SCF Level 2 Exam 3 Drugs Questions and Answers 100% Verified

Metformin Biguanide Adverse Effects - lactic acidosis; most are minor & GI related: N/V/D, abdominal pain, metallic taste, headache. Monitor fasting & postprandial glucose, HbA1c, Hepatic & renal failure Black Box: has been associated w/potentially fatal lactic acidosis Regular insulin (Humulin R, Novolin R) Uses - Short acting, Clear solution, given 15 min before a meal, Parenteral drug for DM; Also emergency management of ketoacidosis Regular insulin (Humulin R, Novolin R) Adverse Effects - Hypoglycemia, irritation of injection sites, lipohypertrophy-accumulation of extra fat at the SQ site Regular insulin (Humulin R, Novolin R) Contraindications - renal or hepatic impairment, thyroid disease, older adults. Pregnancy, hypokalemia Regular insulin (Humulin R, Novolin R) Drug/Drug Interactions - ETOH, MAOI, salicylates, corticosteroids, thyroid hormone, Beta Blockers, Furosemide, Hydrochlorothiazide (HCTZ), Oral Antidiabetics, garlic, ginseng (everything but cortisol will increase the effects of insulin Regular insulin (Humulin R, Novolin R) Special Comments - Do not inject cold insulin, Monitor: Fasting & postprandial glucose, HbA1C, Carry some form of fast acting carbohydrate, "Only type of given via IV" Regular insulin (Humulin R, Novolin R, ReliOn N) Action/Onset/Peak/Duration - Onset 30-60 min, Peak 2-4 h. Duration 5-7 h. Metabolized Liver 2% excreted in urine; Excreted: Kidney. Glyburide MOA - (Sulfonylureas) Stimulate the release of insulin from pancreatic islet cells. Increases the sensitivity of insulin receptors on target cells. Used in Type II. 1st oral hypoglycemic agent available. NOT for TYPE I Glyburide Adverse Effects - (Sulfonylureas) Most common hypoglycemia, heartburn, N/V, Pruritusitching, Weight gain, blurred vision, hepatoxicity. Alcohol, Oral anticoagulants, MAOI's, clarithromycin, thiazides, garlic, ginsengGlyburide Contraindications - (Sulfonylureas) DM Type 1, renal or hepatic impairment, thyroid disease, elderly, children, pregnancy, allergy to sulfonamides, major surgery/severe infection Glyburide Action/Onset/Peak/Duration - (Sulfonylureas) Metabolized in Liver, Excreted in Urine & Feces Onset: 15-60 min. Peak 1-2 h. Duration up to 24 h. so WATCH BS the entire day. Dose is 2.5 mg daily, titrate up to max dose of 20 mg/day divided into 10 mg am & 10 mg pm Metformin Biguanide Use - Treat DM Type 2 to reduce blood glucose, can be used in children, also comes in extended=XR, it helps the body use its own insulin better. Off label, use is polycystic ovarian syndrome Regular insulin (Humulin R, Novolin R) MOA - Lowers blood glucose by stimulating peripheral glucose uptake by skeletal muscle & fat & inhibiting glucose production by the liver. Short-acting insulin to quickly decrease blood glucose Metformin Biguanide Doses - Adults start at 500 mg PO daily, titrate to max dose of 2550 mg/daily in divided doses. Check labs every 3 mo. an A1C and fasting glucose level. Metformin Biguanide Contraindications - Acute MI, diabetic ketoacidosis, renal or liver impairment, sepsis, dehydration, pregnancy, hold for 48 h. before & after the contrast dye administration Metformin Biguanide Drug/Drug - ETOH, Captopril, Lasix, nifedipine, vancomycin, digoxin, morphine, decreases b12 & folic acid, Sitagliptin MOA - Slows the breakdown of incretins-(this is a hormone secreted in the small intestine in response to elevated BG levels it signals the pancreas to secrete insulin & the liver to stop production of glucagon, incretin potentiates the feeling of fullness, slows gastric emptying). (e.g. GLP-1 by inhibiting DPP-4) (Incretin Enhancer DPP-4 inhibitor) Sitagliptin Contraindications - DMI, renal impairment, elderly, history of pancreatitis, pregnancy, kids. Give PO without regards to meals. (Incretin Enhancer DPP-4 inhibitor)Sitagliptin Uses - Treatment of DM2 (Incretin Enhancer DPP-4 inhibitor) Sitagliptin Adverse Effects - Slight risk hypoglycemia, acute pancreatitis, Upper respiratory Infection (URI), Interaction: Increases digoxin levels. Watch dig levels while on this med. (Incretin Enhancer DPP-4 inhibitor) Sitagliptin Special Notes - Monitor baseline & periodic renal function, fasting & postprandial glucose, AC1. (Incretin Enhancer DPP-4 inhibitor) Exenatide MOA - increases insulin release decreases glucagon release & slows gastric emptying. (Incretin Mimetics GLP-1 Agonists) Exenatide Uses - is used in adjunct therapy or monotherapy for pt w/type 2 diabetes, increases insulin release, derived from a hormone that is produced in the small intestine has been found deficient in type 2 diabetics. (Incretin Mimetics GLP-1 Agonists) Exenatide Adverse Effects - hypoglycemia with other diabetic medications but not by itself will not cause hypoglycemia mixed w/Glyburide it can, GI (n/v/d/c): excessive sweating, injection site reaction. (Incretin Mimetics GLP-1 Agonists). Black Box: Risk of thyroid tumor Exenatide Contraindications - May decrease rate of absorption of oral meds requiring GI absorption due to slow gastric emptying, increased risk of hypoglycemic w/other insulin products. (Incretin Mimetics GLP-1 Agonists) Exenatide Special Comments - decreases glucagon release & slows gastric emptying. Do not administer after a meal; give SQ 60 minutes before am and evening meals. Only type 2 diabetic injectable medication. Risk of thyroid tumor. (Incretin Mimetics GLP-1 Agonists) Glucagon MOA - It is a hormone produced by alpha cells secreted by pancreatic that stimulates the liver to breakdown glycogen the stored glucose; an antagonistic hormone to insulin. Give IM, or SQ, or orally. In an emergency situation when the pt can't swallow. Anti-hypoglycemicGlucagon Adverse Effect - Hyperglycemia, Anti-hypoglycemic Finasteride (Proscar) MOA - 5-alpha reductase inhibitor, blocks conversion of testosterone to one of its metabolites (5 Alpha dihydrotestosterone) which can cause enlargement of prostate. Promotes shrinkage of prostate which restores urinary function. absorption: GI tract, elimination: urine & feces Finasteride (Proscar) Indications - BPH(benign prostate hyperplasia) may take 3-6 months of therapy to achieve the effect, monitor PSA, post-void residual