pharm cases Flashcards
case 1: 55 y/o woman with new onset T2DM. She is on no medication yet for her T2DM. HTN, obesity, T2DM. Lisinopril 10 mg daily. 61 inches 210 BMI 40. A1c 8.5, eAG 197.
2 DOC options? 3 options
DOC 1 options:
- metformin
- sulfonylurias
- insulin
DOC2: Atorvastatin since on ACE
what should you make sure to do when starting someone on metformin? why?
titrate up gradually to avoid MASSIVE DIARREAH
what is a SE of metformin?
extreme diarreah
what will most people with diabetes be on? 3
statin
ACE/ARB
metformin
what should you add if someone has cardiovascular disease?
ASA 81 mg
some people argue that HTN is enough for a cardiac issue that this is warrented but there is controversy around this
what is the inital DOC for T2DM?
metformin
what is the drug class for metformin?
biguanides
what is the MOA of metformin? 6 things
- decrease hepatic glucose production
- decrease renal gluconeogensisi
- slow intestinal absorption of glucose
- increase tissue glycolysis
- increase glucose removal from blood
- decrease serum glucagon levels
what is something that metformin can cause?
blockade of hepatic gluconeogenesis impairs renal clearance of lactic acid
leads to lactic acidosis in renal insufficiency
what do you need to do if someone is taking metformin and needs CT contrast?
hold the metformin for 48 hours
a person with T2DM at the time of dx has had this for how long?
10 years….thats how long it has been unknown for
what are the two sulfonylureas?
- glipizide
2. repaglinide
what is the drug class for glipizide?
2nd generation sulfonylureas
what is the MOA of glipizide?
stimulates pancreatic Beta cells release of insulin
what drug when txing diabetes do you need to be careful in sulfa allergy?
glipizide
what is the drug class for repaglinide?
meglitinides
Non-sulfonulurea secretagogue
what is the MOA of repaglinide?
binds to the sulfonylurea receptor on the Beta cell sto stimuate insulin release
which of the sulfonylureas would you want to use in someone that has a sulfa allergy?
repaglinide
what is the name of the rapid acting insulin?
Lispro
what is the name of the short acting insulin?
regular
how long does it take for the rapid acting insulin to work?
5-15 minutes
what is the name of the intermediate-acting insulin?
neutral protamine
what are the names of the long acting insulin?
insulin glargine
what are the two concentrations that insulin glargine comes in?
300 and 100