Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (197 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(glye-me′pi-ride)
Amaryl
(glip-i′zide)
Glucotrol, Glucotrol XL
Func. class.:
Antidiabetic
Chem. class.:
Sulfonylurea (2nd generation)
Do not confuse:
glipiZIDE
/Glucotrol/glyBURIDE
Causes functioning β cells in pancreas to release insulin, leading to drop in blood glucose levels; may improve insulin binding to insulin receptors or increase the number of insulin receptors with prolonged administration; may also reduce basal hepatic glucose secretion; not effective if patient lacks functioning β cells
Type 2 diabetes mellitus
Hypersensitivity to sulfonylureas, type 1 diabetes, diabetic ketoacidosis
Precautions:
Pregnancy (C), geriatric patients, cardiac disease, severe renal/hepatic disease, G6PD deficiency
Calculator
• Adult:
PO
1-2 mg/day with breakfast, then increase by ≤2 mg/day q1-2wk, max 8 mg/day
• Geriatric:
PO
1 mg/day; may increase if needed
• Adult:
PO
1 mg/day with breakfast; may titrate upward as needed
• Adult:
PO
5 mg initially before breakfast then increase by 2.5-5 mg after several days to desired response; max 40 mg/day in divided doses or 15 mg/dose;
PO
(XL) 5 mg/day with breakfast, may increase to 10 mg/day, max 20 mg/day
• Geriatric:
PO
2.5 mg/day; may increase if needed
• Adult:
PO
2.5 mg initially then increase to desired response; max 40 mg/day in divided doses or 15 mg/dose
Available forms:
Glimepiride:
tabs 1, 2, 4 mg;
glipiZIDE:
tabs, scored 5, 10 mg; ext rel tab (XL) 2.5, 5, 10 mg
•
Do not break, crush, or chew ext rel tabs; may crush tabs and mix with fluids if unable to swallow whole
•
GlipiZIDE:
product 30 min before meals (regular release); with breakfast (ext rel);
Glimepiride:
with breakfast; if patient is NPO, may need to hold dose to prevent hypoglycemia
•
Gradual conversion from other oral hypoglycemics to these products is not needed; insulin ≥20 units/day, convert using 25% reduction in insulin dose every day or every other day
CNS:
Headache, weakness, dizziness, drowsiness
, tinnitus, fatigue, vertigo
ENDO:
Hypoglycemia
GI:
Hepatotoxicity, cholestatic jaundice,
nausea, vomiting, diarrhea, heartburn
HEMA:
Leukopenia, thrombocytopenia, agranulocytosis, aplastic anemia;
increased AST, ALT, alk phos;
pancytopenia, hemolytic anemia
INTEG:
Rash, allergic reactions, pruritus, urticaria, eczema, photosensitivity, erythema, allergic vasculitis
PO:
Completely absorbed by GI route;
glipiZIDE:
onset 1-1½ hr, peak 1-3 hr, duration 10-24 hr, half-life 2-4 hr;
glimepiride:
peak 2-3 hr, half-life 5 hr; metabolized in liver, excreted in urine, 90%-95% plasma-protein bound
•
May mask symptoms of hypoglycemia: β-blockers
Increase:
action of digoxin, glycosides
Increase:
hypoglycemic effects—insulin, MAOIs, cimetidine, chloramphenicol, guanethidine, methyldopa, NSAIDs, salicylates, probenecid, androgens, anticoagulants, clofibrate, fenfluramine, fluconazole, gemfibrozil, histamine H
2
antagonists, magnesium salts, phenylbutazone, sulfinpyrazone, sulfonamides, tricyclics, urinary acidifiers, clarithromycin, fibric acid derivatives, voriconazole
Decrease:
hypoglycemic effect—thiazide diuretics, rifampin, isoniazid, cholestyramine, diazoxide, hydantoins, urinary alkalinizers, charcoal, corticosteroids
Increase:
antidiabetic effect—garlic, horse chestnut
Decrease:
hypoglycemic effect—green tea
Increase:
AST, ALT, LDH, BUN, creatinine
•
Hypo/hyperglycemic reaction
that can occur soon after meals; for severe hypoglycemia give IV D
50
W, then IV dextrose solution
•
Blood glucose, A1c levels during treatment to determine diabetes control
Blood dyscrasias: CBC at baseline and throughout treatment; report decreased blood count
•
Storage in tight, light-resistant container at room temp
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; improved serum glucose, A1c
•
Not to drink alcohol; about disulfiram reaction (nausea, headache, cramps, flushing, hypoglycemia)
•
To report bleeding, bruising, weight gain, edema, SOB, weakness, sore throat
•
To check for symptoms of cholestatic jaundice: dark urine, pruritus, yellow sclera; prescriber should be notified
•
About symptoms of hypo/hyperglycemia, what to do about each; to have glucagon emergency kit available; to carry sugar packets
•
That product must be continued on daily basis; about consequences of discontinuing product abruptly; to take product in morning to prevent hypoglycemic reactions at night
•
To use sunscreen or stay out of the sun, wear protective clothing (photosensitivity)
•
To avoid OTC medications unless ordered by prescriber
•
That diabetes is a lifelong illness; product will not cure disease
•
That all food in diet plan must be eaten to prevent hypoglycemia; to continue weight control, dietary restrictions, exercise, hygiene
•
To carry emergency ID with prescriber and medication information
•
To test using blood glucose meter while taking this product
•
That ext rel tab may appear in stool
Glucose 25 g IV via dextrose 50% sol, 50 ml, 1 mg glucagon, or carbohydrate depending on severity
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(gloo′ka-gon)
GlucaGen
Func. class.:
Antihypoglycemic
Increases in blood glucose, relaxation of smooth muscle of the GI tract, and a positive inotropic and chronotropic effect on the heart; increases in blood glucose are secondary to stimulation of glycogenolysis
Hypoglycemia, used to temporarily inhibit movement of GI tract as a diagnostic test
Hypersensitivity, pheochromocytoma, insulinoma
Precautions:
Pregnancy (B), breastfeeding, cardiac disease, adrenal insufficiency
Calculator
• Adult/adolescent/child ≥55 lb (25 kg):
IM/IV/SUBCUT (GlucaGen)
1 mg (1 IU)
• Child <55 lb (25 kg) or <6-8 yr:
IM/IV/SUBCUT
0.5 mg (0.5 IU)(Glucagon)
• Adult/adolescent/child ≥44 lb (20 kg):
IM/IV/SUBCUT
(Glucagon) 1 mg (1IU)
• Child <44 lb (20 kg):
(Glucagon) 0.5 mg (0.5 IU) or 0.02–0.03 mg/kg (IU/kg) max/mg
Available forms:
Powder for injection 1-mg vial
•
Visually inspect for particulate matter and discoloration before use
Reconstitution:
Reconstitute with 1 ml of sterile water for injection or with diluent supplied by the manufacturer; the reconstituted injection should be clear and of water-like consistency (1 mg/ml); discard any unused portion
•
Inject into a large muscle mass; aspirate before injection to avoid injection into a blood vessel
•
Inject, taking care not to inject intradermally
•
Inject directly into a vein at a rate ≤1 IU/min (mg/min); may be given through line running D
5
W or given at the same time as a bolus of dextrose
CNS:
Dizziness, headache
CV:
Hypotension
GI:
Nausea, vomiting
SYST:
Hypersensitivity
IV: Onset immediate, peak 30 min, duration 1-1½ hr
IM/subcut: Onset 5-10 min, peak 13-20 min, duration 12-30 min
Increase:
Increased bleeding risk—anticoagulants
•
Hypoglycemia:
Monitor glucose levels before and after product use; use other products to control hypoglycemia if patient is conscious
•
Decreased hypoglycemia
•
How to use this product, symptoms of hypoglycemia