Module 11 Study Guide PDF

FFP ● When/what lab values make this transfusion a consideration in clinical practice? ● Does it need to be crossed and matched? ● What does the APP need to monitor pre and post transfusion? Cryo ● When/what lab values make this transfusion a consideration in clinical practice? ● Does it need to be...

FFP ● When/what lab values make this transfusion a consideration in clinical practice? ● Does it need to be crossed and matched? ● What does the APP need to monitor pre and post transfusion? Cryo ● When/what lab values make this transfusion a consideration in clinical practice? ● Does it need to be crossed and matched? ● What does the APP need to monitor pre and post transfusion? __________________________________________________________________________________________________________ Module 11 Study Guide Drug Metformin Semaglutide “--glutide” Empagliflozin “---Flozin” Glyburide “---ride” Repaglinide “---glinide” Linagliptin “--gliptin” Thiazolinediones pioglitazone acarbose Class Biguanide GLP1 RA SGLT2 Sulfonylureas Glinides DPP4 inhibitors TZDs A-glucosidase inhibitors MOA Decrease hepatic glucose production; improve insulin sensitivity; increase peripheral glucose uptake Mimics GLP1 action; release of insulin/suppress glucagon; delay gastric emptying/suppress appetite Promotes urinary excretion of glucose Enhance insulin secretion “Cousins of sulfonylureas” Same MOA Inhibits DDP4→ increases incretins→ release insulin/suppress glucagon Increase insulin receptor sensitivity; decrease liver glucose production; enhance glucose uptake in muscle cells Slows the absorption of dietary carbs GI: N/V/D; abd pain Vitamin B deficiency GI: N/V/D Pancreatitis GU infections/necrotizing Hypoglycemia Weight gain Hypoglycemia Weight gain Pancreatitis Severe joint pain -weight gain -edema GI: gas; diarrhea AEs (has a diuretic effect so that’s why it’s great for CHF) Lactic acidosis (RFs: eGFR < 30, alcohol, liver dz, acute HF, contrast dye procedures, past hx of acidosis Gallstones Bowel obstruction/worsening gastroparesis AKI BBW–thyroid c cell tumors in rats Medullary thyroid carcinoma fasciitis of the genitals Dehydration Hypotension Leg infection/amputation? DKA (RF: fasting, alcohol, stress, etc.) Sulfa allergy CI eGFR < 30 (if levels falls during time of therapy–cut dose in ½ ) Family hx of medullary thyroid carcinoma and pts w multiple endocrine neoplasia syndrome -hx of UTI -pancreatic disorder -DKA -eGFR <30 -OB 2nd & 3rd tri/breastfeeding Elderly CrCl < 30 Monitor -renal/liver -B12 -A1C Renal A1C A1C Renal Volume status/BP A1c Renal Extra notes Start dose: 500mg QD w largest meal then gradually increase to up to 2,000 mg/day To reduce GI effects: ER, w food, slow titration #1 med for prediabetes (max dose 850 mg BID) **gradual dose titration** Caloric intake reduction/mindful eating Avoid fatty/spicy foods Tirzepatide (mounjaro) = combo of GLP1 + GIP RA Better weight loss and A1C reduction ● ● ● ● ● ● Insulin detemir (Levemir) Insulin glargine (Lantus, Basaglar) Insulin aspart (Novolog) Insulin lispro (Humalog) Humulin or Novolin N (NPH) Humulin or Novolin R (regular) U-100 and U-500 ○ slower onset and longer duration Take with breakfast d/c if starting insulin Heart failure risk -fractures -liver toxic -bladder CA? -CrCl < 30 -elderly -adrenal insufficiency Heart failure BBW–heart failure CKD Cirrhosis IBD Malabsorption syndrome A1c Renal A1c renal/liver Liver A1c A1c Renal Dc if starting insulin Dosed TID with first bite of each meal Cam take Q other day for GI AEs ○ 100 U most common ● Humalog Mix 75/25 and Novolog Mix 70/30 (analogs); Humulin or Novolin 70/30 ● (insulin NPH + regular premixed insulin) ● Which therapies are expected to have the greatest A1c-lowering effect? ○ GLP1-RA ○ Least? ■ DPP4-I ● What is the difference between Ozempic and Rybelsus, since both are semaglutide? ○ Rybelsus is the oral version for T2DM; Ozempic is injectable ● Which non-insulin T2DM therapies are injected by the patient? ○ Dulaglutide ○ Liraglutide ○ Semaglutide ○ Exenatide ○ Lixisenatide ● ● ● ● ● ● ● ○ Tirzepatide Which T2DM therapies can be combined? ○ GLP1-RA + basal insulin ○ Metformin + insulin Which drugs are currently approved for pediatric patients with Type 2 DM? ○ Peds should really be managed by endo unless they don’t have access to one ○ Ages > 10 yrs ■ GLP1-RA (Liraglutide, dulaglutide) ■ SGLT2I (empagliflozin) Which patients need to monitor their BG more frequently? ○ When starting or adjusting dose; changing diet/exercise ○ 4-10x/day for T1DM & T2DM with very intensive insulin therapies Why do patients with CGM still need a monitoring device with test strips to check their BG with a fingerstick glucose? ○ Suspicion CGM may be inaccurate ○ Waiting for CGM to warm up ○ In clinical setting where BG levels are changing rapidly Which type of glucose-lowering medication is usually used for treatment of T2DM for a patient who is pregnant? -insulin (NPH, Lispro, Aspart, Detemir) -insulin resistance increased during 2nd & 3rd trimesters & decreases immediately postpartum What are principles of treating acute hyperglycemia related to DM in the hospitalized patient? ○ Regular or rapid insulin 1 unit for every 50 mg/dl over goal ○ Fasting goal: <140 ○ Random goal: <180 ○ Best to have basal or sliding scale insulin ○ Critical pts should be on insulin gtt w/ BG checks Q hr ■ Never lower BG <110 in critical pts ○ DKA or HHS ■ Fluids first, then IV insulin ■ Correct acidosis ■ Replace K+ Which drugs are typically held? ○ Oral agents–metformin/SGLT2-I ● How is hypoglycemia treated ○ Levels: ■ 1st (54–70) ■ 2nd (<54) ■ 3rd (severe w AMS findings) ○ Conscious patient—rule of 15 ○ Unconscious patient–assess ABCs, IV dextrose, D10 infusion, thiamine IV, glucagon IV or IM, steroids w no response to regular tx Pharmacotherapy for obesity ● What are the pharmacotherapeutic options? ○ Phentermine-Topiramate (Qsymia)--has an anti seizure med in it ■ Teratogenic ■ Paresthesia ■ Dry mouth, constipation ■ Tachy; HTN ■ Neuropsych effects ■ Metabolic acidosis ○ Phentermine (Adipex-P) ■ Tachy; HTN ■ Dry mouth, HA, insomnia, restlessness ○ Bupropion-Naltrexone (Contrave)--avoid for pts on opioids bc naltrexone is an antagonist ■ BBW: suicidality ■ Dry mouth, N/V/D/C, HA ■ Neuropsych effects ○ Orlistat (Xenical/Alli) ■ GI: oily spotting, gas with discharge, fecal urgency, incontinence ■ Increased risk of kidney stones ○ Liraglutide (Saxenda) ■ N/V/D; pancreatitis, gallbladder dz; gastroparesis; dehydration; tachycardia ■ BBW: medullary thyroid cancer/multiple endocrine neoplasia type 2 ■ Suicidal ideation ○ Semaglutide (Wegovy) ■ Same as above ● Which obesity medication is available over the counter? ○ Orlistat ● Which medication is only approved for short-term use? ○ Phentermine→ max 12 wks→ schedule IV med for abuse