Term
|
Definition
Amaryl
sulfonylurea
1-8mg daily
titrate q1-2weeks
take with first meal of the day
longest acting oral sulfonylurea |
|
|
Term
|
Definition
Glucotrol/ XL
sulfonylurea
2.5-40mg daily (doses greater than 15mg are BID) 30 minutes before meals
XL 2.5-20mg daily with first meal of the day
ghost shell |
|
|
Term
|
Definition
Micronase
sulfonlylurea
1.25-20mg QD (>10mg as bid)
titrate q 1-2 wks
Can take with first meal or 30 minutes before.
Renally excreted/ watch in elderly, renal/liver injury |
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Term
|
Definition
Prandin
meglitinide
0.5-4mg TID AC
Skip dose if skip meal, needs the rise in glucose to work.
CI: concomitant Gemfibrozil use, DKA with or w/o coma, type 1 diabetes
Precaution: concomitant NPH, malnourished pts. elderly pts, hepatic insuff., adrenal insuff., renal insuf., stress caused by infection, fever, trauam or surgery (consider switching to insulin).
0-30 min pre meal, skip if meal is missed (may be good for someone with irregular meal times |
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Term
|
Definition
Starlix
meglitinide
60-120 mg TID AC (60mg initial if pt. is near A1c goal {micromedex}).
skip dose if skip meal
CI: DKA, Type 1 diabetes
Precuation: elderly, adrenal/renal insuff., hepatic dysfx (mod to severe), malnourished pts., stress from infection fever trauma or surgery (switch to insulin).
may cause diarrhea, nausea, or upper resp. infection
0-30 min pre meal, skip if meal is missed |
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Term
|
Definition
Januvia
DPP4 inhibitor
100mg QD
decrease dose if CRCL <50, hypoglycemia in combo therapy
without regard to meals |
|
|
Term
|
Definition
Byetta
Incretin mimetic (GLP-1)
5-10mcg BID
NAUSEA
Inject SQ 60 minutes pre meals, not a monotherapy
injectable |
|
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Term
|
Definition
Glucophage/XR
Biguanide
1000-2550mg 2 or 3 doses, XR 500-2000mg qpm
start 500mg qd, titrate 500mg qwk or 850mg every other wk
take with meals, avoid alcohol
GI SYMPTOMS
Contraindicated in renal failure
DC prior to receiving contrast dye |
|
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Term
|
Definition
Glucovance
1.25/250, 2.5/500, 5/500
1-2 tabs BID
hypoglycemia |
|
|
Term
|
Definition
| Precose alpha-glucosidase inhibitor - alpha glucosidase degrades disaccharides to monosaccharides for absorption, Precose prolongs amount of time disaccharides are in intestinal transit. Bacteria in gut degrade the disaccharides as well and cause the gas. Improves POST PRANDIAL glucose levels 25-100mg TID AC, skip if skip meals. Take with first bite Contraindicated in bowel disease 74%flatulence NO HYPOGLYCEMIA, minimal effect on A1C. tolerance is an issue for most patients. counsel pt. to use only pure glucose (gel or tablets) if hypoglycemic because disaccharides will not get digested to help response if drug in system still. |
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|
Term
|
Definition
Actos
TZD
15-45mg QD titrate q3 months
without regards to meals
Risk of bladder cancer |
|
|
Term
|
Definition
Avandia
TZD
4-8mg QD (4mg BID) titrate q3 months
without regard to meals, risk of MI so not used much
restricted access, use limited to existing therapy or unable to achieve control on other agents and not able/willing to take pioglitazone |
|
|
Term
|
Definition
Humalog
rapid acting, 15 minutes premeal |
|
|
Term
| insulin lispro + protamine suspension |
|
Definition
Humalog Mix
75/25, 50/50, (long/short)
give 15 minutes AC (BID) morning and evening meal |
|
|
Term
|
Definition
Humulin R
give 30 minute AC for meal coverage |
|
|
Term
| isophane insulin suspension |
|
Definition
Humulin N
NPH, BID, cloudy, may use in pregnancy |
|
|
Term
| regular insulin + isophane suspension |
|
Definition
Humulin 70/30 , or 50/50 (NPH, R)
30 minutes prior to AM/PM meals (biphasic) |
|
|
Term
|
Definition
Lantus
long acting/ basal insulin
qpm or HS, do not mix with anything in syringe and don't predraw
if transitioning from NPH reduce dose by 20% |
|
|
Term
| Name the two classes of insulin secretagogues and the agents within those classes |
|
Definition
1. meglitinides: Starlix (Nateglinide) and Prandin (Repaglinide)
2. sulfonylureas: Amaryl (Glimperide) Glucotrol (Glipizide) Micronase (Glyburide) |
|
|
Term
|
Definition
Levemir
long acting/basal insulin
QD (HS) or BID (Q12hrs)
Dont mix with anything in syringe |
|
|
Term
| insulin aspart + protamine suspension |
|
Definition
Novolog Mix (70/30)
10-15 minutes prior to morning and evening meals |
|
|
Term
|
Definition
Novolog
meal coverage, rapid acting 10-15 minutes AC
used in pumps peak 90 minutes |
|
|
Term
Monitoring Response to Therapy (when should you titrate?)
1. Long acting insulin
2. short acting insulin
3. insulin secretagogues
4. biguanides
5. thiazolidinediones |
|
Definition
Max response:
1. long acting insulins: within DAYS
2. short acting insulins: same DAY
3. insulin secretagogue: 1-2 WEEKS
4. biguanides: 2-4 WEEKS
5. TZDs: 2-3 MONTHS |
|
|
Term
|
Definition
Onglyza
2.5-5mg in one dose (daily)
2.5mg qd if CrCl <50 or strong 3A4 |
|
|
Term
|
Definition
Metaglip
in two doses
titrate q 2 weeks
max 20/2000mg per day |
|
|
Term
|
Definition
glucovance
in two doses
titrate q 2 weeks
max 20/2000mg per day |
|
|
Term
|
Definition
acto plus met
in two doses
max 45/2550mg q 24 hours |
|
|
Term
|
Definition
avandamet
in two doses
max 8/2000mg per 24h
RESTRICTED ACCESS |
|
|
Term
|
Definition
tradjenta
5mg in one dose
no dosage adjustment recommended for renal impairment |
|
|
Term
|
Definition
| symlin for Type 1 diabetes: 15 mcg SQ up to 60mg SQ pre meal for Type 2 diabetes: 60mcg up to 120mcg SQ pre-meal take prior to major meals reduce meal time insulin dosage as instructed amylinomemtic- slows gastric emptying, decrease post-prandial glucagon rise, modulates satiety |
|
|
Term
|
Definition
Byetta
for type 2 diabetes
5-10 mcg sq BID before morning and evening meals
surveillance for pancreatitis
administer SQ within 60 min pre-meal BID, skip if meal is missed |
|
|
Term
|
Definition
Victoza
for type 2 diabetes
0.6mg SQ daily x 1 week, then 1.2mg daily (max dose 1.8mg daily)
administer same time each day
black box: history of medullary thyroid carcinoma
surveillance for difficulty swallowing, persistant hoarseness, change in size/shape of throat |
|
|
Term
|
Definition
insulin degludec
daily
fda approval pending
ultra-long acting, for use with rapidly acting inslin |
|
|
Term
|
Definition
Apidra
pre-meal
administer 0-15 mins pre meal |
|
|
Term
|
Definition
Peridex
oral hygiene rinse
usually 1/2 oz for 30 second bid after brushing teeth
spit/do not swallow
avoid rinses, food or water immediately after |
|
|
Term
|
Definition
Chronulac
Indication: constipation; portal system encephalopathy (PSE)
15-30mL daily for constipation
30-45mL TID-QID for PSE
may take 24-48h to produce bowel movement
antancid use could potentially increase pH so best to avoid, decreasing ammonia absorption/facilitating elimination is a desirable effect of lactulose in patients with encephalopathy secondary to cirrhosis |
|
|
Term
| docusate sodium/docusate calcium |
|
Definition
docusate
for constipation relief
sodium: 50-100mg BID (or 250 daily)
calcium: 240mg daily
take with full galss of water
may take 24-72 hours for effect
more effective for prevention than treatment, increase fiber in diet, drink ample fluids
surfactant agent that facilitates the admixture of water and fat in the stool; theoretical risk of emulsification of mineral oil which can also be used as a laxative, resulting in the potential for systemic absorption |
|
|
Term
|
Definition
CoLyte
bowel cleaning prior to GI procedure
8 oz of reconstituted solution q 10 mins as directed
drink until bowel effluent clear or 4L gone
chill to improve taste
ask patient the instructions received by doctor on when to start
do not eat within 3-4 hours prior to starting prep, meds within 1 hr prior may not be absorbed, drink glasses quickly, no food or drink after completion of bowel prep |
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|
Term
|
Definition
Miralax
for constipation relief
1 scoop (heaping tbsp) in 8 oz liquid once daily
use water, juice, soda, tea, coffee;
may take 48-96 hours for effect
avoid with bowel obstruction
PEG-based osmotic laxative |
|
|
Term
| atropine/hyoscyamine/scopolamine/phenobarbital |
|
Definition
donnatal
IBS and acute enterocolitis, GI antispasmodic
1-2 TID to QID;
max 8 tabs/day
contraindications/precautions: anticholinergic-glaucoma; urinary/GI obstruction; severe ulcerative colitis; hepatic/renal disease; elderly |
|
|
Term
|
Definition
tigan
severe nausea/vomiting
300mg PO TID-QID
alternative to compazine as a central-acting antiemetic; tend to see more use in the inpatient setting |
|
|
Term
|
Definition
reglan
for symptomatic GERD with motility disorder: 5-15mg up to QID (30 minutes AC and qhs)
diabetic gastroparesis: 5-10mg QID (30mins AC and QHS) 2-8 week trial of therapy
BLACK BOX WARNING: no more than 12 weeks use, risk of tradive dyskinesia
contraindications/precautions: GI obstruction, concomitant meds prone to EPS
anti-emetic in higher doses |
|
|
Term
|
Definition
zofran
chemotherapy induced N/V: 8mg BID (pre-medicate with 1st dose up to 30mins before chemo)
post-op N/V: 16mg pre-anesthesia |
|
|
Term
|
Definition
kytril
chemotherapy induced N/V: 1mg BID
pre-medicate with 1st dose up to 60mins before chemo
prevention of post-op N/V
5HT-3 serotonin antagonist |
|
|
Term
|
Definition
compazine (5, 10 mg tabs)
for severe N/V
5-10mg TID-QID
contraindications/precautions: CNS depressants, children <2 years or 20 lbs, movement disorders with high and/or prolonged dosage |
|
|
Term
| chlordiazepoxide/clidinium |
|
Definition
Librax
for IBS
1-2 tid-qid
before meals +/- at bedtime
antispasmodic/anticholinergic
drug interactions: CNS depressants
avoid abrupt withdrawal after long term use (benzodiazepine) |
|
|
Term
|
Definition
Levbid
for IBS
0.375mg, 1-2 tabs q12h |
|
|
Term
|
Definition
Levsin 0.125mg tabs
for IBS
1-2 q4h prn
empty stomach prior to meals or prn
max of 12 tabs/
contraindication: anticholinergic
no concomitant antacids, avoid alcohol |
|
|
Term
|
Definition
bentyl
functional IBS
20-40mg TID-QID
give 30 mins prior to meals
contraindications/precautions-anticholinergic |
|
|
Term
|
Definition
azulfidine 500mg, EN 500 mg
for treatment and maintenance of ulcerative colitis
2000-4000mg initial treatment, divided at least TID
maintenance 2000mg divided at least TID
contraindications: aspirin and sulfa allergy
take at even intervals after meals, ample fluids |
|
|
Term
|
Definition
dipentum 250 mg caps
for maintenance of ulcerative colitis
2 capsules BID (adult)
converted to mesalamine in colon
contraindication: aspirin allergy |
|
|
Term
|
Definition
colazal 750mg capsules
treatment of active ulcerative colitis
3 capsules TID (adult)
acute treatment indicated for 8-12 weeks
converted to mesalamine in colon
contraindication: aspirin allergy |
|
|
Term
|
Definition
Anaprox/Anaprox DS
mild to moderate pain/dysmenorrhea up to 1650mg/day 3 or 4 doses
arthritic conditions 550-1100mg/day 2 doses
for rapid onset |
|
|
Term
|
Definition
Naprosyn/EC-Naprosyn
pain up to 1250mg/day 3 or 4 doses
arthritic conditions 500-1000mg/day 2 doses
EC-only for arthritis, peak 4-6 hrs after dosin. Do not crush |
|
|
Term
|
Definition
Motrin
mild to moderate pain/dysmenorrhea 1600-2400mg/day 3 or 4 doses
arthritic conditions 1200-3200mg/day 3 or 4 doses |
|
|
Term
|
Definition
Daypro
arthritic conditions
600-1800mg/day 1 or 2 doses
has longesst half-life of proprionic acids |
|
|
Term
|
Definition
Lodine/Lodine XL
arthritic conditions
600-1200mg/day
2 or 3 doses, XL is 1 dose |
|
|
Term
|
Definition
Voltaren/Voltaren XR
arthritic conditions
up to 200mg/day 2 to 4 doses
XR 100-200mg/day 1 or 2 doses
oral and opthalmic solutions |
|
|
Term
|
Definition
Clinoril
arthritic conditions
300-400mg/day 2 doses
prodrug, sulfafide is active metabolite with 16 hour half-life |
|
|
Term
|
Definition
Feldene
arthritic conditions
up to 20mg/day
can use bid if stomach upset
long terminal half-life |
|
|
Term
|
Definition
Indocin/Indomethacin CR
arthritic conditions
up to 200mg/day 2 or 3 doses
CR up to 150mg/day 1 or 2 doses
take with food, milk, or antacids |
|
|
Term
|
Definition
Toradol
moderate/severe acute pain
no more than 5 days total
3 or 4 doses
PO should follow IM/IV therapy
Contraindications: pentoxifylline, probenecid, severe renal impairment or volume depletion
Has prolonged half-life in renal imparinment and elderly |
|
|
Term
|
Definition
Relefen
arthritic conditions
500-2000mg/day
1 or 2 doses
Notes: abbreviated 6NMA (acetic acid derivative)/ prodrug (dose reduced in hepatic impairment)/ active metabolite renally cleared (lower dose if CrCl < 50) |
|
|
Term
|
Definition
Celebrex
osteoarthitis 200mg/day 1 or 2 doses
rheumatoid arthritis 200-400mg/day 2 doses
sulfonamide allergy
Drug Interactions: warfarin (increase INR), 2C9 inhibitors (fluconazole), increase serum concentration of 2D6 (antidepressants) |
|
|
Term
|
Definition
Mobic
arthritic conditions
7.5-15mg/day |
|
|
Term
|
Definition
Disalcid
arthritis/minor pain
up to 3000mg/day 3 doses
inhibits prostaglandin synthesis, lacks affect on platelet function
2 salicylates fused, insoluble in acidic pH until small intestine |
|
|
Term
|
Definition
Arthrotec
arthritic conditions(+ risk of ulcer)
up to 200mg/800mcg/day 2 to 4 doses(ideally 3)
dose bid if stomach upset
preganacy category X |
|
|
Term
|
Definition
Methotrexate
rheumatoid arthritis, malignancy severe psoriasis
wkly: 7.5mg x 1 day or 2.5mg q 12 hrs x 3 doses
max 15mg/wk
BLACK BOX: bone marrow depression, hepatoxicity, reduced renal clearance with renal dysfunction
Avoid NSAIDs during high-dose therapy, pregnancy category X, photosensitivity, adminster folic acid supplement if recommended |
|
|
Term
|
Definition
Flexeril
musculoskeletal conditions
15-30mg/day 3 doses
short term (3 weeks)
max 60g/day
Contraindications: CHF, arrhythmias/heart conduction abnormalities, acute MI, anticholinergic precautions |
|
|
Term
|
Definition
Robaxin
musculoskeletal condiditons
3-4grams/day 4 doses |
|
|
Term
|
Definition
Norflex
musculoskeletal conditions
200mg/day 2 doses
30mg/ml injection
Contraindicated in condions aggravated by anticholinergic effects |
|
|
Term
|
Definition
Skelaxin
musculoskeletal conditions
up to 3200mg/day 3 or 4 doses
contraindicated in impaired hepatic/renal function |
|
|
Term
|
Definition
Soma
musculoskeletal conditions
up to 1400mg/day 4 doses |
|
|
Term
|
Definition
Zanaflex
management of spasticity
12-36mg/day 3 doses
alpha-2 agonist, may cause hypotension. Cases of liver injury. Take with food or milk if GI upset
contraindications: fluvoxamine and ciprofloxacin |
|
|
Term
|
Definition
Lioresal
management of spasticity
15-80mg/day 3 or 4 doses
start 5mg tid then titrate 15mg q3days
drug interactions: CNS depressants
do not discontinue abruptly-hallucinations and seizures |
|
|
Term
|
Definition
Aciphex
erosive esophagitis 20mg daily 8 week initial treatment; 20mg daily maintenance
adjunct H.pylori regimen
20mg + amoxicillin 1000mg + clarithromycin 500mg bid ideally 14 days |
|
|
Term
|
Definition
Nexium
erosive esophagitis 20-40mg daily 4-8 week initial treatment, 20mg daily maintenance. 60 min before food
adjunct H.pylori regimen 40mg daily + amoxicillin 1000mg + clarithromycin 500mg bid ideally 14 days |
|
|
Term
|
Definition
Prevacid
erosive esophagitis 30mg daily 8 week initial treatment, 15mg daily maintenance
adjunct H.pylori regimen 30mg daily + amoxicillin 1000mg + clarithromycin 500mg bid ideally 14 days
take on empty stomach
NG tube administration in apple juice |
|
|
Term
|
Definition
Prilosec
erosive esophagitis 20mg daily 4-8 week initial treatment, 20mg daily maintenance
adjunct H.pylori regimen 20mg daily + amoxicillin 1000mg + clarithromycin 500mg bid ideally 14 days
high doses in hypersecretory syndromes
drug interactions: plavix, warfarin
take prior to eating |
|
|
Term
|
Definition
Protonix
erosive esphagitis
40mg daily
8 week initial treatment, 40mg daily maintenance, also IV
without regard to meals |
|
|
Term
|
Definition
Dexilant
erosive esophagitis
60mg daily
8 week initial treatment, 30mg daily maintenance
without regard to meals, swallow whole or can sprinkle on apple sauce |
|
|
Term
|
Definition
Pepcid
duodenal ulcer 20mg bid or 40mg qhs 20mg qhs maintenance
GERD 20-40mg bid 6-12 week initial treatment, 20 mg daily maintenance
safest H2 antagonist with warfarin
adverse effect: headache |
|
|
Term
|
Definition
Tagamet
erosive esophagitis, prevention of upper GI bleeding (Iv infusion)
400mg qid
12 week initial treatment
drug interactions: benzodiazepine (all EXCEPT lorazepam, oxazepam, timazepam), carbamazepine, BB (propranolol, metoprolol), labetalol, phenytoin, theophylline, warfarin, plavix
take with food, take antacids no sooner than 2 hours following dose |
|
|
Term
|
Definition
Zantac
duedenal ulcer 150mg bid 150qhs for maintenance
erosive esophagitis 150mg qid 150mg bid maintenance therapy
dissolve effervescent tablets and granules |
|
|
Term
|
Definition
Carafate
duodenal ulcer, also used for stress ulcer
1 gram qid(before meals and hs)
4-8 week initial course, 1 gram bid maintenance
PK: minimal systemic absorption
Precautions: renal dysfunction (accumulation of aluminum)
Drug Interactions: digoxin, warfarin, phenytoin, theophylline, levothyroxine, quinolones, tetracyclines, antacids
avoid antacids before or after (it raises pH) |
|
|
Term
|
Definition
Cytotec
reduce NSAID-induced gastric ulcer
200mcg qid
Pregnancy category X
PGE1 analog
adverse effects: diarrhea, abdominal pain (causes a lot)
take with meals and at bedtime |
|
|
Term
|
Definition
Asacol
treatment and maintenance of ulcerative colitis
2 tabs tid(adult)
acute treatment indicated for 6 weeks
contraindications: aspirin allergy |
|
|
Term
|
Definition
avoid or use caution in elderly or debilitated patients
Drug interactions: concomitant CNS depressants
may cause drowsiness, avoid/limit alcohol, for short-term use, take with food or milk |
|
|
Term
|
Definition
Class Contraindications: for agents combined with antibiotics for H. pylori, do not forget antibiotic allergies
Class drug interactions: concomitant meds that require low gastric pH for absorption (ketoconazole, iron salts). Plavix interaction through 2C19, omeprazole implicated
well tolerated side effects (headache, diarrhea)
empty stomach: prevacid, nexium, prilosec
without regard to meals: protonix, aciphex, dexilant
PRN use does not immediately treat heartburn pain. Concomitant antacid use generally ok |
|
|
Term
|
Definition
A1C <7%
pre-meal 70-130 mg/dL
peak post prandial <180 mg/dL |
|
|
Term
|
Definition
LDL <100 mg/dL
HDL >40 mg/dL men, >50 mg/dL women
TG <150 mg/dL
BP <130/80 mmHg |
|
|
Term
Diabetes Drug Selection
1. renal function
2. hepatic function
3. congestive heart failure
4. gastrointestinal disorders |
|
Definition
renal function: would not use metformin if men Scr >=1.5, women >=1.4, CrCl <30
hepatic function: metformin (lactic acidosis), TZDs, some precaution with sulfonylurea
congestive heart failure: TZDs (fluid rentention), metformin
gastrointestinal disorders: metformin (use low dose), precose, incretin can complicate gastroporesis |
|
|
Term
Hypoglycemia
early warning symptoms
neuroglycopenic symptoms
treatment and monitoring
prevention |
|
Definition
early warning signs: <=70, shaking, palpitations, sweating, individualized
neuroglycopenic: 30-50, agitation, confusion, reasoning, may need helping recognizing what is wrong, passing out, seizures <30
treatment/monitor: life savers, soda, want pure sugar, 15-20 grams, general 6 oz, 4-6 candies. Should recheck blood sugar in 15 min and make sure you have a meal within an hour that contains complex carbs
prevention: don's skip meals, eat about every 4 hours |
|
|
Term
| sulfonylurea/meglitinide agents |
|
Definition
class precautions: renal dysfuntion (glyburide is most problematic), hepatic dysfunction, hypoglycemic warning symptoms, excessive ETOH may contribute to hypoglycemia
class drug interactions: potassium wasting diuretics (contribute to hyperglycemia), BB may mask hypoglycemia |
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|
