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Pharmacy Practice V > Endocrine Material Exam Two > Flashcards

Endocrine Material Exam Two Flashcards

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1
Q

Metformin/Glumetza XR

Improved insulin sensitivity, lower hepatic production and GI absorption

A

Biguanide
CI: severe renal function eGFR <30
Warning: Lactic Acidosis, Somnolence, Malaise, Myalgia, & Respiratory Distress
DO NOT initiate if eGFR 30-45 mL/min
AE: Diarrhea
PC:
1. Take with food
2. Titrate dose
3. Use XR formulation
Dose: 1000-2550 mg

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2
Q

Titration Schedule for Metformin

A

Week 1: 500 mg QD
Week 2: 500 mg BID
Week 3: 500 mg AM, 1000 mg PM
Week 4: 1000 mg BID

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3
Q

SGLT2 Inhibitors

Decrease reabsorption of filtered glucose, increase excretion

A

Invokana, Farxiga, Jardiance, and Steglatro
CI: dialysis patients
Warning: volume depletion, bone fractures, lower limb amputation
AE: INCREASED urination and UTI infections
PC: keep genital area clean
Dosing: PO QD

You must consider an SGLT2 if the patient has PMH f HF, FM, or CKD

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4
Q

What are the dose adjustments for SGLT2 Inhibitors?

A

Invokana eGFR <30
Farxiga eGFR <45
Jardiance eGFR <30
Steglatro eGFR <45

These eGFR = not recommeneded to utilize SGLT2 specificites

Invokana eGFR 30-60 recommend dose ADJUSTMENT

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5
Q

What are the Landmark trials for Canagliflozin?

A

CANVAS = cardiovascular
CREDENCE = renal

Invokana

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6
Q

What are the Landmark trials for Empagliflozin?

A

EMPA-REG = cardiovascular
EMPEROR Reduced/Preserved = HF

Reduced = HFrEF Preserved =HFpEF Jardiance

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7
Q

What are the Landmark trials for Dapagliflozin?

A

DAPA-HF = HF
DAPA-CKD = renal

Farxiga

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8
Q

GLP-1 Receptor Agonist

Increase insulin secretion by beta cells

Decreasee glucagon, gastric emptying, and increased satiety

A

Byetta, Victoza, Adlyxin, Trulicity, Ozempic, and Mounjaro
CI: Medullary Thyroid Carcinoma
Warning: Pancreatitis
AE: Nausea/Diarrhea/HA
PC:
1. Nausea will likely subside over time
2. SUBQ

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9
Q

Byetta/Exenatide

A

GLP-1 Agonist
SQ BID
Starting Dose: 5 mcg
Max Dose: 10 mcg
CI: CrCl <30
PC: Administer within 60 minutes prior to AM/PM meal

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10
Q

Victoza/Liraglutide

A

GLP-1 Agonist
SQ QD
Starting Dose: 0.6 mcg
Max Dose: 1.8 mcg
Landmark Trial: LEADER

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11
Q

Adlyxin/Lixisenatide

A

GLP-1 Agonist
SQ QD
Starting Dose: 10 mcg x 14 days
Max Dose: 20 mcg on day 15

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12
Q

Trulicity/Dulaglutide

A

GLP-1 Agonist
SQ Once Weekly
Starting Dose: 0.75 mg
Max Dose: 4.5 mg
Landmark Trial: REWIND

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13
Q

Ozempic/Semaglutide

A

GLP-1 Agonist
SQ Once Weekly
Starting Dose: 0.25 mg
Max Dose: 2 mg
Landmark Trial: SUSTAIN 6

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14
Q

Mounjaro/Tirzepatide

A

GLP-1 Agonist
SQ Once Weekly
Starting Dose: 2.5 mg
Max Dose: 15 mg

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15
Q

What are the GLP 1 Receptor Agonists used for Weight Loss?

A

Saxenda/Liraglutide: SQ QD, titrate weekly to target dose 3g QD
Wegovy/Semaglutide: SQ once weekly, titrate q4 wks to maintenance dose of 2.4 mg once weekly

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16
Q

DDP-4 Inhibitors

A

Januvia, Onglyza, Tradjenta, and Nesina
Warning: pancreatitis, renal impairment
AE: HA
Dosing: PO QD

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17
Q

What are the dose adjustments for DDP-4 Inhibitors?

A

Januvia eGFR <45
Onglyza eGFR <45 or Strong CYP 3A4 Inhibitors
Tradjenta NONE
Nesina eGFR <60

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18
Q

Insulin Secretagogues

A

Sulfonylurea: Amaryl, Glucotrol, Diabeta
Meglitinides: Prandin and Starlix
CI: T1DM, sulfa allergy
Warning: HYPOglycemia, renal/hepatic dysfunction
DDI: BB = mask s/s of hypoglycemia
AE: weight gain
PC: when to administer in relation to meals

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19
Q

Amaryl/Glimepiride

A

PO QD with Breakfast
Titrate Q1-2 wks; intermediate acting
Consider lower dose and slow titration w/ eGFR <60

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20
Q

Glucotrol/Glipizide

A

PO QD/BID
Take 30 minutes pre-meal; titrate Q1-2 wks
Start lower dose and slow titration with eGFR <50

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21
Q

Diabeta or Micronase/Glyburide

A

PO QD with Breakfast
Titrate Q1-2 wks
NOT recommended with eGFR <60

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22
Q

Prandin/Repaglinide

A

TID with meals
Take 30 minutes pre-meal; titrate weekly
Start lower dose and slow titration with eGFR <40

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23
Q

Starlix/Nateglinide

A

TID with meals
Take 30 minutes pre-meal; titrate weekly
Start lower dose with eGFR <30

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24
Q

Thiazolidinediones

A

Actos and Avandia
CI: T1DM, Patients with Class III or IV HF
Warning: hepatic dysfunction
AE: Edema, Weight Gain
PC: S/S of fluid retention
Dosing: QD
Titrate Q3 months

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25
Precose/Acarbose
MOA: Decreased GI carbohydrate absorption CI: IBD, GI disorders Warning: increased LFTs AE: Flatulence PC: TID, PO w/meals Dosing: Take with first bite of food Titrate Q4-8wks; skip if meal is missed
26
Symlin/Pramlintide
MOA: Synthetic analog of amylin to delay gastric emptying, decrease post-prandial glucagon secretion, suppressed appetite CI: Gastroparesis DDI: meds that impair gastric motility AE: nausea, hypoglycemia PC: SC injection, TID with meals Dosing: Administer in thigh of abdomen
27
Insulin AE
1. Hypoglycemia 2. Injection site skin reactions 3. Weight gain
28
Insulin PC
1. PRIME PEN before each use
29
Insulin Glargine U-100
Lantus/Basaglar/Semglee Reduce total dose by 20% if transferring FROM BID NPH or QD Toujeo to Lantus/Basaglar/Semglee Typically given QD in the evening or before bed Discard after 38 days at room temp
30
Insulin Glargine U-300
Toujeo Discard after 56 days at room temp
31
Insulin Detemir
Levemir QD or BID Give 1:1 if transferring FROM another basal insulin to Levemir Discard after 42 days at room temp
32
Insulin Degludec U-100 or -200
Tresiba Flextouch Longer acting than glargine or detemir Discard after 56 days at room temp
33
Insulin Glargine/Lixisenatide
Soliqua QD, administer within 1 hour before first meal Initial dose based on current basal insulin dose Titrate by 2-4 units weekly Max: 60 units GLP1 agonist or insulin NAIVE = 15 units Basal Insulin <30 units/day = 15 units Basal Insulin 30-60 units/day with or without GLP1 = 30 units
34
Januvia/Sitagliptin
QD Dose Adjust: eGFR <45 mL/min
35
Onglyza/Saxagliptin
QD Dose Adjust: eGFR <45 mL/min or with Strong CYP 3A4 inhibitors
36
Tradjenta/Linagliptin
QD No dose adjustment recommended for renal impairment
37
Nesina/Alogliptin
QD Dose Adjust for CrCl <60 mL/min
38
Invokana/Cangliflozin
QD Dose Adjust for eGFR <60 mL/min; not recommended <30 mL/min for DM Titrate after 4-12 wks if needed for DM
39
Farxiga/Dapagliflozin
QD Not Recommended for eGFR <45 for DM Titrate after 4-12 wks if needed for DM
40
Jardiance/Empagliflozin
QD Not Recommended for eGFR <45 Titrate after 4-12 wks if needed
41
Steglatro/Ertugliflozin
QD Not Recommended for eGFR <45 Titrate after 4-12 wks if needed
42
Symlin/Pramlintide
SQ Pre-Meal, prior to major meals Reduce meal time insulin dosage as instructed
43
Insulin Lispro/Protamine Suspension
Humalog 75/25 or 50/50 Administer 15 minutes before morning and evening meals
44
Insulin Lispro U-100 or -200
Humalog/Ademlog Administer 15 minutes pre-meal Discard after 28 days at room temp
45
Regular/Isophane NPH Insulin
Humulin 70/30 or 50/50 Administer 30 minutes before morning and evening meals
46
Isophane NPH Insulin
Humulin N Intermediate Acting QD or BID Cloudy
47
Regular Insulin U-100 or -500
Humulin R Administer 30 minutes pre-meal Do NOT mix U500 with another insulin U-100: discard after 31 days at room temp U-500: discard after 40 days at room temp Discard ANY PEN after 28 days at room temp
48
Insulin Aspart/Protamine
Novolog Mix 70/30 Administer 15 minutes before morning and evening meal
49
Insulin Aspart
Novolog/Fiasp Administer 15 minutes pre-meal Discard after 28 days at room temp
50
Insulin Gluisine
Apidra Administer 15 minutes pre-meal Discard after 28 days at room temp
51
Regular Human Insulin Inhaled
Afrezza CI: Asthma and COPD Administer at beginning of the meal 1. Unopened in frig = date on package 2. Open foiled pack but sealed blister = discard 10 days 3. Opened blister= discard 3 days
52
Synthroid/Levothyroxine
<60 yrs w/o CVD: 1.6 mcg/kg/day >60 yrs w/o CVD: 25-50 mcg/day With CVD: 12.5-50 mcg/day Titrate by 12-25 mcg/day Q6-8wks based on clinical response and thyroid function panel Take at least 30-60 minutes before food
53
Tapazole
Methimazole MMI Hyperthyroidism NOT preferred in pregnancy, PTU is preferred agent Monitor CBC and LFTs
54
From Toujeo to Lantus/Basaglar/Semglee
Reduce total dose by 20%
55
From Lantus/Basaglar/Semglee to Toujeo
Give total dose 1:1
56
Another basal insulin to Levemir
Give total dose 1:1
57
Levemir to Insulin Glargine
Reduce total dose by 10-20%
58
Another basal insulin to Tresiba
Give total dose 1:1
59
Another basal insulin to NPH
Reduce total dose by 20%
60
Twice Daily NPH to Lantus/Basaglar/Semglee/Toujeo
Reduce total dose by 20%
61
NPH to Levemir
Give total dose 1:1

Pharmacy Practice V (19 decks)

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