Antidiabetic Drugs Emergency Drugs

1. BY:
RABI’ATUL ADAWIYAH BINTI SULAIMAN
3067141004
BACHELOR OF SCIENCE IN NURSING (HONS)
KPJ HEALTHCARE UNIVERSITY COLLEGE, NILAI
MONITORED BY:
MADAM GEMALYN S. MALDISA
BScN PHARMACOLOGY:
NURSING IMPLICATION OF DRUGS

2. INSULIN AND
ORAL DRUGS
ANTIDIABETIC DRUGS

3. INSULIN
 Function as a substitute for the endogenous
hormone
 Effects are the same as normal endogenous
insulin
 Restores the diabetic patient’s ability to:
Metabolize carbohydrates, fats, and proteins
Store glucose in the liver
Convert glycogen to fat stores

4. ORAL ANTIDIABETIC AGENTS
 Used for type 2 diabetes
 Treatment for type 2 diabetes includes lifestyle
modifications
Diet, exercise, smoking cessation, weight loss
 Oral antidiabetic agents may not be effective
unless the patient also makes behavioral or
lifestyle changes

5. ORAL ANTIDIABETIC AGENTS
 Sulfonylureas
Chlorpropamide (Diabinese), tolazamide (Tolinase),
tolbutamide (Orinase)
Glimepiride (Amaryl), glipizide (Glucotrol), glyburide
(DiaBeta)
 Biguanides
Metformin (Glucophage)
 Alpha-glucosidase inhibitors
Acarbose (Precose), miglitol (Glyset)
 Thiazolidinediones
Pioglitazone (Actos), rosiglitazone (Avandia)
Also known as “glitazones”

6. ORAL ANTIDIABETIC AGENTS :
MECHANISM OF ACTION
 Sulfonylureas
Stimulate insulin secretion from the beta cells of the
pancreas, thus increasing insulin levels
Beta cell function must be present
Improve sensitivity to insulin in tissues
Result: lower blood glucose levels

7. ORAL ANTIDIABETIC AGENTS :
MECHANISM OF ACTION
 Biguanides
Decrease production of glucose
Increase uptake of glucose by tissues
Do not increase insulin secretion from the pancreas =
does not cause hypoglycemia
 Alpha-glucosidase inhibitors
Reversibly inhibit the enzyme alphaglucosidase in the
small intestine
Result: delayed absorption of glucose
Must be taken with meals to prevent excessive
postprandial blood glucose elevations

8. ORAL ANTIDIABETIC AGENTS :
MECHANISM OF ACTION
 Thiazolidinediones
Decrease insulin resistance
“Insulin sensitizing agents”
Increase glucose uptake and use in skeletal muscle
Inhibit glucose and triglyceride production in the liver

9. ORAL ANTIDIABETIC AGENTS :
SIDE EFFECTS
 Sulfonylureas
Hypoglycemia, hematologic effects, nausea, epigastric
fullness, heartburn, many others
 Metformin (biguanide)
Abdominal bloating, nausea, cramping, diarrhea,
metallic taste, reduced vitamin B12 levels
 Alpha-glucosidase inhibitors (Precose, Glyset)
Flatulence, diarrhea, abdominal pain
 Thiazolidinediones (Actos, Avandia)
Moderate weight gain, edema, mild anemia, hepatic
toxicity

12. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 Before giving any drugs that alter glucose levels, obtain
and document:
 A thorough history
 Vital signs
 Blood glucose level [HbA1c]
 Potential complications and drug interactions

13. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 Before giving any drugs that alter glucose levels:
 Assess the patient’s ability to consume food
 Assess for nausea or vomiting
 Hypoglycemia may be a problem if antidiabetic agents are given
and the patient does not eat
 If a patient is NPO for a test or procedure, consult physician to
clarify orders for antidiabetic drug therapy

14.  Keep in mind that overall concerns for any diabetic patient
increase when the patient:
 Is under stress
 Has an infection
 Has an illness or trauma
 Is pregnant
ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS

15. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 Thorough patient education is essential regarding:
 Disease process
 Diet and exercise recommendations
 Self-administration of insulin or oral agents
 Potential complications [How to recognize and treat hypoglycemia
and hyperglycemia]

16. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 When insulin is ordered, ensure:
 Correct route
 Correct type of insulin
 Timing of the dose
 Correct dosage
 Insulin order and prepared dosages are second-checked
with another nurse

17. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 Insulin
 Check blood glucose level before giving insulin
 Roll vials between hands instead of shaking them to mix
suspensions
 Ensure correct storage of insulin vials
 ONLY insulin syringes, calibrated in units, are to be used to
measure and give insulin
 Ensure correct timing of insulin dose with meals

18. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 Insulin (cont'd)
 When drawing up two types of insulin in one syringe, always
withdraw the regular or rapid-acting insulin first
 Provide thorough patient education regarding self-administration of
insulin injections, including timing of doses, monitoring blood
glucoses, and injection site rotations

19. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 Oral antidiabetic agents
 Always check blood glucose levels before giving
 Usually given 30 minutes before meals [Administer the medication
at exact time – with meal or when food is in sight*]
 Alpha-glucosidase inhibitors are given with the first bite of each
main meal
 Metformin is taken with meals to reduce GI effects

20. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 Assess for signs of hypoglycemia
 If hypoglycemia occurs:
 Give glucagon
 Have the patient eat glucose tablets or gel, corn syrup, honey, fruit
juice or nondiet soft drink
 Or have the patient eat a small snack such as crackers or half a
sandwich
 Monitor blood glucose levels

21. ANTIDIABETIC AGENTS:
NURSING IMPLICATIONS
 Monitor for therapeutic response
 Decrease in blood glucose levels to the level prescribed by physician
 Watch for hypoglycemia and hyperglycemia
 Measure hemoglobin A1c to monitor long-term compliance to diet and
drug therapy
 Diabetes Association (ADA) recommends A1C as the best test to find
out if a patient's blood sugar is under control over time. The test
should be performed every 3 months for insulin-treated patients,
during treatment changes, or when blood glucose is elevated. For
stable patients on oral agents the recommended frequency is at least
twice per year.

23. EMERGENCY DRUGS
Atropine Sulfate [cardiac drugs]
Lidocaine
Epinephrine

24. EMERGENCY DRUGS
ATROPINE SULFATE
Classification anticholinergics
Indications Pre-op meds/pre-anesthetic meds
To restore cardiac rate and arterial pressure during
anesthesia when vagal
To lessen the degree of A-V heart block
To overcome severe carotid sinus reflex
Antidote for cholinergic toxicity

25. EMERGENCY DRUGS
ATROPINE SULFATE
Contraindications Hypersensitivity
With acute angle closure glaucoma, obstructive
uropathy, obstructive disease of GIT, paralytic ileus,
toxic megacolon, intestinal atony, unstable CV status in
acute hemorrhage, asthma, or myasthenia gravis
Pregnant woman

26. EMERGENCY DRUGS
ATROPINE SULFATE
Nursing
implications
Monitor VS and report if increase HR
Monitor for constipation, oliguria
Instruct to take 30 mins before meals
Eat foods high in fiber and drink plenty fluids
Can cause photophobia
Instruct patient not to drive or participate in activities requiring
alertness
Advise to use hard candy, ice chips and etc. for dry mouth

27. EMERGENCY DRUGS
LIDOCAINE
Classification Anesthetic and CV drugs : anti-arrhythmics
Action Increases electrical stimulation of ventricle and His-purkinje
system by direct action on tissues, resulting to decrease
depolarization, automaticity and excitability in ventricles during
diastolic phase
Indication Anesthesia and arrhythmias
Control of status epilepticus refractory to other treatments

28. EMERGENCY DRUGS
LIDOCAINE
Contraindications Hypersensitivity
Heart block
Hypovolemia
Adams stroke syndromes
Infection at site of injection

29. EMERGENCY DRUGS
LIDOCAINE
Nursing
implications
Monitor ECG, if QT or QRS increases by 50% or more, withhold
the drug
Monitor BP, check the rebound HPN after 1-2 hours
Assess respiratory status, oxygenation and pulse deficits
Monitor blood levels
Monitor CNS symptoms
Assess patient before and after therapy
Monitor renal and liver function

30. EMERGENCY DRUGS:
EPINEPHRINE
 Injection, OTC nasal solution :
 Adrenalin Chloride
 Ophthalmic solution :
 Epifrin, Glaucon
 Insect sting emergencies :
 EpiPen Auto-Injector (delivers 0.3 mg IM adult dose),
 EpiPen Jr. Auto-Injector (delivers 0.15 mg IM for children)
 Nebulization :
 AsthmaNefrin, microNefrin, Nephron, S2

31. EMERGENCY DRUGS
EPINEPHRINE
Classification Beta2 Adrenergic Antagonists
Action Stimulates beta receptors in lung
Relaxes bronchial smooth muscle
Increase vital capacity
Increase HR, BP, PR
Decreases airway resistance

32. EMERGENCY DRUGS
EPINEPHRINE
Indications Asthma
Bronchitis
Emphysema
All cardiac arrest, anaphylaxis
Used for symptomatic bradycardia
Relief of bronchospasm occurring during anesthesia
Exercised-induced bronchospasm
Contraindications In pregnant and breastfeeding woman

33. EMERGENCY DRUGS
EPINEPHRINE
Contraindications With angle-closure glaucoma, shock (other than
anaphylactic shock), organic brain damage, cardiac
dilatation, arrhythmias, coronary insufficiency, or cerebral
arteriosclerosis.
Patient receiving general anesthesia with halogenated
hydrocarbons or cyclopropane and in patient in labor (may
delay second stage)
In conjunction with local anesthesia, epinephrine is
contraindicated for use in finger, toes, ears, nose, and
genitalia

34. EMERGENCY DRUGS
EPINEPHRINE
Nursing
implications
Use extreme caution when calculating and preparing doses;
epinephrine is a very potent drug; small errors in dosage can
cause serious adverse effects. Double-check pediatric dosage.
Use minimal doses for minimal periods of time; "epinephrine-
fastness" (a form of drug tolerance) can occur with prolonged
use.

35. EMERGENCY DRUGS
EPINEPHRINE
Nursing
implications
Protect drug solutions from light, extreme heat, and freezing; do
not use pink or brown solutions. Drug solutions should be clear
and colorless (does not apply to suspension for injection).
Shake the suspension for injection well before withdrawing the
dose.
Rotate SC injection sites to prevent necrosis; monitor injection
sites frequently.
Maintain a rapidly acting alpha-adrenergic blocker (phentolamine)
or a vasodilator (a nitrate) on standby in case of excessive
hypertensive reaction.

36. EMERGENCY DRUGS
EPINEPHRINE
Nursing
implications
Monitor BP, pulse, respirations, and urinary output and observe
patient closely following IV administration. Epinephrine may
widen pulse pressure. If disturbances in cardiac rhythm occur,
withhold epinephrine and notify physician immediately.
Keep physician informed of any changes in intake-output ratio.
Use cardiac monitor with patients receiving epinephrine IV. Have
full crash cart immediately available

37. EMERGENCY DRUGS
EPINEPHRINE
Nursing
implications
Check BP repeatedly when epinephrine is administered IV during
first 5 min, then q3–5min until stabilized.
Advise patient to report to physician if symptoms are not relieved
in 20 min or if they become worse following inhalation.
Advise patient to report bronchial irritation, nervousness, or
sleeplessness. Dosage should be reduced.
Monitor blood glucose & HbA1c for loss of glycemic control if
diabetic.