Drug Cards - Insulin & Other Diabetes Medications PDF

INSULIN: RAPID ACTING. Drugs: Lispro (humalog), aspart (novolog), glulisine (apidra), Afrezza (inhaled). Indications: Given with meals to control postprandial rise in blood glucose. MOA: Mimic actions of endogenously produced insulin. SE/Adverse effects: Significant risk for hypoglycemia. Hypersensi...

INSULIN: RAPID ACTING. Drugs: Lispro (humalog), aspart (novolog), glulisine (apidra), Afrezza (inhaled). Indications: Given with meals to control postprandial rise in blood glucose. MOA: Mimic actions of endogenously produced insulin. SE/Adverse effects: Significant risk for hypoglycemia. Hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes. Contraindications: hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis. Safety: Risk for acute bronchospasm in patients with chronic lung disease (Afrezza). D2D: hypoglycemic agents, hyperglycemic agents, beta adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens. Special Considerations: Must be used in conjunction with an intermediate or long acting agent in DM type 1. Pregnancy/Lactation: safe.  INSULIN: RAPID ACTING. Drugs: Afrezza (inhaled). Indications: Given with meals to control postprandial rise in blood glucose. MOA: Mimic actions of endogenously produced insulin. Faster onset than injected. SE/Adverse effects: Significant risk for hypoglycemia. Hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes. Contraindications: hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis. BBW: Risk for acute bronchospasm in patients with chronic lung disease. D2D: hypoglycemic agents, hyperglycemic agents, beta adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens. Special Considerations: Must be used in conjunction with an intermediate or long acting agent in DM type 1. Need to evaluate spirometry. Pregnancy/Lactation: safe.  INSULIN: SHORT ACTING. Drugs: Regular insulin (Humulin R, Novolin R). Indications: Control postprandial hyperglycemia. Infused via insulin pump for basal glycemic control. MOA: Mimic actions of endogenously produced insulin. SE/Adverse effects: Significant risk for hypoglycemia. Hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes. Contraindications: hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis. D2D: hypoglycemic agents, hyperglycemic agents, beta adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens. Special Considerations: Onset Pregnancy/lactation: Considered safe.  INSULIN: INTERMEDIATE DURATION. Drugs: Natural protamine hagedorn insulin (Humulin N, Novolin N, NPH). Indications: Glycemic control between meals and during the night. MOA: Combines insulin with protamine and decreases solubility, delaying absorption. SE/Adverse effects: Risk for allergic reactions. Contraindications: hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis. D2D: hypoglycemic agents, hyperglycemic agents, beta adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens. Special Considerations: Only insulin that can be mixed with short acting insulins. Pregnancy/lactation: Safe. INSULIN: LONG DURATION. Drugs: Glargine U-100 (lantus), Detemir (levemir). Indications: Once daily dosing to treat type 1 and 2 DM. MOA: Modified human insulin with prolonged duration action. No peak. SE/Adverse effects: Significant risk for hypoglycemia. Hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes. Contraindications: hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis. D2D: hypoglycemic agents, hyperglycemic agents, beta adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens. Special Considerations: can be given at any time of day, but should be given at the same time each day. Can do a split dose, cannot mix. Pregnancy/Lactation: safe.  INSULIN: ULTRA-LONG DURATION. Drugs: Glargine U-300 (toujeo), degludec (tresbia) Indications: Once daily for type 1 and 2 DM. Used to provide basal glycemic control. MOA: Modified human insulin that is concentrated to prolong duration of action in excess of 24 hours. Only human analog with effects persisting up to 42 hours. SE/Adverse effects: Significant risk for hypoglycemia. Hypersensitivity, antibody formation, site irritation, cough/URI symptoms, weight gain, hypokalemia, lipodystrophy, lipohypertrophy, peripheral edema, vision changes. Contraindications: hypoglycemia, hypersensitivity, severe renal dysfunction, acute or chronic metabolic acidosis. Safety: Risk for acute bronchospasm in patients with chronic lung disease (Afrezza). D2D: hypoglycemic agents, hyperglycemic agents, beta adrenergic blocking agents, MAOIs, SSRIs, salicylates, quinolones, androgens. Special Considerations: Must be used in conjunction with an intermediate or long acting agent in DM type 1. Pregnancy/Lactation: safe. ORAL DIABETIC MEDICATIONS: BIGUANIDES. Drugs: Metformin (glucophag, fortamet). Indications: Initial therapy in patients with type 2 DM. Prevention of T2DM, GDM, PCOS MOA: Decrease glucose production by the liver, increases tissue response to insulin, decreases absorption of glucose in the gut. Cannot cause hypoglycemia. SE/Adverse effects: GI (N/V, decreased appetite, diarrhea). Weight loss. Safety: use caution with pre-existing renal impairment. Contraindicated in heart failure. D2D: Tagamet (increases serum concentration). Carbonic anhydrase inhibitors, alcohol, insulin, other glycemic controlling drugs. Special Considerations: Monitor elderly for renal impairment. Causes decreased absorption of vitamin B12 and folic acid after 12-15 years of use. Pregnancy/Lactation: Safe. BBW: Severe metabolic acidosis can occur with accumulation. Highest risk in patients with significant renal impairment. ORAL DIABETIC MEDICATIONS: SULFONYLUREAS. Drugs: Glipizide, glyburide, glimepiride. Indications: Type 2 DM. MOA: promote insulin secretion by the pancreas, may also increase tissue response to insulin. Must have endogenous insulin production to work. SE/Adverse effects: Hypoglycemia, weight gain, increased risk for CV mortality. Safety: contraindicated in T1DM, diabetic ketoacidosis. Use with caution in renal and hepatic disease, hemolytic anemia and the elderly. D2D: increased risk for hypoglycemia when used with medications that lower glucose. (Fluoroquinolone, macrolides, sulfonamides). Special considerations: Secondary failure can occur, the effect of medication wears out over time as disease progresses. Pregnancy/Lactation: do not use. ORAL DIABETIC AGENTS: MEGLITINIDES (GLINIDES) Drugs: Nateflinide (starlix), repaglinide (prandin). Indications: Type 2 DM. MOA: Promote insulin secretion by the pancreas. Shorter acting than sulfonylureas, taken with each meal. SE/Adverse effects: hypoglycemia, weight gain. Contraindications: contraindicated in diabetic ketoacidosis, T1DM, and combination with NPH and gemfibrozil. D2D: CYP inhibitors/inducers: rifampin, barbiturates, carbamazepine, ketoconazole, itraconazole, erythromycin, trimethoprim, montelukast. Pregnancy/Lactation: do not use. ORAL DIABETIC AGENTS: THIAZOLIDINEDIONES (GLITAZONES). Drugs: Pioglitazone (actos), rosiglitazone (avandia). - Associated with MI. Indications: Type 2 DM. MOA: Turn on insulin responsive genes and increase sensitivity that help regulate carbohydrate and lipid metabolism. (decrease insulin resistance). Usually added to metformin. SE/Adverse effects: Hypoglycemia in presnce of excess insulin, heart failure, bladder cancer, fractures (females), ovulation (unintended pregnancy), headache, myalgia, sinusitis. Safety: contraindicated in patients with established heart failure. Caution with use in CHF, hypoglycemia, renal impairment and edema. D2D: CYP inhibitors/inducers, topiramate. Pregnancy/Lactation: limited data, not recommended. BBW: Pioglitazone: Associated with heart failure secondary to renal retention of fluid. D/C or reduce dose if HF is diagnosed. ORAL DIABETIC AGENTS: DPP-4 INHIBITORS. Drugs: Sitagliptin (Januvia), Linagliptin (Tradjenta). Indications: Type 2 diabetes, monotherapy or combined therapy. MOA: Increase insulin release and decrease glucagon. Decrease gluconeogenesis. SE/Adverse effects: pancreatitis, severe hypersensitivity reactions, SJS, angioedema, anaphylaxis (rare), HF, acute renal failure, arthralgia, URI, HA, inflammation of nasal and throat passages. Safety: use caution with other hypoglycemic agents. D2D: sulfonylurea, insulin. Pregnancy/Lactation: limited data, do not use. ORAL DIABETIC AGENTS: SGLT2 INHIBITORS. Drugs: Canagliglozin (inovkana), Dapagliflozin (farxiga). Indications: Type 2 diabetes, weight loss, reduce ESKD. MOA: Increase glucose excretion in urine, lowers circulating glucose. SE/Adverse effects: Genital fungal infections, UTI, increased urination, postural hypotension, dizziness, necrotizing fasciitis of the perineum. Safety: caution in volume depletion. D2D: rifampin, phenytoin, phenobarbital and similar inducers can decrease efficacy. Pregnancy/Lactation: do not use.  GLP-1 RECEPTOR AGONIST. Drugs: Exenatide (Byetta), Exenatide ER (Bydureon), Semaglutide (Ozempic), Liraglutide (Victoza), Dulaglutide (trulicity). Indications: T2DM, weight loss. MOA: activates GLP-1, causing decreased gastric emptying and increased glucose dependent release of insulin, decreased glucagon release. Centrally acting appetite suppression. SE/Adverse effects: GI (N/V, diarrhea), pancreatitis, renal impairment, diabetic retinopathy, acute gallbladder disease. Safety: Caution in renal and liver impairment. D2D: sulfonylureas, insulin, warfarin. Pregnancy/Lactation: do not use. BBW: risk for thyroid C-cell tumors. Contraindicated in MEN2, hx or family hx of MTC.  THYROID REPLACEMENT Drugs: Levothyroxine T4 (Synthroid). Indications: Hypothyroidism. MOA: Synthetic preparation of thyroxine. Converts to active T3. SE/Adverse effects: Thyrotoxicosis with overdose. Fatigue, increased appetite, weight loss, fever, sweating, HA, anxiety, tremors, muscle weakness, dyspnea, diarrhea, abd cramps, hair loss, flushing, decreased BMD, menstrual irregularities. Safety: caution in the elderly and diabetic patients. Contraindicated in uncorrected adrenal insufficiency. D2D: reduced absorption with histamine receptor blocker, PPI, sucralfate, antacids, calcium supplements, iron supplements, magnesium salts. Increased absorption with warfarin, catecholamines. Digoxin, insulin. Special Considerations: Should be given in the morning with water and 30-60 minutes before meals. Check levels 6- 8 weeks after initiating or dose change. Maintain the same brand, if change must be made, check TSH and/or T4 in 6-8 weeks. Pregnancy: Generally safe. (Need increased dosing in pregnancy). BBW: Not for use with weight loss. Large doses can produce serious life-threatening manifestations of toxicity.  TESTOSTERONE REPLACEMENT. Drugs: Topical gels, solutions, patches (Androgel, Adroderm, Axiron), Nasal gel (Natesto), Parenteral: T. Cypionate (Depo- testosterone), T. Enthanthate (Delatestyrl). Indications: Male hypogonadism, replacement therapy, delayed puberty, therapy in menopause, cachexia, anemias, transgender affirming therapy. MOA: Effects mediated by specific receptors in target tissues. SE/Adverse effects: Premature epiphyseal closure, hepatotoxicity, increased LDL, decreased HDL, edema, increased risk for thromboembolic events. Safety: Caution in BPH, polycythemia, known cardiac disease. Contraindicated with known breast or prostate carcinoma and pregnancy. D2D: Insulin, oral anticoagulants, corticosteroids. Special Considerations: Controlled substance schedule 3. Monitor levels 2-3 weeks after initiating and 3-6 months. Children: Males- pubic hair, penile enlargement, increased erections, priapism. Females- pubic hair, clitoral enlargement. BBW: Secondary exposure to gel on skin and unwashed clothing has resulted in virilization in children.  PHOSPHODIESTERASE-5 INHIBITORS (PED-5). Drugs: Sildenafil (viagra), tadalafil (cialis), vardenafil (levitra), avanafil (stendra). Indications: Erectile dysfunction. MOA: Selective inhibition of PDE-5. Local artery dilation, decrease venous outflow. SE/Adverse effects: hypotension, priapism, ischemic optic neuropathy, sudden hearing loss, HA, flushing, intensifies sleep apnea. Safety: Contraindicated in concurrent use of nitrates, Levitra: if on class 1 or 2 antidysrhythmic. D2D: nitrates, ketoconazole, CYP inhibitors can increase levels, grapefruit juice. QT: Levitra- possible risk. Special Considerations: Separate last dose and administration of nitrate by 24 hours. High fatty foods delay absorption. May only be used once daily.  5-ALPHA-REDUCTASE INHIBITORS. Drugs: Finasteride (Proscar), Dutasteride (Avodart). Indications: BPH. Large prostates and mechanical obstruction. MOA: Reduces size of prostate over time. (6-12 months). Improves urinary flow. SE/Adverse effects: Decreased ejaculate volume and libido, gynecomastia. Safety: Can be absorbed through the skin. Do not donate blood while taking medication and up to 6 months after stopping. D2D: Dutasteride- calcium channel antagonist. Special Considerations: May reduce male pattern baldness at low doses in some patients. Pregnancy/Lactation: contraindicated.  ALPHA-1 ADRENERGIC ANTAGONISTS & NONSELECTIVE ALPHA-1 BLOCKERS Drugs: Tamsulosin (flomax), silodosin (rapaflo). Indications: BPH. Smaller prostates and dynamic obstruction. MOA: Causes smooth muscle relaxation in the bladder neck, prostate capsule and prostatic urethra. Improves urinary flow. SE/Adverse effects: Antagonist- Abnormal ejaculation, floppy iris syndrome during cataract surgery. Nonselective- lower BP, dizziness, fainting, somnolence, nasal congestion. Use caution with antihypertensives, nitrates and PDE-5. D2D: CYP inhibitors can increase levels of silodosin and alfuzosin, PDE-5. QT: Alfuzosin- possible risk. Special Considerations: Pregnancy: do not use.  BISPHOSPHONATES. Drugs: Alendronate (fosamax), ibandronate (boniva), risedronate (actonel), zoledronic acid (reclast). Indications: Osteoporosis and GIOP. Prevention and treatment in postmenopausal women. Treatment for osteoporosis in men. MOA: Suppress reabsorption of bone by decreasing the number and activity of osteoclasts. SE/Adverse effects: esophagitis, musculoskeletal pain, ocular inflammation, atypical femur fractures, osteonecrosis of the jaw. Esophageal cancer, hyperparathyroidism, atrial fibrillation. Safety: contraindicated in esophagus abnormalities, inability to stand or sit for longer than 30 minutes, hypocalcemia, hypersensitivity. Can swell in the esophagus. D2D: calcium supplements/antacids, aspirin, NSAIDs. Special Considerations: caution in preexisting mineral absorption issues and long term use. Pregnancy: not enough data/do not use. SELECTIVE ESTROGEN RECEPTOR MODULATORS (SERMs). Drugs: Raloxifene (Evista). Indications: Prevention and treatment of osteoporosis in postmenopausal women and protection against estrogen receptor-positive breast cancer. MOA: Bind to estrogen receptors. Agonist/antagonist effect depending on the tissue. Mimics effect of estrogen on bone, lipid metabolism and blood clotting. SE/Adverse effects: thromboembolic events, fetal harm, weight gain, hot flashes. Safety: Caution in hepatic impairment, use of systemic estrogens, renal impairment and cancer. Contraindicated in active or past thromboembolisms. D2D: cholestyramine, warfarin, diazepam, lidocaine, systemic estrogens, ampicillin, antacids, corticosteroids, digoxin. Special Considerations: D/C for 72 hours before prolonged immobilization. Pregnancy/Lactation: do not use/contraindicated. BBW: increased risk for venous thromboembolic events (DVT and PE). Increased risk of death from stroke when used in postmenopausal women with history or risk for coronary heart disease.  PARATHYROID HORMONE ANALOGS. Drugs: Teriparatide (Forteo). Indications: Treatment of osteoporosis in postmenopausal women, osteoporosis in men, and GIOP. MOA: Increases bone resorption and deposition. Increased GI tract CA absorption. SE/Adverse effects: Nausea, HA, arthralgias, back pain, leg cramps, injection site discomfort. Orthostatic hypotension and dizziness. Safety: Increased risk for urolithiasis, increased risk of cutaneous calcification. D2D: digoxin- risk for toxicity. Pregnancy/Lactation: not enough data/do not use.  LIPASE INHIBITOR. Drugs: Orlistat (Alli, Xenical). Indications: Maintain and promote weight loss in patients 12 and older. MOA: Reduces absorption of fat. 30% reduction in ingested fats. SE/Adverse effects: Oily rectal leakage, flatulence, fecal urgency, fatty or oily stools. Possible liver damage. Acute pancreatitis, kidney stones, vitamin K deficiency. Reduces fat soluble vitamins (ADEK). Safety: Contraindicated in malabsorption syndrome or cholestasis. Use caution in existing impaired liver function. D2D: Levothyroxine(take 4 hours apart), cyclosporine, warfarin (increased risk for bleeding). Special Considerations: Must adopt a reduced calorie diet in which 30% of calories come from fat. Pregnancy: Do not use.  SYMPATHOMIMETIC AMINES: Drugs: Diethylpropion, Phentermine (Adipex-P, Lomaira). Indications: Short term weight loss (3 months or less). MOA: CNS stimulant, suppresses appetite. SE/Adverse effects: Nervousness, insomnia, HTN, tachycardia, dry mouth, constipation. Safety: contraindicated in CV disease, arrhythmias, CHF, uncontrolled HTN, hyperthyroidism, glaucoma, agitated states, pulmonary HTN, valvular heart disease. D2D: MAOI within 14 days, alcohol, insulin and oral hypoglycemics. QT: Special risk for patients with congenital long QT. Special Considerations: Do not co-administer with other drugs for weight loss. Administer before 4pm, Schedule 4 controlled substance. Pregnancy: Do not use.  ANTICONVULSANT, SYMPATHOMIMETIC: Drugs: Phentermine/topiramate (Qsymia). Indications: chronic weight loss therapy. MOA: Suppress appetite and promote satiety. SE/Adverse effects: Elevated HR, BP, blurred vision, dry mouth, altered taste, constipation, hypoglycemia in patients with DM. Safety: Contraindicated in glaucoma and hyperthyroidism. Use caution in hepatic impairment and HTN. D2D: MAOIs, CNS depressants. Carbamazepine & Phenytoin increase topiramate levels, combined oral contraception, non potassium sparing diuretics. QT: special risk for patients with congenital long QT. Special Considerations: schedule 4 controlled substance. Pregnancy: Do not use.  ANTIDEPRESSANT, DOPAMINE/NOREPINEPHRINE-REUPTAKE INHIBITOR, OPIOID ANTAGONIST: Drugs: Naltrexone and bupropion (Contrave). Indications: Promoting and maintaining weight loss. MOA: Decrease appetite. Exact mechanism unknown. SE/Adverse effects: N/V, headache, insomnia, dizziness, dry mouth, constipation, fatigue. Safety: Contraindicated in seizure disorders, eating disorders, alcohol, barbiturate or benzodiazepine withdrawal. Use caution in uncontrolled HTN, chronic opioid use. D2D: MAOI within 14 days, bupropion, opioid antagonist. Pregnancy: Do not use. BBW: Associated with increased risk for suicidal ideation and attempts in children, adolescents and young adults. -When given concurrently with other bupropion medications, severe neuropsychiatric reactions, including depression, mania, psychosis and homicidal ideations have occurred.  GLP-1 RECEPTOR AGONIST: Drugs: Liraglutide (saxenda, victoza), Semaglutide (Wegovy). Indications: Weight loss. MOA: Promotes satiety, slows gastric emptying. SE/Adverse effects: N/V, elevated HR, hypoglycemia in patients with DM. Safety: caution in hx of pancreatitis, renal impairment, cholecystitis. D2D: hypoglycemic agents, androgens, fluoroquinolone antibiotics, MAOIs, SSRIs. Pregnancy: do not use. BBW: Risk for thyroid C-cell tumors. Contraindicated in multiple neoplasia syndrome type 2, or hx of medullary thyroid carcinoma.  DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs): Drugs: Methotrexate (Trexall) Indications: RA, psoriasis, acute lymphoblastic leukemia, polyarticular juvenile idiopathic arthritis. MOA: Decrease activity of B and T lymphocytes leading to immunosuppression. SE/Adverse effects: Hepatic fibrosis, bone marrow suppression, GI ulceration, pneumonitis. Safety: hepatic compromise, immunosuppressed. Contraindicated with live vaccines. D2D: Alcohol, other hepatotoxic drugs, vaccines. Special Considerations: Elderly are at greater risk for infection secondary to immunosuppressive effects. Pregnancy: Do not use. BBW: Cause numerous and potentially fatal toxicities of the bone marrow, liver, lungs, and kidneys. Other fatalities associated with skin reactions d/t hemorrhagic enteritis and gastrointestinal perforation.  CONVENTIONAL SYNTHETIC (csDMARDs): Drugs: Leflunomide (Arava). Indications: Active RA MOA: Prodrug, converted to metabolite 1, inhibits T-cell proliferation and decreases inflammation. SE/Adverse effects: Diarrhea, respiratory infection, alopecia, rash, SJS, peripheral neuropathy, HTN, hepatotoxicity. Safety: hepatic compromise, immunosuppressed. D2D: NSAIDs-increase levels, other hepatotoxic drugs, rifampin, cholestyramine and activated charcoal. Pregnancy: contraindicated.  CONVENTIONAL SYNTHETIC (csDMARDs): Drugs: Sulfasalazine (Azulfidine), Hydroxychloroquine (Plaquenil). Indications: RA, IBS. Adjunct to methotrexate, antimalarial. MOA: Exact mechanism unknown. May attenuate local mediators of inflammatory response. Thought to decrease movement of neutrophils and eosinophils. SE/Adverse effects: N/V, diarrhea, anorexia, abdominal pain, pruritus, rash, urticaria, fatal dermatologic SJS. Retinal damage, cardiac problems, some fatal. Safety: hepatic compromise, immunosuppressed. QT: Hydroxychloroquine- known risk of TdP. Pregnancy: do not use.  BIOLOGIC DMARDs: TNF-INHIBITORS. Drugs: Rituximab (Rituxan), Etanercept (Enbrel), Adalimumab (Humira), Inflixmab (Remicade). Indications: RA, also used for inflammatory disorders like psoriatic arthritis, Crohn's, ankylosing spondylitis. MOA: Suppress inflammation. SE/Adverse effects: Lymphoma and other malignancies in children and adolescents, injection side reactions, headache, rhinitis, dizziness, cough, abdominal pain, serious infections, severe allergic reactions, HF, hematologic disorders, liver injury, CNS disorders. Safety: Contraindicated in live vaccines and immunosuppression. D2D: glucocorticoids, methotrexate. Pregnancy: Do not use. BBW: Increased risk for developing serious infection and sepsis.  TARGETED SYNTHETIC DMARDS/JANUS KINASE INHIBITORS: Drugs: tofacitinib (xeljanz), Baricitinib (olumiant). Indications: Moderate to severe RA not responsive to methotrexate. Psoriatic arthritis, ulcerative colitis. MOA: reduce inflammatory responses. SE/Adverse effects: Infection, bone marrow suppression, GI perforations, liver injury, hyperlipidemia, increased occurrence of malignancies. D2D: CYP inducers/inhibitors, vaccines. Pregnancy: Contraindicated. Do not use. BBW: Increase risk for infections.  ORAL GLUCOCORTICOIDS: Drugs: Prednisone, prednisolone, methylprednisolone, betamethasone, dexamethasone. Indications: RA, SLE, inflammatory disorders, allergic reactions, dermatological conditions. MOA: Anti-inflammatory and immunosuppressive effects. SE/Adverse effects: toxicity with long term therapy, GI bleeding, infection, hyperglycemia, growth delay, cataracts and glaucoma, peptic ulcer disease, Cushing’s disease, adrenal suppression. Safety: Caution in pediatric, breastfeeding, HTN, renal impairment, HF, DM, osteoporosis, gastritis, treatment resistant infection, glaucoma. D2D: NSAIDs, insulin, digoxin, potassium sparing diuretics, oral hypoglycemics. Pregnancy: Not enough data, do not use.