Diabetes Medication Formulary Flashcards
metformin dosages
-initial dose: 500 mg PO BID or 850 mg PO QD with meals
-titrate weekly or bi-monthly and increase by 250-500 mg/day
-maximum dose: 2550 mg/day
metformin adverse effects
-lactic acidosis
-diarrhea
-flatulence
-nausea
-vomiting
-vitamin B12 deficiency
-dementia
metformin monitoring
-eGFR ≥ 60: monitor SCr annually
-eGFR 45-60: monitor SCr every 3-6 months
-eGFR 30-45: monitor SCr every 3 months
-avoid in acute decompensated hospitalized HF, unstable HF, and/or HF coupled with severe renal/hepatic disease
-avoid excessive intake of alcohol
-hold metformin 1-2 days before and then ~2 days after depending upon patient status for surgery/radiologic procedure with contrast dye
-titrate dosage for GI side effects
-monitor vitamin B12 annually and provide supplementation if needed
metformin counseling points
-side effects: diarrhea, flatulence, nausea, vomiting, heartburn, headache, fatigue
-call a doctor if you are experiencing lactic acidosis, hypoglycemia, or an allergic reaction
alogliptin dosages
-25 mg PO QD
-12.5 mg PO QD (CrCl 30-60)
-6.25 mg PO QD (CrCl <30 or with ESRD on dialysis)
sitagliptin dosages
-100 mg PO QD (CrCl > 50)
-50 mg PO QD (CrCl 30-50)
-25 mg PO QD (CrCl < 30 or ESRD on dialysis)
DPP-4 inhibitors adverse effects
-nasopharyngitis
-upper respiratory tract infections (URIs)
-headache
-acute pancreatitis
-joint pain
-HF risk
DPP-4 inhibitors monitoring
-adjust dose for renal function
-avoid use in patients with history of chronic pancreatitis
DPP-4 inhibitors counseling points
-signs/symptoms of acute pancreatitis
-side effects: common cold symptoms, sore throat, stuffy nose, runny nose, headache
-call a doctor if you are experiencing severe joint pain, persistent joint pain, skin blisters, skin breakdown, heart problems, hypoglycemia, pancreatitis, liver problems, Stevens-Johnson syndrome/toxic epidermal necrolysis, allergic reaction, or kidney problems
dulaglutide dosages
-0.75 mg SQ weekly
-titrate up to 4.5 mg SQ weekly if needed for BG control
liraglutide dosages
-0.6 mg SQ QD for 1 week, then increase to 1.2 mg SQ QD
-titrate up to 1.8 mg SQ QD if needed for BG control
Ozempic dosages
-0.25 mg SQ weekly for 4 weeks to prevent nausea
-0.5 mg SQ weekly and titrate up to 2 mg SQ weekly if needed for BG control
Rybelsus dosages
-3 mg PO QD for 30 days, then increase to 7 mg PO QD
-titrate to 14 mg QD if needed for BG control
-if on Ozempic 0.5 mg SQ weekly, then change to 7 mg PO QD
GLP-1 agonists adverse effects
-nausea
-vomiting
-diarrhea
-acute pancreatitis
-thyroid C-cell tumors
-gallbladder disease
-retinopathy
GLP-1 agonists monitoring
-contraindicated in patients with personal or family history of MTC or with multiple endocrine neoplasia syndrome type 2 (MEN 2)
-use with caution or avoid in patients with preexisting gallbladder disease
-avoid in patients with gastroparesis
-monitor patients with history of retinopathy
-use with caution in patients with severe non-proliferative disease and avoid in patients with proliferative diabetic retinopathy
dulaglutide counseling points
-may be given at anytime, independent of meals
-may be administered in thigh, abdomen, or arm
-may be administered cold
-available in single dose pens
-remove grey base cap and place pen firmly against skin
-unlock top of pen and press green button to administer medication
-at second click, medication has been administered (can remove pen)
liraglutide counseling points
-may be given at anytime, independent of meals
-may be administered in thigh, abdomen, or arm
-available in pre-filled pens with 18 mg per pen
-should be stored in refrigerator when not opened
-in-use pen may be kept at room temperature
-discard unused medication after 30 days
-only prime prior to first injection
Ozempic counseling points
-may be administered in thigh abdomen, or arm
-store pens in refrigerator prior to use
-after first use, pen can be stored for 56 days at room temperature or refrigerator
-check flow with each new pen
-during injection, push button until dose counter goes to “0,” then count to “6” before removing pen
Rybelsus counseling points
-take 30 minutes before first food, beverage, or other oral medications with no more than 4 oz. plain water
GLP-1 agonists counseling points
-side effects: no appetite, fatigue, diarrhea, upset stomach, vomiting, abdominal pain, constipation, site irritation, headache, nose or throat irritation, back pain
-call a doctor if you are experiencing neck mass, difficulty breathing, difficulty swallowing, hoarseness, pancreatitis, gallbladder problems, kidney problems, change in eyesight, hypoglycemia, dizziness or passing out, abnormal heartbeat, mood changes, slurred speech, or an allergic reaction
ultra-short acting insulin dosages
-type 1: average daily dose is 0.5-0.6 U/kg/day (30%-50% is given as bolus dose)
-type 2: add bolus for patients on ≥ 0.5 units/kg/day; can start with 10% of basal dose or 4-5 units with largest meal
ultra-short acting insulin adverse effects
-hypoglycemia (if not meal within 15 minutes of dose)
-hyperglycemia/ketosis (if insulin delivery interrupted)
ultra-short acting insulin monitoring
-increase/decrease dose every 2-4 days until goals are met
insulin aspart counseling points
-side effects: weight gain, site irritation, nose or throat irritation, common cold symptoms
-call a doctor immediately if experiencing hypokalemia; thick skin, pits, or lumps at injection site; change in skin color at injection site; arm or leg edema; urination pain; hypoglycemia; or an allergic reaction
