Metformin (Glucophage)

Action: inhibits hepatic glucose production and increases

Sensitivity to peripheral tissue to insulin
Indication: Management of type 2 diabetes mellitus; may be used with diet, insulin,
or sulfonylurea oral hypoglycemics.
Adverse Effect: heart failure, lactic acidosis, thrombocytopenia
Nursing Implications: monitor for hypoglycemic reactions:
hyperglycemic reactions after meals, CBC and other labs (A1c)
Lisinopril (Prinivil, Zestril)
Indication: Alone or with other agents in the management of hypertension.
Adverse effect: CNS: dizziness, fatigue, headache, weakness.
Resp: cough. CV: hypotension, chest pain.GI: abdominal pain, diarrhea, nausea,
vomiting. GU: erectile dysfunction, impaired renal function. Derm: rashes. F and
E hyperkalemia. Misc: ANGIOEDEMA.
Nursing Implication: Hypertension: Monitor BP and pulse frequently during
initial dosage adjustment and periodically during therapy. Notify health care
professional of significant changes. Monitor frequency of prescription refills to
determine compliance. Assess patient for signs of angioedema (dyspnea, facial
swelling). Heart Failure: Monitor weight and assess patient routinely for resolution
of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular
venous distention).
Simvastatin (Zocor)
Indication: Adjunctive management of primary hypercholesterolemia and mixed
dyslipidemias. Secondary prevention of myocardial infarction, coronary
revascularization, stroke, and cardiovascular mortality in patients with clinically
evident coronary heart disease.
Adverse effect: CNS: dizziness, headache, insomnia, weakness. GI: abdominal
cramps, constipation,diarrhea, flatus, heartburn, altered taste, drug-induced
hepatitis, dyspepsia, liver enzymes, nausea, pancreatitis. GU: erectile
dysfunction. Derm: rashes, pruritus.MS: RHABDOMYOLYSIS, arthralgia,
myalgia, myopathy ( risk with 80 mg dose).Misc: hypersensitivity reactions.
Nursing Implication: Obtain a diet history, especially with regard to fat
consumption. Evaluate serum cholesterol and triglyceride levels before initiating,
after 46 wk. of therapy, and periodically thereafter. Avoid grapefruit and
grapefruit juice during therapy; may increase risk of toxicity.