Medicines Knowledge Week 1 (Dapagliflozin, Metformin +/- combinations, Clopidogrel +/- combinations, Enoxaparin, Nitrates: Oral and Sub-lingual) Flashcards
Dapagliflozin drug class
Sodium-glucose co-transporter 2 inhibitor (SGLT2 inhibitor)
Dapagliflozin indication (2 marks)
Type 2 diabetes
Symptomatic heart failure with reduced ejection fraction, adjunct to standard treatment
Dapagliflozin dosage range and timing (2 marks)
Adult, oral 10 mg once daily
Dapagliflozin Counselling (3 marks)
Your urine will test positive for glucose while you are taking this medicine.
Make sure you drink enough water to control your thirst, in order to avoid dehydration.
Both men and women may be more likely to get a genital infection (eg thrush) while taking this medication; maintaining good hygiene is important to reduce the chance of this happening. Ask your doctor, pharmacist or diabetes educator if you need more information or if you think you may have an infection, especially if you have a fever and pain, tenderness or swelling in the genital area.
This medicine can be taken with or without food.
Dapagliflozin monitoring (2 marks)
Monitor blood glucose levels while on this medication, this includes HbA1c levels and fasting blood glucose levels.
Monitor for signs of thrush. This includes fever and pain, tenderness or swelling in the genital area.
Metformin drug class
Biguanide
Metformin indication
Type 2 diabetes
Polycstic ovarian syndrome for management of infertility and metabolic features
Metformin dosage range and timing
Immediate release (normal renal function): 500 mg orally, twice daily as an initial dose, increase daily dose slowly according to response, up to 2 g, daily in divided doses.
Modified release (normal renal function): 500 mg orally, daily with evening meal as an initial dose, increase daily dose slowly according to response, up to 2 g daily.
Metformin counselling
Take with or after food to reduce stomach upset.
Tell your doctor immediately if you have loss of appetite, nausea, vomiting, abdominal pain, cramps, fatigue, diarrhoea or weight loss.
Drinking alcohol can affect control of your diabetes. It can also increase the risk of serious side effects. Limit your alcohol intake, avoid binge drinking and have something to eat when you drink alcohol.
Metformin monitoring
Monitor blood glucose levels
Monitor weight
Monitor for adverse effects such as rash, abdominal pain, fatigue, cramps and loss of appetite
Metformin with glibenclamide drug class
Metformin: biguanide
Glibenclamide: sulfonylurea
Metformin with glibenclamide indication
Type 2 diabetes
Metformin with glibenclamide dosage range and timing
Adult, initially 1 tablet of 500 mg metformin with 2.5 mg glibenclamide daily with breakfast.
- Increase by 1 tablet (of this strength) every 2 weeks or longer according to response.
Maximum dose, 1 tablet of 500 mg metformin with 5 mg glibenclamide 3 times a day.
Metformin with glibenclamide counselling
Make sure that you, and your friends and family, know how to recognise and treat hypoglycaemia (low blood glucose); ask your doctor or diabetes educator if you are unsure.
- Signs of hypolgycaemia include: hunger, irritability, sleepiness, sweating, trembling, weakness and shaking.
- Treat hyplogycaemia (fast acting carbs)
> 6-7 jellybeans
> 1/2 can of regular soft drink
> 1/2 glass of fruit juice
> 3 teaspoons of sugar or honey
long acting carbs: slice of bread, glass of milk or a piece of fruit
- Take with food to minimise risk of low blood glucose
- Drinking alcohol decreases your blood glucose. It can also mask warning symptoms of hypoglycaemia. Avoid binge drinking and have something to eat when you drink alcohol.
Metformin with glibenclamide monitoring
Monitor for signs of hypoglycaemia. Sweating, hunger, mood changes and irritability.
Monitor blood glucose levels
Metformin with saxagliptin, sitgaliptin, alogliptin, linaglaptin, vildagliptin drug class
(ALSSV)
Biguanide and dipeptidyl peptidase 4 inhibitors (DPP4 inhbitors)
Metformin with saxagliptin, sitgaliptin, alogliptin, vildagliptin indication
Type 2 diabetes
Metformin with saxagliptin, sitgaliptin, alogliptin, linagliptin, vildagliptin dosage range and timing
(ALSSV)
Metformin and alogliptin:
- Adult, 1 tablet (of any strength) twice daily with or after food. (12.5 mg with metformin in either 500mg, 850mg or 1000mg)
Metformin and linagliptin:
- Adult, 1 tablet (of any strength) twice daily with or after food. (2.5mg with metformin in either 500mg, 850mg or 1000mg)
Metformin and saxagliptin:
- Adult, 1 tablet (of any strength) once daily or 2 tablets of 2.5 mg/1000 mg once daily.
Metformin and sitagliptin:
- Adult, 1 tablet (of any strength) twice daily –> janumet normal
> comes in 50/500, 50/850, 50/1000
- Adult, 1 tablet of 100 mg/1000 mg or 2 tablets of 50 mg/1000 mg once daily. –> janumet controlled release
Metformin and vildagliptin:
- 1 tablet (of any strength) twice daily.
> come in 50/500, 50/850, 50/1000
Metformin with saxagliptin, sitgaliptin, alogliptin, linagliptin, vildagliptin counselling
(ALSSV)
Take with or after food to reduce stomach upset.
Tell your doctor immediately if you have loss of appetite, nausea, vomiting, abdominal pain, cramps, fatigue, diarrhoea or weight loss.
Drinking alcohol can affect control of your diabetes. It can also increase the risk of serious side effects. Limit your alcohol intake, avoid binge drinking and have something to eat when you drink alcohol.
Metformin with saxagliptin, sitgaliptin, alogliptin, linagliptin, vildagliptin monitoring
(ALSSV)
Monitor blood glucose levels and hypoglycaemia
Monitor weight
Monitor for adverse effects such as rash, abdominal pain, fatigue, headache, cramps and loss of appetite
Metformin with dapagliflozin, empagliflozin, etruglifozin drug class
Biguanide and sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors)
Metformin with dapagliflozin, empagliflozin, etruglifozin indication
type 2 diabetes
Metformin with dapagliflozin, empagliflozin, etruglifozin dosage range and timing
Metformin with dapagliflozin
- Adult, 1 tablet of 10/500 mg or 10/1000 mg once daily or 2 tablets of 5/1000 mg once daily.
Metformin with empagliflozin
- Adult, 1 tablet (of any strength) twice daily, with or after food.
> comes in 5/500, 5/1000, 12.5/500, 12.5/1000
Metformin with etruglifozin
- Adult, 1 tablet (of any strength) twice daily, with or after food.
> comes in 2.5/500, 2.5/1000, 7.5/500, 7.5/1000
Metformin with dapagliflozin, empagliflozin, etruglifozin counselling
Take with or after food to reduce stomach upset.
Tell your doctor immediately if you have loss of appetite, nausea, vomiting, abdominal pain, cramps, fatigue, diarrhoea or weight loss.
Drinking alcohol can affect control of your diabetes. It can also increase the risk of serious side effects. Limit your alcohol intake, avoid binge drinking and have something to eat when you drink alcohol.
Metformin with dapagliflozin, empagliflozin, etruglifozin monitoring
Monitor blood glucose levels and hypoglycaemia
Monitor weight
Monitor for adverse effects such as rash, abdominal pain, fatigue, headache, cramps and loss of appetite
Clopidrogrel drug class
P2Y12 antagonist
Clopidrogrel drug indication
History of symptomatic atherosclerosis
Acute coronary syndrome with aspirin
Prevention of vascular ischaemic events
Clopidrogrel dosage range and timing
Prevention of vascular ischaemic events
- 75mg once daily
ACS
- Oral, loading dose 300mg, then 75mg once daily with aspirin, continue for 1–12 months or longer; seek specialist advice.
Placement of coronary stent
- Oral, loading dose 300–600 mg at least 6 hours before the procedure, then 75 mg once daily with aspirin; continue for 1–12 months or longer; seek specialist advice
Clopidogrel counselling
Avoid grapefruit juice as it may decrease the efficacy of clopidogrel
The main side effect of clopidogrel is bleeding more easily than normal. You may have nosebleeds, heavier periods, bleeding gums or bruising.
You can drink alcohol with clopidogrel. But do not drink too much while taking this medicine. It can irritate your stomach.
Clopidogrel monitoring
Monitor for severe side effects such as rash, red blood in stools, swelling of the face, throat and lips.
Monitor for side effects such as bleeding and bruising
Clopidogrel with aspirin drug class
P2Y12 antagonist and antiplatelet
Clopidogrel with aspirin indications
ACS (acute coronary syndrome) → (MI)
History of symptomatic atherosclerosis
Secondary prevention of MI or unstable angina
MI, unstable angina or after cardiac stent insertion
Clopidogrel with aspirin dosage range and timing
Adult, 1 tablet once daily.
> tab, clopidogrel 75 mg, aspirin 100
Clopidogrel with aspirin counselling
Avoid grapefruit juice as it may decrease the efficacy of this medication
The main side effect of this medication is bleeding more easily than normal. You may have nosebleeds, heavier periods, bleeding gums or bruising.
You can drink alcohol with this medicaiton. But do not drink too much while taking this medicine. It can irritate your stomach.
Don’t take any other products containing aspirin while taking this medication.
Clopidogrel with monitoring
Monitor for severe side effects such as rash, red blood in stools, swelling of the face, throat and lips.
Monitor for side effects such as bleeding and bruising
Enoxaparin drug class
Low molecular weight heparin
Enoxaparin indications
Prevention of VTE in surgical patients and in high-risk medical patients immobilised due to acute illness
Treatment of venous thrombosis
Treatment of acute STEMI, non-STEMI and unstable angina
Enoxaparin dosage range and timing
Prevention of VTE
- Surgical patients, moderate risk, SC 20 mg once daily for 7–10 days or until mobilised, starting 2 hours before surgery.
Treatment of VTE
- SC, 1 mg/kg twice daily, or 1.5 mg/kg once daily until adequate oral anticoagulation is established.
Unstable angina
- Adult, SC 1 mg/kg twice daily
Enoxaparin counselling
Tell your doctor immediately if you have any signs of bleeding (eg nosebleeds, black or tarry bowel motions, or unexplained bruising) during and after treatment.
Other drugs that can affect the clotting process may increase the risk of bleeding; avoid combinations or monitor closely. Low-dose aspirin (75–150 mg daily) may be used where indicated.
Like most LMWHs, Clexane is not recommended while you are breastfeeding.
Enoxaparin monitoring
Monitoring of blood clotting factors required by doctor
Monitoring for severe adverse effects such as skin necrosis and alopecia with long term use
Isosorbide dinitrate drug class
Nitrate
Isosorbide dinitrate indications
Prevention and treatment of angina
Isosorbide dinitrate dosage range and timing
Treatment of acute angina
- sublingual: adult 5-10mg
Prevention of acute angina before a precipitating activity
- sublingual: adult 5-10mg taken 10 minutes before activity
Isosorbide dinitrate counselling
Use during episodes of angina or before an activity expected to bring on angina.
Sit or lie down before use as the drug may cause dizziness.
Call an ambulance if symptoms are severe, get worse quickly or last for 10 minutes.
Place 1 or 2 tablets under your tongue; do not chew tablets; after angina has been relieved, you may spit out what is left of the tablet to avoid adverse effects such as headache.
This medicine may make you feel dizzy on standing. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.
Isosorbide dinitrate monitoring
Monitor blood pressure and heart rate
Monitor for adverse effects such as headache, fainting and heart palpitations
Isosorbide mononitrate drug class
Nitrate
Isosorbide mononitrate indications
Prevention of angina
Isosorbide mononitrate dosage range and timing
Adult, oral, initially 30–60 mg once daily, increased if necessary up to 120 mg once daily.
> take at the time of day when angina is most frequent, eg at night for nocturnal angina or in the morning for daytime angina
Isosorbide mononitrate counselling
This medicine may make you feel dizzy on standing. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.
Swallow whole; do not crush or chew the tablet.
This medication is not recommended for acute episdoes of angina because it takes a while to work –> only used for prevention of angina
Isosorbide mononitrate monitoring
Monitor blood pressure and heart rate
Monitor for adverse effects such as headache, fainting and heart palpitations
Glyceryl trinitrate drug class
Nitrate
Glyceryl trinitrate indication
Prevention and treatment of stable angina
Glyceryl trinitrate dosage range and timing
Prevention of acute angina before a precipitating activity
- Sublingual spray, adult, 400 micrograms (1 spray) 5–10 minutes before activity
- Sublingual tablet, adult, 300–600 micrograms 5–10 minutes before activity.
Acute angina
- Sublingual spray, adult, 400–800 micrograms (1 or 2 sprays); repeat after 5 minutes if necessary to a maximum of 3 sprays.
- Sublingual tablet, adult, 300–600 micrograms repeated every 3–4 minutes until pain is resolved, to a maximum of 1800 micrograms.
Glyceryl trinitrate counselling
This medicine may make you feel dizzy on standing. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.
sublingual tablets: Place under your tongue; do not swallow. After the pain has been relieved, you may spit out or swallow what is left of the dose to avoid adverse effects such as headache.
sublingual spray: Prime the spray before using it for the first time by pressing the nozzle 5 times, spraying it into the air
Glyceryl trinitrate monitoring
Monitor blood pressure and heart rate.
Monitor for adverse effects such as headache, fainting and heart palpitations
