NURS 1566 Clinical Form 3: Clinical Medications Worksheets(You will need to make additional copies of these forms)

Generic Namemetformin

Trade NameGlugophage

ClassificationOral Antidiabeticbiguanides

Dose500mg

RoutePO

Time/frequencyBID with meals

Peak2-4 weeks

OnsetSeveral days

Duration12 hrs

Normal dosage range500 mg twice daily; may increase by 500 mg at weekly intervals up to 2000 mg/day.

Why is your patient getting this medicationType II Diabetes

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)Decreases hepatic glucose production, Decreases intestinal glucose absorption, and Increases sensitivity to insulin. Indicated for the management of type 2 diabetes mellitus; may be used with diet, insulin, or sulfonylurea oral hypoglycemics

Nursing Implications (what to focus on) Contraindications/warnings/interactions.;Hypersensitivity, metabolic acidosis, dehydration, sepsis, hypoxia, hepatic impairment, excessive alcohol use, Renal dysfunction, Radiographic studies requiring iv iodinated contrast media, CHF. Use cautiously in geriatric/debilitated patients (↓ doses may be required; avoid in patients >80 yr unless renal function is normal). Interacts with other drugs include Acute or chronic alcohol ingestion or iodinated contrast media ↑ risk of lactic acidosis, amiloride , digoxin , morphine , procainamide , quinidine , ranitidine , triamterene , trimethoprim , calcium channel blockers , and vancomycin may compete for elimination pathways with metformin. Altered responses may occur, cimetidine and furosemide may ↑ effects of metformin. Natural interactions include glucosamine may worsen blood glucose control and Chromium , and coenzyme Q-10 may produce ↑ hypoglycemic effects.

Common side effectsDiarrhea, nausea, vomiting, abdominal bloating

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)Furosemide may increase the effects of metformin

Lab value alterations caused by medicineMay cause false-positive results for urine ketones

Be sure to teach the patient the following about this medicationInstruct patient to take metformin at the same time each day, as directed. If a dose is missed, take as soon as possible unless almost time for next dose. Do not double doses. Explain to patient that metformin helps control hyperglycemia but does not cure diabetes. Therapy is usually long term. Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes. Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice or 2-3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional. Emphasize the importance of routine follow-up exams and regular testing of blood glucose, glycosylated hemoglobin, renal function, and hematologic parameters.

Nursing Process- Assessment(Pre-administration assessment)fingerstick blood glucose

AssessmentWhy would you hold or not give this med?If fsbg is less than 100, before or at the time of studies requiring IV administration of iodinated contrast media and for 48 hr after study

EvaluationCheck after givingControl of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes. Control may be achieved within a few days, but full effect of therapy may be delayed for up to 2 wk. If patient has not responded to metformin after 4 wk of maximum dose therapy, an oral sulfonylurea may be added. If satisfactory results are not obtained with 1-3 months of concurrent therapy, oral agents may be discontinued and insulin therapy instituted