metformin
DQ-1
There are several medications that are used to treat diabetes mellitus. One of the most common medications that is prescribed often is Glucophage. This medication is also known as metformin. This medication is used to decrease hepatic glucose production. This medication also functions by decreasing intestinal absorption of glucose. Another way this medication helps control glucose is by increasing sensitivity of insulin (Li, Hu, Xu, Hu, Zhang, Pang, 2019). The therapeutic goal of this medication is to help control blood glucose. This medication duration is set to be 12-24hrs depending on type of concentration and if the medication is extended release. Adverse effects of this medication are abdominal bloating, diarrhea, nausea, vomiting , metallic taste, hypo or hyperglycemia, lactic acidosis, decreased vitamin b12 absorption. Drug interactions associated with this medication areacute alcohol consumption, iodine contrast media, amiloride,digoxin,morphine, procainamide,quinidine, ranidine,tramterenetrimethoprim, calcium channel blockers and vancomycin. Cimetidine and furosemide may increase the effects of metformin. Nifedipine increases the absorption and effects. Natural pruducts such as glucosamine may worsen blood glucose control. Chromium and coenzyme q-10 may increase hypoglycemia. Patients with well controlled blood glucose and on metformin and develop illness or abnormal blood laboratory results must be investigate further. Patients experiencing this must be screened for ketoacidosis or lactic acidosis. Electrolytes , ketones ,glucose, blood ph, lactate , pyruvate and metformin levels must be assessed. Blood glucose needs to be monitored for a period of 3 months to determine the effects of the therapy. Renal function must me assessed before initiating therapy or changing dose of therapy. Monitoring serum folic acid and vitamin b12 every 1-2 years is also necessary (Deglin,Vallerand, Sanoski, 2018).
Deglin, J. H., Vallerand, A. H., & Sanoski, C. A. (2018). Daviss drug guide for nurses. Philadelphia: F.A. Davis (830-834).
Li, M., Hu, X., Xu, Y., Hu, X., Zhang, C., & Pang, S. (2019). A Possible Mechanism of Metformin in Improving Insulin Resistance in Diabetic Rat Models. International Journal of Endocrinology, 1–9. https://doi.org/10.1155/2019/3248527
DQ-2
Type 2 diabetes mellitus is a disease process that affect many people worldwide. It is an endocrine disorder that leads to insulin resistance and/or a combination of decreased insulin secretion (Shaw & Robinson, 2019, p. 994). This disease affects more Native Americans, Latinos, African Americans, Asian Americans, and Pacific Islanders than it does any other ethnic group (Shaw & Robinson, 2019, p. 994). Risk factors include genetic predisposition, obesity, hypertension, gestational history, familial history, age, and sedentary lifestyles (Shaw & Robinson, 2019, p. 994). Complications of the disorder include kidney disease, heart disease, ocular disease, and nervous system complications (Shaw & Robinson, 2019, p. 995). Diagnostic screening for the disease includes checking a hemoglobin A1C, fasting blood glucose levels, glucose tolerance testing, and casual glucose testing with patients who present with symptoms of diabetes (Shaw & Robinson, 2019, p. 995). One class of drug I have seen used more frequently for type 2 diabetes is Januvia which is a dipeptidyl Peptidase-4 inhibitor, also known as gliptins (Robinson & Shaw, 2019, p. 586). This drug acts on the incretin hormone system to increase insulin production, they are well tolerated by patients, have a lower risk for hypoglycemia, and are oral agents that act in the gut to control the disease (Robinson & Shaw, 2019, p. 586). It works by increasing the action of the limited glucagon-like peptide (GLP-1) hormone receptors in diabetics that aid in increasing the availability of the GLP-1 hormones, and this helps stimulates insulin secretion, increases beta cell production, decreases beta cell death, reduces glucagon secretion, and controls appetite and food intake for these patients (Robinson & Shaw, 2019, p. 586). There is caution in the use of Januvia with renal impairment due to the fact it is eliminated from the kidneys, so toxicity can occur in patients with moderate to severe kidney disease (Robinson & Shaw, 2019, p. 586). Common side effects include edema, headache, UTI’s, and hypoglycemia if Januvia is paired with other medications to control insulin secretion (Robinson & Shaw, 2019, p. 586). Monitoring includes pancreatic enzymes due to the risk of pancreatic metaplasia in patients with pancreatitis (Robinson & Shaw, 2019, p. 586). Other monitoring includes renal function, hemoglobin A1C levels, and glucose levels. Drug interactions include co-administration with other gliptins due to hypoglycemia, ACE inhibitors due to the risk of angioedema, and administration with Digoxin due to the risk of increased concentrations of Digoxin (Robinson & Shaw, 2019, p. 587). Co-administration with other insulins needs monitoring and dose adjustments may be warranted to prevent hypoglycemia. This drug is expensive due to it being relatively new, so it is not considered a first line therapy in most cases but has been shown to be better tolerated. In a clinical trial conducted by Umpierrez et al. (2013) it was found that the use of Januvia alone or in combination with insulin was safe in hospitalized patients with type 2 diabetes (p. 1). Normally in the hospital setting patients are placed on insulin to control their glucose levels so that interactions with contrast media or other medications is less likely to happen. Once the patient is improving then transition to oral diabetic medications is resumed to prepare the patients to go home. They found that when administering Januvia alone or in combination with insulin the hospital setting on patients in the general medical/surgical ward that glucose levels were better controlled and the need for insulin was reduced during their hospitalization (Umpierrez et al., 2013, p. 4).
References
Robinson, M. & Shaw, K. (2019). Drugs affecting the endocrine system. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (pp. 541-614). Philadelphia, PA: F. A. Davis Company.
Shaw, K. & Robinson, M. (2019). Diabetes Mellitus. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (pp. 991-1020). Philadelphia, PA: F. A. Davis Company.
Umpierrez, G. E., Gianchandani, R., Smiley, D., Jacobs, S., Wesorick, D. H. Newton, C., … & Pasquel, F. (2013). Safety and efficacy of sitagliptin therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes. Diabetes Care, 36(11), 3430-3435. Doi: 10.2337/dc13-0277
DQ-3
Levothyroxine sodium is a medication used to treat hypothyroidism. It is a synthetic hormone replacement for thyroxine (T4) that is taken when the thyroid does not produce enough. It helps with metabolism, growth and development, enhances the use of glycogen stores, and promotes protein synthesis (Levothyroxine, n.d.). It should be taken on an empty stomach 30-60 minutes before breakfast and at least 4 hours apart from food that decrease absorption, such as soybean flour, walnuts, and dietary fiber (Levothyroxine, n.d.). Its mechanism of action is entering the system as T4 and being metabolized to T3 to be used throughout the body. It is monitored by lab work to monitor levels of TSH to be within the therapeutic range starting 6 weeks after initiating and titrate therapy as needed. If the patient is still experiencing symptoms then consider checking free T4 and TSH to reach steady state. Pediatric patients require more frequent monitoring (every 1-2 months), especially if initiating young to prevent growth and development delay (Levothyroxine, 2019).
It is advised to use in caution with adrenal insufficiency, benign thyroid nodules, and in diabetes. It can cause poor glycemic control and diabetes insipidus since it increases glomerular filtration rate. Levothyroxine can decrease bone mineral density and should be monitored especially in postmenopausal women. Once a specific type of thyroid medication is started it is advised to stick with that bran because different forms/manufacturers can result in variations in TSH values (Levothyroxine, 2019). The most common side effect is hair loss, arrhythmias, increased appetite, heat sensitivity, and headache. Medications that interact with the absorption of levothyroxine are antacids, estrogen-containing birth control, and bile acid sequestrants that would need to be administered 4 hours after the levothyroxine is taken.
There was a study done at a medical center to test the bioequivalence of Synthroid and levothyroxine and had the kids on one for 8 weeks and switched to the other for 8 weeks. The study concluded that once they were switched the TSH dropped and it shouldn’t be switched once a patient is therapeutic (Carswell, Gordon, Popovsky, Hale, & Brown, 2013).
Levothyroxine. (n.d.). Retrieved February 6, 2020, from https://www.pdr.net/drug-summary/Synthroid-levothyroxine-sodium-26
Levothyroxine (Professional Patient Advice). (2019, June 21). Retrieved February 6, 2020, from https://www.drugs.com/ppa/levothyroxine.html
Carswell, J., Gordon, J., Popovsky, E., Hale, A., & Brown, R. S. (2013). Generic and Brand-Namel-Thyroxine Are Not Bioequivalent for Children With Severe Congenital
