Pharm review Flashcards by Nayla Mansoor

If the patient experiences postural hypotension, hyponatremia, and hyperkalemia, what should you do to the fludrocortisone dose

INCREASe it!

It causes salt retention and edema

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What mineralocorticoid has the most salt retaining ability

Fludrocortisone

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What is first line in Addison’s (adrenal insufficiency) treatment

Hydrocortisone!
Prednisone is second line
dexamethasone is rarely used to treat

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Which drugs cause hypoglycemia

Insulin
Sulfonylurea
Meglitinides

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Which drugs cause weight gain

Insulin
Sulfonylurea
TZD
(meglitinides?)

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Which drugs cause weight loss

GLP-1 agonist
SGLT-2 antagonist
+/- metformin

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Which drugs are weight neutral

DPP4 inhibitors

Metformin

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Which drugs are CV beneficial

Liraglutide 
Empagliflozin 
Canagliflozin 
\+/- metformin  
Pioglitazone

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Which drugs are renally benficial

Liraglutide
Empagliflozin
Canagliflozin

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Which drugs are contraindicated in renal failure

metformin 
canagliflozin 
dapagliflozin 
empagliflozin 
exenatide 
lixisenatide 
*Adjust DPP4 dose in renal failure

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FDA BBW for diabetes meds

Pio/Rosi: CHF
GLP-1: Thyroid C-cell tumors
Canagliflozin: risk of amputation and bone Fx

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FDA special warning on Tolbutamide (sulfonylurea)

increased risk of CV death

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At what BMI do you initiate pharmacotherapy

BMI 27 (25-29.9 is obese) 
Initiate metabolic surgery at BMI 30+ (obese)

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What drug is aproved for short term Tx of obesity

Phentermine; only a few weeks

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ADE of phentermine

HA, high BP, tachy, insomnia, dry mouth, constipation, anxiety, palpitations

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Which drug is used for long term Tx of obesity

Orlistat

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ADE of orlistat are

abd pain 
oily stool
flatulence
malabsorption of ADEK 
potentiates warfarin

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When do you use a statin in obesity

If they are <40 with ASCVD, or anytime over 40
High: Atorv (40-80), Rosuv (20-40)
Mod: Atorv (10-20) Rosuv (5-10)

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What are ACE guidelines (more stringent)

A1c: <6.5%
FBG: <110
post-prandial <140

What are ADA guidelines (less stringent)

A1c: <7%
FBG: 80-130
post-prandial: <180

First line drug in T2DM

Metformin
Then GLP
then DPP4
(sulfonylurea not the best 2/2 weight gain and hypoglycemia)

What drug family is metformin

biguianide

How does metformin work

increase insulin sensitivity

decrease gluconeogenesis

Metformin is indicated for

PCOS, DM2

ADE of metformin are

Diarrhea | lactic acidosis

How mich does metformin lower A1c

1-2%

What suplement do you give with metformin

B12

What option is good for older T2DM who eat constant meals

Basal bolus (NPH:short)

What should we know about sliding scale

at BG 181-240, low dose scale is 4 units insulin, and 1 unit insulin lowers 30 BG points

When is sliding scale good

in a situation where pt cant tell you their normal carb intake

TDD is calculated using

lbs/4 | kg*0.55

If their A1c is >8 and not coming down, what do you do

ADD BOLUS

what is correction factor

rule of 1800 | 1800/TDD= amount that 1 unit insulin will lower BG

If no other medical conditions, what do you start women on (estrogen dose)

35 mcg | if adolescent, underweight, of >35, start at 20-25 to reduce risk of exposure

KNow the changes in contraception times (pill to...)

pill: no change ring: no change patch: 1 day implant: 4 days shot: 1 week hormonal IUD: 1 week Cupper IUD: 5 days of coverage

Women >45

Use: implant, or POP | Injections second line

Smokers

<35: Any except CHC | >35: CHC stage 4

HTN

Use: implant, LNG or Cu-IUD | >160/100: NO CHC

Dyslipidemia

Use: Cu-IUD | DONT use: CHC

Dm w/ microvascular complications, or >20 years

Use: Cu-IUD 3: injection (depo) DONT use: CHC

Migraines:

Add estrogen? Cycleesa

Breast cancer

Use: Cu-IUD | No hormones

DVT

Use: Cu-IUD | DONT use: CHC

Obesity BMI >30

DONT use CHC

Obesity >30 but <18 y/o

DONT use CHC or Depo

Lupus

Use: Cu-IUD (unless w/ thrombocytopenia) | DONT use: CHC if w/ + ALA Abs

Absolute NO’s

Distorted uterus: No IUD Cervical cancer: no IUD Cirrhosis: No CHC (can use Cu-IUD