Unknowns 2

Question 1

Recommendation for DDIs

Answer 1

-Alternative noninteracting drug
-Dose adj for object drug
-Adj in dosing times
-Monitoring for altered response

Question 2

Clinically Significant DDI

Answer 2

-when the therapeutic activity/toxicity of drug is changed to such an extent that a dose adjustment or medical intervention is needed

-narrow therapeutic range, quality of literature

Question 3

Common CYP Inhibitors

Answer 3

-ketoconazole
-itraconazole
-cimetidine
-GFJ
-erythromycin
-clarithomycin

Question 4

Common CYP Inducers

Answer 4

-rifampin
-carbamazepine
-St John’s wort

Question 5

Altered intestinal CYP3A/PGP activity

Answer 5

• CYP located in small intestine
• ~70-80% of intestinal CYP is CYP3A
• Overlap of drugs that are CYP3A and PGP substrates

Question 6

Metformin Goals

Answer 6

• Initial treatment depends on patient-specific goal:
• (1) Cardiorenal Risk reduction in high-risk patients = Not metformin
• (2) Achieve glycemic & weight loss goals = Metformin

Question 7

Sick Day Management, Insulin

Answer 7

-Hydration (8oz, add electrolytes)
-Continue insulin (may require supplemental short/rapid insulin)
*1-2 units for q 30-50 over 120
-Increase SMBG q2-4h
-Notify PCP

Question 8

Hypoglycemia TX

Answer 8

Rule of 15
-15 g carbs

*3-4 glucose tabs
*1/2 cup juice/soda
*8-10 hard candies
*6 skittles
-Glucagon for NPO or unconscious pts

Question 9

A1C Goals

Answer 9

Healthy: <7-7.5
*few illness

Multiple illnesses: <8

Poor health: avoid reliance on A1C, avoid hyper sx and hypo sx

Older Adults with Diabetes ^^^

Question 10

Adrenal Hormone/Gland

Answer 10

Hypothalamus: CRH

PIT: ACTH

Adrenal: cortisol

ZG: aldosterone
ZF: cortisol
ZR: sex hormones

Question 11

Fentanyl Patch Counseling

Answer 11

-Apply patch to body with some subq fat (not location of pain)
-No cutting patch
-Press firmly, 15 sec
-Normal skin
-Avoid heat/if have fever
-No showering bc of heat

-Dispose at RX Drug Drop Boxes, Dispose RX, mix with cat liter, flush