STUDENT MEDICATION ADMINISTRATION FORM DRUG NAME CLASSIFICATION Therapeutic: Antidiabetics Pharmacologic: biguanides ACTIONS Decreases hepatic Glucose

production; decreases intestinal glucose absorption; increases sensitivity to insulin(maintenance of blood glucose)

NUR 105 SIDE EFFECTS GI: abdominal bloating, diarrhea, nausea, vomiting, unpleasant metallic taste; ENDO: hypoglycemia; F&E: lactic acidosis; MISC: decreased vitamin b12 levels Symptoms of Lactic acidosis are chills, diarrhea, dizziness, low blood pressure, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea or weakness

STUDENT NAME

Jessica Lynn King Dye PT TEACHING Explain to the patient the risk of lactic acidosis and the potential need for discontinuation of metformin therapy if a severe infection, dehydration, or severe or continuing diarrhea occurs or if medical tests or surgery is required

Metformin

CONTRAINDICATION PROPER DOSAGES Hypersensitivity, PO 500 mg twice metabolic acidosis; daily; may dehydration, sepsis, increase by 500 hypoxemia, hepatic mg at weekly impairment, intervals up to excessive alcohol 2000 mg/day;if use(acute or doses > chronic), renal 2000mg/day are dysfunction(serum required, give in creatinine > 1.5 3 divided doses( mg/dL in men or not to exceed >1.4 mg/dL in 2500mg/day in women), divided doses ( radiographic studies up to 850 mg 3 requiring IV times a day) iodinated contrast media(withhold metformin), CHF

DRUG ACTOS (pioglitazone)

CLASSIFICATION Therapeutic: Antidiabetics Pharmacologic: Thiazolidinediones

ACTIONS Improves sensitivity to insulin by acting as a agonist at receptor sites involved in insulin responsiveness and subsequent glucose production and utilization( decreased insulin resistance, resulting in glycemic control without hypoglycemia)

SIDE EFFECTS CV: CHF, edema; EENT: macular edema; GI: hepatitis, increased liver enzymes; HEMAT: anemia; MISC: fractures (arm, hand, foot) in female patients

CONTRAINDICATIONS Hypersensitivity ; Type 1 diabetes; diabetic ketoacidiosis; clinical evidence of active liver disease or increased ALT;(>2.5 upper limit of normal OB/LACTATION: insulin should be used to control blood sugar levels PEDI: children

PROPER DOSAGE 15-30 mg once daily/ may be increased to 45 mg/day if needed; doses >30 mg have not been evaluated in combinations with insulin and other antidiabetics

PT TEACHING Reviews the signs of hypoglycemia and hyperglycemia with the patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2-3 tsps of sugar, honey, or corn syrup dissolved into water and notify health care professional

DRUG EPINEPHRINE

CLASSIFICATION Therapeutic: Antiasthmatics Bronchodilators Pharmacologic: Adrenergics

ACTIONS Results in the accumulation of cAMP at betaadrenergic receptors; affects both beta1 (cardiac)adrenergic receptors and beta 2(pulmonary)adrenergic receptor sites; produces bronchodilation; also had alphaadrengeric agonist properties, which result in vasoconstriction; inhibits the release of mediators of immediate hypersensitivity reactions from mast cells

SIDE EFFECTS CNS: nervousness, restlessness, tremor, headache, insomnia. Resp: paradoxical bronchospasm (excessive use of inhalers). CV: angina, arrhythmias, hypertension, tachycardia. GI: nausea, vomiting. Endo: hyperglycemia.

CONTRAINDICATIONS PROPER DOSAGE SC, IM (Adults): Hypersensitivity to Anaphylactic adrenergic amines reactions/asthma Cardiac 0.10.5 mg (single arrhythmias dose not to exceed Some products may 1 mg); may repeat q 1015 min for contain bisulfites anaphylactic shock or fluorocarbons (in some inhalers) or q 20 min4 hr for asthma; IV and should be (Adults): Severe avoided in anaphylaxis0.1 patients with 0.25 mg q 515 known hypersensitivity or min; may be followed by 14 intolerance mcg/min continuous infusion; cardiopulmonary resuscitation (ACLS guidelines)1 mg q 35 min; bradycardia (ACLS guidelines)210 mcg/min).

PT TEACHINGS Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain; Advise patient to maintain adequate fluid intake (2000 3000 mL/day) to help liquefy tenacious secretions

DRUG Byetta (exenatide)

CLASSIFICATIONS Therapeutic: Antidiabetics Pharmacologic: Incretrin mimetic agents

ACTIONS Mimics the action of incretin which promotes endogenous insulin secretion and promotes other mechanisms of glucoselowering(improved control of the blood glucose)

SIDE EFFECTS Dizziness, headache, jitteriness, weakness, pancreatitis, diarrhea, nausea, vomiting, dyspepsia, gastrointestinal reflux; hyperhidrosis; decreased appetite and weight loss

CONTRAINDICATIONS

PROPER DOSAGE Hypersensitivity; type 1 5mcg within 60 diabetes or diabetic minutes before ketoacidosis; end stage morning and renal evening meals; disease(ccr<30ml/min); after 1 month, severe gastrointestinal dose may be disease; has caused increased to 10 fetal defects and mcg depending neonatal death in on response to animal studies; medication excretion into breast milk is unknown

PT TEACHING Advise patient to notify health care professional immediately if symptoms of pancreatitis( unexplained, persisten, severe abdominal pain which may or may not be accompanied by vomiting) occur

DRUG Augmentin

CLASSIFICATION Therapeutic: Anti-infectives Pharmacologic: Aminopenicillins/beta lactamase inhibitors

ACTIONS Binds to bacterial cell wall, causing cell death; spectrum of amoxicillin is broader than penicillins. Clavulanate resists action of betalactamase, an enzyme produced by bacteria that is capable of inactivating some penicillin (bactericidal actions against susceptible bacterias

SIDE EFFECTS

PROPER DOSAGE Seizures(high Hypersensitivity to P.O. 250 mg doses);pseudomemb- penicillins of every 8 Reaneous colitis, clavulanate; suspension hours or diarrhea, hepatic and chewable tablets 500 mg dysfunction, nausea, contain aspartame and every 12 vomiting; vaginal should be avoided in hours candidiasis; rashes, phenylketonurics; urticarta; blood history of dyscrasias; allergic amoxicillin/clavulanatereactions including associated cholestatic anaphlayxis and jaundice serum sichness, superinfection

CONTRAINDICATIONS

PT TEACHING Monitor bowel functions. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembraneous colitis; may begin up to several weeks following cessation of therapy

DRUG Nubain

CLASSIFICATION Therapeutic: Opioid analgesics Pharmacologic: Opioid analgesics/agonists

ACTIONS Binds to opiate receptors in the CNS, alters the perception of and response to painful stimuli while producing generalized CNS depression. In addition, has partial antagonist properties, which may result in opioid withdrawl in physically dependent patients (decrease pain)

SIDE EFFECTS Headache, dizziness, sedation, confusion, dysphoria, euphoria, floating feeling, hallucinations and unusual dreams;blurred vision, diplopia, miosis (*high dose*); respiratory depression; hypertension, orthostatic hypotension, palpitations; dry mouth, nausea, vomiting, constipation, ileus; urinary urgency; clammy feeling, sweating, physical dependence, tolerance

CONTRAINDICATIONS Hypersensitivity to nalbuphine or bisulfities, patients physically dependent on opioids and who have not been detoxified may anticipate a withdrawl;use cautiously in head trauma, increased intracranial pressure, severe renal, hepatic, or pulmonary disease; hypothyroidism; adrenal insufficiency;alcoholism, undiagnosed abdominal pain,prostatic hyperplasia, patients who have recently received opioid agonists; has been used during labor but may cause respiratory depression in the newborn;safety not established in peds,lactation;decreased does for geriatrics

PROPER DOSAGE Im/subQ/IVusual dose is 10 mg every 3-6 hours(single dose not to exceed 20 mg; total daily dose not to exceed 160 mg

10-20 mg/ml concentration; Administer slowly, each 10 mg over 3-5 minutes

PT TEACHING Encourage patient to turn, cough, and breathe deeply every 2 hours to prevent atelectasis;may cause drowsiness or dizziness. Advise patient to call for assistance when ambulating and to avoid driving or other activities requiring alertness until response to the medication is known