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38 Cards in this Set
- Front
- Back
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DM
a)normal insulin physiology/secretion b)type 1 vs. 2 |
a1)basal (background insulin level)
a2)bolus (insulin spike after a meal) bTYPE1)absolute insulin deficiency bTYPE2)"relative" deficiency w/ features of insulin resistance and obesity |
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DM Goals of therapy (3)
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1)minimize occurence/symptoms of hypo or hyperglycemia
2)minimize chronic complications 3)minimize CV morbidity/mortality |
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DM monitoring parameters (3)
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1)symptoms of high glc in blood (incr urination, dry mouth/thirst)
2)glycemic parameters (fasting plasma glc 90-130 & A1c less than 7%) 3)plus drug specific ones |
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DM drug selection should consider (5)
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1)type 1 vs 2 DM
2)renal fxn 3)hepatic fxn 4)CHF 5)GI disorders |
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Insulin secretagogues (agent types) (4) AND MECHANISM
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1)sufonylurea
2)meglitinide 3)incretin mimetic 4)sitagliptin INCREASE INSULIN RELEASE |
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Sufonylurea and Meglitinide agents
a)class CI (2) b)class precautions (3) c)class drug interactions (2) |
a1)type 1 DM
a2)diabetic ketoacidosis b1)renal dysfxn (especially if drug has active metabolites) b2)hepatic dysfxn b3)hypoglycemic warning symptoms (symptomatic at less than 70) c1)K-wasting diuretics (contribute to hyperglycemia) c2)BB may mask hypoglycemic warning symptoms |
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Insulin secretagogues
a)class ADRs (2) b)Class pt consultation (5) |
a1)HYPOGLYCEMIA
a2)mild GI side effects b1)s/sx of hypoglycemia b2)avoid excessive EtOH (can result in prolonged hypoglycemia) b3)regular glipizide and meglitinides = premeal b4)glimepiride and glipizide XL = with meals b5)regular glyburide = before or with a meal |
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Lyrica
a)generic b)FDA indications (2) c)precautions (3) |
a)Pregabalin
b1)neuropathic pain associated with diabetic peripheral neuropathy b2)posttherpetic neuralgia and adjunct treatment in certain seizure disorders c1)taper gradually over at least 1 week prior to dc c2)edema when used w/ glitazones c3)rare reports of myopathy |
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Lyrica
a)ADR's (3) b)pt consultation (2) |
a1)dizzy/drowsy
a2)dry mouth a3)peripheral edema b1)do not abruptly dc b2)report unexplained muscle weakness/pain |
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Amaryl
a)generic b)class c)PK d)consult (2) |
a)glimepiride
b)sulonylurea c)24 hour duration (so dose qd) d1)take w/ breakfast or 1st main meal d2)watch in old due to long acting |
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Glucotrol/XL
a)generic b)class c)PK (2) d)pt consultation (2) |
a)glipizide
b)sulfonylurea c1)regular release--food delays absorption c2)XL-- food may increase Cmax d1)take regular release 30min before food d2)take XL release with 1st main meal of the day |
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Micronase
a)generic b)class c)PK d)precautions e)pt consultation |
a)Glyburide
b)sufonylurea c)24 hour effect w/ active metabolites are renally excreted d)renal/hepatic dysfxn e)take 30min before food or with food |
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Prandin
a)generic b)class c)pt consultation (3) |
a)repaglinide
b)megletinide c1)take up to 30min prior to meals c2)can take immediately pre-meal c3)SKIP IF A MEAL IS MISSED*** |
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Starlix
a)generic b)class c)pt consultation (3) |
a)nateglitinide
b)meglitinide c1)take up to 30min prior to meals c2)can take immediately pre-meal c3)SKIP IF A MEAL IS MISSED*** |
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Januvia
a)generic b)class c)FDA indications (2) d)pharmacology |
a)Sigagliptin
b)insulin secreatgogues c1)combined with metformin or glitazone c2)type 2 DM d)DPP-4 inhibitor (this enzyme degrades incretins) |
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Januvia
a)precautions (2) b)ADR c)other (2) |
a1)requires dosage reduction for CrCL less than 50
a2)risk of hypoglycemia if used w/ secretagogues b)HA c1)GLP/GIP are the incretins released by the body c2)incretins released in response to meal and bind Bcells to incr glc dependent insulin secretion and decr glucagon secretion |
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Byetta
a)generic b)pharmacology c)ADR d)pt consultation (3) |
a)exenatide
b)mimics incretin action to increase glucose-dependent insulin release & decr gastric emptying c1)n/v/d******* d1)store unused syringes in refrigerator d2)INJECT SQ within 60min premeal BID d3)SKIP IF MEAL IS MISSED |
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Glucophage/XR
a)generic b)PK c)CI d)ADR e)pt consultation (3) |
a)metformin
b)EXCLUSIVELY renally eliminated c)SCr over than 1.4 for women, 1.5 for men (WILL RESULT IN LACTIC ACIDOSIS) d)n/v/d/gas***** TRANSIENT e1)take w/ meals e2)avoid alcohol e3)XR-- shell may be present in stool |
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Precose
a)generic b)pharmacology c)CI d)ADR (2) e)pt consultation (2) f)other |
a)acarbose
b1)alpha-glucosidase inhibitor b2)slows digestion of carbs = decr glc peak after meal c)inflammatory bowel disease d1)FLATULENCE d2)diarrhea e1)TAKE WITH FIRST BITE OF MEAN e2)SKIP IF MEAL IS MISSED f)WILL NOT CAUSE HYPOGLYCEMIA IF MONOTHERAPY |
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TZD's
a)class CI b)class warnings/precautions (2) c)class ADR (2) |
a)type 1 DM
b1)FLUID RETENTION (do not used in class 3/4 CHF) b2)hepatic dysfxn (baseline and periodic LFTs) c1)edema/wt gain c2)no hypoglycemia IF MONOTHERAPY |
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TZD's class pt consultation (3)
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1)s/sx of fluid retention
2)s/sx of hepatoxicity 3)importance of lab monitoring |
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Actos
a)generic b)requires c)pt consultation d)mechanism |
a)pioglitazone
b)insulin adjustment LATER ON c)can take w/o regard to meals d)insulin sensitizers (make insulin more effective) |
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Avandia
a)generic b)requires c)pt consultation |
a)rosigliatzone
b)insulin adjustment LATER ON c)take w/o regard to meals |
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Insulin
a)class precautions b)drug precautions (2) c)class ADR's (3) |
a)hypoglycemia
b1)HYPERGLYCEMIC w/ corticosteroids and diuretics b2)HYPOGLYCEMIC w/ alcohol, BB c1)hypoglycmia c2)injexn site skin rxns c3)wt gain |
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Insulin class pt consultation (4)
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1)recognition/tx of hypoglycemia
2)when to admin (agent specific)***** (know for each) 3)consistent admin site (rotate within an injexn site) 4)impotance/schedule of monitoring blood glc |
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Humalog/Mix
a)generic b)pt consultation (2) |
a1)lispro
a2)lispro & protamine b1)HUMALOG admin 15min prior to eating**** b2)mix has biphasic peak give BID before morning and evening meal*** |
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Humulin
a)generic b)pt consultation (2) |
a1)HumulinN- isophane
a2)HumulinR- regular human insulin a3)mix- regular insulin & isophane b1)R- admin 30min prior to meal b2)70/30 & 50/50 have biphasic peak give BID 30min prior to morning/evening meal |
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Lantus
a)generic b)mechanism c)dosing d)consultation (2) |
a)Glargine
b)long acting/basal insulin c)SUBQ USE ONLY d1)qd- usually pm or hs d2)DO NOT dilute or mix w/ other insulin |
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Novolog/Mix
a)generic b)PK c)pt consultation (2) |
a)Aspart, mix is Aspart and protamine
b)more rapid acting than regular insulin c1)Novolog- admin 10-15 min prior to meal c2)mix has biphasic peak (admin 10-15min prior to morning/evening meals) |
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Levemir
a)generic b)mechanism c)dosing d)consultation (4) |
a)Detemir
b)long acting/basal insulin c)SUBQ USE ONLY d1)qd or bid d2)if qd, admin pm or hs d3)if bid, admin morning and evening meals (12h apart) d4)do NOT diute or mix with other insulin |
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Alphagan P
a)generic b)drug interaxns c)ADR (3) d)pt consultation (2) |
a)brimonidine
b)additive effects w/ BB c1)hyperemia c2)burn/sting c3)blurred vision d1)5min b/w different eye drops d2)remove contact lenses prior to instillation |
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Cosopt
a)generic b)CI (5) c)ADR (3) d)pt consultation (2) |
a)dorzolamide/timolol
b1)asthma b2)severe COPD b3)sinus bradycardia b4)CHF b5)allergy to sulfonamides c1)ocular burning/blurring c2)hyperemia c3)itching d1)10min b/w different eye drops d2)remove contact lenses prior, re-insert after 15min |
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Betoptic
a)generic b)pharmacology c)CI/precautions (4) d)ADR (3) e)pt consultation |
a)betaxolol
b)B1 selective c1)sinus bradycardia c2)CHF c3)bronchial asthma c4)severe COPD d1)ocular burn/blur d2)hyperemia d3)itching e)10min b/w different eye drops |
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Timoptic/Timoptic XE
a)generic b)pharmacology c)CI (4) d)ADR (2) e)pt consultation |
a)timolol
b)nonselective BB c1)asthma c2)severe COPD c3)sinus bradycardia c4)CHF d1)ocular burn/blur d2)HA e)10min b/w different eye drops |
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Xalatan
a)generic b)when to dose c)precautions d)ADR (3) e)pt consultation (2) |
a)latanoprost
b)PM c)iris can permanently change color w/ long term use d1)burn/blur d2)itching d3)incr pigmentation e1)allow atleast 5min b/w different eye drops e2)remove contact lenses prior |
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Lumigan
a)generic b)when to dose c)precautions (2) d)ADR (3) e)pt consultation (3) |
a)bimatoprost
b)PM c1)iris AND eyelid may incr pigmentation (permanently) c2)eyelashes grow faster and incr in pigmentation d1)hyperemia d2)darkening/growth of eyelashes d3)ocular itch/burn e1)allow 5min b/w different eye drops e2)remove contacts prior to use e3)awareness of eye/eyelash changes |
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Travatan
a)generic b)when to dose c)precautions (2) d)ADR (2) e)pt consultation (3) |
a)travoprost
b)PM c1)iris AND eyelid may incr pigmentation (permanently) c2)eyelashes grow faster and incr in pigmentation d1)hyperemia d2)eye discomfort/itching e1)allow 5min b/w different eye drops e2)remove contacts prior to use e3)awareness of eye/eyelash changes |
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Patanol
a)generic b)precautions c)ADR (4) d)pt consultation (2) |
a)olpatadine
b)not to be used w/ contact or to treat contact related irritation c1)HA c2)blur vision c3)burn/sting c4)dry eye d1)remove contacts prior, reinsert after atleast 10min d2)advise not to wear contact lenses if eyes are red |
