Taking Medication

Question 1

What are some risk factors for poor medication taking behavior?

Answer 1

Age (elderly and adolescents at highest risk), med dosing frequency/complexity of regimen, number of meds person is taking, presence of other concurrent medical conditions, depression, SES, cost of meds, poor social support, poor rapport, duration of DM

Question 2

What are some medication regimen changes/adjustments that can be made to enhance an individuals ability to follow their medication plan?

Answer 2

Decreasing the frequency of med administration by using once daily meds when possible, decreasing pill burden by using combo tablets

Question 3

What Medicare program is Rx drug coverage organized through?

Answer 3

Medicare part D; pt’s should be encouraged to sign up as soon as able as there is a late enrollment penalty

Question 4

In a patient taking Pramlintide (Amylin analog), by how much will insulin doses need to be adjusted initially?

Answer 4

by about 50%

May cause N/V and hypoglycemia

Question 5

How should oral medications be adjusted with administration of Pramlintide?

Answer 5

Pramlintide can delay absorption of certain oral meds, and may need to be administered at least 1 hour before or two hours after pramlintide injection

Question 6

How should Metformin be titrated to enhance tolerability/reduce GI related side effects?

Answer 6

Initiated at lowest dose (500 mg once or twice daily) and titrated slowly (by 500 mg each week) to target of 2000 mg/day

Advise to take with meals

Question 7

What are some other issues to consider regarding lack of engagement with metformin therapy?

Answer 7

Very large tablet size (esp for 1000 mg strength) and c/o very strong odor. This can be overcome by ordering liquid form (Riomet). Comes in cherry or strawberry flavor.

Film coated ER formulation can decrease odor, but still has large tablet size

Question 8

What precautions should be taken for colesevelam (Welchol)

Answer 8

May interfere with the absorption of other meds, as well as fat soluble vitamins

Affected meds should be taken at least 4 hours prior to Welchol. Tablets are large, and dose is 6 tabs once daily or 3 tabs BID with a meal

An oral powder for suspension formulation and a chewable bar are available

Question 9

Should should patients be advised to monitor for when they are taking DPP4 inhibitors?

Answer 9

Pancreatitis; may also be associated w/ severe arthralgia

Question 10

What should patients taking GLP-1 receptor agonists monitor for?

Answer 10

Pancreatitis

Question 11

What is the difference in frequency between SU and nonsulfonylurea secreatagogues (i.e. Meglitinides)

Answer 11

SUs are given once or twice daily
Meglitinides must be given up to 3 or 4x a day (before each meal) due to their short half life

This property is an advantage if persons who have erratic meal schedules (can skip dose if if meal not eaten/delay dose if meal is delayed)

Question 12

what is the most physiologic insulin regimen?

Answer 12

Basal-bolus regimen

Premixed may be chosen over basal bolus due to pt preference for fewer injections

Question 13

What are the cons to premixed insulins?

Answer 13

Inability to separately adjust the dose of the 2 components, increased risk of hypoglycemia

Question 14

What are some different delivery options

for administering insulin?

Answer 14

insulin pen, needle free jet injector, inhaled insulin

Question 15

What are the different needle lengths for insulin admiinistration

Answer 15

4 mm (pen needles)
6 mm syringes
8 mm
12.7 mm

4 mm need is adequate to reach past the epidermis and dermis into subq fat, while minimizing risk of IM injection

Question 16

What is the thinnest pen needle available?

Answer 16

a 32 gauge

Question 17

At what angle should most needles be inserted?

Answer 17

90 degrees; however, 45 degrees is advised for frail elderly or cachexic adults or children

Question 18

When should pinching a skinfold be advised prior to insulin injection?

Answer 18

Persons using a 6,8 or 12.7 mm needle DO need to pinch a skinfold for the med to reach its intended absorption site

As a general rule, persons using 4 or 5 mm needles do not need to pinch a skinfold (exception: children and adults w/ lesser amounts of subq fat who use arms or thighs for injection)

Question 19

What method should be taught to patients using needles to prevent accidental needlesticks?

Answer 19

Do not recap syringes and pen needles after use

Question 20

Patients taking insulin or insulin secretagogues should avoid what ingredient in OTC products?

Answer 20

ETOH

Question 21

Why would a person with DM be advised to avoid NSAIDS?

Answer 21

If they have renal impairment, HTN, HF, or GI ulcers

Some OTC pain reliever products contain large quantities of sodium (Alka-Seltzer, aspirin)

Question 22

What should the CDCES be aware of when discovering a patient is taking nonRx products for GI ailments?

Answer 22

May be a sign that the person is experiencing gastrointestinal autonomic neuropathy

Question 23

What is the only oral glucose lowering agent approved by the FDA for children 10 years and older with DM2?

Answer 23

Immediate release Metformin, In teens with DM2 treated with Metformin, the risk of lactic acidosis and binge drinking needs to be discussed

GLP-1 receptor (liraglutide) can also be given to children > 10 years with DM2