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Pharmacy Practice V > Endocrine Material Exam Two > Flashcards

Endocrine Material Exam Two Flashcards

1
Q

Metformin/Glumetza XR

Improved insulin sensitivity, lower hepatic production and GI absorption

A

Biguanide
CI: severe renal function eGFR <30
Warning: Lactic Acidosis, Somnolence, Malaise, Myalgia, & Respiratory Distress
DO NOT initiate if eGFR 30-45 mL/min
AE: Diarrhea
PC:
1. Take with food
2. Titrate dose
3. Use XR formulation
Dose: 1000-2550 mg

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2
Q

Titration Schedule for Metformin

A

Week 1: 500 mg QD
Week 2: 500 mg BID
Week 3: 500 mg AM, 1000 mg PM
Week 4: 1000 mg BID

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3
Q

SGLT2 Inhibitors

Decrease reabsorption of filtered glucose, increase excretion

A

Invokana, Farxiga, Jardiance, and Steglatro
CI: dialysis patients
Warning: volume depletion, bone fractures, lower limb amputation
AE: INCREASED urination and UTI infections
PC: keep genital area clean
Dosing: PO QD

You must consider an SGLT2 if the patient has PMH f HF, FM, or CKD

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4
Q

What are the dose adjustments for SGLT2 Inhibitors?

A

Invokana eGFR <30
Farxiga eGFR <45
Jardiance eGFR <30
Steglatro eGFR <45

These eGFR = not recommeneded to utilize SGLT2 specificites

Invokana eGFR 30-60 recommend dose ADJUSTMENT

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5
Q

What are the Landmark trials for Canagliflozin?

A

CANVAS = cardiovascular
CREDENCE = renal

Invokana

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6
Q

What are the Landmark trials for Empagliflozin?

A

EMPA-REG = cardiovascular
EMPEROR Reduced/Preserved = HF

Reduced = HFrEF Preserved =HFpEF Jardiance

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7
Q

What are the Landmark trials for Dapagliflozin?

A

DAPA-HF = HF
DAPA-CKD = renal

Farxiga

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8
Q

GLP-1 Receptor Agonist

Increase insulin secretion by beta cells

Decreasee glucagon, gastric emptying, and increased satiety

A

Byetta, Victoza, Adlyxin, Trulicity, Ozempic, and Mounjaro
CI: Medullary Thyroid Carcinoma
Warning: Pancreatitis
AE: Nausea/Diarrhea/HA
PC:
1. Nausea will likely subside over time
2. SUBQ

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9
Q

Byetta/Exenatide

A

GLP-1 Agonist
SQ BID
Starting Dose: 5 mcg
Max Dose: 10 mcg
CI: CrCl <30
PC: Administer within 60 minutes prior to AM/PM meal

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10
Q

Victoza/Liraglutide

A

GLP-1 Agonist
SQ QD
Starting Dose: 0.6 mcg
Max Dose: 1.8 mcg
Landmark Trial: LEADER

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11
Q

Adlyxin/Lixisenatide

A

GLP-1 Agonist
SQ QD
Starting Dose: 10 mcg x 14 days
Max Dose: 20 mcg on day 15

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12
Q

Trulicity/Dulaglutide

A

GLP-1 Agonist
SQ Once Weekly
Starting Dose: 0.75 mg
Max Dose: 4.5 mg
Landmark Trial: REWIND

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13
Q

Ozempic/Semaglutide

A

GLP-1 Agonist
SQ Once Weekly
Starting Dose: 0.25 mg
Max Dose: 2 mg
Landmark Trial: SUSTAIN 6

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14
Q

Mounjaro/Tirzepatide

A

GLP-1 Agonist
SQ Once Weekly
Starting Dose: 2.5 mg
Max Dose: 15 mg

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15
Q

What are the GLP 1 Receptor Agonists used for Weight Loss?

A

Saxenda/Liraglutide: SQ QD, titrate weekly to target dose 3g QD
Wegovy/Semaglutide: SQ once weekly, titrate q4 wks to maintenance dose of 2.4 mg once weekly

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16
Q

DDP-4 Inhibitors

A

Januvia, Onglyza, Tradjenta, and Nesina
Warning: pancreatitis, renal impairment
AE: HA
Dosing: PO QD

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17
Q

What are the dose adjustments for DDP-4 Inhibitors?

A

Januvia eGFR <45
Onglyza eGFR <45 or Strong CYP 3A4 Inhibitors
Tradjenta NONE
Nesina eGFR <60

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18
Q

Insulin Secretagogues

A

Sulfonylurea: Amaryl, Glucotrol, Diabeta
Meglitinides: Prandin and Starlix
CI: T1DM, sulfa allergy
Warning: HYPOglycemia, renal/hepatic dysfunction
DDI: BB = mask s/s of hypoglycemia
AE: weight gain
PC: when to administer in relation to meals

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19
Q

Amaryl/Glimepiride

A

PO QD with Breakfast
Titrate Q1-2 wks; intermediate acting
Consider lower dose and slow titration w/ eGFR <60

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20
Q

Glucotrol/Glipizide

A

PO QD/BID
Take 30 minutes pre-meal; titrate Q1-2 wks
Start lower dose and slow titration with eGFR <50

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21
Q

Diabeta or Micronase/Glyburide

A

PO QD with Breakfast
Titrate Q1-2 wks
NOT recommended with eGFR <60

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22
Q

Prandin/Repaglinide

A

TID with meals
Take 30 minutes pre-meal; titrate weekly
Start lower dose and slow titration with eGFR <40

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23
Q

Starlix/Nateglinide

A

TID with meals
Take 30 minutes pre-meal; titrate weekly
Start lower dose with eGFR <30

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24
Q

Thiazolidinediones

A

Actos and Avandia
CI: T1DM, Patients with Class III or IV HF
Warning: hepatic dysfunction
AE: Edema, Weight Gain
PC: S/S of fluid retention
Dosing: QD
Titrate Q3 months

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25
Q

Precose/Acarbose

A

MOA: Decreased GI carbohydrate absorption
CI: IBD, GI disorders
Warning: increased LFTs
AE: Flatulence
PC: TID, PO w/meals
Dosing: Take with first bite of food
Titrate Q4-8wks; skip if meal is missed

26
Q

Symlin/Pramlintide

A

MOA: Synthetic analog of amylin to delay gastric emptying, decrease post-prandial glucagon secretion, suppressed appetite
CI: Gastroparesis
DDI: meds that impair gastric motility
AE: nausea, hypoglycemia
PC: SC injection, TID with meals
Dosing: Administer in thigh of abdomen

27
Q

Insulin AE

A
  1. Hypoglycemia
  2. Injection site skin reactions
  3. Weight gain
28
Q

Insulin PC

A
  1. PRIME PEN before each use
29
Q

Insulin Glargine U-100

A

Lantus/Basaglar/Semglee
Reduce total dose by 20% if transferring FROM BID NPH or QD Toujeo to Lantus/Basaglar/Semglee
Typically given QD in the evening or before bed
Discard after 38 days at room temp

30
Q

Insulin Glargine U-300

A

Toujeo
Discard after 56 days at room temp

31
Q

Insulin Detemir

A

Levemir
QD or BID
Give 1:1 if transferring FROM another basal insulin to Levemir
Discard after 42 days at room temp

32
Q

Insulin Degludec U-100 or -200

A

Tresiba Flextouch
Longer acting than glargine or detemir
Discard after 56 days at room temp

33
Q

Insulin Glargine/Lixisenatide

A

Soliqua
QD, administer within 1 hour before first meal
Initial dose based on current basal insulin dose
Titrate by 2-4 units weekly
Max: 60 units
GLP1 agonist or insulin NAIVE = 15 units
Basal Insulin <30 units/day = 15 units
Basal Insulin 30-60 units/day with or without GLP1 = 30 units

34
Q

Januvia/Sitagliptin

A

QD
Dose Adjust: eGFR <45 mL/min

35
Q

Onglyza/Saxagliptin

A

QD
Dose Adjust: eGFR <45 mL/min or with Strong CYP 3A4 inhibitors

36
Q

Tradjenta/Linagliptin

A

QD
No dose adjustment recommended for renal impairment

37
Q

Nesina/Alogliptin

A

QD
Dose Adjust for CrCl <60 mL/min

38
Q

Invokana/Cangliflozin

A

QD
Dose Adjust for eGFR <60 mL/min; not recommended <30 mL/min for DM
Titrate after 4-12 wks if needed for DM

39
Q

Farxiga/Dapagliflozin

A

QD
Not Recommended for eGFR <45 for DM
Titrate after 4-12 wks if needed for DM

40
Q

Jardiance/Empagliflozin

A

QD
Not Recommended for eGFR <45
Titrate after 4-12 wks if needed

41
Q

Steglatro/Ertugliflozin

A

QD
Not Recommended for eGFR <45
Titrate after 4-12 wks if needed

42
Q

Symlin/Pramlintide

A

SQ Pre-Meal, prior to major meals
Reduce meal time insulin dosage as instructed

43
Q

Insulin Lispro/Protamine Suspension

A

Humalog 75/25 or 50/50
Administer 15 minutes before morning and evening meals

44
Q

Insulin Lispro U-100 or -200

A

Humalog/Ademlog
Administer 15 minutes pre-meal
Discard after 28 days at room temp

45
Q

Regular/Isophane NPH Insulin

A

Humulin 70/30 or 50/50
Administer 30 minutes before morning and evening meals

46
Q

Isophane NPH Insulin

A

Humulin N
Intermediate Acting
QD or BID
Cloudy

47
Q

Regular Insulin U-100 or -500

A

Humulin R
Administer 30 minutes pre-meal
Do NOT mix U500 with another insulin
U-100: discard after 31 days at room temp
U-500: discard after 40 days at room temp
Discard ANY PEN after 28 days at room temp

48
Q

Insulin Aspart/Protamine

A

Novolog Mix 70/30
Administer 15 minutes before morning and evening meal

49
Q

Insulin Aspart

A

Novolog/Fiasp
Administer 15 minutes pre-meal
Discard after 28 days at room temp

50
Q

Insulin Gluisine

A

Apidra
Administer 15 minutes pre-meal
Discard after 28 days at room temp

51
Q

Regular Human Insulin Inhaled

A

Afrezza
CI: Asthma and COPD
Administer at beginning of the meal
1. Unopened in frig = date on package
2. Open foiled pack but sealed blister = discard 10 days
3. Opened blister= discard 3 days

52
Q

Synthroid/Levothyroxine

A

<60 yrs w/o CVD: 1.6 mcg/kg/day
>60 yrs w/o CVD: 25-50 mcg/day
With CVD: 12.5-50 mcg/day
Titrate by 12-25 mcg/day Q6-8wks based on clinical response and thyroid function panel
Take at least 30-60 minutes before food

53
Q

Tapazole

A

Methimazole MMI
Hyperthyroidism
NOT preferred in pregnancy, PTU is preferred agent
Monitor CBC and LFTs

54
Q

From Toujeo to Lantus/Basaglar/Semglee

A

Reduce total dose by 20%

55
Q

From Lantus/Basaglar/Semglee to Toujeo

A

Give total dose 1:1

56
Q

Another basal insulin to Levemir

A

Give total dose 1:1

57
Q

Levemir to Insulin Glargine

A

Reduce total dose by 10-20%

58
Q

Another basal insulin to Tresiba

A

Give total dose 1:1

59
Q

Another basal insulin to NPH

A

Reduce total dose by 20%

60
Q

Twice Daily NPH to Lantus/Basaglar/Semglee/Toujeo

A

Reduce total dose by 20%

61
Q

NPH to Levemir

A

Give total dose 1:1

Pharmacy Practice V (19 decks)

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