6024 pharm exam 3 mods.pdf

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 Decre...

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 AEs GI: N/V/D; abd pain Vitamin B deficiency Lactic acidosis (RFs: eGFR < 30, alcohol, liver dz, acute HF, contrast dye procedures, past hx of acidosis GI: N/V/D Pancreatitis Gallstones Bowel obstruction/worsening gastroparesis AKI BBW–thyroid c cell tumors in rats Medullary thyroid carcinoma GU infections/necrotizing fasciitis of the genitals Dehydration Hypotension Leg infection/amputation? DKA (RF: fasting, alcohol, stress, etc.) Hypoglycemia Weight gain Sulfa allergy Hypoglycemia Weight gain Pancreatitis Severe joint pain Heart failure risk -weight gain -edema -fractures -liver toxic -bladder CA? GI: gas; diarrhea 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 -CrCl < 30 -elderly -adrenal insufficiency Heart failure BBW–heart failure CKD Cirrhosis IBD Malabsorption syndrome Monito r -renal/liver -B12 -A1C Renal A1C A1C Renal Volume status/BP A1c Renal A1c Renal A1c renal/liver Liver A1c 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 Dc if starting insulin Dosed TID with first bite of each meal (has a diuretic effect so that’s why it’s great for CHF) Take with breakfast d/c if starting insulin Cam take Q other day for GI AEs