1_Medications 2025 Flashcards
CLASS OF MED:
Metformin (Glucophage)
Biguanide
DAILY DOSE RANGE:
Metformin (Glucophage)
500 to 2550 mg BID w/ meal
CLASS OF MED:
Riomet
Liquid Metformin
Biguanides
DAILY DOSE RANGE:
Riomet (liquid metformin)
500 to 2550 mg (500 mg/mL)
What are the 3 forms of XL biguanides?
1) Glucophage XR
2) Glutmetza
3) Fortamet
CLASS OF MED:
Glucophage XR
Biguanides - long acting
DAILY DOSE RANGE:
Glucophage XR
500 to 2000 mg (once per day WITH DINNER)
CLASS OF MED:
Glumetza
Biguanides - long acting
DAILY DOSE RANGE:
Glumetza
500 to 2000 mg (once per day WITH DINNER)
CLASS OF MED:
Fortamet
Biguanide - long acting
DAILY DOSE RANGE:
Fortamet
500 to 2500 mg (once per day WITH DINNER)
What is the mechanism of action for biguanides?
1) Decreases hepatic glucose output
2) First line medication for T2DM diagnosis
COMMON SIDE EFFECTS:
Biguanides
Nausea, bloating, diarrhea, B12 deficiency
To minimize GI side effects of biguanides, what should you recommend?
1) Switch to XR
2) Take with meals
CONTRAINDICATIONS:
Biguanides
GFR < 30, do not use
GFR < 45, do not START
If a patient starts on metformin and their GFR falls to 30-45, what do you recommend?
1) Evaluate the risk versus benefit
2) Consider decreasing dose
For a dye study, when can metformin be restarted?
-What 4 conditions are we worried about here?
After 48 hours, if renal function is stable.
For those with:
1) GFR < 60
2) Liver disease
3) Alcoholism, or
4) HF
When would you consider stopping metformin (glucophage)?
-Why?
Due to the risk of lactic acidosis?
-GFR > 30
-Liver disease
-ETOH abuse
-Over 80 y/o
-During IV dye study
-CHF requiring medication
(TRUE/FALSE)
Biguanides are approved for pediatrics?
TRUE - 10 y/o ++
BENEFITS:
Biguanides
1) Lowers cholesterol
2) No hypo risk
3) No weight gain
4) Cheap
5) Approved for pediatrics, 10 y/o & older
6) Lowers A1c 1.0 to 2.0%
METFORMIN:
-Cause hypos?
-Cause weight gain?
-Affordable?
-Lowers CVD risk?
-Can most tolerate/use?
-HYPOS: No
-WT GAIN: No
-AFFORDABLE: Yes
-LOWER CVD RISK: Yes* lowers LDL
-TOLERATE: Yes/No (GFR, GI)
MECHANISM OF ACTION:
Sulfonylureas
Stimulates sustained insulin release
CLASS OF MED:
Glyburide (Diabeta)
Sulfonylurea
When should you take sulfonylureas?
1-2x/day; BEFORE MEALS
DAILY DOSE RANGE:
Glyburide (Diabeta)
1.25 to 2.0 mg
Can take once or twice per day; BEFORE meals
CLASS OF MED:
Glyburide (Glynase Prestabs)
Sulfonylureas
DAILY DOSE RANGE:
Glyburide (Glynase Prestabs)
0.75 to 12 mg
can take once or twice per day; BEFORE meals
CLASS OF MED:
Glipizide (Glucotrol)
Sulfonylureas
DAILY DOSE RANGE:
Glipizide (Glucotrol)
2.5 to 40 mg
can take once or twice per day; BEFORE meals
CLASS OF MED:
Glipizide (Glucotrol XL)
Sulfonylureas
DAILY DOSE RANGE:
Glipizide (Glucotrol XL)
2.5 to 20 mg
can take once or twice per day; BEFORE meals
CLASS OF MED:
Glimepiride (Amaryl)
Sulfonylureas
DAILY DOSE RANGE:
Glimepiride (Amaryl)
1.0 to 8.0 mg
can take once or twice per day; BEFORE meals
(TRUE/FALSE)
Sulfonylureas are available low cost generic.
TRUE
COMMON SIDE EFFECTS:
Sulfonylureas
1) Hypos
2) Weight gain
3) Eliminated via kidney
Which sulfonylurea is the most likely to cause hypos?
Sulfonylureas
BENEFITS:
Sulfonylureas
Lowers A1c 1.0 to 2.0%
Can be helpful in presence of glucose toxicity
Sulfonylureas:
-Cause hypos?
-Cause weight gain?
-Affordable?
-Lowers CVD risk?
-Can most tolerate/use?
-HYPOS: Yes
-WT GAIN: Yes
-AFFORDABLE: Yes
-LOWER CVD RISK: No
-TOLERATE: Yes/No
What 2 brand names are Glipizide?
1) Glucotrol
2) Glucotrol XL
What 2 brand names medications are Glyburide?
1) Diabeta
2) Glynase Prestabs
SIDE EFFECTS:
SGLT-2
1) Hypotension
2) UTIs (increased urination)
3) Gential infections
4) Weight loss
5) Ketoacidosis
6) Volume depletion (monitor electrolytes - K, Na)
Which class of medication is considered “glucoretic?” What is the mechanism of action?
SGLT-2
“Sodium-Glucose Transport Protein 2”
Decreases glucose reabsorption in the kidneys
CLASS OF MED:
Canagliflozin (Invokana)
SGLT-2
DAILY DOSE RANGE:
Canagliflozin (Invokana)
100 to 300 mg (1x/day)
CLASS OF MED:
Dapagliflozin (Farxiga)
SGLT-2
DAILY DOSE RANGE:
Dapagliflozin (Farxiga)
5 to 10 mg (1x/day)
CLASS OF MED:
Empagliflozin (Jardiance)
SGLT-2
DAILY DOSE RANGE:
Empagliflozin (Jardiance)
10 to 25 mg (1x/day)
CLASS OF MED:
Ertugliflozin (Steglatro)
SGLT-2
DAILY DOSE RANGE:
Ertugliflozin (Steglatro)
5 to 15 mg (1x/day)
CLASS OF MED:
Bexagliflozin (Brenzavvy)
SGLT-2
DAILY DOSE RANGE:
Bexagliflozin (Brenzavvy)
20 mg (1x/day)
What class of medication is the first line for:
-HF
-CVD
-CKD Protection?**
SGLT-2
Before or with metformin
(TRUE/FALSE)
SGLT-2’s have limited BG lowering effect if GFR < 30.
FALSE
GFR < 45
(TRUE/FALSE)
Use SGLT-2 to reduce CVD, HF, and preserve renal function.
TRUE
If CKD and GFR > or equal to 20
BENEFITS:
SGLT-2
1) 3 medications reduce bG
2) Reduce CVD death & HF
3) Slow CKD
4) 3 medications approved for Peds
5) Lowers A1c 0.6 to 1.5%
Which 3 SGLT-2s reduce BG?**
1) Canagliflozin (Invokana)
2) Dapagliflozin (Farxiga)
3) Empagliflozin (Jardiance)
Which 3 SGLT-2 are approved for pediatrics?**
1) Canagliflozin (Invokana)
2) Dapagliflozin (Farxiga)
3) Empagliflozin (Jardiance)
SGLT-2s reduce the A1c by how much?
Lowers 0.6 to 1.5%
SGLT-2:
-Cause hypos?
-Cause weight gain?
-Affordable?
-Lowers CVD risk?
-Can most tolerate/use?
-HYPOS: No
-WT GAIN: No
-AFFORDABLE: No ($600 cash pay)
-LOWER CVD RISK: Yes!
-LOWER HF RISK: Yes!
-LOWER CKD RISK: Yes!
-TOLERATE: Yes!
Which medication class is referred to as “incretin enhancers?”
DPP-4s
What is meant by “incretin enhancers?”
1) Prolongs actions of gut hormones
2) Increases insulin secretions WITH MEALS
3) Delays gastric emptying
ALSO: DPP-4s suppress glucagon & stop DPP-4 enzymes from breaking down endogenous gut hormones
What 3 medications are DPP-4s?
1) Sitagliptin (Januvia)
2) Linagliptin (Tradjenta)
3) Alogliptin (Nesina)
DAILY DOSE RANGE:
Sitagliptin (Januvia)
25 to 100 mg daily
Sitagliptin (Januvia)
-Eliminated via XXXX?
Kidney
*Caution dose if creatinine is elevated
DAILY DOSE RANGE:
Linagliptin (Tradjenta)
5 mg daily
Linagliptin (Tradjenta)
-Eliminated via XXXX?
Feces
DAILY DOSE RANGE:
Alogliptin (Nesina)
6.25 to 25 mg daily
Alogliptin (Nesina)
-Eliminated via XXXX?
Kidney
*Caution dose if creatinine elevated
Which 2 DPP-4s are eliminated by the kidneys?
1) Sitagliptin (Januvia)
2) Alogliptin (Nesina)
SIDE EFFECTS:
DPP-4s
1) Headache
2) Flu-like symptoms
3) Severe, disabling joint pain* (recommend contacting MD and discontinuing)
4) Report signs of pancreatitis
Which DPP-4 can increase the risk of HF?
-Signs to contact MD about? (3)
Apogliptin (Nesina)
Signs:
1) SOB
2) Edema
3) Weakness
Do DPP-4s have any CVD or CKD benefit?
No
(TRUE/FALSE)
DPP-4s cause weight gain.
FALSE
(TRUE/FALSE)
DPP-4s cause hypoglycemia.
FALSE
How much do the DPP-4s lower A1c?
Lowers 0.6 to 0.8%
DPP-4s:
-Cause hypos?
-Cause weight gain?
-Affordable?
-Lowers CVD risk?
-Can most tolerate/use?
-HYPOS: No
-WT GAIN: No
-AFFORDABLE: No
-LOWER CVD RISK: No
-TOLERATE: Yes!
Which class of medications has the least ability to lower A1c and is expensive?
DPP-4s
(TRUE/FALSE)
TZDs are protective for peripheral fracture risk?
FALSE - cause increased RISK for peripheral fracture risk
Actos may increase the risk for what type of cancer?
Bladder cancer
For those with NAFLD or a hx of stroke, the ADA recommends what medication?
Pioglitazone (Actos)
Pioglitazone (Actos) is what class of medication?
Thiazolidinediones
How much do TZDs lower the A1c?
Lowers 0.5 to 1.0%
MECHANISM OF ACTION:
Thiazolidinediones
Increases insulin sensitivity
What 2 medications are thiazolidinediones?
1) Pioglitazone (Actos)
2) Rosiglitazone (Avandia)
DAILY DOSE RANGE:
Pioglitazone (Actos)
15 to 45 mg daily
DAILY DOSE RANGE:
Rosiglitazone (Avandia)
4 to 8 mg daily
What is the black box warning for TZDs?*
TZDs may cause or worsen CHF
-Monitor for edema and weight gain*
Thiazolidinediones:
-Cause hypos?
-Cause weight gain?
-Affordable?
-Lowers CVD risk?
-Can most tolerate/use?
-HYPOS: No
-WT GAIN: Yes (FLUID RETENTION)
-AFFORDABLE: Yes
-LOWER CVD RISK: ?? - post stroke
-TOLERATE: Monitor for CHF
MECHANISM OF ACTION:
Glucosidase Inhibitors
Delays carb absorption
What 2 medications are glucosidase inhibitors?
1) Acarbose (Precose)
2) Miglitol (Glyset)
Acarbose (Precose) & Miglitol (Glyset) are what class of medication?
Glucosidase Inhibitors
DAILY DOSE RANGE:
Miglitol (Glyset)
25 to 100 mg w/ meals
-300 mg max daily dose
-start low dose, increase at 4-8 week interval to decrease side effects
DAILY DOSE RANGE:
Acarbose (Precose)
25 to 100 mg w/ meals
-300 mg max daily dose
-start low dose, increase at 4-8 week interval to decrease side effects
Which conditions warrant caution when starting a glucosidase inhibitor?
Caution with liver or kidney problems
(TRUE/FALSE)
Glucosidase inhibitors can cause hypos?
FALSE - only when taken in combination w/ insulin or sulfonylureas
-take glucose tabs
SIDE EFFECTS:
Glucosidase Inhibitors
Excessive gas because they absorb carbs later in the small intestine and the bacteria ‘go crazy’
How much do glucosidase inhibitors lower A1c?
Lowers 0.5 to 1.0%
MECHANISM OF ACTION:
Meglitinides
Stimulates rapid insulin burst
What 2 medications are meglitinides?
1) Repaglinide (Prandin)
2) Nateglinide (Starlix)
DAILY DOSE RANGE:
Repaglinide (Prandin)
0.5 to 4 mg w/ meals
Where is repaglinide (prandin) metabolized?
Liver
Where is nateglinide (starlix) metabolized?
eliminated via kidney
DAILY DOSE RANGE:
Nateglinide (Starlix)
60 to 120 mg w/ meals
When should meglitinides be taken?
take BEFORE meals
SIDE EFFECTS:
Meglitinides
1) Hypoglycemia
2) Weight gain
How much do meglitinides lower the A1c?
Lowers 1.0 to 2.0%
What are the benefits of meglinitides?
1) Decreases peak postprandial glucose
2) Decreases plasma glucose, 60-70 mg/dL
3) Reduces A1c 1.0-2.0%
4) Cheap ($35/mo)
Which medication is safe for those with renal failure?
Repaglinide (Prandin)
because it is metabolized by the liver
What should be considered if the A1c if 8.5% or greater?
Combination medications
-Can be cheaper than 2 separate medications
-Easier to manage and take
Trijardy XR contains what 3 medications?
1) Empagliflozin (5-25 mg)
2) Linagliptin (2.5-5 mg)
3) Metformin XR (1000 mg)
MECHANISM OF ACTION:
GLP-1 RA
“Incretin mimetic”
1) Increases insulin release w/ food
2) Slows gastric emptying
3) Promotes satiety
4) Suppresses glucagon
Name the 6 medications in the GLP-1 RA class.
1) Exenatide (Byetta)
2) Exenatide XR (Bydureon)
3) Liraglutide (Victoza)
4) Dulaglutide (Trucility)
5) Semaglutide (Ozempic)
6) Rybelsus
DOSE RANGE
Exenatide (Byetta)
5 and 10 mcg BID
DOSE RANGE
Exenatide XR (Bydureon)
2 mg 1x/WEEK
Pen injector = Bydureon BCise
DOSE RANGE
Liraglutide (Victoza)
0.6 mg
1.2 mg
1.8 mg
taken DAILY
DOSE RANGE
Dulaglutide (Trucility
0.75 mg
1.5 mg
3.0 mg
4.5 mg
taken 1x/WEEK via pen injector
DOSE RANGE
Semaglutide (Ozempic)
0.25 mg
0.5 mg
1.0 mg
2.0 mg
taken 1x/WEEK via pen injector
DOSE RANGE
Rybelsus
3 mg
7 mg
14 mg*
taken DAILY in AM (ORAL TABLET)
*increase to max dose if A1c is not at target
What needs to be considered when taking Rybelsus?
1) Take at least 30 minutes BEFORE first food, beverage, and other medications
2) Take with no more than 4 oz plain water
3) Do not cut or crush; take wholeL
Liraglutide was also FDA approved for weight loss, under what 2 names?
1) Saxenda (3 mg - higher dose)
2) Victoza (1.8 mg)
Semaglutide was FDA approved for weight loss under what name?
Wegovy (2.4 mg)
versus Ozempic (2 mg) for diabetes
Tirzepatide was FDA approved for weight loss under what name?
Zepbound
(TRUE/FALSE)
GLP-1 RA & GIP potentially increase diabetes neuropathy.
TRUE
ask patients if they have had a recent eye exam
SIDE EFFECTS:
GLP-1 RAs
Nausea
Vomiting
Weight loss
Injection site reaction
When should the GLP-1 RAs be stopped?
1) Signs of acute pancreatitis
2) Signs of ileus
What is the black box warning for GLP-1 RAs?
Thyroid C-cell tumor warning
Avoid if family hx of medullary thyroid tumor
Which GLP-1 RAs are approved for pediatrics?
10-17 y/o
1) Exenatide XR (Bydureon)
2) Liraglutide (Victoza)
3) Dulaglutide (Trucility)
What are the benefits of the GLP-1s?
1) Significantly reduces risk of CV death, MI, and stroke
2) Weight loss (4-6% BW)
3) Lowers A1c (0.5-1.6%)
How much do the GLP-1s reduce the A1c?
Lowers 0.5-1.6%
GLP-1 RA abbreviation
Glucagon-Like Peptide Receptor Agonist
GIP abbreviation
Glucose-dependent Insulinotrophic Polypeptide (GIP)
Which medication belongs to the GLP-1 & GIP RA?
Tirzepatide (Mounjaro)
DOSE RANGE
Tirzepatide (Mounjaro)
2.5 mg
5.0 mg
7.5 mg
10 mg
12.5 mg
15 mg
1x/WEEK via prefilled single dose pen
How should GLP-1s be titrated?
Increase dose monthly to achieve targets
How should tirzepatide (mounjaro) be titrated?
Increase dose by 2.5 mg every month to reach targets
SIDE EFFECTS:
Tirzepatide (Mounjaro)
Nausea
Diarrhea
Injection site reaction
-Report pancreatitis & ileus signs
(TRUE/FALSE)
Tirzepatide (Mounjaro) has the same black box warning as the GLP-1.
TRUE
BENEFITS:
Tirzepatide (Mounjaro)
1) Weight loss (7-13% BW at max dose)
2) Lowers A1c (~1.8-2.4%)
Which 2 GLP-1s require a prescription for needles?
1) Exenatide (Byetta)
2) Liraglutide (Victoza)
GLP-1 & GIP
-Cause hypos?
-Cause weight gain?
-Affordable?
-Lowers CVD risk?
-Can most tolerate/use?
-HYPOS: No
-WT GAIN: No
-AFFORDABLE: No
-LOWER CVD RISK: Yes*
-TOLERATE: Yes, No (GI)
*Liraglutide (Victoza)
*Dulaglutide (Trucility)
*Semaglutide (Ozempic)
(TRUE/FALSE)
Tirzepatide is contraindicated in pregnancy.
TRUE
What is the eligibility criteria for GLP-1/GIP for weight loss?
Adults with:
-BMI > or equal to 30; OR
-BMI > or equal to 27 w/ HTN, T2DM, Dyslipidemia
Sudden discontinuation of semaglutide and tirzepatide results in how much regain?
-Strategies?
1/3 to 2/3 of the weight loss in 1 year
-try lowest effective dose
-intermittent therapy
-stop medication w/ close weight monitoring
What are the 3 medications (GLP-1/GIP) that are FDA approved for weight loss?
1) Liraglutide (Saxenda) - 3 mg (max dose)
2) Semaglutide (Wegovy) - 2.4 mg (max dose)
3) Tirzepatide (Zepbound) - 15 mg (max dose)
For patients of child-bearing age, what is the recommendation when starting tirzepatide?
If on oral conception, use back-up contraception for ~4 weeks
Which class of medication can potentially increase diabetes retinopathy?
GLP-1/GIP
Ask about recent eye exam
For hypoglycemia episodes, in those on alpha-glucosidase inhibitors, how should it be treated?
Treat with glucose tabs or milk (other starches are blocked by the medication)
For those with CHF, what class of medication should be used? Why?
SGLT-2
-Improve HF & kidney outcomes
Which medications or medication classes are associated with weight LOSS? (3)
1) GLP-1/GIP
2) SGLT-2
3) Symlin (Pramlintide)
-Amylin analog given as an injection before meals; used when fast-acting insulin is not enough
For those with renal failure, use what class of medication?
-Use until when?
-Or use what other class if first class isn’t tolerated?
SGLT-2 w/ GFR > or equal to 20
Continue until:
-Initiation of dialysis
-Transplantation
GLP-1 w/ proven CVD benefit if not tolerated or contraindicated
Which 2 medication classes contain medications that reduce MACE?
-Bonus: name the 6 medications.
1) GLP-1
-Semaglutide (Ozempic)
-Liraglutide (Victoza)
-Dulaglutide (Trucility)
2) SGLT-2
-Empagliflozin (Jardiance)
-Canagliflozin (Invokana)
-Dapagliflozin (Farxiga)
MACE: Major Adverse Cardiac EventsI
In older frail adults, hypoglycemia can cause…?
-What would you recommend as goals?
Arrhythmias & dizziness potentially leading to falls
GOALS:
-Lower A1c goal: 7.0-8.0%
-Focus on drug safety
What 3 medication classes cause hypoglycemia?**
1) Sulfonylurea
2) Meglinitides
3) Insulin**
(TRUE/FALSE)
Individuals w/ CKD, especially advanced CKD are at low risk for hypoglycemia.
FALSE - at high risk for hypos
Which class of medication is good for those with glucose toxicity?
-When insulin is not an operation?
Sulfonylureas
If CKD individuals are being treated with what 2 medications, they need to be closely monitored and adjusted as GFR declines.
1) Insulin; and/or
2) Sulfonlyureas
What 2 medication classes should be considered in glucose toxicity?
If A1c greater than or equal to 10%
1) Insulin
2) Sulfonylureas
Those with a history of pancreatitis should avoid which class of medication?
GLP-1/GIP
Which medications or medication classes are weight neutral? (2)
1) Metformin
2) DPP-4i
3) AGIs - Acarbose
What medication classes do NOT cause hypoglycemia?
1) DPP-4
2) GLP-1
3) SGLT-2
4) TZD
5) Biguanide
What 2 medications are very rapid-acting analogs - insulin?
1) Aspart (Fiasp)
2) Lispro-aabc (Lyumjev)
ONSET TIME
Aspart (Fiasp)
16-20 minutes
PEAK TIME
Aspart (Fiasp)
1-3 hours
What is the duration time for aspart (Fiasp) and Lispro-aabc (Lyumjev)?
5-7 hours
ONSET TIME
Lispro-aabc (Lyumjev)
15-17 minutes
PEAK TIME
Lispro-aabc (Lyumjev)
2-3 hours
What 3 medications are rapid-acting analogs - insulin?
1) Aspart (Novolog)
2) Lispro (Humalog/Ademelog)
3) Glulisine (Apidra)
ONSET TIME
Aspart (Novolog)
20-30 minutes
PEAK ACTION TIME
Aspart (Novolog)
1-3 hours
DURATION ACTION TIME
Aspart (Novolog)
3-7 hours
ONSET TIME
Lispro (Humalog*/Admelog)
30 minutes
PEAK ACTION TIME
Lispro (Humalog/Ademelog)
2-3 hours
DURATION ACTION TIME
Lispro (Humalog/Ademelog)
5-7 hours
ONSET ACTION TIME
Glulisine (Apidra)
15-30 minutes
PEAK ACTION TIME
Glulisine (Apidra)
1-3 hours
DURATION ACTION TIME
Glulisine (Apidra)
3-4 hours
Which insulin is short-acting?
Regular*
ONSET ACTION TIME
Regular insulin
30-60 minutes
PEAK ACTION TIME
Regular insulin
2-4 hours
DURATION ACTION TIME
Regular insulin
5-8 hours
Which medications are considered bolus insulins? (6 total)
1) Aspart (Fiasp)
2) Lispro-aabc (Lyumjev)
3) Aspart (Novolog)
4) Lispro (Humalog/Admelog)
5) Glulisine (Apidra)
6) Regular
Which insulin is considered an intermediate basal insulin?
NPH
Which 2 medications are considered long-acting basal insulins?
1) Glargine (Lantus/Basaglar/Semglee/Rezvoglar)
2) Degludec (Tresiba)
ONSET ACTION TIME
NPH
2-4 hours
PEAK ACTION TIME
NPH
4-10 hours
DURATION TIME
NPH
10-16 hours
Glargine
-what are the 4 brand names?
1) Lantus
2) Basaglar
3) Semglee
4) Rezvoglar
ONSET ACTION TIME
Glargine
2-4 hours
PEAK ACTION TIME
Glargine
No peak
DURATION ACTION TIME
Glargine
20-24 hours
ONSET ACTION TIME
Degludec (Tresiba)
~1 hour
PEAK TIME
Degludec (Tresiba)
No peak
DURATION ACTION TIME
Degludec (Tresiba)
< 42 hours
What is the best way to assess the effectiveness of bolus insulin?
Post-meal glucose
What is the best way to assess the effectiveness of basal insulin?
FBG
What are the side effects of insulin?
1) Hypoglycemia
2) Weight gain
What is the typical dosing range for insulin?
0.5 - 1.0 units/kg/day
Once insulin vials have been opened, how long do they last?
Discard after 28 days
What 2 medications are combo insulins-consisting of NPH + Regular?
1) 70/30 (NPH/Regular)
2) 50/50
ONSET TIME
70/30 & 50/50
30-60 minutes
DURATION ACTION TIME
70/30 & 50/50
10-16 hours
Which 3 medications consisting of intermediate + rapid insulins?
1) Novolog mix (70/30)
2) Humalog mix (75/25) and (50/50)
ONSET ACTION TIME
Novolog mix & Humalog mix
5-15 minutes
DURATION ACTION TIME
Novolog mix & Humalog mix
24 hours
For the basal/bolus combo insulins, what is the peak action time?
Dual peaks
Which medications is the “high potency” insulin?
Humulin Regular U-500
-KwikPen
-Vial
-Contains 500 units/mL
Who is appropriate for U-500 insulin?
Indicated for those taking 200 + units PER DAY
A 3 mL U-500 pen holds how many units?
1,500 units (of U-500)
A 20 mL vial of Humulin Regular U-500 holds how many units?
10,000 units
MAX DOSE
MAX DOSE FOR U-500 SYRINGE
U-500 Humulin Regular
-300 units
-250 units for U-500 syringe
(TRUE/FALSE)
All concentrated insulin pens and the U-500 syringe automatically deliver correct dose (in less volume).
TRUE
-No longer need to convert or calculate
-Example: If the order reads 30 units, dial the concentrated pen up to 30 units, or draw up 30 units on the U-500 syringe
(TRUE/FALSE)
Never withdraw concentrated insulin from the pen using a syringe.
TRUE!
Which medication is an inhaled insulin?
Afrezza inhaled regular human insulin
ACTION
Afrezza
Bolus rapid-acting
*Patients will still need to inject basal insulin
CONSIDERATIONS:
Afrezza
Assess lung function
SIDE EFFECTS:
Afrezza
1) Hypos
2) Cough
3) Throat irritation
IDegLira
-Combines what 2 medications?
Insulin degludec (IDeg or Tresiba)
(Ultra-long insulin)
+
Liraglutide (Victoa)
(GLP-1)
iGlarLixi
-Combines what 2 medications?
Insulin glargine (Lantus)
(basal insulin)
+
Lixisenatide (Adlyxin)
(GLP-1)
Glucagon Emergency Kit
-Delivery
Injection requires mixing glucagon powder
Glucagon Emergency Kit
-Supplied
Vial + Syringe
via subQ or IM administration
Glucagon Emergency Kit
-Dosing for adults
1 mg
Glucagon Emergency Kit
-Dosing for Pediatrics
< 6 y/o OR < 25 kg = 0.5 mg
> 6 y/o OR > 25 kg = 1 mg
Baqsimi
-Delivery
Nasal glucagon powder
Baqsimi - raises BG how much?
67-73 mg/dL
*depending on how much glycogen is stored in their liver
Gvoke
-Delivery
Injectable liquid stable glucagon solution
Glucagon Emergency Kit
-Approved for ages
All ages approved
Baqsimi
-Approved for ages
Approved ages 4+
Gvoke
-Approved for ages
Approved age 2+
Dasiglucagon (Zegalogue)
-Delivery
Stable liquid glucagon analog via autoinjector
Name the top 4 classes of cholesterol medications.
1) Statins
2) Bile Acid Sequestrants
3) Cholesterol Absorption Inhibitors
4) PCSK9 Inhibitors
‘Statins’ belong to what class
HMG-Coa Reductase Inhibitors
MECHANISM OF ACTION
-Statins
HMG-CoA reductase inhibitors
Inhibit enzyme that convert HMG-CoA to mevalonate; limiting cholesterol production
USUAL DAILY DOSE RANGE
Atorvastatin (Lipitor)
10-80 mg
ADDITIONAL BENEFITS:
Statins
Lowers TG 7-30%
Raise HDL 5-15%
SIDE EFFECTS:
Statins
1) Weakness
2) Muscle pain
3) Elevated glucose levels
What 2 statin medications are considered high intensity statins?
-Include their dose range
1) Atorvastatin (Lipitor): 40-80 mg
2) Rosuvastatin (Crestor): 20-40 mg
What class of medication does Ezetimibe belong to?
Cholesterol Absorption Inhibitors
WHEN USED:
Ezetimibe
Usually in combination w/ statin, if LDL goal is not achieved
SIDE EFFECTS:
Ezetimibe
1) Headache
2) Rash
What 2 medications are PCSK9 inhibitors?
1) Alirocumab (Praluent)
2) Evolocumab (Repatha)
What are the 3 FDA-approved indications for the PCSK9 inhibitors?
1) Primary hyperlipidemia
2) HoFH (Homozygous Familial Hypercholesterolemia)
3) Secondary prevention of cardiac events
ADMINISTRATION
Alirocumab (Praluent) & Evolocumab (Repatha)
SubQ injections every 2-4 weeks
What 2 classes of medications are the preferred therapy for diabetes w/ HTN and albuminuria?
1) ACE Inhibitors (Angiotension Converting Enzyme)
2) ARBs (Angiotension Receptor Blockers)
Name contraindications for ACE inhibitors and ARBs.
1) Pregnancy
2) Renal dysfunction
3) Hepatic dysfunction
SIDE EFFECTS:
ACE Inhibitors
Cough
Hypotension
If medication is not tolerated, try a different medication in the same class.
CONSIDERATIONS
ACE Inhibitors
1) Take at the same time daily
2) Monitor changes in the K+ and renal function (annually)
CONSIDERATIONS:
ARBs
1) Take at the same time daily
2) Monitor changes in the K+ and renal function (annually)
3) May cause hypotension
Beta Blockers
-when used?
Commonly prescribed as an add-on to other BP meds for PWD.
Beneficial for people w/ concurrent cardiac problems and prevention of recurrent MI and HF
SIDE EFFECTS:
Beta blockers
Usually CNS related
-sedation
-dizziness
-lightheadness
CONSIDERATIONS
Beta blockers
Watch for bradycardia, hypotension, depression, sexual dysfunction
& exercise intolerance
-When stopping medication, taper dose gradually
(TRUE/FALSE)
Beta blockers can cause hyperglycemia and mask hypoglycemia induced tachycardia in PWD.
TRUE
They do not block hypo related dizziness and sweating
What should be monitored in those on beta blockers?
BP
HR
Lipids
BG
WHEN USED:
Diuretics
If BP is not at goal with either ACE inhibitor or ARB
What to monitor in those on diuretics?
Baseline glucose levels
BP
Electrolytes
Uric acid
Lipids
-Monitor at start & periodically
Those on diuretics may need supplementation of what?
Magnesium + Potassium
When would calcium channel blockers be used?
2nd or 3rd line BP med for diabetes, since they have impact on CVD
used for those who can’t tolerate ACE or ARB therapy
