Medications (brand - generic - class) Flashcards
1
Q
Brand: Prandin Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Repaglinide Class: Meglitinides Route: Oral Dose: 0.5 - 4 mg 15 - 30 minutes prior to each meal (TID). Skip if meal skipped. Cost: Moderate
2
Q
Brand: Starlix Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Nataglinide Class: Meglitinides Route: Oral Dose: 60 - 120 mg po 1 - 30 minutes prior to each meal (TID). Skip if meal skipped. Cost: Moderate
3
Q
Mechanism of Action:
Meglitinides
A
Stimulates beta cells to release insulin
4
Q
Major Side Effects:
Meglitinides
A
Hypoglycemia, weight gain, frequent dosing, possibly blunts myocardial ischemic preconditioning
5
Q
Brand: Glucophage Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Metformin Class: Biguanides Route: Oral Dose: 500 - 2550 mg po daily (divided doses) Cost: Low
6
Q
Mechanism of Action:
Biguanides
A
Decrease hepatic glucose production and intestinal glucose absorption; increases insulin sensitivity
7
Q
Contraindications:
Metformin
A
SCr > 1.4 in women or > 1.5 in men, patients receiving IV contrast, severe dehydration, hypoxia, acidosis, severe CKD
8
Q
Metformin: Caution use in _________
A
CHF, elderly, alcohol abuse
9
Q
Major Side Effects:
Metformin
A
GI side effects (diarrhea, abdominal cramping), rare lactic acidosis, vitamin B12 deficiency
10
Q
Brand: Januvia Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Sitagliptin Class: DPP-4 Inhibitor Route: Oral Dose: 100 mg po daily (reduce in renal dysfunction) Cost: High
11
Q
Brand: Onglyza Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Saxagliptin Class: DPP-4 Inhibitor Route: Oral Dose: 2.5 - 5 mg po daily (reduce in renal dysfunction) Cost: High
12
Q
Brand: Tradjenta Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Linagliptin Class: DPP-4 Inhibitor Route: Oral Dose: 5 mg po daily (no dosage adjustment in renal dysfunction) Cost: High
13
Q
Brand: Nesina Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Alogliptin Class: DPP-4 Inhibitor Route: Oral Dose: 25 mg po daily (reduce in renal dysfunction) Cost: High
14
Q
Mechanism of Action:
DPP-4 Inhibitors
A
Inhibits dipeptidyl peptidase-4 (DPP-4) and therefore decreases the metabolism of incretin; increased incretin leads to glucose-dependent increase in insulin secretion and decrease in glucagon secretion
15
Q
Major Side Effects:
DPP-4 Inhibitors
A
Rare angioedema/urticaria and other immune-mediated dermatological effects, possibly increase in pancreatitis, possibly increase in heart failure hospitalizations
16
Q
Classes of DM drugs that are weight NEUTRAL
A
- DPP-4 Inhibitors
- Metformin/Biguanides
- Alpha-Glucosidase Inhibitors
- Bile Acid Sequestrants
- Dopamine 2 Agonists
17
Q
Classes of DM drugs that cause weight GAIN
A
- Sulfonylureas
- Meglitinides
- TZDs
- Insulin
18
Q
Classes of DM drugs that cause weight LOSS
A
- SGLT-2 Inhibitors (sometimes weight neutral)
- GLP-1 Agonists
- Amylin Mimetics
19
Q
DPP-4 Inhibitors:
Average HbA1c reduction =
A
Average A1c reduction of 0.5 - 0.8%
20
Q
Brand: Byetta Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Exenatide Class: GLP-1 Agonist Route: SubQ Dose: 5 - 10 mcg SQ BID within 1 hr before meals Cost: High
21
Q
Brand: Bydureon Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Exenatide Class: GLP-1 Agonist Route: SubQ Dose: 2 mg SQ every week Cost: High
22
Q
Brand: Victoza Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Liraglutide Class: GLP-1 Agonist Route: SubQ Dose: 1.2 - 1.8 mg SQ daily Cost: High
23
Q
Brand: Trulicity Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Dulaglutide Class: GLP-1 Agonist Route: SubQ Dose: 0.75 - 1.5 mg SQ every week Cost: High
24
Q
Brand: Tanzeum Generic: ? Class: ? Route: ? Dose: ? Cost: low, moderate, or high?
A
Generic: Albiglutide Class: GLP-1 Agonist Route: SubQ Dose: 30 - 50 mg SQ every week Cost: High
25
Mechanism of Action:
| GLP-1 Agonists
Activates the GLP-1 receptor causing glucose-dependent insulin secretion, decreased glucagon secretion, slows gastric emptying, and increases satiety.
26
Contraindications:
| GLP-1 Agonists
History or family hx of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2 (MENS type 2)
27
GLP-1 Agonists: Caution use in _______
History of pancreatitis, GI disease/bowel obstruction, severe gastroparesis, renal impairment
28
Counseling point: When taking daily GLP-1 agonists, when should you take your other medications?
Take regular medications at least one hours prior to GLP-1 agonists due to delayed gastric emptying
29
GLP-1 Agonists:
| Average HbA1c reduction =
Average A1c reduction of 0.5 - 1%
30
Major side effects:
| GLP-1 Agonists
GI side effects (N/V/D), increased heart rate, possibly increase risk of pancreatitis
31
```
Brand: Welchol
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Colesevelam
Class: Bile Acid Sequestrant
Route: Oral (tablet or powder)
Dose: 3750 mg (6 tabs or one packet) po daily or 1875 mg (3 tabs or one packet) po BID
Cost: High
```
32
Mechanism of Action:
| Bile Acid Sequestrants
Exact DM mechanisms unknown; binds bile acids in GI tract and increases hepatic bile acid production. Likely decreases hepatic glucose production and possibly increases incretin levels.
33
Major side effects:
| Bile Acid Sequestrant
Constipation, increased triglycerides, bowel obstruction, may decrease absorption of other medications, may cause malabsorption of fat-soluble vitamins
34
Bile Acid Sequestrant:
| When added to metformin, SU, or insulin, average HbA1c reduction =
Average A1c reduction of 0.5%
35
Contraindications:
| Bile Acid Sequestrants
History of or current GI obstruction, pancreatitis, Triglycerides > 500 mg/dL
36
Bile Acid Sequestrates: caution use in _____
GI motility disorders/gastroparesis, patients at risk for GI obstruction, major GI surgery, patients with fat-soluble vitamin deficiency risk.
37
Counseling point: When taking a bile acid sequestrant, when should you take your other medications?
Take other medications at least 1 hour before or 4 - 6 hours after bile acid sequestrants since BAS can prevent absorption of medications
38
```
Brand: Actos
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Pioglitazone
Class: TZD
Route: Oral
Dose: 15 - 45 mg po daily
Cost: Low
```
39
```
Brand: Avandia
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Rosiglitazone
Class: TZD
Route: Oral
Dose: 4 - 8 mg po divided daily or BID
Cost: Low
```
40
Mechanism of Action:
| Thiazolidinediones (TZDs)
Increases insulin sensitivity
41
Major Side Effects:
| Thiazolidinediones (TZDs)
Weight gain, edema, CHF exacerbation, bone fractures, hepatotoxicity, increased LDL (rosiglitazone only), possibly increased MI (rosiglitazone only), possibly increased bladder cancer (pioglitazone only)
42
Contraindications:
| Thiazolidinediones (TZDs)
NYHA III-IV CHF, symptomatic CHF, active bladder cancer, ACS, baseline ALT > 2.5x ULN
43
Thiazolidinediones (TZDs): Caution use in _____
Patients at risk for CHF, with underlying edema, hepatic impairment, concurrent SU (hypoglycemia), bladder cancer history
44
```
Brand: Precose
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Acarbose
Class: Alpha Glucosidase Inhibitor
Route: Oral
Dose: 50 - 100 mg po TID w/ meals
Cost: Moderate
```
45
```
Brand: Glyset
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Miglitol
Class: Alpha Glucosidase Inhibitor
Route: Oral
Dose: 50 - 100 mg po TID w/meals
Cost: Moderate
```
46
Mechanism of Action:
| Alpha Glucosidase Inhibitors (AGIs)
Inhibits alpha-glucosidase which slows intestinal carbohydrate digestion/absorption. Slows the breakdown of oligo-, tri-, and disaccharides.
47
Major Side Effects:
| Alpha Glucosidase Inhibitors (AGIs)
GI side effects such as flatulence, diarrhea, abdominal pain
48
Contraindications:
| Alpha Glucosidase Inhibitors (AGIs)
Patients with inflammatory bowel disease, cirrhosis, partial GI obstruction, malabsorption syndromes, SCr > 2
49
Counseling point: If a patient experiences hypoglycemia and has been taking an alpha-glucosidase inhibitors, what should they use to treat their hypoglycemia?
Options include:
1. Glucose tabs/gel
2. IV glucose
3. Non-fat or low-fat milk
4. Glucagon
Table sugar (sucrose) and other sugars will not work since AGIs slow the breakdown/absorption oligo-, tri-, and disaccharides
50
```
Brand: Glucotrol
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Glipizide
Class: Sulfonylureas (SU)
Route: Oral
Dose: 2.5 - 20 mg po daily-BID (limited efficacy above 20 mg daily)
Cost: Low
```
51
```
Brand: DiaBeta
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Glyburide (non-micronized)
Class: Sulfonylurea
Route: Oral
Dose: 1.25 - 20 mg po divided daily-BID
Cost: Low
```
52
```
Brand: Micronase (brand discontinued)
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Glyburide (micronized)
Class: Sulfonylurea
Route: Oral
Dose: 1.5 - 12 mg po divided daily-BID
Cost: Low
```
53
```
Brand: Amaryl
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Glimepiride
Class: Sulfonylurea
Route: Oral
Dose: 1 - 8 mg po daily
Cost: Low
```
54
Mechanism of Action:
| Sulfonylureas (SU)
Increases insulin secretion by stimulating pancreatic beta cells
55
Major Side Effects:
| Sulfonylureas (SU)
Hypoglycemia, weight gain, possibly blunts myocardial ischemic preconditioning. Less common: rash, headache, N/V, photosensitivity
56
Contraindications:
| Sulfonylureas (SU)
Allergy to sulfonamides (sulfa allergy)
57
Sulfonylureas: Caution use in ____
Patients with hypoglycemia unawareness, severe renal impairment, severe hepatic impairment, elderly patients, adrenal insufficiency, malnutrition, G6PD deficiency
58
If used, which sulfonylurea is the safer option in patients with renal disease?
Glipizide (shorter duration, metabolites are not really eliminated)
59
Mechanism of Action:
| Dopamine-2 Agonists
Precise DM mechanism unknown; may modulate hypothalamic regulation of metabolism (may decrease hepatic glucose production); increase insulin sensitivity
60
Contraindications:
| Dopamine-2 Agonists (Bromocriptine)
Hypersensitivity to ergot derivatives, syncopal migraines
61
Bromocriptine: Caution use in ______
Hepatic impairment, psychosis, concomitant use with dopamine receptor antagonists including neuroleptic drugs
62
```
Brand: Cycloset
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Bromocriptine
Class: Dopamine-2 Agonists
Route: Oral
Dose: 1.6 - 4.8 mg po qAM (within 2 hours of waking, with food)
Cost: High
```
63
Major Side Effects:
| Dopamine-2 Agonists
Dizziness, syncope, nausea, fatigue, rhinitis
64
Sulfonylureas:
| Average HbA1c reduction =
Average A1c reduction of 1 - 2%
65
Biguanides:
| Average HbA1c reduction =
Average A1c reduction of 1 - 2%
66
Meglitinides:
| Average HbA1c reduction =
Average A1c reduction of 1 - 1.5%
67
Thiazolidinediones:
| Average HbA1c reduction =
Average A1c reduction of 0.5 - 1.4%
68
Alpha-Glucosidase Inhibitors:
| Average HbA1c reduction =
Average A1c reduction of 0.5 - 0.8%
69
Dopamine-2 Agonists:
| Average HbA1c reduction =
Average A1c reduction 0.3 - 0.8%
70
SGLT-2 Inhibitors:
| Average HbA1c reduction =
Average A1c reduction of 0.7 - 1%
71
Amylin Mimetics:
| Average HbA1c reduction =
Average A1c reduction of 0.5 - 1%
72
```
Brand: Symlin
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Pramlintide
Class: Amylin Mimetic
Route: SubQ
Dose: T1DM: 30-60 mcg SQ TID
T2DM: 120 mcg SQ TID
Cost: High
```
73
Mechanism of Action:
| Amylin Mimetics
Decreases glucagon secretion, slows gastric emptying, and increases satiety thereby decreasing post-prandial glucose excursions
74
Contraindications: Amylin Mimetics
Gastroparesis, recurrent severe hypoglycemia, hypoglycemia unawareness
75
Major Side Effects:
| Amylin Mimetics
GI side effects (N/V), increases risk for hypoglycemia
76
Amylin Mimetics: Caution use in _____
Patients on sulfonylureas (increased hypoglycemia), insulin (need to lower meal time insulin doses).
77
Mechanism of Action:
| SGLT2 Inhibitors
Inhibits sodium-glucose cotransporter type 2 (SGLT2) in the proximal nephron which blocks glucose reabsorption and increases urinary glucose excretion
78
```
Brand: Invokana
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Canagliflozin
Class: SGLT2 Inhibitor
Route: Oral
Dose: 100 - 300 mg po daily
Cost: High
```
79
```
Brand: Farxiga
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Dapagliflozin
Class: SGLT2 Inhibitor
Route: Oral
Dose: 5 - 10 mg po daily
Cost: High
```
80
```
Brand: Jardiance
Generic: ?
Class: ?
Route: ?
Dose: ?
Cost: low, moderate, or high?
```
```
Generic: Empagliflozin
Class: SGLT2 Inhibitor
Route: Oral
Dose: 10 - 25 mg po daily
Cost: High
```
81
Major Side Effects:
| SGLT2 Inhibitors
Female genital mycotic infections, UTI, orthostatic hypotension, transient increase in SCr, increase LDL, increased urination, ketoacidosis, hyperkalemia
82
Contraindications:
| SGLT2 Inhibitors
Volume depletion, eGFR less than 45 ml/min (or 60 ml/min for dapagliflozin)
83
SGLT2 Inhibitors: Caution use in _____
Elderly (more side effects, less A1c benefits), uncircumcised males, hyperlipidemia, hyperkalemia risk, hypotension risk, concurrent nephrotoxic agents
