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NURP 424 > Exam 2 Meds > Flashcards

Exam 2 Meds Flashcards

1
Q

Albuterol

A
  • short acting, beta 2 receptor agonist
  • acts on the smooth muscle of the bronchi to reverse bronchospasm, decreases airway resistance and residual volume…increases vital capacity and airflow
  • avoid in arrhythmias

AE: tachycardia, dizziness, palpitations, tremors, nervousness, headaches

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2
Q

Salmeterol

A
  • long acting beta 2 receptor agonists
  • relaxes bronchial smooth muscle by selective action on beta 2 receptors
  • do NOT use without the use of an asthma controller med such as inhalled steroid
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3
Q

Theophylline

A
  • Xanthine derivatives
  • inhibits specific phosphodiesterases, increases cAMP, leads to relaxation of bronchial smooth muscle and pulmonary vessel relaxation
  • avoid in patients w/ hypersensitivity to xanthine, PUD, seizures
  • tachycardia, palpitations, headaches
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4
Q

Ipratroprium bromide (atrovent)

A

short-acting anticholinergic

blocks the action of acetylcholine at the muscarinic cholinergic receptors in bronchial smooth muscle causing bronchdilation

  • avoid in patients w/ urinary retention, BPH, closed angle-glaucoma
  • AE: cough, dry mouth, dyspepsia, N/V
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5
Q

Tiotropium bromide (Spiriva)

A
  • long-acting anticholinergics
  • inhibits muscarinic M3 receptors in the lungs leading to smooth muscle bronchodilation
  • avoid in patients with urinary retention, BPH, closed angle glaucoma
  • AE: dry mouth, pharyngitis, URI, headache, mouth irritation
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6
Q

Isotretinoin (Accutane)

A
  • systemic retinoid
  • reduces sebum production by reducing sebaceous gland size, normalizing follicular keratinization and indirectly reducing acne
  • AE: chelitis, dry skin, fragility, fatigue, visual disturbance, GI rxn
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7
Q

Rational Drug Selection for Acne

A

Noninflammatory Comedonal Acne= topical retinoid or bonzoyl peroxide

Inflammatory Papulopustular Acne= topical combination therapy of topical antibiotic or retinoid plus benzoyl peroxide

Severe Inflammatory= oral abx combined with topical combo therapy with topical abx or retinoid plus benzoyl peroxide

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8
Q

Topical Corticosteroids

A

use for dermatitis, psoriasis

anti-inflammatory, antipruritic, vasoconstriction

enhanced by increased skin temp, hydration
Ointments more occlusive and potent, creams less occlusive less potent w/ lotions being less potent

Do not use on face, groin, axilla
Caution in pregnancy
Children require the lowest strength

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9
Q

Pimecrolimus (Elidel) and Tacrolimus (Protopic)

A

Topical Calcineurin Inhibitors

indicated for atopic dermatitis

supresses cellular immunity through inhibiting T-cell activation by binding to intracellular proteins, including calcineurin-dependent proteins. Inhibits inflammatory cytokines and mediators from mast cells

Do not use in lactation, consult for use in pregnancy
Do not use in children younger than 2 years

AE: local reaction at the site- burning, pruritis, tingling, headache, fever, flu-like sx, acne, folliculitis

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10
Q

Diphenhydramine (benadryl)

A

Topical antihistamine and antipruritic

provides local relief of itching and swelling b/c of effects on H1 receptors; suppresses the formation of edema and pruritus
blocks transmission of nerve impulses

*do not use longer than 7 days

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11
Q

Doxepin (Zonalon)

A

Topical antihistamine and antipruritic

histamine-blocking action of H1 and H2 receptors, inhibiting the activation of the histamine receptors

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12
Q

Pyrethrins (RID)

A

for LICE

absorbed through the exoskeleton of arthorpods, causing paralysis/death

avoid in chrysanthemum or ragweed allergy
avoid in children younger than 2 years
compatible with pregnancy and lactation

AE: localized burning, pruritis, skin irritation

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13
Q

Permethrin

A

for lice and scabies
*1st line treatment for lice and scabies

absorbed through exoskeleton, causing paralysis and death

has residual activity against lice for up to 10 days

avoid near eyes, avoid in peds younger than 2 months

compatible with pregnancy and lactation

AE: localized burning, pruritis, skin irritation

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14
Q

Malathione (Ovide)

A

second line for lice Acts as a pediculicide by inhibiting cholinesterase activity in vivo

Both pediculicidal and ovicidal

Some residual activity for up to seven days

Flammable, do not use hair dryer
Avoid in children under 6
Avoid in pregnancy and lactation

AE: organophosphate poisoning and severe resp distress if ingested

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15
Q

Benzyl Alcohol (Ulesfia)

A

stuns the lice, leading to the ability to penetrate their respiratory mechanism, which leads to asphyxiation

avoid in peds younger than 6 months
compatible with pregnancy and lactation

AE: pruritis, erythema

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16
Q

Ivermectin (Sklice)

A

can be for scabies and lice
interferes w/ the function of the nerve and muscle cells, resulting in parasite paralysis and death

single application of topical ivermectin is effective for eradication of head lice

avoid in pregnancy and lactation; approved for children over 6 months

AE: dry skin, burning sensation, eye irritation

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17
Q

Warfarin (Coumadin)

A

Competitively inhibits VKORC1 complex, thus depleting functional vitamin K reserves and hence reducing hepatic synthesis of several clotting factors

Black box warning: may cause fatal bleeding•Caution in hepatic impairment that may enhance response•Avoid in pregnancy but safe in lactation•Maintain stable intake of foods high in vitamin K

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18
Q

Heparin

A

Prevention of postoperative thromboembolism

Potentiates the action of antithrombin III and thereby inactivates thrombin as well as other anticoagulation factors (i.e., factor Xa) and prevents the conversion of fibrinogen to fibrin

Avoid in pregnancy; compatible with lactation•Use caution when combining with conditions that may predispose to hyperkalemia

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19
Q

Low molecualr weight heparin (LOVENOX)

A

DVT and/or PE, prophylaxis

Potentiates the activity of (antithrombin) III and inactivates factors Xa and IIa (prothrombin)

Compatible with pregnancy and lactation

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20
Q

Dabigatran (Pradaxa)

A

Reducing the risk of stroke and systemic embolism in patients with nonvalvular atrial fib

Direct thrombin inhibitor; thrombin is required for the conversion of fibrinogen to fibrin in the clotting cascade; remember that fibrin directly precedes clot formation

Black box warning concerning epidural or spinal hematomas with spinal interventions•Not safe in pregnancy and lactation, needs more information

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21
Q

Rivaroxaban, Apixaban, Edoxaban, and Betrixaban

A

Treatment of DVT and/or PE and reduction of stroke and systemic embolism in nonvalvular afib

All are direct factor Xa inhibitors

Black box warning concerning epidural or spinal hematomas with spinal interventions•Not recommended in pregnancy and lactation, needs more information

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22
Q

Aspirin

A

MI and stroke prevention and acute coronary
syndrome

Irreversibly antagonizes the cyclooxygenase pathway
thus interfering with platelet aggregation
*do not use in peds with flu or chicken pox
*Steven Johnson Syndrome a AE

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23
Q

Clopidrogel (Plavix)

A

Unstable angina, recent MI, ACS

Reduces platelet aggregation by inhibiting the adenosine diphosphate (ADP) pathway of platelets•Has no effect on prostaglandins

Avoid with severe hepatic disease or patients with GI ulcers

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24
Q

Ferrous Sulfate (20% elemental iron)

A

Replaces iron, found in hemoglobin, myoglobin, and other enzymes; allows the transportation of oxygen via hemoglobin

-cost effective, most easily absorbed

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25
Q

Montelukast (Singulair)

A

Leukotriene Modifiers

Chronic asthma, allergic rhinitis

Inhibits the cysteinyl leukotriene (CysLT1) receptor, which is correlated with the pathophysiology of asthma, including airway edema and smooth muscle contraction

Notto be used for asthma exacerbation•May be used in pregnancy and caution in lactation

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26
Q

Zileuton (Zyflo)

A

Leukotriene Modifiers

Chronic asthma

Inhibits 5-lipoxygenase, the enzyme that catalyzes the formation of leukotrienes from arachidonic acid

Not recommended in pregnancy and lactation
Should not be used in active liver disease

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27
Q

Fluticasone (Flovent or Flonase)

A

Corticosteroids

Extremely potent vasoconstrictive and anti-inflammatory activity

do not use for asthma exacerbation, can cause oral candida

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28
Q

Cromolyn sodium

A

Inhaled Anti-Inflammatory Agent

Asthma, bronchospasm prophylaxis, allergic rhinitis

Inhibits antigen-induced bronchospasm and blocks the release of histamine by inhibiting mast cell degranulation

not for asthma exacerbation-

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29
Q

Azelastine (Astepro) and Olopatadine (Patanase)

A

Inhaled Antihistamines

Seasonal allergic rhinitis and vasomotor rhinitis

Inhibit the release of histamine by competing with histamine at H1 receptor sites

Not to be combined with CNS depressants•Avoid driving or operating heavy machinery

Somnolence (greater with azelastine)

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30
Q

Diphenhydramine (Benadryl)

A

First-Generation Antihistamines

Allergic rhinitis, hypersensitivity reactions, urticaria and angioedema, insomnia, motion sickness antiemetic

Competitively antagonizes the effects of histamine at the peripheral H1 receptor sites at the GI tract, blood vessels, and respiratory tract

Caution in elderly patients and young children
Alternative agents recommended in pregnancy- avoid in lactation

Sedation, dizziness, confusion, ataxia, urinary retention, paradoxical excitation, dry mouth, tremor, blurred vision

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31
Q

Cetirizine, Loratadine, and Fexofenadine

A

Second-generation antihistamines

Respiratory allergies, urticaria

Competitively antagonize the effects of histamine at the peripheral H1 receptor sites at the GI tract, blood vessels, and respiratory tract

AE= headache, drowsiness, nervousness

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32
Q

Decongestants

A

Sudafed, Afrin

Avoid in severe hypertension and coronary artery disease (oral)•Not recommended for children younger than four years (oral)•Not recommended in pregnancy and lactation•Avoid in combination with beta blockers

Anxiety, restlessness, headache, insomnia, psychological disturbances, tremors, hypertension, tachycardia

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33
Q

Dextromethorphan

A

Antitussive

Acts centrally in the medulla to elevate the threshold for coughing; structurally related to codeine

Avoid in persistent or chronic cough caused by smoking, asthma, or emphysema

drowsiness, dizziness, and GI upset

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34
Q

Codeine

A

Antitussive

Direct effect on cough receptors in the medulla

Avoid in persistent or chronic cough caused by smoking, asthma, or emphysema

risk of abuse; drowsiness, dizziness, and GI upset

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35
Q

Benzonatate

A

Antitussive

Related to anesthetic tetracaine and thought to anesthetize the stretch receptors in the respiratory passages, calming the cough

Avoid in persistent or chronic cough caused by smoking, asthma, or emphysema

chest numbness, dizziness, GI upset, headache, and “chilly” sensation

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36
Q

Mucinex

A

Expectorant

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37
Q

Antacids

A

Aluminum hydroxide, magnesium hydroxide, calcium carbonate

Indications: Hyperacidity, peptic ulcer disease, GERD

Antacids are weak bases that interact with hydrochloric acid in your stomach to reduce gastric acidity and increase pH

Avoid aluminum-and magnesium-based in renal impairment

Avoid calcium-based in hypercalcemia
Caution in patients who are on sodium restriction
calcium and aluminum cause constipation while mag causes diarrhea

Take at least 2 hours before or after other meds

38
Q

Sucralfate (Carafate)

A

cytoprotective agents

Prophylaxis and treatment of duodenal ulcers associated with NSAID use and treatment for duodenal ulcers from other causes

Selectively binds to necrotic ulcer tissue, covering it and acting as a barrier for outside stimuli such as acids

Compatible with pregnancy and lactation•Limited data in children•Caution in geriatric patients with CrCl less than 30 mL/minute

AE= constipation, GI upset

39
Q

Misoprostol (Cytotec)

A

Cytoprotective Agents

Prophylaxis and treatment of duodenal ulcers associated with NSAID use

Inhibition of gastric secretion through inhibition of histamine stimulated cAMP•Mucosal protective qualities by increasing mucus and bicarbonate

Avoid in pregnancy and lactation

Diarrhea, abdominal pain, nausea, postmenopausal bleeding, headache

40
Q

Ranitidine and Famotidine

A

Histamine 2Receptor Antagonists

Mild intermittent GERD, peptic ulcer disease, heartburn

Reversible competitive inhibition of histamine at H2 receptors of the gastric parietal cells, thus inhibiting gastric acid secretion

Caution in renal impairment•Compatible with pregnancy and lactation•Approved in pediatrics

AE: Headache, dizziness, confusion

41
Q

Omeprazole, Pantoprazole, Esomeprazole

A

Proton Pump Inhibitor

Duodenal and gastric ulcers, erosive gastritis, Zollinger-Ellison syndrome, GERD

Inhibit gastric proton pumps specifically, the H+/K+-ATPase pump, located on the parietal cells to suppress acid secretion

Black box warning for omeprazole and clopidrogel

Compatible in pregnancy and lactation
Approved in pediatrics

42
Q

Diphenoxylate/Atropine

A

antimotility agent

Inhibits excessive GI motility and GI propulsion. Atropine is added to this agent, which provides anticholinergic effects that decrease secretion in the bowel and slow peristalsis

43
Q

Loperamide

A

antimotility agent

Acts through opioid receptors to inhibit peristalsis and prolong gastric time. It also reduces fecal volume and diminishes loss of fluid and electrolytes

44
Q

Bismuth Subsalicylate

A

Exhibits both antisecretory and antimicrobial action and may have some anti-inflammatory action as well

45
Q

Kaolin and Pectin

A

Kaolin is a clay-like powder that attracts and holds bacteria, and pectin thickens the stool by absorbing moisture

46
Q

Polycarbophil (FiberCon)

A

Can provide bulk to your stools by absorbing water in the GI tract

47
Q

Ondansetron (Zofran)

A

5HT3 Receptor Antagonists

Blocks serotonin both peripherally on vagal nerve terminals and centrally in the CTZ

Caution in QT prolongation•Caution with other serotonin medications•Caution in pregnancy and lactation

AE: headache, constipation, fatigue

48
Q

Dramamine and Meclizine

A

Antihistamines

In addition to competing with histamine for H1 receptor sites, they also block the CTZ, diminish vestibular stimulation, and depress labyrinthine function through its central anticholinergic activity

Drowsiness, dry mouth, blurred vision, urinary retention, and paradoxical excitation in children may occur

Avoid in elderly patients included in Beers list. In elderly patients, you can have an increased risk for confusion and CNS depression- compatible with pregnancy, avoid in lactation

49
Q

Scopolamine (Transderm Scop)

patch for motion sickness

A

Anticholinergics

Blocks the action of acetylcholine at the parasympathetic sites in smooth muscle, CNS, and secretory glands

AE: Drowsiness, dry mouth, blurred vision, urinary retention, dilated pupils

Avoid in pregnancy and lactation and peds
Avoid in elderly patients

50
Q

Promethazine and Prochlorperazine

A

Phenothiazines

Block dopamine receptors in the CTZ as well as cholinergic, alpha 1 adrenergic, and histamine 1 receptors

Sedation, extrapyramidal reactions, agranulocytosis, dry mouth, blurred vision, constipation, bradycardia, hypotension
Avoid in elderly patients
Other agents preferred in pregnancy; avoid in lactation

51
Q

Dronabinol (Marinol)

A

Cannabinoids

Activates CB1 receptors in the brain, which prevents the pro-emetic effects of endogenous compounds such as dopamine and serotonin

Depression, dizziness, paranoid thoughts, somnolence, palpitations, tachycardia, hypotension

High potential for abuse•Avoid in pregnancy and lactation

Caution in patients with seizure disorder- do not use for kids under 12

52
Q

Metoclopramide (Reglan)

A

Prokinetic Agent

Dopamine receptor antagonist in the CNS leading to prevention of nausea; also stimulates motility in the upper GI tract

AE: Black box warning for extrapyramidal side effects, depression, drowsiness, dizziness, diarrhea, and hypoglycemia

Can prolong QTc•High potential for abuse; can be used in pregnancy/peds, avoid in lactation

53
Q

Senna (Senokot)

A

Stimulants

Stimulates the myenteric plexus, which results in prostaglandin release and increase cAMP concentration

May be used in pregnancy and lactation

54
Q

Psyllium (Metamucil)

A

Bulk Laxatives

Soluble fiber that absorbs water in the intestine to form a viscous liquid that promotes peristalsis and reduces transit time

Caution in narrowed esophageal or intestinal lumen

55
Q

Magnesium hydroxide and polyethylene glycol

A

Osmotic

Draw water into the intestinal lumen to increase intraluminal pressure, which distends the colon and increases peristalsis

Caution with lactulose in diabetic patients•Caution with magnesium-based preparations and renal impairment•All may be used in pregnancy and lactation

56
Q

Docusate sodium (Colace)

A

Stool Softener

Reduces the surface tension of the oil–water interface on the stool and facilitates admixture of fat and water into the stool, producing an emollient action

Compatible with pregnancy and lactation

57
Q

Mineral oil

A

Lubricants

Eases passage of stool by decreasing water absorption and lubricating the intestine

Avoid in pregnancy and lactation•Avoid in elderly per Beers Criteria

AE: Abdominal cramping, diarrhea, nausea, oily rectal leakage, vomiting

58
Q

Lubiprostone (Amitiza)

A

Chloride Channel Activators

Activates chloride channels in the GI epithelial lining, producing chloride-rich secretions that soften the stool and increase motility

Not recommended in pediatrics and pregnancy

59
Q

Methylnaltrexone (Relistor)

A

Opioid-Receptor Antagonists

Antagonist at mu receptors in the GI tract

Known or suspected bowel obstruction•Caution in pregnancy•Not recommended in pediatrics

60
Q

-prils

A

ACE Inhibitors

Hypertension, hypertensive proteinuric diabetes, angina and ischemic heart disease, post-MI, heart failure

Lower blood pressure by inhibiting the conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor. They also inhibit the degradation of bradykinin and increase the synthesis of vasodilating prostaglandins

Avoid in pregnancy and lactation
Approved in >6 y/o

61
Q

-sartans

A

ARBs

Hypertension, hypertensive proteinuric diabetes, angina and ischemic heart disease, post-MI, heart failure

Block the angiotensin II receptors, which is a potent vasoconstrictor. By reducing the levels of angiotensin II, there is also a reduction in aldosterone secretion, which reduces the retention of sodium and water

Avoid in pregnancy and lactation
Caution with other medications that can cause hyperkalemia

Dizziness, hypotension, hyperkalemia, fatigue, URI

62
Q

Nifedipine (Procardia) and Amlodipine (Norvasc)

A

Dihydropyridines

Hypertension and angina

Inhibit calcium ions from crossing the cell membrane, resulting in a marked decrease in transmembrane calcium content and prolonged vascular smooth muscle relaxation

Avoid in patients with significant peripheral edema
Approved in pediatrics >6 y/o

63
Q

Verapamil and Diltiazem (Cardizem)

A

Non-Dihydropyridines

Angina, hypertension, atrial fibrillation, SVT

Inhibit calcium ions from crossing the cell membrane, resulting in a decrease of calcium content, leading to vascular smooth muscle relaxation and coronary vasodilation

Avoid if SBP is below 90 mmHg, Avoid in HF with ejection fraction of less than 40%, ventric dysfunction, pregnancy and lactation

Edema, headache, gingival hyperplasia, constipation

64
Q

Chlorthalidone and Hydrochlorothiazide (HCTZ)

A

Thiazide Diuretics

Hypertension, mild fluid retention

Act on the distal renal tubule to inhibit sodium reabsorption

Caution in elderly•Compatible with pregnancy

65
Q

Furosemide (Lasix)

A

Loop Diuretics

Edema associated with congestive heart failure, hepatic cirrhosis, and renal disease

Inhibits sodium reabsorption in the ascending loop of Henle

Avoid in patients who are anuric

66
Q

Spironolactone (Aldactone)

A

Potassium-Sparing Diuretics

Edema related to CHF

Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium and water excretion and maintaining potassium

AE: Gynecomastia, hyperkalemia, rash, hyperuricemia, hyponatremia

67
Q

Amiodarone

A

Atrial fibrillation, atrial flutter

Class III antiarrhythmic agent that inhibits adrenergic stimulation, affects sodium, potassium, and calcium channels, and prolongs the action potential and refractory period in the myocardium

Prescribing in pregnancy and lactation via cardiologist

Increased risk of development of pulmonary fibrosis
Increased risk for hypothyroidism or hyperthyroidism

Extrapyramidal syndrome, hepatic dysfunction, corneal deposits, peripheral neuropathy, and extreme burning photosensitivity which can result in blue-gray skin tone

Need to monitor w/ Monitoring•Chest x-ray, pulmonary function tests•Thyroid stimulating hormone (TSH), free T4•Ophthalmic exam•Liver function tests

68
Q

Digoxin

A

Atrial fibrillation, supraventricular tachycardia, heart failure

inhibits the sodium potassium (ATPase) pump in myocardial cells, which results in a transient increase in intracellular sodium, which promotes calcium influx leading to increased contractility•Decreases positive inotropic effect, enhances vagal tone, and decreases ventricular rate

Fatigue, anorexia, nausea and vomiting, diarrhea, visual disturbances

69
Q

Nitrates

A

increases nitric oxide and cGMP…desphorylation of myosin light chain…vascular smooth muscle relaxation

70
Q

Hydralazine

A

Vasodilators

Hypertension, heart failure

Acts by direct relaxation and dilation of arteriolar smooth muscle, leading to a decrease in peripheral vascular resistance

Avoid in patients who have CAD
Caution in pregnancy•Compatible with lactation

71
Q

-statins

A

HMG CoA Reductase Inhibitors

Block the conversion of HMG-CoA to mevalonate, which is the rate-limiting step in the production of cholesterol in the liver. Blocking cholesterol production leads to an increase in the number of LDL receptors in the liver, allowing for a larger amount of LDL and VLDL to be taken up by the liver

Avoid in pregnancy and lactation

Myalgia, arthralgia, diarrhea, nausea, abdominal pain, headache

72
Q

Niacin

A

This is a naturally-occurring B vitamin with the MOA uncertain. It appears to reduce VLDL synthesis, inhibits lipolysis in adipose tissue, and increase lipoprotein lipase activity

Avoid with active peptic ulcers•Avoid in pregnancy and lactation

Pruritus, flushing, rash, diarrhea, hepatotoxicity (rare)

73
Q

Gemfibrozil (Lopid) and Fenofibrate (Tricor)

A

Fibrates

Increase lipolysis of triglycerides via lipoprotein lipase, resulting in a large decrease in triglyceride, thus increasing HDL

Increased serum transaminases, dyspepsia, abdominal pain, diarrhea
Avoid in pregnancy and lactation

74
Q

Cholestyramine (Questran)

A

Bile Acid Sequestrants

Forms a nonabsorbable complex with bile acids in the intestine; inhibits enterohepatic reuptake of intestinal bile salts, resulting in increase fecal removal of LDL cholesterol

Flatulence, bloating, abdominal pain, constipation

Avoid in patients with triglyceride levels of greater than or equal to 300 mg/dL
Recommended in pregnancy and lactation when treatment is needed

75
Q

Ezetimibe (Zetia)

A

Cholesterol Absorption Inhibitors

Blocks the absorption of cholesterol across the intestinal border

AE= Fatigue, diarrhea, increased serum transaminases, arthralgia

Avoid in pregnancy and lactation

76
Q

Evolocumab (Repatha)

A

PCSK9 Inhibitors

Human monoclonal antibody that binds to PCSK9 and inhibits the binding of PCSK9 to LDL receptors allowing for increased LDL receptors on the cell surface, decreasing LDL in the blood stream

Avoid in pregnancy and lactation
• Evolocumab may be used in children older
than 13 years

77
Q

Insulin

A

Stimulates glucose entry into cells
• Increases storage of glucose as glycogen in
muscle and liver cells
• Inhibits glucose production in liver and muscle
cells
• Promotes protein synthesis by increasing amino
acid transport into cells
• Enhances fat storage and prevents mobilization of fat for energy

Close monitoring in patients with: Hepatic dysfunction
• Renal impairment
• Pregnancy
• Hypo- and hyperthyroidism

78
Q

Glucagon

A

It accelerates liver glucogenolysis, which
results in increased breakdown of glycogen to
glucose and inhibition of glycogen synthesis.
This leads to elevated blood glucose levels

Contraindicated if there is a hypersensitivity to
glucagon or lactose
• Avoid in patients with insulinoma or
pheochromocytoma

79
Q

Insulin Types

A

Rapid: onset of 15 minutes, peak 30-90 minutes, lasts for 5 hours. Have meal at bedside

Regular: onset of 30 minutes, peak of 1-2 hours, lasts 3-7 hours

MPH (intermediate acting): onset 1.5 hours, peak 4-12 hours, duration of 10-16 hours

Determir: glargine- onset 3-6 hours, NO PEAK, lasts about 24 hours

80
Q

Metformin (Glucophage)

A

Biguanides

Increases peripheral glucose uptake and
utilization, thus improving insulin sensitivity;
decreases hepatic glucose production and
intestinal absorption of glucose

Avoid with eGFR less than 30
• Caution: with eGFR between 30–45, would
require close monitoring
• Hold 48 hours before to 48 hours after
radiologic studies with contrast
• Avoid in liver disease
• Insulin first-line therapy in pregnancy, though
metformin may be considered by OB

AE: Lactic acidosis (rare), diarrhea, bloating,
nausea, flatulence, headache, vitamin B12
deficiency

81
Q

Pioglitazone (Actos)

A

Thiazolidinediones (TZDs)

Enhances insulin sensitivity by improving insulin
action in the cell. This leads to increased utilization of
available insulin by the liver and muscle cells as well
as adipose tissue. Also decreases hepatic glucose
production

Avoid in patients with NYHA class III and IV heart
failure
• Avoid in patients with ALT levels greater than 2.5
times above normal limit
• Avoid in active or history of bladder cancer
• Increase risk for bone fractures
• Avoid in pregnancy, lactation, and children younger
than 18 years of age

AE: Fluid retention, weight gain, headache, myalgia,
hypertension, URI

82
Q

Glipizide, glyburide, glimepiride

A

Sulfonylureas

Cause an increase in endogenous insulin secretion
by the beta cells of the pancreas. Reduce glucose
release from the liver

avoid in elderly, children, pregnancy, lactation

AE: Hypoglycemia, weight gain, nausea, epigastric
fullness, heartburn, rashes, pruritus, urticaria,
agranulocytosis (rare)

83
Q

Repaglinide (Prandin), nateglinide (Starlix)

A

Meglitinides

Block ATP-dependent potassium channels,
depolarizing the membrane and facilitating calcium
entry through calcium channels. Increased calcium
stimulates insulin release from pancreatic beta cells
• Short-acting insulin secretagogues that are most
effective at reducing postprandial blood glucose
levels

avoid in elderly, pregnancy, lactation

AE: Hypoglycemia, weight gain, headache, diarrhea,
arthralgias, chest or back pain

84
Q

Acarbose

A

Alpha-Glucosidase Inhibitors

used for diabetes- poop out the glucose

Competitively inhibits the absorption of
complex carbohydrates from the small bowel

Flatulence, diarrhea, abdominal pain,
elevated serum transaminases

Avoid in bowel diseases
• Caution in renal and hepatic impairment
• Avoid in patients predisposed to intestinal
obstruction
• Avoid in pregnancy and lactation

85
Q

-flozins

A

Selective Sodium-Glucose
Cotransporter 2 Inhibitors (SGLT-2)

Inhibit renal SGLT-2 in the proximal tubule, blocking
the reabsorption of glucose in the kidneys. This leads
to increased urinary glucose excretion and reduction
of plasma glucose

AE: Hyperkalemia, GU fungal infections, UTI, renal
insufficiency, urinary frequency, hypotension, urticaria

Black box warning: risk of Fournier’s gangrene
• Avoid with eGFR less than 30
• Increased risk for bone fractures
• Avoid in pregnancy and lactation

86
Q

-gliptins

A

Dipeptidyl Peptidase-4
Inhibitors (DPP-4)

Inhibit DPP-4 enzyme,
resulting in prolonged
incretin (GLP-1 and
GIP) hormone levels
*incretin is part of the insulin secretory response to food

Caution in renal impairment (except for
linagliptin)
• Avoid in pregnancy and lactation

AE: Hypersensitivity reactions (rare), acute
pancreatitis (rare), arthralgias, hypoglycemia

87
Q

-tides

A 
Glucagon-Like Peptide 1
Receptor Agonists (GLP-1)

Analog of the incretin hormone GLP-1, which
increases glucose-dependent insulin
secretion, decreases inappropriate glucagon
secretion, and slows gastric emptying

AE: Nausea and vomiting, diarrhea, injection site
reaction, headache

Avoid in moderate- to end-stage renal disease
• Avoid in patients with severe GI disease
• Black box warning: risk of thyroid c-cell
tumors
• Limited data in pregnancy and lactation

88
Q

Levothyroxine (Synthroid)

A

Synthetic form of T4, which is an endogenous
hormone secreted by the thyroid gland. T4 is
converted to its active metabolite T3. These
hormones then bind to thyroid receptor proteins in the
cell nucleus and exert metabolic effects through
control of DNA transcription and protein synthesis

Avoid after recent MI
• Caution in patients with cardiovascular disease
• Caution in patients with adrenal insufficiency
• Compatible in pregnancy and lactation
avoid in peds

AE: Increased heart rate, increased blood pressure,
anxiety, nervousness, insomnia, weight loss

89
Q

Methimazole (Tapazole)

A

Inhibits the synthesis of thyroid hormones by
blocking the oxidation of iodine in the thyroid
gland; does not inactivate circulating T3 and T4

AE: Drowsiness, headache, arthralgia, skin rash,
urticaria, fever, agranulocytosis (rare),
hepatitis (rare)

Avoid in first trimester of pregnancy
• Use lowest dose in lactation
• Approved in pediatrics
• Use with caution with other medications that can suppress bone marrow

90
Q

Propylthiouracil (PTU)

A

Inhibits the synthesis of thyroid hormones by
blocking the oxidation of iodine in the thyroid
gland; also blocks conversion of T4 to T3 in
the peripheral tissues. Does not inactivate
circulating T3 and T4

AE: Drowsiness, headache, arthralgia, skin rash,
urticaria, fever, agranulocytosis (rare),
hepatitis (rare)

Black box warning: hepatotoxicity
• Use lowest dose in lactation
• Avoid in pediatrics
• Increased bleeding risk
• Use with caution with other medications that
can suppress bone marrow

NURP 424 (2 decks)

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