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DM2 Thiazolidinediones - Pioglitazone (Actos) Cheat Sheet by

Treats type 2 diabetes mellitus

Medication Names

Piogli­tazone (Actos)

Therap­eutic Use

Type 2 diabetes mellitus, with or without drug therapy with insulin or metformin (Gluco­phage)

Adverse Drug Reactions

Fluid retention
Hepato­tox­icity (poten­tial)
Increased serum lipid levels
Increased risk for bladder cancer
Upper respir­atory tract infection

Nursing Interv­entions

Monitor for edema, weight gain, or indica­tions of heart failure.
Obtain serum alanine aminot­ran­sferase (ALT) levels: Baseline and every 3 to 6 months therea­fter.
Stop drug therapy for indica­tions 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.

Drug Admini­str­ation

Give orally once per day with or without food.

Patient Education

Follow instru­ctions provided in access program.
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


Cardio­vas­cular disease, including hypert­ension
Severe heart failure
Active hepatic disease
Type 1 diabetes
Diabetic ketoac­idosis


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.


Insulin increases the risk of heart failure and edema.
Gemfib­rozil (Lopid) 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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