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treatment of type 2 diabetes mellitus
Adverse Drug Reactions
Lactic acidosis (rare, but potentially fatal) |
Nausea, diarrhea, vomiting |
Unpleasant metallic taste |
Vitamin deficiencies (vitamin B12, folic acid) |
Interventions
Monitor for indications of lactic acidosis. |
For signs of lactic acidosis, stop drug therapy immediately. |
Expect that severe lactic acidosis will require hemodialysis. |
Monitor for persistent nausea, vomiting, or diarrhea |
Monitor fluid intake and output. |
Monitor for indications of vitamin B12 or folic acid deficiency. |
Recommend the appropriate supplements. |
Monitor renal function upon initial therapy and yearly afterward |
Precautions
Diarrhea, Dehydration |
Anemia |
Pituitary insufficiency |
Gastroparesis |
Gastrointestinal obstruction. |
Hyperthyroidism |
Older adults |
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Drug Administration
Give orally twice a day with the morning and evening meals (immedi- ate-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. |
Patient Education
Avoid drinking alcohol. |
Report weakness, fatigue, lethargy, or hyperventilation. |
If these symptoms develop, stop taking the drug and seek medical care immediately |
Expect these effects to diminish as drug therapy continues |
Lie down when feeling nauseated |
Maintain adequate carbohydrate and fluid intak |
Report weakness, fatigue, pallor, or reddened tongue. |
Contraindications
Diabetic ketoacidosis |
Cardiopulmonary, hepatic, or renal insufficiency |
Alcoholism |
Heart failure |
Severe infection |
Shock |
Acute myocardial infarction |
Hypoxemia |
Lactic acidosis |
Interactions
Alcohol and cimetidine (Tagamet) increase the risk of lactic acidosis. |
Any contrast medium containing iodine increases the risk of acute renal failure, thus worsening lactic acidosis |
Nifedipine (Procardia), furosemide (Lasix), morphine, antifungals, and many other drugs increase hypoglycemic effects. |
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