Pharmacology Made Easy

Medication Information Table

Alpha-Glucosidase Inhibitors – acarbose

Category Information
THERAPEUTIC USE • Type 2 diabetes mellitus, with or without medication therapy with insulin, a
sulfonylurea, or metformin
ADVERSE DRUG • Gastrointestinal effects (distention, flatus, hyperactive bowel sounds,
REACTIONS diarrhea)
• Hypoglycemia (combination therapy with insulin or a sulfonylurea)
• Liver dysfunction
• Anemia
INTERVENTIONS • Monitor hyperactive bowel sounds, distention, and diarrhea.
• Report persistent gastric distress.
• Monitor for manifestations of hypoglycemia (diaphoresis, tachycardia,
fatigue, excessive hunger, tremors).
• Measure liver enzymes at baseline, every 3 months for the first year, and
periodically thereafter.
• Stop medication therapy for indications of liver injury.
• Monitor CBC.
• Watch for manifestations of anemia (pallor, fatigue, shortness of breath).
• Recommend iron-rich foods and supplements accordingly.
ADMINISTRATION • Give with the first bite of food, three times a day.
• Tell clients who skip a meal to also skip the dose usually taken with that
meal and to take only one dose at the next meal.
CLIENT INSTRUCTIONS • Warn client about the gastric side effects of alpha-glucosidase inhibitors.
• Follow the diet regimen recommended by the provider.
• Wear a medical alert bracelet.
• Watch for and report manifestations of hypoglycemia.
$ Test blood glucose to confirm.
$ Consume oral glucose tablets if necessary.
$ Retest in 15 min and repeat if still low.
$ Carry glucose tablets at all times.
• Report dark urine, abdominal pain, vomiting, or fatigue.
• Report pallor, fatigue, or shortness of breath.

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 Pharmacology Made Easy: Medication Information Table
Alpha-Glucosidase Inhibitors – acarbose

Category Information
CONTRAINDICATIONS • Gastrointestinal disorders (such as inflammatory bowel disease),
obstruction, ulceration
PRECAUTIONS • Hepatic impairment
• Gastrointestinal distress
• Not typically used in U.S.
INTERACTIONS • Insulin and sulfonylureas increase the risk of hypoglycemia.

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 Pharmacology Made Easy
Medication Information Table

Amylin Mimetics – pramlintide

Category Information
THERAPEUTIC USE • Types 1 and 2 diabetes mellitus (as an insulin or hypoglycemic medication
supplement)
ADVERSE DRUG • Hypoglycemia (severe) when combined with insulin
REACTIONS
• Nausea
• Injection site reactions
INTERVENTIONS • Recommend a reduced insulin dosage when initiating therapy.
• Monitor for manifestations of hypoglycemia, which tends to occur within 3
hr after dosing.
• Recommend gradual titration of doses.
• Monitor for persistent nausea and vomiting (more common with type 1
than with type 2).
• Use appropriate injection technique for medication.
ADMINISTRATION • Do not mix with insulin in the same syringe.
• Give subcutaneously in thigh or abdomen prior to meals that contain at
least 30 g of carbohydrates.
• Rotate injection sites.
• Expect the peak action 20 min after dosing.
• Refrigerate unopened vials until their expiration date.
• Keep vials in use at room temperature for 28 days.
CLIENT INSTRUCTIONS • Wear a medical alert bracelet.
• Watch for and report manifestations of hypoglycemia, especially 3 hr
after dosing. Test blood glucose to confirm, then consume a snack of
carbohydrates, and retest in 15 to 20 min and repeat if still low.
• Carry a carbohydrate snack at all times.
• Lie down when feeling nauseated.
• Instruct on proper injection technique.
CONTRAINDICATIONS • Poor insulin regimen adherence
• Gastroparesis and medications affecting GI motility
PRECAUTIONS • Visual or dexterity impairment
INTERACTIONS • Insulin increases the risk for hypoglycemia.
• Absorption of oral medications slows, so clients should take them 1 hr
before or 2 hr after pramlintide.
• Medications that slow gastric emptying, such as opioids, and medications
that delay food absorption, such as acarbose and miglitol, further slow
gastric emptying.

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 Pharmacology Made Easy
Medication Information Table

Antidiuretic Hormone – desmopressin

Category Information
THERAPEUTIC USE • Diabetes insipidus
• NOTE: For detailed information about the use of desmopressin to treat
hemophilia, see the Hematologic System module.
ADVERSE DRUG • Fluid retention (leading to water intoxication), hyponatremia
REACTIONS
• Vasoconstriction (vasopressin, not desmopressin)
• Seizures
INTERVENTIONS • Monitor for headache, confusion, or other signs of water intoxication.
• Monitor fluid intake and output.
• Monitor serum sodium levels.
• Restrict fluid intake when appropriate.
• Recommend diuretic therapy for moderate and severe fluid retention.
ADMINISTRATION • Administer orally, intranasally, subcutaneously, sublingually, or via IV.
• Spray the nasal form high into the nasal cavity but not into the throat.
• Monitor blood pressure, intake and output, urine and plasma osmolality,
and creatinine clearance.
• With IV vasopressin, monitor the IV insertion site, as extravasation can lead
to gangrene.
• Expect lifelong therapy.
CLIENT INSTRUCTIONS • Report pounding headache, sleepiness, fluid retention, weight gain, and
edema.
• Limit fluid intake during therapy.
• Record fluid intake and output daily.
• Report chest pain or pressure.

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 Pharmacology Made Easy: Medication Information Table
Antidiuretic Hormone – desmopressin

Category Information
CONTRAINDICATIONS • Vasopressin
• Coronary artery disease
• Poor peripheral circulation
• Chronic nephritis
• Desmopressin
• Electrolyte imbalances (oral form)
• Renal failure
• Nephrogenic diabetes insipidus
PRECAUTIONS • Older adults
• Cardiovascular disease
• Hypertension
• History of hyponatremia
• Severe heart failure
• History of thromboembolic events
INTERACTIONS • Carbamazepine and chlorpropamide increase antidiuretic action.
• Other vasopressors and lithium decrease antidiuretic action.
• Loop diuretics
• Glucocorticoids
• SSRIs, NSAIDs, thiazide diuretics

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 Pharmacology Made Easy
Medication Information Table

Radioactive Iodine – iodine-131

Category Information
THERAPEUTIC USE • Hyperthyroidism (Graves’ disease)
• Thyroid cancer
ADVERSE DRUG • Hypothyroidism (expected for most clients, but still requires medication
REACTIONS therapy)
• Bone marrow depression (rare)
• Radiation sickness (rare)
INTERVENTIONS • Monitor thyroid function.
• Monitor for indications of thyroid dysfunction (drowsiness, depression,
weight gain, edema, anorexia, cold intolerance, dry skin, menorrhagia).
• Monitor CBC and platelet count at baseline and periodically thereafter.
• Monitor for indications of anemia, leukopenia, and thrombocytopenia.
• Monitor for manifestations of radiation sickness (hematemesis, epistaxis,
intense nausea, vomiting).
ADMINISTRATION • Give orally.
• Obtain a negative pregnancy test before administration.
• Measure baseline vital signs and weight and monitor periodically thereafter.
• Dosage is miniscule for thyroid disorders, larger for thyroid cancers.
• Initiate radiation precautions for large doses (limited contact, increased
fluids, body waste disposal per facility protocol).
CLIENT INSTRUCTIONS • Watch for and report anxiety, drowsiness, depression, weight gain, swelling,
appetite loss, cold intolerance, dry skin.
• Report fever, sore throat, weakness, or fatigue.
• Report bloody vomit, nosebleeds, or severe nausea and vomiting.
CONTRAINDICATIONS • Pregnancy: teratogenic effects
• Lactation
PRECAUTIONS • Children prior to puberty
INTERACTIONS • Other antithyroid medications reduce uptake.

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 Pharmacology Made Easy
Medication Information Table

Biguanides – metformin
Category Information
THERAPEUTIC USE • Type 2 diabetes mellitus
ADVERSE DRUG • Lactic acidosis (rare, but potentially fatal)
REACTIONS
• Nausea, diarrhea, vomiting
• Unpleasant metallic taste
• Vitamin deficiencies (vitamin B12, folic acid)
INTERVENTIONS • Monitor for manifestations of lactic acidosis.
• For manifestations of lactic acidosis, stop medication therapy immediately.
• Expect that severe lactic acidosis will require hemodialysis.
• Monitor for persistent nausea, vomiting, or diarrhea.
• Monitor fluid intake and output.
• Monitor for manifestations of vitamin B12 or folic acid deficiency.
• Recommend the appropriate supplements.
• Monitor renal function upon initial therapy and yearly afterward.
ADMINISTRATION • Give orally twice a day with the morning and evening meals (immediate-
release) or once a day with the evening meal (extended-release).
• Make sure clients swallow the extended-release form whole and do not
crush or chew it.
CLIENT INSTRUCTIONS • Avoid drinking alcohol.
• Report weakness, fatigue, lethargy, or hyperventilation.
$ If these manifestations develop, stop taking the medication and seek
medical care immediately.
• Expect these effects to diminish as medication therapy continues.
• Lie down when feeling nauseated.
• Maintain adequate carbohydrate and fluid intake.
• Report weakness, fatigue, pallor, or reddened tongue.

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 Pharmacology Made Easy: Medication Information Table
Biguanides – metformin

Category Information
CONTRAINDICATIONS • Diabetic ketoacidosis
• Cardiopulmonary, hepatic, or renal insufficiency
• Alcoholism
• Heart failure
• Severe infection
• Shock
• Acute myocardial infarction
• Hypoxemia
• Lactic acidosis
PRECAUTIONS • Diarrhea
• Dehydration
• Anemia
• Pituitary insufficiency
• Gastroparesis
• Gastrointestinal obstruction
• Hyperthyroidism
• Older adults
INTERACTIONS • Alcohol and cimetidine increase the risk of lactic acidosis.
• Any contrast medium containing iodine increases the risk of acute renal
failure, thus worsening lactic acidosis.
• Nifedipine, furosemide, morphine, antifungals, and many other
medications increase hypoglycemic effects.

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 Pharmacology Made Easy
Medication Information Table

Dipeptidyl Peptidase 4 (DPP-4) Inhibitors – sitagliptin

Category Information
THERAPEUTIC USE • Treats type 2 diabetes alone or in combination with other medications for
diabetes.
ADVERSE DRUG • Upper respiratory tract infection and inflamed nasal passages
REACTIONS
• Headache
• Pancreatitis
• Stevens-Johnson syndrome
• Anaphylaxis
• Angioedema
INTERVENTIONS • Monitor for respiratory manifestations.
• Monitor temperature if respiratory effects occur.
• Monitor for headaches.
• Administer over-the-counter analgesic for persistent headache, if provider
approves.
• Monitor for gastrointestinal effects that could be manifestations of
pancreatitis.
• Monitor blood amylase level to help confirm pancreatitis if needed.
• Assess skin for manifestations of Stevens-Johnson syndrome.
• Monitor for acute renal failure.
ADMINISTRATION • Administer orally alone or in combination with metformin.
• Give with or without food.
• Give a reduced dosage to clients with severe renal impairment and low
creatinine clearance.
CLIENT INSTRUCTIONS • Report persistent upper respiratory manifestations or fever.
• Report persistent or unrelieved headaches.
• Report severe upper abdominal pain or abdominal pain that radiates to the
back and is associated with nausea or vomiting.
• Take medication as prescribed, taking any missed medication as soon as
remembered.
• Instruct clients on proper technique for obtaining routine blood glucose
levels.

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 Pharmacology Made Easy: Medication Information Table
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors – sitagliptin

Category Information
CONTRAINDICATIONS • Hypersensitivity
• Type 1 diabetes
• Diabetic ketoacidosis
PRECAUTIONS • Hemodialysis
• Moderate to severe renal dysfunction
• History of pancreatitis
INTERACTIONS • Sitagliptin may increase digoxin levels.
• Concurrent use with other antidiabetics increases risk of hypoglycemia.

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 Pharmacology Made Easy
Medication Information Table

Glucocorticoids – hydrocortisone
Category Information
THERAPEUTIC USE • Replacement therapy for acute and chronic adrenocortical insufficiency
(Addison’s disease)
• NOTE: For detailed information about glucocorticoids that treat asthma,
refer to the Respiratory System module. For detailed information about
glucocorticoids that treat pain and inflammation, refer to the Pain and
Inflammation module.
ADVERSE DRUG • Few at low, therapeutic levels
REACTIONS
• Multiple at high levels needed to suppress inflammation and the immune
system
• Adrenal insufficiency
• Cushing’s syndrome
INTERVENTIONS • Monitor for side effects related to adrenal insufficiency.
• Weight loss, hypotension, weakness, anorexia, nausea, vomiting, confusion,
lethargy or restlessness
ADMINISTRATION • Give orally (with meals) for chronic adrenal insufficiency, as a total daily
dose in the morning right after waking up or in divided doses (two thirds in
the morning and one third in the early afternoon).
• Give IV for acute and emergency situations.
• Obtain CBC, electrolytes, glucose, and glucocorticoid levels at baseline
and periodically thereafter.
• Make sure clients wear a medical alert band and carry an emergency supply
of glucocorticoids.
• Taper the dose slowly to establish the lowest possible oral dose.
• Give supplemental doses as needed in times of stress.
CLIENT INSTRUCTIONS • Report increased stress, as higher dosages are essential at such times
(generally three times the usual dose for three days).
• Avoid live vaccines.
• Monitor and report weight gain, swelling, or vision changes.
• Include a diet high in protein, potassium, calcium and low in sodium and
carbohydrates.
CONTRAINDICATIONS • When given in small doses – none.
• Large doses: severe infection and live vaccines
PRECAUTIONS • When given in small doses – none.
INTERACTIONS • When given in small doses – none.
• Large doses: oral contraceptives, phenytoin, phenobarbital, and rifampin

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 Pharmacology Made Easy
Medication Information Table

Growth Hormone – somatropin

Category Information
THERAPEUTIC USE • Growth hormone deficiencies, such as Turner’s syndrome
• Growth hormone deficiency in adults, in order to increase lean muscle mass
• AIDS wasting syndrome
ADVERSE DRUG • Hyperglycemia
REACTIONS
• Fatality for clients who have Prader-Willi Syndrome (PWS)
• Neutralizing antibodies
INTERVENTIONS • Monitor blood glucose levels.
ADMINISTRATION • Give IM or subcutaneously (preferable).
• Dosage is based on weight.
• Given daily or several times a week.
• Very costly
• Pediatric Clients: Obtain baseline height, weight, thyroid function, and
growth hormone levels and monitor monthly; yearly x-rays of long bones.
• When reconstituting the medication, rotate the vial gently and do not
shake it.
• Inject subcutaneously into the abdomen and thighs and rotate sites.
• Discontinue treatment prior to epiphyseal closure in children.
CLIENT INSTRUCTIONS • Injection site should be rotated.
CONTRAINDICATIONS • Severe obesity
• Severe respiratory impairment
• Closed epiphyses in children
• Critical illness
PRECAUTIONS • Diabetes mellitus
• Prader-Willi Syndrome
• Hypothyroidism
• Chronic renal failure
INTERACTIONS • Glucocorticoids and adrenocorticotropic hormone counteract growth-
stimulating effects.
• Thyroid hormones, estrogens, and androgens promote epiphyseal closure.

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 Pharmacology Made Easy
Medication Information Table

Hyperglycemics – glucagon
Category Information
THERAPEUTIC USE • Hypoglycemia from an insulin overdose
ADVERSE DRUG • Gastrointestinal effects (nausea, vomiting)
REACTIONS
• Hypotension
• Anaphylaxis
INTERVENTIONS • Turn unconscious clients on their side to prevent aspiration from vomiting.
• Monitor for persistent nausea and vomiting.
• Monitor fluid and carbohydrate intake.
• Assess neurologic status throughout treatment.
• Monitor for signs of hypoglycemia before and during treatment.
ADMINISTRATION • Give IV, IM, or subcutaneously.
• Expect unconscious clients to regain consciousness about 20 min after IV
administration.
• Provide food after clients regain consciousness and can swallow.
• Be aware that, for severe hypoglycemia, IV dextrose (D50W) is the
treatment of choice because it acts faster than glucagon does.
CLIENT INSTRUCTIONS • Warn client and family that vomiting is common after administration of
glucagon.
• Explain need to keep client on side until consciousness is regained.
• Encourage oral intake when tolerated to prevent another episode of
hypoglycemia.
• Educate client on manifestations of hypoglycemia and how to prevent
severe hypoglycemic event by carrying sugar packets or candy for
emergencies.
CONTRAINDICATIONS • Hypoglycemia from starvation (due to the lack of stored glycogen)
• Pheochromocytoma
• Hypersensitivity
PRECAUTIONS • Cardiovascular disorders
• Adrenal insufficiency
INTERACTIONS • Effects of oral anticoagulants (warfarin) increase.
• Negates effects of insulin.
• Phenytoin inhibits glucagon.

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 Pharmacology Made Easy
Medication Information Table

Incretin Mimetics – exenatide

Category Information
THERAPEUTIC USE • Type 2 diabetes mellitus, as a supplement to sulfonylureas or metformin
ADVERSE DRUG • Hypoglycemia
REACTIONS
• Nausea, vomiting, diarrhea
• Pancreatitis
• Renal failure
• Severe hypersensitivity reactions
INTERVENTIONS • Recommend a reduced oral hypoglycemic medication dosage when
initiating therapy.
• Monitor for manifestations of hypoglycemia.
• Monitor for persistent nausea, vomiting, or diarrhea.
• Monitor fluid and carbohydrate intake.
• Monitor for manifestations of pancreatitis.
• Stop medication therapy for clients who develop manifestations of
pancreatitis.
ADMINISTRATION • Injection considerations
• Give subcutaneously into the thigh, abdomen, or upper arm up to 60 min
prior to the morning and evening meals, not after meals.
• Rotate injection sites.
• Expect the peak action 2 hr after dosing.
• Preparation and care of the injection pen
• Available in 5 mcg and 10 mcg doses
• Follow manufacturer’s instructions for “New Pen Setup.”
• Use needle size prescribed by provider.
• Use new needle each time injection pen is used.
• Keep pens in use at room temperature up to 30 days.
• Do not store pens with needle attached.
• Refrigerate unused injector pens until their expiration date.
CLIENT INSTRUCTIONS • Watch for and report manifestations of hypoglycemia. Test blood glucose
to confirm, then consume a snack of carbohydrates, and retest in 15 to 20
min and repeat treatment if still low.
• Carry a carbohydrate snack at all times.
• Wear a medical alert bracelet.
• Lie down when feeling nauseated.
• Consume adequate number of calories.
• Report severe, persistent abdominal pain and stop taking exenatide.

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 Pharmacology Made Easy: Medication Information Table
Incretin Mimetics – exenatide

Category Information
CONTRAINDICATIONS • Renal impairment
• Type 1 diabetes mellitus
• Diabetic ketoacidosis
• Severe gastrointestinal disease
• Pregnancy – teratogenic effects
• Children
PRECAUTIONS • Thyroid disease and carcinoma
• Moderate renal dysfunction
• History of pancreatitis
• Concurrently with insulin
INTERACTIONS • Sulfonylureas increase the risk for hypoglycemia.
• Absorption of oral medications slows, especially oral contraceptives and
antibiotics, so clients should take them 1 hr before taking exenatide.

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 Pharmacology Made Easy
Medication Information Table

Insulin – lispro (rapid-acting), regular (short-acting),

NPH (intermediate-acting), glargine (long-acting)
Category Information
THERAPEUTIC USE • Diabetes mellitus (type 1, type 2, gestational)
ADVERSE DRUG • Hypoglycemia
REACTIONS
• Injection site reactions – lipodystrophy or lipohypertrophy
• Hypersensitivity to insulin
• Allergic response
INTERVENTIONS • Monitor for manifestations of hypoglycemia (with abrupt onset: tachycardia,
palpitations, diaphoresis, shakiness; with gradual onset: headache, tremors,
weakness).
$ Check blood glucose level to confirm, then give 4 oz of orange juice
or 2 to 3 tsp of sugar, honey, or corn syrup dissolved in water or an
appropriate number of glucose tablets as needed for hypoglycemia.
$ For unconscious clients, administer glucagon parenterally.
$ Monitor skin for subcutaneous fat accumulation.
$ Monitor potassium levels.
• Monitor ECG.
• Monitor for indications of hypokalemia.

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 Pharmacology Made Easy: Medication Information Table
Insulin – lispro (rapid-acting), regular (short-acting), NPH (intermediate-acting), glargine (long-acting)

Category Information
ADMINISTRATION • Injection considerations
• Give subcutaneously (using an insulin syringe) or IV.
• Select an appropriate needle length for injecting insulin into subcutaneous
tissue versus intradermal (too short) or intramuscular (too long).
• For insulin suspensions (cloudy insulins), gently roll the vial between your
palms to disperse the particles.
• When mixing short-acting insulin with longer-acting insulin, draw the short-
acting insulin into the syringe first, then the longer-acting insulin.
• Do not mix insulin glargine or insulin detemir with any other insulin.
• Do not administer short-acting insulins if they appear cloudy or discolored.
• Instruct clients to self-administer insulin subcutaneously in one general area
for consistent absorption rates.
• Storage of insulin
• Keep vials in use at room temperature for 1 month.
• Refrigerate unopened vials of a single type of insulin until their expiration
date.
• Keep insulins premixed in syringes for 1 to 2 weeks under refrigeration
and vertical, with the needles pointing upward. Prior to administration,
resuspend the insulin via gentle motion.
• Expect dosage adjustments in response to caloric intake, infection,
exercise, stress, growth spurts, and pregnancy.
• Make sure adequate glucose is available at onset and peak insulin times.
CLIENT INSTRUCTIONS • Wear a medical alert bracelet.
• Watch for manifestations of hypoglycemia. Test blood glucose to confirm,
then consume a snack of carbohydrates, and retest in 15 to 20 min and
repeat treatment if still low.
• Carry a carbohydrate snack at all times.
• Report recurring episodes of hypoglycemia to provider.
• Rotate injection sites systematically and space them 1 inch apart.
• Do not inject cold insulin.
• Report weakness, nausea, palpitations, or paresthesia.
CONTRAINDICATIONS • Hypersensitivity to insulin
PRECAUTIONS • Older adults
• Fever
• Stress
• Altered nutrition
INTERACTIONS • Sulfonylureas, meglitinides, beta blockers, salicylates, and alcohol increase
hypoglycemic effects.
• Thiazide and loop diuretics, sympathomimetics, thyroid hormones,
and glucocorticoids increase blood glucose levels, thus counteracting
hypoglycemic effects.
• Beta blockers mask manifestations of hypoglycemia (tachycardia, tremors).

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 Pharmacology Made Easy
Medication Information Table

Meglitinides – repaglinide
Category Information
THERAPEUTIC USE • Type 2 diabetes mellitus
ADVERSE DRUG • Hypoglycemia
REACTIONS
• Nausea, vomiting
INTERVENTIONS • Monitor for manifestations of hypoglycemia (diaphoresis, tachycardia,
fatigue, excessive hunger, tremors).
$ If the client is conscious, give glucose orally in either pill form, 4 oz of
orange juice, 2 to 3 tsp of sugar, honey, or corn syrup dissolved in water.
$ If the client is not conscious, give intravenous glucose (D50W); give
parenteral glucagon if IV not available.
$ Check the client’s blood glucose every 15 to 20 min.
$ Continue treatment until the blood glucose has returned to the
expected reference range and the client no longer has manifestations of
hypoglycemia.
• Monitor for persistent nausea, vomiting, or diarrhea.
• Monitor CBC levels.
ADMINISTRATION • Give orally 30 min or less before meals, usually three times a day.
• Tell clients to skip a dose if they skip a meal and to add a dose if they add a
meal.
• Do not exceed 4 doses a day.
CLIENT INSTRUCTIONS • Wear a medical alert bracelet.
• Watch for and report manifestations of hypoglycemia.
• Test blood glucose to confirm.
• If hypoglycemia occurs, advise client to take 4 oz of orange juice or 2 to
3 tsp of sugar, honey, or corn syrup dissolved in water (glucose, not table
sugar, if taking miglitol), and notify health care professional.
• Retest in 15 to 20 min and repeat treatment if still low.
• Carry a carbohydrate snack at all times.
• Lie down when feeling nauseated.
• Consume adequate carbohydrates.

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 Pharmacology Made Easy: Medication Information Table
Meglitinides – repaglinide

Category Information
CONTRAINDICATIONS • Diabetic ketoacidosis
• Liver, kidney, and endocrine disorders
PRECAUTIONS • Renal or hepatic dysfunction
• Systemic infection
• Older adults
• Use of alcohol, NSAIDs, warfarin, loop diuretics, and anabolic steroids
INTERACTIONS • Gemfibrozil, erythromycin, and chloramphenicol increase hypoglycemic
effects.
• Alcohol, corticosteroids, and rifampin decrease hypoglycemic effects.

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 Pharmacology Made Easy
Medication Information Table

Mineralocorticoids – fludrocortisone
Category Information
THERAPEUTIC USE • Replacement therapy for acute and chronic adrenocortical insufficiency
(Addison’s disease-use caution as clients with Addison’s may have an
exaggerated response, primary hypoaldosteronism, congenital adrenal
hyperplasia), usually along with hydrocortisone.
ADVERSE DRUG • Few at low, therapeutic levels
REACTIONS
• At levels above that is therapeutic, fluid and electrolyte imbalances that can
lead to hypertension, edema, heart failure, hypokalemia
INTERVENTIONS • Monitor for side effects related to inappropriate dosing.
• Manifestations of excess dosing (increase in weight, fluid retention,
increase in blood pressure, hypokalemia).
• Manifestations of inadequate dosing (weight loss, poor appetite, fatigue,
muscle weakness, hypotension).
ADMINISTRATION • Give orally daily or three times a week.
• Obtain CBC and electrolyte levels at baseline and periodically thereafter.
• Make sure clients wear a medical alert band.
• Expect lifelong therapy.
CLIENT INSTRUCTIONS • Report weight gain or swelling (high sodium levels).
• Report weakness or heart palpitations (low potassium levels).
• Have blood pressure checked regularly.
• Follow a diet high in potassium.
CONTRAINDICATIONS • Medication hypersensitivity
PRECAUTIONS • Heart failure
• Addison’s disease
• OB
INTERACTIONS • Rifampin and phenobarbital decrease levels.
• Potassium-depleting diuretics, such as furosemide, increase the risk of
hypokalemia.
• Salt and foods high in sodium – increases sodium retention and K loss.

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 Pharmacology Made Easy
Medication Information Table

Antithyroid Medications - propylthiouracil

Category Information
THERAPEUTIC USE • Hyperthyroidism (Graves’ disease)
• Thyrotoxic crisis
• Suppression of thyroid hormone production in preparation for
thyroidectomy
ADVERSE DRUG • Hypothyroidism
REACTIONS
• Agranulocytosis
• Hepatotoxicity
• Aplastic Anemia
• Rash
• Arthralgia, headache
• Vertigo, drowsiness, headache
INTERVENTIONS • Monitor thyroid function.
• Monitor for manifestations of hypothyroidism (fatigue and weakness,
weight gain, cold intolerance, dry skin, and listlessness).
• Recommend a reduced dosage for clients who develop these effects.
• Monitor CBC at baseline and periodically thereafter (leukocytes,
neutrophils).
• Monitor for manifestations of agranulocytosis; for these manifestations,
stop therapy.
• Monitor integumentary status.
• Monitor for joint and muscle pain and headache.
ADMINISTRATION • Give orally at regular intervals, such as every 8 hr.
• Measure baseline vital signs and weight and monitor periodically thereafter.
• Monitor T3 and T4 levels.
CLIENT INSTRUCTIONS • Watch for and report manifestations of hyperthyroidism and
hypothyroidism.
• Report fever or sore throat.
• Report rash.
• Report joint or muscle pain or headache.
• Report any OTC medications, herbal remedies, and supplements to the
provider.

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 Pharmacology Made Easy: Medication Information Table
Antithyroid Medications - propylthiouracil

Category Information
CONTRAINDICATIONS • Hypersensitivity
PRECAUTIONS • Immunosuppression
• Bone marrow depression
• Infection
• Liver dysfunction
• Pregnancy
INTERACTIONS • Concurrent use with antineoplastics or radiation therapy can lead to
additional bone marrow depression.
• Increased antithyroid effects noted when taken with lithium or potassium
iodide.
• Risk of agranulocytosis increases with concurrent use of phenothiazines.

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 Pharmacology Made Easy
Medication Information Table

Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i) – empagliflozin

Category Information
THERAPEUTIC USE • Type 2 diabetes mellitus
• Heart failure
• Cardiovascular disease
ADVERSE DRUG • Diabetic ketoacidosis
REACTIONS
• Hypoglycemia
• Dehydration
• Hypotension
• Fractures
• Acute kidney injury
INTERVENTIONS • Monitor blood glucose levels.
• Monitor LDL levels.
• Monitor kidney function.
• Monitor for manifestations of dehydration.
• Assess for manifestations of diabetic ketoacidosis.
• Monitor for UTI.
ADMINISTRATION • Oral administration
• Give once a day
• Can be given with or without food
CLIENT INSTRUCTIONS • Notify the provider immediately if experiencing adverse effects.
• Monitor blood pressure.
• Monitor blood glucose.
• Maintain adequate hydration.
• Watch for manifestations of genital yeast infections.
• Watch for manifestations of UTIs.

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 Pharmacology Made Easy: Medication Information Table
Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2i) – empagliflozin

Category Information
CONTRAINDICATIONS • Type 1 diabetes mellitus
• Renal failure
PRECAUTIONS • Risk of diabetic ketoacidosis
• Reduced caloric intake, fasting
• Hypotension
• Moderate renal impairments
INTERACTIONS • Diuretics
• Anti-hyperglycemics
• Oral hypoglycemics
• Salicylates
• MAOIs

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 Pharmacology Made Easy
Medication Information Table

Sulfonylureas – glipizide
Category Information
THERAPEUTIC USE • Type 2 diabetes mellitus
ADVERSE DRUG • Hypoglycemia
REACTIONS
• Nausea, diarrhea
INTERVENTIONS • Monitor for manifestations of hypoglycemia (diaphoresis, tachycardia,
fatigue, excessive hunger, tremors).
$ If the client is conscious, give glucose orally in either pill form, 2 to 3 tsp
of sugar, 4 oz of orange juice, honey, or corn syrup dissolved in water.
$ If the client is not conscious, give intravenous glucose (D50W); give
parenteral glucagon if IV not available.
$ Check the client’s blood glucose every 15 to 20 min.
$ Continue treatment until the blood glucose has returned to the expected
reference range and the client is no longer having manifestations of
hypoglycemia.
• Monitor for persistent nausea, vomiting, or diarrhea.
• Monitor CBC levels.
ADMINISTRATION • Give orally 30 min before selected meal.
• Make sure clients swallow the sustained-release form whole and do not
crush or chew it.
CLIENT INSTRUCTIONS • Wear a medical alert bracelet.
• Watch for and report manifestations of hypoglycemia.
• Test blood glucose to confirm.
• Consume a snack of carbohydrates.
• Retest in 15 to 20 min and repeat if still low.
• Carry a carbohydrate snack at all times.
CONTRAINDICATIONS • Pregnancy, lactation (insulin is recommended during pregnancy)
• Diabetic ketoacidosis
PRECAUTIONS • Renal or hepatic dysfunction
• Adrenal or pituitary insufficiency
INTERACTIONS • Alcohol poses a risk for a disulfiram-like reaction (nausea, palpitations,
flushing) and increases hypoglycemic effects.
• Sulfonamide antibiotics, NSAIDs, oral anticoagulants, salicylates,
monoamine oxidase inhibitors, and cimetidine increase hypoglycemic
effects.
• Thiazides counteract hypoglycemic effects.
• Beta blockers mask manifestations of hypoglycemia.

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 Pharmacology Made Easy
Medication Information Table

Sympatholytic D2-Dopamine Agonists – bromocriptine

Category Information
THERAPEUTIC USE • Oral hypoglycemic
• Treat hyperglycemia in clients with type 2 diabetes mellitus (T2DM).
• Used in combination with other hypoglycemics.
• Not a first-line agent for T2DM.
• Stimulates dopamine type 2 receptors in the hypothalamus, increasing
dopamine levels, improving glucose tolerance and insulin sensitivity, and
decreasing glucose production.
ADVERSE DRUG • Psychosis
REACTIONS
• Seizures
• Lung and heart valve fibrosis
• Stroke
• Myocardial infarction
• Common adverse effects: nausea, vomiting, dizziness, hypotension,
headache, and fatigue
INTERVENTIONS • Monitor for hypoglycemia and adverse effects.
• Assess heart sounds and BP.
• Monitor liver function tests for elevated liver enzymes.
ADMINISTRATION • Available in oral tablets or capsules.
• Give once a day with food in the morning within 2 hr after waking.
• Dosage increased until the desired blood glucose goal is achieved.
CLIENT INSTRUCTIONS • Report dizziness, drowsiness, or syncope.
• Use caution with driving or operating machinery.
• Avoid or limit alcohol.
• Review manifestations of hyperglycemia and hypoglycemia and proper
blood glucose testing procedures.
• Avoid drinking grapefruit juice because it may increase serum
concentrations of bromocriptine.

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 Pharmacology Made Easy: Medication Information Table
Sympatholytic D2-Dopamine Agonists – bromocriptine

Category Information
CONTRAINDICATIONS • Medication hypersensitivity
• Type 1 diabetes mellitus (T1DM)
• Uncontrolled hypertension, syncope, or severe psychotic disorders.
• Client who has diabetic ketoacidosis, severe liver disorders, or pregnant,
postpartum, lactating.
PRECAUTIONS • History of cardiovascular disorders (stroke, myocardial infarction,
uncontrolled hypertension, or dysrhythmias)
INTERACTIONS • Bromocriptine is metabolized in the liver by the CYP3A4 enzyme.
• Avoid administering to clients who are taking CYP3A4 inhibitors or
inducers.
• Effects may be increased, causing hypoglycemia or adverse effects with
the following CYP3A4 inhibitor medications: ergot alkaloids, levodopa,
antihypertensives, and macrolide antibiotics.
• Effects may be decreased, causing hyperglycemia with medications with
the following CYP3A4 inducers: antipsychotics, tricyclic antidepressants,
and dopamine antagonists (metoclopramide).
• Dopamine antagonists like phenothiazines can diminish the effectiveness of
dopamine agonists.

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 Pharmacology Made Easy
Medication Information Table

Thiazolidinediones – pioglitazone
Category Information
THERAPEUTIC USE • Type 2 diabetes mellitus, with or without medication therapy with insulin or
metformin
ADVERSE DRUG • Fluid retention
REACTIONS
• Hepatotoxicity (potential)
• Increased serum lipid levels
• Increased risk for bladder cancer
• Upper respiratory tract infection
• Headaches
• Myalgia
INTERVENTIONS • Monitor for edema, weight gain, or indications of heart failure.
• Hepatotoxicity
• Obtain serum alanine aminotransferase (ALT) levels: Baseline and every 3 to
6 months thereafter.
• Stop medication therapy for manifestations of liver injury.
• Monitor serum lipid levels.
• Watch for increases in triglycerides.
• Watch for increases in both high-density (favorable) and low-density
(unfavorable) lipoproteins.
ADMINISTRATION • Give orally once per day with or without food.
CLIENT INSTRUCTIONS • Report swelling, weight gain, or shortness of breath immediately.
• Report jaundice, dark urine, abdominal pain, vomiting, or fatigue.
• Expect periodic cholesterol testing.
• Report chest pain or discomfort, diaphoresis, or atypical fatigue.
• Report swelling, rapid weight gain, dyspnea.

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 Pharmacology Made Easy: Medication Information Table
Thiazolidinediones – pioglitazone

Category Information
CONTRAINDICATIONS • Cardiovascular disorders, including hypertension
• Severe heart failure
• Active hepatic disorder
• Type 1 diabetes
• Diabetic ketoacidosis
PRECAUTIONS • Mild heart failure, risk for heart failure
• Hepatic impairment
• Pioglitazone – may increase risk of bladder cancer after 1 year of use.
• Caution should be used in clients with a history of bladder cancer.
INTERACTIONS • Insulin increases the risk of heart failure and edema.
• Gemfibrozil and ketoconazole increase hypoglycemic effects.
• Reduced effectiveness of contraceptives.
• Glucosamine can have a negative impact on blood glucose control.
• Chromium as well as coenzyme Q10 can increase hypoglycemic effects.

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 Pharmacology Made Easy
Medication Information Table

Thyroid Replacements – levothyroxine

Category Information
THERAPEUTIC USE • Hypothyroidism
ADVERSE DRUG • Thyrotoxicosis, hyperthyroidism (from excessive doses)
REACTIONS
• Headache, irritability, insomnia
• Abdominal cramping, diarrhea
• Tachycardia, arrhythmia
• Heat intolerance, diaphoresis
• Menstrual irregularities
INTERVENTIONS • Monitor thyroid function.
• Monitor for indications of hyperthyroidism (anxiety, tachycardia,
palpitations, tremors, altered appetite, heat intolerance, fever, diaphoresis,
weight loss).
ADMINISTRATION • Give orally to treat hypothyroidism and IV to treat myxedema coma.
• Give daily on an empty stomach (at least 30 to 60 min before breakfast with
full glass of water).
• Measure baseline vital signs, weight, and height, and monitor periodically
thereafter.
• Monitor for cardiac excitability (angina, chest pain, palpitations,
dysrhythmias).
• Monitor T4 and TSH levels.
• Be aware that the various formulations of thyroxine are not
interchangeable; instruct clients to notify the provider if a pharmacy
dispenses a different levothyroxine product.
• Expect lifelong replacement therapy.
CLIENT INSTRUCTIONS • Watch for and report nervousness, rapid heart rate, palpitations, tremors,
altered appetite, heat intolerance, fever, sweating, weight loss, and chest
pain.

Copyright ©2023 Assessment Technologies Institute, L.L.C. All rights reserved. This resource is copyright protected material of ATI and is provided
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 Pharmacology Made Easy: Medication Information Table
Thyroid Replacements – levothyroxine

Category Information
CONTRAINDICATIONS • Thyrotoxicosis
• Recent myocardial infarction
PRECAUTIONS • Cardiovascular disorders (hypertension, angina pectoris, ischemic heart
disease)
• Renal impairment
• Diabetes mellitus
• Older adults
INTERACTIONS • Cholestyramine, antacids, iron and calcium supplements, and sucralfate
reduce absorption, so clients should not take levothyroxine within 4 hr of
these medications.
• Food reduces absorption.
• Many antiseizure and antidepressant medications, including
carbamazepine, phenytoin, phenobarbital, and sertraline, decrease levels.
• Anticoagulant effects of warfarin increase.
• Cardiac response to catecholamines (such as epinephrine) increases.

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