McKenna's Pharmacology for Nursing, 2e

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P A R T 6  Drugs acting on the endocrine system

Adverse effects Glucagon is associated with GI upset, nausea and vomiting. Clinically important drug–drug interactions Increased anticoagulation effects have been noted when glucagon is combined with oral anticoagulants. If this combination is needed, the dose should be adjusted. Diabetic patient with hypertension

■ ■ Monitor for adverse effects (hyperglycaemia, GI distress). ■ ■ Evaluate the effectiveness of the teaching plan (person can name drug, dosage, adverse effects to watch for and specific measures to avoid them). ■ ■ Monitor the effectiveness of comfort measures and compliance to the regimen.

KEY POINTS

■■ Glucose-elevating agents are used to increase glucose when levels become dangerously low. Imbalance in glucose levels while taking insulin or oral agents is a common cause of hypoglycaemia. ■■ Individuals need to be carefully monitored to determine the effectiveness of therapy with these drugs and to prevent inadvertent overdose, which could lead to hyperglycaemia. CHAPTER SUMMARY ■■ Diabetes mellitus is the most common metabolic disorder. It is characterised by high blood glucose levels and alterations in the metabolism of fats, proteins and glucose. ■■ Glucose control is a complicated process affected by various hormones, enzymes and receptor sites. ■■ Diabetes mellitus is complicated by many end-organ problems. These are related to thickening of basement membranes and the resultant decrease in blood flow to these areas. ■■ Treatment of diabetes involves tight control of blood glucose levels using diet and exercise, a combination of other agents to stimulate insulin release or alter glucose absorption, or the injection of replacement insulin. ■■ Replacement insulin was once obtained from beef and pork pancreas. Today, most replacement insulin is human, derived from genetically altered bacteria. ■■ The amount and type of insulin given must be regulated daily. People taking insulin must learn to inject the drug, to test their blood glucose levels and to recognise the signs of hypoglycaemia and hyperglycaemia. ■■ Insulin is used for type 1 diabetes and for type 2 diabetes in times of stress or when other therapies have failed. ■■ Other oral hypoglycaemic agents include first- and second-generation sulfonylureas, which stimulate the pancreas to release insulin, and other agents that alter glucose absorption, decrease insulin resistance, decrease the formation of glucose or increase the urinary excretion of glucose. These agents are often used in combination to achieve effectiveness.

Care considerations for people taking glucose-elevating agents

Assessment: History and examination

■ ■ Perform a complete physical assessment to establish a baseline before beginning therapy, monitor effectiveness of therapy and evaluate for any potential adverse effects during therapy. ■ ■ Assess orientation and reflexes and baseline pulse, blood pressure and adventitious sounds to monitor the effects of altered glucose levels , and abdominal sounds and function, which could be altered by these drugs. ■ ■ Monitor blood glucose levels as ordered to assess the effectiveness of the drug and response to treatment. ■ ■ Monitor the results of laboratory tests, including urinalysis, to evaluate for glycosuria , serum glucose levels to evaluate response to therapy , and renal and liver function tests to determine the need for possible dose adjustment or identify possible toxic effects. Implementation with rationale ■ ■ Monitor blood glucose levels to evaluate the effectiveness of the drug. ■ ■ Have insulin on standby during emergency use to treat severe hyperglycaemia if it occurs as a result of overdose. ■ ■ Monitor nutritional status to provide nutritional consultation as needed. ■ ■ Provide thorough teaching, including drug name, dosage and schedule for administration; signs and symptoms of hyperglycaemia; administration technique if indicated; signs and symptoms of adverse effects; need for follow-up monitoring and laboratory testing if indicated; nutritional measures; and blood glucose monitoring. Evaluation ■ ■ Monitor response to the drug (stabilisation of blood glucose levels).