    • Action: direct effect on intestinal wall muscles, slowing intestinal motility
    • Uses:
    • symptomatic relief of acute nonspecific diarrhea
    • chronic diarrhea associated with inflammatory bowel disease
    • Contraindications and Precautions:
    • hepatic or renal disease
    • dehydration with electrolyte depletion
    • use with caution in young children
    • Side effects:
    • drowsiness, dizziness, nausea
    • watch for sedation, flushing, tachycardia, fatigue, depression, GI discomfort, and constipation
    • Nursing implications:
    • encourage adequate fluid intake, monitor hydration status
    • check bowel sounds for peristalsis; discontinue and report abdominal pain and distention
    • do not give in presence of bloody diarrhea or temperature of > 101o F.
  13. Lactulose
    • Classification: Hyperosmotic laxative and ammonia detoxicant
    • Action: retains ammonia in the colon by producing osmotic effects. Promotes increased peristalsis, bowel evacuation (expelling ammonia from colon)
    • Uses:
    • treats portal systemic (heptic encephalopathy (disease of the brain))
    • treats constipation
    • Contraindications:
    • galactose-free diet
    • undiagnosed abdominal pain
    • vomiting
    • Precautions:
    • diabetes mellitus (dehydration)
    • conditions in which increased sodium can cause problems (heart failure, hypertension)
    • renal dysfunction
    • Side effects:
    • dehydration
    • increased thirst
    • abdominal discomfort, frequent loose stools
    • belching, abdominal distention, (flatulence)
    • nausea and vomiting
    • diarrhea
    • Nursing implications:
    • encourage increased fluid intake
    • monitor bowel activity; may receive dose even with loose stools
    • anticipate need for low-protein diet
    • maybe given by mouth (PO) or by enema
    • PO: mix with fruit juice, water, or milk to improve flavor
    • Rectally: use rectal balloon catheter; need to retain enema for 30 to 60 min
  14. Sodium Polystyrene Sulfonate (Kayexalate)
    • Classification: Cation exchange resin
    • Action: ion exchange releases sodium for potassium. Removes potassium from the intestine before the resin is excreted
    • Uses: treatment for hyperkalemia
    • Contraindications:
    • hypernatremia, intestinal obstruction or perforation
    • Precautions:
    • use with caution in clients with sodium restriction (congestive heart failure, hypertension, edema)
    • Side effects:
    • anorexia, nausea and vomiting, constipation, fecal impaction
    • hypokalemia
    • watch for gastric irritation, diarrhea, sodium retention
    • Nursing implications:
    • encouraage increased fluid intake
    • monitor bowel activity; may receive dose even with loose stool
    • anticipate need for low-protien diet
    • may be given by mouth (PO) or by enema:
    • PO: mix with fruit juice, water, or milk to improve flavor
    • Rectally: use rectal balloon catheter; need to retain enema for 30 to 60 minutes
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