Metformin is an oral medication for diabetic patient used to regulate blood the levels of blood sugar in blood. It is commonly used by patients with type II diabetes. It can be used together with blood insulin therapy. Lisinopril, on the other hand is an ACE inhibitor. It is used to treat high blood pressure in children and adults.
How will you properly monitor each medication for efficacy and toxicity?
Metformin monitoring should frequently be conducted through measuring the blood glucose during fast or the levels of hemoglobin A1C. The glycosylated hemoglobin provides healthcare professional information about the average blood sugar regulation of the patients for a 2-3 month. Importantly, it can be used to monitor blood glucose level at home especially when diabetic medication is adjusted (Nazir, Sheikh, Aslam, &Javaid, 2016). There should be periodic monitoring as well as the initial monitoring of hematologic parameters such as red blood cell indices, hematocrit, and hemoglobin. Additionally, a renal function such as the monitoring of the serum creatinine should also be conducted. For patients who are eighty or above eighty years of age, monitoring of renal function should be conducted on a regular basis. This is important because metformin is excreted in the kidney and research shoes that it could lead to kidney impairments due to lactic acidosis and accumulation of the drug. Patients are educated on the importance of monitoring the blood sugar on a regular basis, checking the renal function, glycosylated hemoglobin observation. Importantly, patients should also be reminded of the importance of observing a balanced diet and carrying out physical activities. Patients need to be aware of the drug contraindication. They are not supposed to take alcohol while taking metformin.
Lisinopril should be monitored for toxicity and efficacy through monitoring the patient’s renal function on a regular basis. The drug is associated with a renal complication such as acute renal failure as a result of the inhibition of the renin-angiotensin system by the drug thus the need to monitor renal system regularly. Other elements that should be monitored include serum potassium. This should be done because of the ability of the lisinopril to inhibit the renin-angiotensin system thereby causing hyperkalemia (Scalese&Reinaker, 2016). The risk factors linked with hyperkalemia development include diabetes mellitus, renal insufficiency, and concomitant use if potassium-spring diuretics as well as the potassium-containing salt substitutes and potassium supplements. The intake of alcohol is prohibited with the use of lisinopril because it is associated with an increase in certain side-effects and the lowering of the blood pressure of the patients (Chukwu Nwachukwu et al., 2015). The drug can increase the process of sweating, and therefore patients are advised to avoid becoming dehydrated during hot weather or when carrying out exercises. ACE inhibitors such as Lisinopril effects on blood pressure is less in black patients who are African American compared to non-African Americans. For patients with diabetes, the use of drug together with aliskiren-containing medication such as Valturna, Tekamlo, Tekturna and Amturnide is not recommended.
Are you concerned with any drug-drug interactions? If so, what are they, and what is the mechanism of the interaction?
The drug-drug interaction concerned for the patients is the interaction between lisinopril and metformin. The combination of the two medication together increases the effects of metformin lowering the blood sugar level in the body to dangerous levels. Patients need to understand the effects associated with low blood sugars in the body such as tremor, confusion, sweating, nervousness, drowsiness, dizziness, weakness, hunger and headache. The use of home monitors for checking blood sugars in the body can enable care givers to monitor the levels of blood in the body. They can understand the adjustment of the dosage they need to make to ensure the blood sugar level remain at normal levels.
Metformin and lisinopril are two type of drug used to treat diabetes and high blood pressure respectively. The side effects and adverse side effects should be monitored frequently when using the drugs.
Chukwu Nwachukwu, D., IkemefunaAneke, E., Fidelis Obika, L., &ZuadaNwachukwu, N. (2015). Effects of aqueous extract of Hibiscus sabdariffa on the renin-angiotensin-aldosterone system of Nigerians with mild to moderate essential hypertension: A comparative study with lisinopril. Indian Journal Of Pharmacology, 47(5), 540-545. doi:10.4103/0253-7613.165194
Nazir, A., Sheikh, F. M., Aslam, S., &Javaid, U. (2016). ACE INHIBITORS; COMPARISON OF ACE INHIBITORS (PERINDOPRIL, RAMIPRIL & LISINOPRIL) INDUCED COUGH. Professional Medical Journal, 23(9), 1145-1148. doi:10.17957/TPMJ/16.3501
Scalese, M. J., &Reinaker, T. S. (2016). Pharmacologic management of angioedema induced by angiotensin-converting enzyme inhibitors. American Journal Of Health-System Pharmacy, 73(12), 873-879. doi:10.2146/ajhp150482