GLICLAZIDE DIAMICRON

GENERIC NAME TRADE NAME

Pharmacologic Class: Sulfonylurea Therapeutic Class: Antidiabetics

Action: Lowers blood glucose by stimulating the release of insulin from the pancreas and increasing sensitivity to insulin at receptor sites

Reason Given (Disease States): Diabetes Mellitus type 2

Nursing Process

Pre-Administration Assessment: Post Administration Assessment: Nursing Considerations:

 Instruct patient to take gliclazide as  Control of blood glucose levels to  Observe for signs and symptoms of
directed at the same time every day. avoid episodes of hypoglycaemia and hypoglycemia (hunger, weakness,
 Explain to patient that this medication hyperglycemia. sweating, dizziness, tachycardia,
does not cure diabetes and must be anxiety).
used in conjunction with a prescribed  Assess patient for allergy to
diet, exercise regimen, to prevent sulfonylureas.
hypoglycemic and hyperglycemic  Lab Test Considerations: Monitor
events. serum glucose and glycosylated
 Instruct patient on proper technique for hemoglobin periodically during therapy
home glucose monitoring. Monitor to evaluate effectiveness of treatment.
closely during periods of stress or  Monitor liver function periodically in
illness and health care professional patients with mild to moderate liver
notified if significant changes occur. dysfunction. May cause qAST, ALT,
 Review signs of hypoglycemia and alkaline phosphatase and LDH.
hyperglycemia with patient. If  Monitor renal function periodically in
hypoglycemia occurs, advise patient to patients with mild to moderate renal
drink a glass of orange juice or ingest dysfunction. May causeqcreatinine
2– 3 tsp of sugar, honey, or corn syrup and hyponatremia.
dissolved in water or an appropriate  Toxicity and Overdose: Overdose is
number of glucose tablets and notify manifested by symptoms of
health care professional. hypoglycemia. Mild hypoglycemia may
 Encourage patient to follow prescribed be treated with administration of oral
diet, medication, and exercise regimen glucose. Treat severe hypoglycemia
to prevent hypoglycemic or with IV D50W followed by continuous
hyperglycemic episodes. IV infusion of more dilute dextrose
 solution at a rate sufficient to keep
serum glucose at approximately 100
mg/dL.

Other: Contraindications

 Hypersensitivity; cross sensitivity with other sulfonylureas may occur

 Unstable diabetes, type 1 diabetes mellitus, diabetic ketoacidosis, diabetic coma or pre-coma; Severe hepatic or renal disease.
 Concurrent use of oral/oromucosal miconazole, alcohol or alcohol-containing medications, or systemic phenylbutazone.
 OB: Should not be used during pregnancy, insulin is preferred.
 Lactation: Should not be used during lactation, insulin is preferred. Use Cautiously in: Glucose 6-phosphate dehydrogenase deficiency (risk of
hemolytic anemia); Infection, stress, or changes in diet may alter requirements for control of blood sugar or require use of insulin; Impaired thyroid,
pituitary, or adrenal function; Malnutrition, high fever, prolonged nausea, or vomiting.
 Pedi: Safe and effective use in children 18 years has not been established.

Adverse Reactions

 Endo: Hypoglycemia
 GI: abdominal pain, diarrhea, dyspepsia, liver enzymes, nausea, vomiting.
 Derm: photosensitivity, rashes.
 EMPAGLIFLOZIN JARDIANCE
GENERIC NAME TRADE NAME

Pharmacologic Class: Sodium-glucose cotransporter 2 (SGLT2) inhibitors Therapeutic Class: Antidiabetics

Action: Inhibits renal reabsorption of glucose and lowers renal threshold for glucose, resulting in increased urinary excretion of glucose.

Reason Given (Disease States): Diabetes Mellitus type 2

Nursing Process

Pre-Administration Assessment: Post Administration Assessment: Nursing Considerations:

 Diabetes: Monitor blood glucose,  Positive Outcome: Decreased blood  Assess renal function before initiating
glycosylated haemoglobin Alc (HbAlc), glucose, Alc therapy and periodically during
serum cholesterol profile, serum  Instruct the patient to take drug in the treatment. Don’t start therapy if GFR is
creatinine/BUN, assess for polydipsia, morning, with or without food. less than 45 mL/minute. Closely
other products taken by the patient.  Advise patient that if a dose is missed, monitor patients with GFR of less than
 Fractures: Assess fracture risk before to take missed dose as soon as 60 mL/minute.
use, do not use in patients with risk of remembered and not to double a  Assess fluid status. Correct volume
fractures. dose. depletion before starting therapy.
 Pregnancy/breastfeeding: Use if  Stress importance of adhering to diet,  Monitor patients for signs and
benefits outweigh risk to fetus, no well- weight reduction, exercise, personal symptoms of hypotension (fatigue,
controlled studies, does not hygiene, and blood glucose monitoring dizziness, blurred vision, clammy skin)
breastfeed. while on therapy. during therapy. Drug may increase risk
 Teach patient to report all adverse of hypotension due to intravascular
reactions and how to identify and volume contraction.
manage signs and symptoms of  Monitor glucose level closely during
hypoglycemia (dizziness, weakness, drug initiation. Concomitant use of
shaking, and fast heartbeat). insulin and other antidiabetic agents
 Teach the patient how to identify and may increase risk of hypoglycaemia.
manage signs and symptoms of
hypotension (fatigue, dizziness,
blurred vision, and clammy skin).
Encourage patient to maintain
adequate fluid intake.
 Counsel patient to consult prescriber
before starting new prescription or
 OTC medications or supplements.
 Advice patient to inform prescriber if
she becomes pregnant, intends to
become pregnant, or is breastfeeding.

Other: Contraindications

 Contraindicated in patients with history of serious hypersensitivity reaction to drug or its components.
 Contraindicated in patients with severe renal impairment or ESRD and in those on dialysis.
 Don’t use in patients with GFR of less than 45 mL/minute.
 Drug isn’t recommended for type 1 diabetes and for the treatment of diabetic ketoacidosis.
 Use cautiously in patients with low BP or moderate renal impairment and in those taking diuretics; drug may increase risk of hypotension.

Adverse Reactions

 GI: nausea, thirst

 GU: genital infection, UTI, renal impairment, increased urination
 Metabolic: dyslipidemia, hypoglycemia
 Musculoskeletal: arthralgia
 Respiratory: URI
 ALENDRONATE BINOSTO, FOSAMAX
GENERIC NAME TRADE NAME

Pharmacologic Class: Bisphosphonates Therapeutic Class: Antiosteoporotics

Action: Suppresses osteoclast activity on newly formed reabsorption surfaces, which reduces bone turnover. Bone formation exceeds resorption at
remodelling sites, leading to progressive gains in bone mass.

Reason Given (Disease States): Osteoporosis and Paget's disease of bone

Nursing Process

Pre-Administration Assessment: Post Administration Assessment: Nursing Considerations:

 Assess for serious reactions:  Positive Outcome: Increase bone  Correct hypocalcaemia and other
angioedema, Stevens- Johnson mass; absence of fractures disturbances of mineral metabolism
syndrome, toxic epidermal necrolysis,  Tell patient who misses a once- (such as vitamin D deficiency) before
atrial fibrillation. weekly dose to take one dose on the therapy begin.
 Assess dental status, regular dental morning after remembering and then  When used to treat osteoporosis,
exams should be done, dental return to weekly dosing on the chosen disease may be confirmed by findings
extractions (cover with antiinfectives) day as originally scheduled. of low bine masses on diagnostic
prior to procedure.  Assess patient for reports of adverse studies of by history of osteoporotic
 Hormonal status if a woman, prior to reactions immediately, especially fracture.
treatment. chest pain or difficulty in swallowing.  Patients at risk form vitamin D
 Assess for osteoporosis: bone deficiency, such as those who are
density testing baseline and during chronically ill, who are nursing homes
treatment, history of fractures. bound, who have bound, who have a
 For Paget’s diseases: increased skull GI malabsorption syndrome, or who
size, bone pain, headache. are older than age 70, may require
 Monitor renal studies and electrolytes vitamin D supplementation.
(calcium, potassium, magnesium, and  In Paget disease, drug is indicated for
phosphorus) BUN/creatinine. patients with alkaline phosphatase
 Assess for hypercalcemia: level at least 2 x ULN, for those who
parathesia, twitching, laryngospasm, are symptomatic, and for those at risk
Chvostek’s, Trousseau’s signs, correct for future complications from the
before use. disease.
 Monitor alkaline phosphatase; level 2  Monitor patient’s calcium and
x upper limit of normal is indicated for phosphate levels throughout the
 Paget’s disease. therapy.
 Pregnancy/breastfeeding: Use in  Severe musculoskeletal pain has been
pregnancy only if benefits outweigh associated with bisphosphonate use
fetal risk; use cautiously in and may occur within days, months, or
breastfeeding. years of start of therapy. When drug is
 MS or bone pain: may occur in a few stopped, symptoms may resolve
days after start of treatment to years partially or completely.
later, usually pain resolves after  Patients who develop osteonecrosis of
stopping treatment. the jaw should receive care by an oral
surgeon.
 Optimal length of treatment hasn’t
been determined. Reevaluate need for
continued therapy periodically.
Patients at low risk for fracture should
be considered for discontinuation after
3 to 5 years of treatment.

Other: Contraindications

 Contraindicated in patients hypersensitive to drug and in those with hypocalcemia or abnormalities of the esophagus that delays
esophageal emptying.
 Drug isn’t recommended for patients with CrCl of less than 35 mL/minute.
 Contraindicated in patients unable to stand or sit upright for at least 30 minutes.
 Use cautiously in patients with active upper GI problems (dysphagia, symptomatic esophageal diseases, gastritis, duodenitis, and ulcers)
or mild to moderate renal insufficiency.

Adverse Reactions

 CNS: dizziness, fatigue, headache, pain

 EENT: pharyngitis, sinusitis
 GI: abdominal pain, constipation, dyspepsia, nausea
 GU: erectile, dysfunction
 Respiratory: bronchitis, URL
 OXYTOCIN PITOCIN
GENERIC NAME TRADE NAME

Pharmacologic Class: Exogenous hormones Therapeutic Class: Oxytocics

Action: Causes potent and selective stimulation of uterine and mammary gland smooth muscle.

Reason Given (Disease States): Inducing labor, controlling bleeding after childbirth, and for the treatment of incomplete or inevitable abortion.

Nursing Process

Pre-Administration Assessment: Post Administration Assessment: Nursing Considerations:

 Assess labor contractions: feta; heart  Positive Outcomes:  All patients receiving oxytocin I.V.
tones, frequency, duration, intensity of  Stimulation of milk letdown (nasal) must be under continuous observation
contractions; if fetal heart tones  Induction of labor by trained personnel who have
increase or decrease significantly or if  Decreases postpartum bleeding thorough knowledge of the drug and
contractions are longer than 1 min,  Assess the patient to promptly reports are qualified to identify complications.
notify the prescriber; turn patient left of adverse reactions (site irritation,  Discontinue oxytocin infusion
side to increase oxygen to fetus. nausea, and bleeding, blurred vision, immediately if uterine hyperactivity of
 Assess for water intoxication: difficulty speaking, wheezing, itching fetal distress occurs. Administer
confusion, anuria, drowsiness, and and swelling). oxygen to the mother. Mother and
head ache; monitor I&O and notify the fetus must be evaluated by the
prescriber. responsible physician.
 Watch for fetal distress, acceleration,  Drug is used to induce or reinforce
deccelaration, fetal presentation, labor only when pelvis is known to be
pelvic dimensions. adequate, when vaginal delivery is
 Monitor B/P, pulse, respiratory rate, indicated, when fetal maturity is
rhythm, depth assured, and when fetal position is
 Assess for fetal presentation, pelvic favourable. Use drug only in hospital
dimensions before use. where critical care facilities and
 Provide an environment conducive to prescriber are immediately available.
letdown reflex.  Monitor fluid intake and output.
Antidiuretic effect may lead to fluid
overload, seizures, and coma from
water intoxication.
 Monitor and record uterine
contractions, HR, BP, intrauterine
 pressure, fetal HR, and character of
blood loss at least every 15 minutes.

Other: Contraindications

 Contraindicated in patients hypersensitive to drug.

 Contraindicated when vaginal delivery isn’t advised (placenta previa, vasa previa, invasive cervical carcinoma, genital herpes),
when cephalopelvic disproportion is present, or when delivery requires conversion, as in transverse lie.
 Contraindicated in fetal distress when delivery isn’t imminent, in prematurity, in other obstetric emergencies, and in patients with severe
toxaemia or hypertonic uterine patterns.
 Use cautiously, if at all, in patients with invasive cervical cancer and in those with previous cervical or uterine surgery (including
Caesarean section), grand multiparity, uterine sepsis, traumatic delivery, or over distended uterus.

Adverse Reactions

 Maternal
CNS: subarachnoid haemorrhage, seizures, coma
GI: nausea, vomiting
GU: abruption placentae, tetanic uterine contractions, postpartum haemorrhage, uterine rupture, impaired uterine blood flow, pelvic hematoma,
increased uterine motility.
Hematologic: afibrogenemia, possibly related to postpartum bleeding
Other: anaphylaxis, death from oxytocin-induced water intoxication, hypersensitivity reactions.
 Fetal
CNS: infant brain damage, seizures
CV: bradycardia, arrhythmias, PVCs
EENT: neonatal retinal haemorrhage
Hepatic: neonatal jaundice
Other: low Apgar scores at 5 minutes, death