Pharm Quiz 4 Medium

Biguanides

• Metformin is an example of this drug class, brands include Glucophage, Glucophage XR, Riomet, Fortamet, and Glycon
• Reduce hepatic glucose production via gluconeogenesis
• Increases peripheral glucose utilization by increasing tissue sensitivity to insulin
• Interstitial glucose production reduces
• Improves glucose uptake in muscles
• Does not increase insulin secretion from the pancreas and hypoglycemia is not associated with this drug type
• Treats type 2 diabetes, especially in overweight patients
• Does not actively drive blood glucose down, rather it modulates the rise in glucose that happens after a meal
• Contraindicated with renal impairment, severe heart failure, metabolic acidosis, liver disease, MI, and septicemia
• Do not mix with contrast agents
• GI upset, including nausea, diarrhea, vomiting, abdominal pain, and flatulence, is an adverse effect
• Can cause lactic acidosis, a rare but serious effect with a Black Box Warning
• Conditions warranting caution include hepatic failure, cardiac failure, and/or renal failure patients
• Vitamin B12 deficiency is a risk
• Should temporarily withhold administration 48 hours before and after contrast studies
• Monitor renal function (eGFR)
• LFTs and creatinine levels require checking
• Discontinue if creatinine surpasses 1.5 mg/dl for men or 1.4 mg/dl for women
• Ensure normal levels prior to initiation
• Take with food to reduce GI side effects
• Monitor Vitamin B12 levels every 2–3 years

Sulfonylureas

• Includes both 1st and 2nd-generation categories of drugs
• 1st-generation examples are acetohexamide sold as Dymelor, chlorpropamide sold as Diabinese, tolazamide sold as Tolinase, and tolbutamide sold as Orinase
• 2nd-generation examples are glyburide sold as Diabeta, Glynase Prestabs, and Micronase
• Mechanism of action for 1st generation: inhibiting potassium channels in pancreatic beta cells, leading to depolarization and calcium channel activation, to enhance insulin secretion
• 2nd-generation agents drive down blood glucose by increasing insulin
• Treats type 2 diabetes, especially when metformin is insufficient
• Contraindicated if allergic to sulfa, or with severe renal/liver disease
• Carries a risk of hypoglycemia, weight gain, and photosensitivity
• GI effects such as nausea, epigastric fullness, and heartburn are adverse effects
• Pruritis, erythema, urticaria, and transient maculopapular eruptions can cause skin reactions
• Monitor for hepatotoxicity
• Administer 30 minutes before meals
• Caution in elderly patients due to hypoglycemia risk

Meglitinides

• Repaglinide under the brand Prandin, and nateglinide under the brand Starlix are examples
• Stimulates rapid, short-lived insulin secretion from the pancreas
• Interacts with binding sites on potassium channels on pancreatic beta cells
• Mechanism requires functioning beta cells in pancreatic islets
• Stimulates insulin release from beta cells of the pancreas
• Used in type 2 diabetes, particularly to address postprandial spikes
• Treats meal-related hyperglycemia that hasn't responded to other agents
• Can cause hypoglycemia and weight gain
• Avoid use when a type 1 diabetic or severely impaired liver function
• Take 30 minutes before meals; skip dose if skipping a meal
• Monitor for hypoglycemia, especially with erratic eating habits

Thiazolidinediones (TZDs)

• Rosiglitazone under the brand Avandia, rosiglitazone combined with metformin under the brand Avandamet, pioglitazone under the brand Actos, and pioglitazone combined with metformin under the brand Actoplus are examples
• Effective only in the presence of insulin
• Lowers insulin resistance at peripheral sites and in the liver, increasing insulin-dependent glucose disposal
• Used for type 2 diabetes, either as monotherapy or in combination with other oral agents
• Can be used in patients with renal dysfunction
• Do not use patients with heart failure, bladder cancer or severe liver disease
• Can cause fluid retention with peripheral edema, and weight gain
• Monitor patient for signs of heart failure which includes edema and dyspnea
• Assess liver enzymes regularly
• Increases fracture risk

Dipeptidyl Peptidase-4 (DPP-4) Inhibitors

• Sitagliptin, linagliptin and saxagliptin are examples
• Also known as gliptins
• Inhibits DPP-4 enzyme, prolonging incretin hormone activity to increase insulin release and decrease glucagon secretion
• Does not drive blood glucose down, rather, they simply modulate the rise in glucose that happens after a meal
• Use for type 2 diabetes, either as monotherapy or in combination
• Use as an adjunct to diet and exercise to improve glycemic control in Type 2 DM
• Do not use with patient with history of pancreatitis or severe renal disease
• May induce pancreatitis, upper respiratory infections, joint pain, headaches, or nasopharyngitis, and hypersensitivity reaction
• Monitor for pancreatitis symptoms: severe abdominal pain
• Assess renal function before starting therapy

Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors

• Empagliflozin, canagliflozin and dapagliflozin are examples
• Increases glucose excretion via the urine by inhibiting SGLT-2 in the kidney tubules, decreasing glucose levels and inducing weight loss via caloric loss through the urine
• Used for type 2 diabetes, a cardiovascular risk reduction and in treatment of chronic kidney disease
• Contraindicated if severe renal impairment, in patient with recurrent UTIs, and/or history of diabetic ketoacidosis (DKA)
• UTIs, female genital fungal infections, dehydration, and hypotension are adverse effects, including ketoacidosis and risk of amputation
• Urosepsis and pyelonephritis is possible
• Do not drive blood glucose down, rather, they simply modulate the rise in glucose that happens after a meal
• Encourage hydration to prevent dehydration and UTIs

Alpha-Glucosidase Inhibitors

• Acarbose sold as Precose, and miglitol sold as Glyset are examples
• Delays and decreases carbohydrate absorption in the GI tract by inhibiting alpha-glucosidase
• Lowers postprandial glucose levels
• Treats type 2 diabetes, especially for postprandial glucose control
• Can be first-line or adjunctive therapy for treating type 2 DM, but usually used in 2nd line due to frequency of admin
• Especially applicable to individuals with normal FBS levels but elevated postprandial readings
• Do not drive blood glucose down, rather, they simply modulate the rise in glucose that happens after a meal
• Inflammatory bowel disease, intestinal obstruction, and severe renal dysfunction are contraindications/cautions
• Flatulence, bloating, diarrhea, and abdominal pain are adverse effects
• Doses > 100mg TID of acarbose cause elevated serum transaminase levels in 15% of patients
• Take with first bite of a meal
• Treat hypoglycemia with glucose, not sucrose, due to delayed sugar absorption
• Candy containing sucrose will not be effective as treatment for hypoglycemia

Levothyroxine

• Examples include Synthroid, and Liothyronine
• Synthetic form of thyroxine which converts to triiodothyronine in the body
• Mimics the function and activity of the T3 hormone
• Primary hypothyroidism, secondary hypothyroidism, and help manage Goiter
• Management of thyroid cancer
• Acute MI and hypersensitivity to the drug are contraindications
• Usually only seen when excessive doses
• Results in hyperthyroidism
• Monitor TSH
• Assess for hypo- or hyperthyroidism
• Take on an empty stomach
• Assess for symptoms of toxicity
• 30-60 minutes before meals
• Avoid taking calcium and iron
• Report any changes
• Given in microgram dosages
• Doses are specific to the patient
• Do not change dosages without consulting doctor

Antacids

• Aluminum hydroxide, magnesium hydroxide, calcium carbonate and sodium bicarbonate are examples
• Neutralize stomach acid
• Raise stomach contents
• Interacts with hydrochloric acid
• Forms water
• Alleviates acidity
• Treats GERD, PUD and heartburn
• Severe renal impairment, heart failure and GI obstrucion are precautions
• Can cause diarrhea, constipation and acid rebound

Proton Pump Inhibitors (PPIs)

• Omeprazole Prilosec, esomeprazole Nexium and lansoprazole Prevacid
• Decrease stomach acid
• Treats GERD and PUD
• Decreases gastric acidity
• Can cause pneumonia and a C.Diff infection
• Can cause fractures with long term use

Misoprostol

• Cytotec is an example
• Synthetic prostaglandin
• Inhibits gastric secretions
• Increases bicarbonate
• Treats NSAID and induced ulcers
• Pregnancy is the main contraindication
• GI and labor induction are main uses

H. Pylori Treatment

• Triple Therapy (1st Line Treatment) for 10-14 days:
• A proton pump inhibitor (PPI) to reduce stomach acid.
• Clarithromycin (500mg BID).
• Amoxicillin 1gm BID or Metronidazole 500mg BID.
• Quadruple Therapy (Alternative Treatment):
• Used if triple therapy fails or if known antibiotic resistance.
• Treatment is for 10-14 days:
• A PPI.
• Bismuth subsalicylate 535mg QID.
• Tetracycline 500mg QID.
• Metronidazole 250mg QID.
• Sequential Therapy (Less Common):
• Involves combinations of antibiotics and a PPI over 10 days:
• Standard dose PPI + amoxicillin 1 gm BID for 5 days.
• Followed by PPI + clarithromycin 500mg once a day + tinidazole 500mg BID for 5-7 days.
• Concomitant Therapy:
• Includes a PPI and three antibiotics (clarithromycin, amoxicillin, and metronidazole) taken simultaneously.
• Important Considerations:
• Adherence is crucial; missing doses can lead to treatment failure and antibiotic resistance.
• Side effects: GI upset, taste disturbances with clarithromycin, diarrhea, or metallic taste with metronidazole.
• Confirm eradication; a urea breath test or stool antigen test is typically done 4 weeks after completing therapy to ensure the infection is cleared.
• Lifestyle modifications: Advise patients to avoid NSAIDS, alcohol, smoking, and irritating foods to help with symptom relief.

Levopoda

• Brand name Sinemet
• A precursor to dopamine
• Crosses the blood brain barrier
• Once in the brain it is converted to dopamine

Amantadine

• Functions as an antiviral and dopaminergic agent
• Increases dopamine release
• Meds can be used for dyskinesia

Alzheimer's Disease Management

• Pharmacological Management (Drugs for Cognitive Impairment):*
• Cholinesterase Inhibitors:
• Meds: Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Razadyne).
• Use: Provides modest improvements in cognition, behavior, and function while delaying disease progression.
• NMDA Receptor Antagonists:
• Meds: Memantine (Namenda).
• Use: Can slow the decline in function, and, in some cases, may actually cause symptoms to improve.
• Non-Pharmacological Management:*
• Cognitive and behavioral interventions
• Lifestyle and environmental modifications
• Caregiver support
• Education

Donepezil

• Inhibits the enzyme that boosts cognitive function
• Aids in improving alzheimers
• Side effects are insomnia, dizziness and seizures

Phenytoin

• Treats epilepsy
• Can cause cardiac and cardio adverse effects
• Monitor seizure frequency and characteristics

Carbamazepine

• Treats seizures and nerve pain
• Check for skin disorders and infections

Valproic Acid

• Treats seizures
• Can be used to treat mania or migraine

Overactive Bladder

• Anticholinergics like oxybutynin
• Used for urinary function
• Dizziness and drowsiness side effects

Oral Contraceptives

• Can have adverse effects
• Must be taken with caution
• Can create hormonal imbalance

Sildenafil

• Brand name is Viagra
• Causes arteries to dilate
• Used for ED
• Caution for heart patients

Finasteride

• Brand name Proscar
• Inhibits enzyme that promotes hair growth
• For hormonal therapy
• Women shouldn't handle the crushed tablets

Bulk Laxatives

• Treat constipation
• Absorb water
• Can cause cramping