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TREATMENT

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Liothyronin e sodium (T3) (Cytomel)

Tab 25 mcg/day

Thyroid hormone

Unclear. Enhances oxygen consumption by most tissues of the body; increases the basal metabolic rate and the metabolism of carbohydrates, lipids and proteins.

I-Congenital hypothyroidism; Myxedema; myxedema coma, premyxedema coma; simple (nontoxic) goiter; thyroid hormone replacement

1.)Watch for angina, coronary occlusion, or stroke in patients w/ arteriosclerosis who are receiving rapid replacement.

C/I-Hypersensitive to drug and in those w/ acute MI uncomplicated by hypothyroidism, uncorrected adrenal insufficiency; use cautiously in elderly patients & in those w/ angina pectoris, hypertension, other CV disorders, renal insufficiency or ischemia; use cautiously w/ diabetes insipidus, mellitus

2.)Long term therapy causes bone loss in premenopausal & postmenopausal women. Consider a basal bone density measurement, & monitor patient closely for osteoporosis.

S/E CNS-nervousness, insomnia, tremor, headache CV-tachycardia, arrhythmias, angina, cardiac decompensation & collapse GI-diarrhea & vomiting Metabolic-weight loss Muscu-accelerated bode maturation in infants & children

3.)Thyroid hormone replacement requirements are about 25% lower in patients older than age 60 than in young adults. 4.)Monitor pulse and BP 5.)When switching from IV to PO therapy, gradually increase IV dose while starting PO dose. 6.)In pregnant patients, dosage may need to be increased.

1.)Teach patient importance of compliance. Tell him to take thyroid hormones at same time each day, preferably before breakfast, to maintain constant hormone levels & help prevent insomnia. 2.)make sure patient understands that replacement therapy is usually for life. Drug should never be stopped unless directed by prescriber. 3.)Advise patient who has achieved a stable response not to change brands. 4.)tell patient to report unusual bleeding and bruising. 5.)For diabetic patients, advise them to monitor glucose level closely. 6.)Advise woman to report pregnancy to prescriber because dosage may need adjustments.

Skin-skin reactions, diaphoresis Other- heat intolerance

Potassium iodide (ThyroSafe)

Salt of stable iodine

I-To prepare for thyroidectomy; thyrotoxic crisis; Radiation protectant

1.)The FDA doesn’t recommend prophylaxis w/ potassium iodide for

1.)Show patient how to mask salty taste of oral

65 mg/ml

Inhibits thyroid hormone formation, limits iodine transport into the thyroid gland, & blocks thyroid hormone release.

for thyroid gland C/I-w/ tuberculosis, acute bronchitis, iodide hypersensitive or hyperkalemia; use cautiously in patients w/ goiter or autoimmune thyroid disease. S/E CNS-fever EENT-periorbital edema GI-nausea & vomiting, diarrhea, inflammation of salivary glands, burning mouth and throat, sore teeth and gums Metabolic-potassium toxicity Skin-acneiform rash Other-hypersensitivity reactions

a radiation emergency in adults over 40 y.o unless a large internal radiation dose is anticipated. 2.)For thyrotoxicosis, first iodine dose is given at least 1 hour after first dose of propylthiouracil and methimazole. 3.)Dilute oral solution in water, milk or fruit juice and give after meals to prevent gastric irritation, hydrate patient & mask salty taste. 4.)Give iodides through straw to avoid tooth discoloration. 5.)Earliest signs of delayed hypersensitivity reactions caused by iodides are irritation and swollen eyelids. 6.)Store in lightresistant container.

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solution. Tell him to take all forms of drug after meals. 2.)Warn patient that sudden withdrawal may precipitate thyroid crisis. 3,)Teach patient s/s of potassium toxicity, including confusion, irregular heartbeat, numbness, tingling, pain or weakness of hands or feet & tiredness. 4.)Tell patient to ask prescriber about using iodized salt & eating shellfish. These foods contain iodine & may alter drug’s effectiveness. 5.)Tell patient not increase the amount of potassium through diet. 6.)tell patient to stop drug & notify prescriber if epigastric pain, rash, metallic taste, nausea or vomiting occurs.

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Calcitonin – salmon (Fortical)

200 units/ml in 2-ml ampoules

Calcium regulator

Decreases osteoclastic activity by inhibiting osteocytic osteolysis; decreases mineral release and matrix or collagen breakdown in bone.

I-Paget disease of bone (osteitis deformmans); Hypercalcemia; postmenopausal osteoporosis

1.)Skin test is usually done in patients w/ suspected drug sensitivity before therapy.

C/I-Hypersensitive to drug

2.)Systemic allergic reactions are possible because hormone is protein. Keep epinephrine nearby.

S/E CNS-headache, weakness, dizziness, paresthesia CV-chest pressure, facial flushing EENT-eye pain, nasal congestion, rhinitis GI-transient nausea, unusual taste, diarrhea, anorexia, vomiting, epigastric discomfort, abdominal pain GU-increased urinary frequency, nocturia Resp-shortness of breath Skin-rash, pruritus of ear lobes Other-anaphylaxis, edema of feet, chills, tender palms and soles

Vitamin D analog, Calcitriol Calcium regulator (1,25dihydoxych olecalciferol )

I-Hypocalcemia in patients undergoing long term

3.)Give at bedtime, when possible, to minimize nausea and vomiting. 4.)Use freshly reconstituted solution w/in 2 hours. 5.)Observe patient for signs of hypocalcemic tetany during therapy (muscle twitching, titanic spasms and seizures when hypocalcemia is severe). 6.)Periodic examinations of urine sediment are recommended. 7.)In patients w/ good first response to drug who have relapse, expect to evaluate antibody response to the hormone protein.

1.)Monitor calcium level; this level times the phosphate level shouldn’t exceed 70.

1.)When drug is given for postmenopausal osteoporosis, remind patient to take adequate calcium and vitamin D supplements. 2.)Show home care patient & family member how to give drug. Tell them to do so at bedtime if only one dose is needed daily. If nasal spray is prescribed, tell patient to alternate nostrils daily. 3.)Advise patient to notify prescriber if significant nasal irritation or evidence of an allergic response occurs. 4.)Inform patient that facial flushing and warmth occur in 20% to 30% of patients w/in minutes of injection & usually last about 1 hour. 5.)Tell patient that nausea and vomiting may occur at the onset of therapy.

1.)Tell patient to immediately report early symptoms of Vitamin D intoxication. 2.)Instruct patient to

(Rocaltrol)

0.25 to 0.75 mcg PO daily

Stimulates calcium absorption from the GI tract and promotes movement of calcium from bone to blood.

dialysis; Hypoparathyroidism; To manage secondary hyperparathyroidism and resulting metabolic bone disease in predialysis patients. C/I-w/ hypercalcemia or Vitamin D toxicity; use cautiously in patients receiving cardiac glycosides and in those w/ sarcoidosis or hyperparathyroidism S/E

2.)Monitor phosphorus level, esp. in hypoparathyroid patients and dialysis patients.

CNS-headache, somnolence, weakness, irritability

3.)Reduce dose as parathyroid hormone levels decrease in response to therapy.

CV-hypertension, arrhythmias

4.)Protect drug from heat and light.

EENT-conjunctivitis, photophobia, rhinorrhea GI-nausea and vomiting, constipation, polydipsia, pancreatitis, metallic taste, dry mouth, anorexia GU-polyuria, nocturia Metabolic-weight loss Muscu-bone and muscle pain Skin-pruritus Other-hyperthermia, decreased libido

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During dose adjustment, determine calcium level twice weekly. If hypercalcemia occurs, stop drug and notify prescriber, but resume after calcium level returns to normal.

INDICATION/CONTR

adhere to diet and calcium supplementation and to avoid unapproved OTC drugs and antacids that contain magnesium. 3.)Tell patient that drug is the most potent form of Vitamin D available and shouldn’t be taken by anyone else. 4.)Encourage patient to receive adequate daily intake of calcium.

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Glimepirid e (Amaryl)

1-2 mg once a day

Antidiabetic, oral; second generation sulfonylurea

I-Adjunct to diet and exercise to lower glucose level in patients w/ type 2 diabetes whose hyperglycemia can’t be managed by diet and exercise alone

Lowers glucose level, possibly by stimulating release of insulin from functioning pancreatic beat cells, and may lead to increased sensitivity of peripheral tissues to insulin.

C/I-Hypersensitivity; in pregnant women or elderly patients and as sole therapy for type 1 diabetes; in breastfeeding women because it can cause hypoglycemia in breast-fed infants; use cautiously w/ allergic to sulfonamides. S/E CNS-dizziness, asthenia, headache EENT-changes in accommodation GI-nausea Hematologic-leukopenia, hemolytic anemia,agranulocytosis

1.)Glimepiride and insulin May be used together in patients who lose glucose control after first responding to therapy. 2.)Monitor fasting glucose level periodically to determine therapeutic response. Also monitor glycosylated hemoglobin level, usually every 3-6 months, to precisely assess long-term glycemic control.

3.)Advise patient to wear or carry medical identification at all times. 4.)Advise woman to consult prescriber before planning pregnancy. Insulin may be needed during pregnancy and breastfeeding.

4.)When changing patient from other sulfonylureas to glimepiride, a transition period isn’t needed.

5.)Advise patient ot consult prescriber before taking any OTC products.

1.)Give immediaterelease tablet about 30 minutes before meals.

1.)Instruct patient about disease and importance of following therapeutic regimen, adhering to diet, losing weight, getting exercise, following personal hygiene programs, and avoiding infection.

6.)Advise patient to avoid alcohol w/c lowers glucose level.

Sulfonylurea

(Glucotrol)

5mg PO daily

2.)make sure patient understands that therapy relieves symptoms but doesn’t cure the disease. He should also understand potential risks and advantages of taking drug and of other treatment methods.

3.)Use of oral hypoglycemic may carry higher risk of CV mortality than use of diet alone or of diet and insulin therapy.

Skin-pruritus, erythema, urticaria

Glipizide

1.)Tell patient to take drug with first meal of the day.

Unknown. A sulfonylurea that probably stimulates insulin release from pancreatic beat

I-Adjunct to diet to lower glucose level in patients w/ type 2 (non-insulindependent) diabetes; To

2.)Some patients may attain effective control on a once-daily regimen, whereas other respond better w/

cells, reduces glucose output by the liver, and increases peripheral sensitivity to insulin.

replace insulin therapy

divided dosing.

C/I-Hypersensitivity; in pregnancy or breastfeeding women; use cautiously in patients w/ renal or hepatic disease

3.)Patient may switch from immediate-release dose to extendedrelease tablets at the nearest equivalent total daily dose.

S/E CNS-dizziness, drowsiness, headache, syncope GI-nausea, dyspepsia, flatulence, constipation, diarrhea Hematologic-leukopenia, hemolytic anemia Hepatic-cholestatic jaundice Metabolic-hypoglycemia Resp-rhinitis Skin-rash, pruritus, photosensitivity

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4.)During periods of increased stress, patient may need insulin therapy. Monitor patient closely for hyperglycemia in these situations. 5.)Patient switching from insulin therapy to an oral antidiabetic should check glucose level at least three times a day before meals. Patient may need hospitalization during transition.

Explain how and when to monitor glucose level, and teach recognition of episodes of low & high glucose levels. 2.)tell patient to carry candy or other simple sugars to treat mild lowglucose episodes. 3.)Instruct patient not to change drug dosage w/out prescribers consent and to report abnormal blood or urine glucose test results. 4.)Advise woman planning pregnancy to first consult prescriber. Insulin may be needed during pregnancy and breastfeeding. 5.) Advise patient to avoid alcohol w/c lowers glucose level.

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Hydrocorti sone (Cortenema )

240mg/day

Glucocorticoid

Not clearly defined. Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response; stimulates bone marrow, and influences protein, fat and carbohydrate metabolism.

I-Severe inflammation, adrenal insufficiency; Shock; adjunct treatment for ulcerative colitis and proctitis C/I-Hypersensitivity; use cautiously in patient w. recent MI; w/ GI ulcer, renal disease, hypertension, diabetes mellitus, hypothyroidism, active hepatitis S/E CNS-euphoria, insomnia psychotic behavior EENTcataracts, glaucoma GI-nausea, increased appetite, peptic ulceration Hematologic-easy bruising Skin-delayed wound healing Muscu-qrowth suppression, muscle weakness

1.)Determine whether patient is sensitive to other corticosteroids.

1.)Tell patient not to stop drug abruptly or w/out prescriber’s consent.

2.)For better results and less toxicity, give a once-daily dose in morning.

2.)Instruct patient to take oral form of drug w/ milk or food.

3.)Give oral dose w/ food when possible. Patient may need other drug to prevent GI irritation. 3.)Enema may produce same systemic effects as other forms of hydrocortisone. If enema therapy must exceed 21 days, taper off by giving every other night for 2 to 3 weeks. 4.)Always adjust to lowest effective dose. 5.)Monitor patients weight, BP, and electrolyte level. 6.)Watch for depression or psychotic episodes, esp. during high-dose therapy.

Triamcinolo ne

Glucocorticoid

(Aristospan ) More potent than prednisone.

I-Severe infalammation, immunosuppression; asthma C/I-Hypersensitive; use cautiously w/ recent MI, GI ulcer, renal disease,

1.)Drug isn’t used for alternate-day therapy. 2.)Parenteral form isn’t for IV use. 3.)Monitor patients

3.)Teach patient s/s early adrenal insufficiency; fatigue, muscle weakness, joint pain, fever, anorexia, nausea, shortness of breath, dizziness and fainting. 4.)Warn patient about easy bruising. 5.)Advise patient receiving long term therapy to have periodic eye examinations. 6.)Urge patient receiving long-term therapy to consider exercise or physical therapy. Also, tell him to ask prescriber about Vitamin D or calcium supplement.

1.)Instruct patient to take oral form of drug w/ milk or food. 2.)Teach patient s/s early adrenal insufficiency; fatigue, muscle

3 mg/ml

Intermmediateacting. Has no mineralocorticoid activity.

hypertension,DM,osteoporos is S/E CNS-euphoria, insomnia, pseudotumor cerebri, seizures GI-pancreatitis, peptic ulceration, GI irritation GU-menstrual irregularities, increased urine calcium level Metabolic-hypokalemia, hyperglycemia and carbohydrate intolerance Muscu-growth suppression

weight, BP and electrolyte level. 4.)Watch depression or psychotic episodes, esp. high dose therapy. 5.)Diabetic patient may need increased insulin dosage; monitor glucose level. 6.)Gradually reduce dosage after long term therapy. Drug may affect patient’s sleep. 7.)Unless contraindicated, give low-sodium diet that’s high in potassium and protein. Give potassium supplements as needed.

weakness, joint pain, fever, anorexia, nausea, shortness of breath, dizziness and fainting. 3.)Tell patient not to stop drug abruptly or w/out prescriber’s consent. 4.)Warn patient on long term therapy about cushingoid effects (moon face, buffalo hump) and the need to notify prescriber about sudden weight gain and swelling. 5.)Tell patient to report slow healing.