Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (361 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(ros-ih-glit′ah-zone)
Avandia
Func. class.:
Antidiabetic, oral
Chem. class.:
Thiazolidinedione
Improves insulin resistance by hepatic glucose metabolism, insulin receptor kinase activity, insulin receptor phosphorylation
Type 2 diabetes mellitus, alone or in combination with sulfonylureas, metformin, insulin
Unlabeled uses:
Increased ovulation frequency in those with polycystic ovary syndrome; reduced in-stent restenosis in those with diabetes
Breastfeeding, children, hypersensitivity to thia
zolidinediones, diabetic ketoacidosis, jaundice
Black Box Warning:
NYHA III, IV acute heart failure, heart failure
Precautions:
Pregnancy (C), geriatric patients, thyroid disease, renal/hepatic disease, heart failure, class I, II NYHA
Black Box Warning:
MI
Calculator
• Adult:
PO
4 mg/day or in 2 divided doses, may increase to 8 mg/day or in 2 divided doses after 12 wk; may be added to metformin, sulfonylurea for adult dose
Available forms:
Tabs 2, 4, 8 mg
•
Once or in 2 divided doses, without regard to food
•
Tabs crushed and mixed with food or fluids for patients with difficulty swallowing
•
Only through the REMS Program 1-800-Avandia
CNS:
Fatigue,
headache
CV:
MI, CHF, death (geriatric patients)
ENDO:
Hypo/hyperglycemia
GI:
Weight gain,
hepatotoxicity,
increase total, LDL, HDL cholesterol; decrease free fatty acids, diarrhea
MISC:
Accidental injury, URI, sinusitis, anemia, back pain, diarrhea, edema, bone fractures (female)
SYST:
Anaphylaxis, Stevens-Johnson syndrome, lactic acidosis
Maximal reductions in FBS after 6-12 wk; protein binding 99.8%; excreted in urine, feces; elimination half-life 3-4 hr; may be excreted in breast milk
Increase:
hypoglycemia—gemfibrozil, fluvoxaMINE, ketoconazole, trimethoprim; monitor glucose
•
Avoid concurrent use with insulin, nitrates
•
May increase or decrease level: CYP2C5 inducer/inhibitors
Increase:
antidiabetic effect—garlic, horse chestnut
Increase:
ALT, HDL, LDL, total cholesterol, blood glucose
Decrease:
Hgb/Hct
Black Box Warning:
CHF/MI:
dyspnea, crackles, edema, weight gain ≥5 lb, jugular venous distention; may need to change dose or discontinue product, do not use in acute coronary syndrome, NYHA Class 3/IV heart failure
Lactic acidosis:
dyspnea, abdominal pain, muscle pain; notify prescriber
•
Hypoglycemic reactions (sweating, weakness, dizziness, anxiety, tremors, hunger), hyperglycemic reactions soon after meals
Systemic reactions: anaphylaxis, Stevens-Johnson syndrome, lactic acidosis
Hepatotoxicity:
LFTs periodically AST, ALT (if ALT >2.5 × ULN, do not use product)
•
Fasting blood sugar, A1c, plasma lipids/lipoproteins, B/P, body weight during treatment
•
To use product provider/patient must be enrolled in the Avandia-Rosiglitazone Medicines Access Program
•
Conversion from other oral hypoglycemic agents if needed; change may be made without gradual dosage change; monitor blood glucose during conversion
•
Storage in tight container in cool environment
•
Therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gait; blood glucose, A1c improvement
•
To monitor blood glucose; that periodic liver function tests mandatory; to report edema, weight gain
•
About the symptoms of hypo/hyperglycemia, what to do about each
•
That product must be continued on daily basis; about the consequences of discontinuing the product abruptly
•
To avoid OTC medications, herbal preparations, nitrates, or insulin unless approved by prescriber
•
That diabetes is lifelong; that product is not a cure, only controls symptoms
•
That all food included in diet plan must be eaten to prevent hypoglycemia
•
To carry emergency ID and glucagon emergency kit
To report symptoms of hepatic dysfunction (nausea, vomiting, abdominal pain, fatigue, anorexia, dark urine, jaundice)
•
That 2 wk is needed to see reduction in blood glucose level and 2-3 mo needed to see full effect of product
•
To notify prescriber if oral contraceptives are used
•
Not to use if breastfeeding, may be secreted in breast milk
•
That a medication guide should be dispensed with each prescription/refill
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert