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112 Cards in this Set

  • Front
  • Back
oral antidiabetics, Thiazolidinediones
Antidiabetic, sulfonylureas
oral antidiabetics, Thiazolidinediones
Analgesic, otic, topical
Topical abx, for acne vulgaris
Topical immunosuppressant, for atopic dermatitis
Selective estrogen receptor modulator for osteoporosis prevention, treatment
Biophosphanate, used for calcium metabolism to prevent or treat osteoporosis
Antidiabetic, sulfonylureas
Rapid acting analog of regular insulin. Acts as insulin
A 70/30 of intermediate insulin and regular insulin.
Anti-Inflammatory Agent
Used topically it suppresses inflammation and enhances healing.
Otic topical
Long acting insulin
levothyroxine sodium, hormone,
hypothyroidism, goiter, thyrotropin-dependent well-differentiated thyroid cancer, myxedema coma
Antineoplastic, used for
advances breast carcinoma that has not responded to other therapy in estrogen receptor-positive patients, prevention of breast cancer, after breast surgery/radiation in ductal carcinoma in situ.
Antibiotic + steroid, used for Superfic. Ocular bacterial infection
Discuss diagnostic criteria for diabetes
• Fasting plasma glucose ≥ 126 mg/dL OR
• Casual plasma glucose ≥ 200 mg/dL plus symptoms of diabetes OR
• Oral glucose tolerance test (OGTT): two hour plasma glucose ≥ 200 mg/dL
Know the step wise approach for treating type 2 diabetes
• Step 1: Implement lifestyle changes, caloric restrictions, exercise and weight los
• Step 2: Add one oral hypoglycemic. Drug selection is based on the patient’s body composition. For lean patients use a sulfonylurea because lean patients are usually insulin deficient and sulfonylureas will promote insulin release. For obese patients use metformin because obese patients are usually insulin resistant and metformin will reduce insulin resistance.
• Step 3: Treat with two oral hypoglycemics. They must have different mechanisms of action. It would be irrational to treat with two sulfonylureas.
• Step 4a: Treat with three oral hypoglycemics
• Step 4b: Treat with an oral hypoglycemic plus insulin
• Step 5: Treat with insulin alone, increase dose as needed.
Name the three immediate acting insulins
Lispro (Humalog) – onset 15-30 minutes
Aspart (NovoLog) – onset 10-20 minutes
Glulisine (Apidra) – onset 10-15 minutes
Name the two regular insulins
(Humulin R, Novolin R) – onset 30-60 minutes
(Exubera) – onset 15-30 minutes (Inhaled)
Name the two intermediate acting insulins
NPH (Humulin N, Novolin N) – onset 60-120 min, duration 16-24 hours
(Levemir) – duration 12-24 hours
Name the long acting insulin
(Lantus) – Onset 70 minutes, duration 24 hours
What are the side effects of insulin?
Hypoglycemia, allergic reaction
What are the side effects specific to exubera?
hypoglycemia, cough and bitter taste, long term effects are unknown.
What are the potential drug interactions of insulin?
Hypoglycemic agents such as sulfonyureas, meglitinides, beta adrenergic blocking agents, and alcohol

Hyperglycemic agents such as thiazide diuretics, glucocorticoids, sympathomimetics

Beta edrenergic blocking agents beta blockers can delay awareness of hypoglycemia by masking signs of hypoglycemia such as tachycardia and palpitations. They also impair glucogenolysis, the body’s means for counteracting a fall in blood glucose
Is insulin OK in pregnancy and lactation?
Yes - preferred
Name the three sulfonylureas.
Tolbutamide (Orinase)
Glipizide (Glucotrol)
Glyburide (Micronase)
How do sulfonylureas work?
Promotes insulin secretion by the pancreas, may also increase tissue response to insulin
Side effects of sulfonylureas?
Hypoglycemia – most likely in hepatic or renal dysfunction
What are the potential drug interactions with sulfonylureas?
Alcohol – can cause a disulfiram –like rxn with flushing, palpitations and nausea.
Drugs that can intensify hypoglycemia include NSDAIS, sulfa abx, etoh, ranitidine, cimetidine
Beta blockers – interfere by suppressing insulin’s release. Also block awareness of hypoglycemia by masking symptoms.
Should sulfonylureas be used in pregnancy and lactation?
No - particularly bad near term can cause severely prolonged hypoglycemia.
Name the two meglitinides.
Repanglinide (Prandin)
Nateglinide (Starlix)
How do meglitinides work?
Promotes insulin secretion by the pancreas.
What are the side effects of meglitinides?
What are the potential drug interactions with meglitinides?
Gemfibrozil – can inhibit metabolism of repaglinide causing hypoglycemia.
Pregnancy / lactation with meglitinides?
C / safety unk.
Name the two thiazolidinediones.
Glitazones (thiazolidinediones)
Rosiglitazone (Avandia)
Pioglitazone (Actos)
How do thiazolidinediones work?
Decrease insulin resistance, and thereby increase glucose uptake by muscle and decrease glucose production by liver
What are the side effects of thiazolidinediones?
Hypoglycemia, but only in the presence of excessive insulin, can cause edema use with caution in heart failure. Can raise plasma lipids
What are the potential drug interactions with thiazolidinediones?
Insulin can also cause fluid retention so use with caution.
Gemfibrozil can raise plasma levels and lead to hypoglycemia
Pregnancy/Lactation for thiazolidinediones?
Name the biguianides.
Metformin (Fortamet, Glucophage, Glmetza, Riomet)
How do biguianides work?
Decreases glucose production by the liver and increases glucose uptake by muscle.
What are the side effects of biguianides?
GI symptoms: decreased appetite, nausea, diarrhea, lactic acidosis (rarely) NEVER use in renal insufficiency.
Possible drug interactions with biguianides?
Alcohol increases the chances of lactic acidosis and should be avoided.
Pregnancy/lactation in biguianides?
B/Prob safe
Name the Alpha glucosidase reducers.
Alpha glucosidase reducers
Acarbose (Precose)
Miglitol (Glyset)
How do the Alpha glucosidase reducers work?
Inhibit carbohydrate absorption and digestion, thereby decreasing the postprandial rise in blood sugar. Act in the intestines.
What are the side effects of the Alpha glucosidase reducers?
GI symptoms: flatulence, cramps, abdominal distention, borborygmus (Rumbling)
What are the potential drug interactions of alpha glucosidase reducers?
Combo with metformin should be avoided due to increased GI side effects.
Pregnancy/lactation in alpha glucosidase reducers?
Discuss differences in mechanism of action in agents used for Type II diabetes.
There are five classes of oral hypoglycemic agents. Sulfonylureas, meglitinides, thiazolidinediones, biguianides, and alpha glucosidase reducers.

The first two, sulfonylureas and meglitinides have similar mechanisms of action. They both work on the pancreas to produce more insulin. Sulfonylureas work specifically by bind with and thereby block ATP-sensitive potassium channels in the cell membrane. As a result there is an influx of calcium, which in turn causes insulin release. Meglitinides also work on the ATP-sensitive potassium channels facilitating calcium influx and release of insulin.

The next two, thiazolidinediones and biguianides, also have similar mechanisms of action. They both work by increasing the cell’s receptivity to insulin. Specifically thiazolidinediones work by activation of a specific receptor type in the cell nucleus called peroxisome proliferators-activated receptor gamma (PPAR-gamma). By activating PPAR-gamma insulin-responsive genes that help regulate carbohydrate and lipid metabolism are turned on. Biguianides (Metformin) work by decreasing production of glucose in the liver by suppressing gluconeogenesis. It also enhances glucose uptake and utlilization in the muscles.

The fifth class of oral hypoglycemics are the alpha glucosidase reducers. These drugs work in the intestines to delay the absorption of carbohydrates and thereby reduces the rise in blood glucose after a meal.
Discuss different forms of insulin and indications for use.
Insulin can be classified into four classes: immediate or short acting, regular, intermediate acting and long acting.

Short acting insulins are administered in association with meals to control the postprandial rise in blood glucose. Should be administered immediately before or with the first bite of a meal.

Regular insulin can be (1) injected or ihaled before meals to control postprandial glucose (30 min prior for injectable or immediately before with inhalation), and (2) infused subQ to provide basal control via pump.

Intermediate insulin or NPH is injected twice daily to provide glycemic control between meals and during the night. Only preparation suitable for mixing with regular insulin.

Long duration insulin (Lantus) is indicated for once daily subQ admin of adults or children with type 1 or 2 diabetes. Should be done at bedtime. Provides a constant dose for 24 hours, no peak and trough effect.
Discuss monitoring for hypothyroidism and medication adjustment based on lab values
· The goal of thyroid replacement therapy is to provide a dosage that will compensate precisely for the existing thyroid deficiency. This should be based on a combo of clinical judgment and lab tests.
· When therapy is successful there should be a reversal of the signs and symptoms of thyroid deficiency and an absence of signs of thyroid excess.
· Measurement of TSH is an important means of evaluation. Elevated TSH levels should fall. It does not change quickly and lags behind the elevation of T3 and T4 so evaluation of TSH should be done 6-8 weeks after starting treatment.
· A target of 0.5 to 2 microunits/mL is appropriate for most patients.
· In some patients T4 must be measured directly to evaluate therapy because in some patients TSH remains high despite treatment. When this happens T4 levels in the normal to high normal range measure success.
What are the side effects of thyroid replacement products?
Rare when given I appropriate doses. With acute overdose thyrotoxicosis may occur. Tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance and sweating.
What are the drug interactions with thyroid replacement products?
Drugs that reduce thyroid metabolism include cholestyramine (questran), cholestipol (colestid), calcium supplements, sucralfate (carafate), aluminum containing antacids, iron supplements. These should all be admin 1-2 hours away from thyroid hormone.Drugs that accelerate thyroid metabolism include phenytoin (dilantin), carbamezapine (tegretol), rifampin, Zoloft, phenobarbitol.Warfarin – levothyroxine accelerates the degradation of wvitamin K dependant clotting factors increasing the level of anticoagulation from warfarin.Catecholamines – increases cardiac response to catecholaminesCan increase requirements for insulin and digoxin.
What are the indications for Biphosphonates?
postmenopausal osteoporosis, glucocorticoid induces osteoporosis, paget’s disease, and hypercalcemia of malignancy.
How do biphosphonates work?
Undergo incorporation into bone, structurally similar to phosphate, then inhibit bone resorption by decreasing the activity of osteoclasts.
Side effects of biphosphonates?
Generally very safe, can have esophagitis, musculoskeletal pain, ocular inflammation and osteonecrosis of the jaw
Special instructions for administration of biophosphanates?
Very poor oral bioavailability. Need to be taken in the morning, with a full glass of water, at least 30 min before anything else including coffee or juice and must remain upright after taking it to reduce risk of esophagitis.
Side effects of steroids?
Adrenal insufficiency, osteoporosis, infection, glucose intolerance, mopathy, fluid and electrolyte disturbance, growth retardation, psychologic disturbance, cataracts and glaucoma, PUD, iatrogenic cushing syndrome. All adverse effects increase with dose.
Drug interactions with steroids?
Interactions related to K loss: can increase urinary loss of K, so should be used with caution with other drugs that cause this such as digoxin, thiazide or loop diuretics.
NSAIDS – concurrent use increases risk for PUD
Insulin and oral hypoglycemics – will require an increased dose
Vaccines – can decrease antibody response to vaccines.
Steroids OK in preg/lactation?
Only if really needed, not a good idea, must have clear benefits.
What are the primary indications of glucocorticoids?
o Rheumatoid arthritis
o Inflammatory bowel disease
o Miscellaneous inflammatory disorders
o Allergic conditions
o Asthma
o Dermatological disorders
o Neoplasms
o Suppression of allograft rejection
o Prevention of RDS in preemies
Treatment of anxiety. Management of panic attacks, (Xanax)
sedative/hypnotic for
Muscle Relaxant, used for
Spasticity from MS, may have some value in spinal cord injury
Anti-Parkinsonian, used for
Parkinsonism, extrapyramidal reactions, acute dystonic reactions
Antianxiety agent (anxiolytic)
Antiparkinson agent
long acting benzodiazepine
CNS stimulant for ADHD
muscle relaxant, CNS depressant for
centrally acting, for acute, painful musculskel. Conditions as adjunct to rest/phy therapy
antiepileptic drug closely related to barbituates, anticonvulsant
Anticonvulsants or Analgesic Properties
Antihistamine+ Antiemetic
Mania, bipolar, anticonvulsant
Antimanic agent
AntiAnxiety Drug (anxiolytic)
nonbenzodiazepine hypnotic agent
tricyclic antidepressant
Antipsychotic, atypical
antidepressant, smoking cessation
antidepressant, antiosessant, antipanic
Indications for topical glucocorticoids.
relief of inflammation and itching associated with bites, burns, dermatitis, psoriasis, eczema and pemphigus.
adverse effects of topical glucocorticoids.
Many factors including where applied, how long, how potent, use of occlusive dressing. Local effects: increase risk of local infection and may produce irritation. With prolonged use they can cause atrophy, thinning, striae, purpura and telangiectasia. Long term use can cause acne and hypertrichosis (excessive hair growth) Systemic effects: growth retardation in children, adrenal suppression
What antibotics are used for acne?
 Benzoyl Peroxide – first line for mild to mod. Suppresses growth of P. acnes. Also promotes keratolysis. Considered topical antimicrobial, but does not lead to resistance, combo c other abx to prevent resistance.
 Clindamycin and erythromycin – also suppresses growth or P. acnes. Also decreases inflammation. Monotherapy quickly leads to resistance so there are two combo products available – clinda/benzo (benzalin) and erythro/benzo (benzamycin)
What are retinoids?
derivatives of vit A, can unplug existing comedones and prevent development of new ones. Reduce inflammation and enhance penetration of other topical agents.
What drugs are used to treat glaucoma?
o First Line Agents
 Beta blockers – decrease aqueous formation
 Alpha adrenergic agonists – decreases aqueous formation
 Prostaglandin analogs – increased aqueous outflow
o Second line agents
 Cholinergic agonists – increased aqueous outflow
 Carbonic anhydrase inhibitors – decreased aqueous formation
 Nonselective adrenergic agonists – increased aqueous outflow
What drugs are used to treat bacterial conjunctivitis?
- treated with antibacterial opthalmic drops or ointments containing a quinolone antibiotic, tobramycin, sulfacetamide or erythromycin.
What drugs are used to treat Ceruminosis ?
Cerumenosis (ear wax occluding the ear canal) may lead to hearing loss and local irritations. Cerumen may be softened for removal using a cerumenolytic OTC solution such as Cerumenex
What drugs are used to treat otitis externa?
Otitis externa is frequently treated with antibiotics. Topical antibiotics are most commonly used. Corticosporin otic reduces inflammation and treats the infection. Floxin Otic is effective in treatment of otitis externa and has also been found to be effective in treatment of otitis media.