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4 categories of endocrine system drugs
- Pituitary hormones
- Adrenal Corticosteroids
- Thyroid agents
- Antidiabetic agents
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refers to an internal secretion (hormone) produced by a ductless gland that secretes directly into the bloodstream
Endocrine
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_____ is located at the base of the brain and is called the Master Gland
Pituitary Gland
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why is the pituitary gland called the master gland?
because it regulates the function of other glands
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what hormones does the pituitary gland secrete?
- Thyroid stimulating hormone
- Adrenocorticotropic Hormone
- Gonadotropic Hormone
- Somatotropin Hormone
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the anterior pituitary lobe hormone that is called the human growth hormone?
somatotropin hormone
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the hormone that regulates growth
somatotropin
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who can only be the one to treat growth abnormalities?
endocrinologists
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is only available for parenteral use as corticotropin
adrenocorticotropic hormone
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a synthetic peptide of adrenocorticotropic hormone that is used for diagnosis of adrenocortical insufficeincy
cosyntropin (cortrosyn)
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where are the adrenal glands located?
adjacent to the kidneys (they lay on top)
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what type of hormone do the adrenal glands secrete?
corticosteroids
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____ act on the immune system to suppress the body's response to infection or trauma. relieves inflammation, reduces swelling, and supresses symptoms
corticosteroids
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2 categories of corticosteroids
- 1. replacement therapy
- 2. antiinflammatory/immunosupressant
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is used as a short term therapy and localized to prevent system effects. is also not a curative, but used as a supportive therapy with other meds
corticosteroids
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prolong use of this can cause suppresion of the pituitary gland
corticosteroids
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what can be given if corticosteroids is needed for an extended time period?
give intermediate acting corticosteroids with alternate day therapy
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1. allergic reactions (poisoning,bites)
2. acute flare-ups of rheumatic or
collagen disorders (inflamed joints, decreased crippling)
3. acute flare ups of severe skin conditions
4. acute respiratory disorders
5. malignancies (luekemia, lymphoma, hodgkins disease)
6. Cerebral edema
7. organ transplant (to prevent rejection)
8. life threatening shock
9. acute flare ups
are all conditions treated with?
corticosteroids
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abrupt withdrawal of ______ can lead to acute adrenal insufficiency, shock, death
corticosteroids
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SE:
-delayed wound healing, increased susceptibility to infection
-muscle pain/weakness
-osteoporosis w/ fractures (esp. in older women)
-stunted growth in children
-endocrine disorders
-gastric/esophageal irritation
-CNS effects
-petechiae, bruising, skin thinning
-fluid & electrolyte imbalances (edema/fluid retention)
corticosteroids
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CI: -hypothyroidism/cirrhosis
-emotional instability
-glaucoma
-HTN/DM
corticosteroids
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PE:
-take oral meds during/immediately after meals to reduce gastric irritation, but not near bedtime
-antacids or asprin should be avoided
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corticosteroids
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live virus vaccines/toxoids (inhibits antibody response)
corticosteroids interaction
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thyroid agent medications
- levothyroxine
- liothyronine
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____ absorbs all iodine in blood
thyroid
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______ are released from pituitary gland when levels are low
TSH (thyroid stimulating hormone)
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TSH promotes biosynthesis & secretion of 2 bioactive thyroid hormones called
- thyroxine (T4)
- triiodothyronine (T3)
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is the major product of the thyroid gland & much is later converted into T3 form
Thyroxine (T4)
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causes slow metabolism w/ symptoms of fatigue, dry skin, thinning hair, weight gain
hypothyroidism
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treatment for hypothyroidism
replacement therapy
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hypothyroid conditions requiring replacement therapy include:
- *myxedema
- *Haskimoto's
- *cretenism
- *pituitary disorders
- *thyroid destruction after surgery/radiation
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how is hypothyroidism diagnosed?
through blood tests before medication is given
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toxic effects are the result of overdosage of thyroid and are manifested in the signs of ______
hyperthyroidism
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toxic effects of ________ include:
-palpations, cardiac arrhythmias, tachycardia
-nervousness, insomnia, HA
-weight loss, diarrhea
-intolerance to heat, fever, sweating -menstrual irregularities
-exopthalmos (bulging eyes)
thyroid medication
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CI:
-cardiovascular disease
-elderly
-adrenal insufficiency
-DM
-normal thyroid function (euthyroid)
thyroid meds
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IA:
-oral coagulants (potentiate)
-insulin & hypoglycemics (dosage required)
-adrenergic effects w/ epinephrine (potentiates) WATCH CLOSELY!
-estrogen, bcp (decrease thyroid response)
-soy products (decrease response)
-calcium/iron/magnesium salts (decrease absorption, space several hours apart)
thyroid meds
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PE:
-meds taken for life
-take on empty stomach 30-60 mins prior to breakfast
-periodic lab test to determine effectiveness & dosage
thyroid meds
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hypothyroidism is the reult of the thyroid not making enough _____
thyroxine
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hyperthyroidism is when the body makes _____ thyroxine
too much
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_______ used to relieve symptoms of hyperthyroidism in preparation for surgical & radioactive iodine therapy
- antithyroid agents
- (Methimazole & propylthiouracil (PTU)
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SE (rare):
-rash, pruritus, urticaria
-blood dysrasias (esp. agranulocytosis)
antithyroid agents
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CI:
-prolonged therapy
-pts who are older than 40 y.o.
-hepatic disorders
antithyroid meds
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IA:
-drugs that cause agranulocytosis (potentiate)
antithyroid meds
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PE:
-inform physician if any signs of illness (chills, rash, sore throat)
antithyroid agents
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used to lower blood glucose levels in those with impaired metabolism of carbs, fats, and proteins
antidiabetic agents
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characterized by destruction of pancreatic beta cells
DM type 1
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characterized by insulin resistance and deficeincy
DM type 2
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___ was formally described as juvenile diabetes
DM I
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most common form of diabetes (90-95%)
DM II
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DM II is increasing in earlier ages due to?
obesity
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what is the result of poorly controlled diabetes?
vascular injury (micro/macrovascular)
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microvascular complication includes:
- retinopathy
- nephropathy
- nueropathy
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macrovascular complications include:
- coronary artery disease (MI)
- cerebrovascular disease (stroke)
- peripheral vascular disease
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why is insulin required for type 1 diabetes?
for replacement therapy bc of insufficient production of insulin
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why is insulin required for type 2 diabetes?
required for those who have failed to maintain blood glucose
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____ is used in the emergency treatment of diabetic ketoacidosis or coma
insulin regular
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how is insulin administered?
parenterally
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why is insulin administered parenterally?
bc the GI tract will destroy it
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2 types of injected insulin
1. biosynthetic insulin - amino acid structure
2. analog - manmade
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types of insulins
- rapid
- short
- intermediate
- long
- mixtures
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how are biosynthetic adn analog insulins created
recombinant DNA technology
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in a 100 unit ml insulin syringe how much does each line represent
2 units
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in a 50 unit ml insulin syringe how much does each line represent
1 unit
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what type of insulin can ONLY be given intravenously and intramuscularly?
regular insulin
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what types of insulin are clear and ultra rapid acting with a short duration?
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what types of insulins can be given subcutaneously?
all others EXCEPT regular insulin
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what is an intermediate acting insulin?
isophane (NPH)
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what are long acting insulins?
- glargine (lantus)
- detemir (levemir)
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regular insulin can sometimes be combined with _______ in the same syringe
isophane (humulin N/novolin N)
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if two insulins are ordered at the same time, what must be done first?
draw up the regular insulin in the syringe first
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what types of insulin should no tbe mixed with any other types of insulin?
glargine and other mixtures
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this is sometimes ordered as a corrective action insulin
regular insulin
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what must be done to prevent one of the most common and most dangerous medication error?
crosscheck physician orders and verify with another caregiver
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elevated blood glucose is also known as
hyperglycemia
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undiagnosed diabetes
insufficient insulin dose
infections
surgical or other trauma
emotional stress
endocrine disorders
pregnancy
can all be a result of:
hyperglycemia
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Symptoms of _____: polydipsia/polyuria
excessive sweating
fruity breath
weight loss, anorexia
lethargy
vision proglems
ketoacidosis
hyperglycemia
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treatment of acute hyperglycemia
IV fluids to correct electrolyte imbalance with regular insulin added
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lowered blood glucose is also known as
hypoglycemia
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loss of consciousness
irritability
tachycardia
pallor, hunger, N/V
may result from:
hypoglycemia
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treatment for conscious hypoglycemia
- 1st – administer 4 oz. oj,candy,honey
- 2nd – provide protein snack
- 3rd – recheck blood glucose
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treatment for comatose hypoglycemia
1st – administer 10-30 mL of 50% dextrose IV or -1 unit of glucagon (1mg) IM or IV
2nd – follow w/ carb snack when pt awakens
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what is the somogyi effect?
a rebound effect of hypoglycemia overdose resulting in hyperglycemia
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how are oral anitdiabetic medications administered?
1. single dose before breakfast
or
2. 2 divided doses before morning and evening meals
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what is a principal therapy for DM II management?
weight reduction and modified diet
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oral hypoglycemic drugs are also known as:
sulfonylureas
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chlorpropamide & tolbutamide are what generation solfonylureas?
1st
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glipizide & glyburide are what generation solfonylureas?
2nd
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____ work by increasing insulin production from the pancreas and by imporving peripheral insulin activity
sulfonylureas
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major side effect of sulfonylurea
hypoglycemia
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only insulin administered IV, IM and SubQ
regular
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side effect of sulfonylureas, biguanides, and alpha-glucosidase inhibitors
GI Effects
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stimulates pancreas beta cells to produce insulin
meglitinides
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oral hypoglycemic drugs consisting of first-generation agents
sulfonylurea
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therapy for an allergic reaction to poison ivy
corticosteroid
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should be done to insulin injection sites
rotation
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hormone used for diagnosis of adrenocortical insufficiency
adrenocorticotropic
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if possible, corticosteroids are administered this way
locally
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time that opened vials of insulin may be stored without loss of potency
1 month
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adjunctive therapy for clients with type 2 diabetes without glycemic control
exenatide
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side effect of long-term corticosteroid use in children
stunted growth
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decreases hepatic glucose output and enhances insulin sensitivity
biguanides
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common side effect of thiazolidinediones
myalgia
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SE of _____:
-GI distress
-dermatological distress
-pruritus, rash, urticaria
-photosensitivity
-hepatic dysfunction including jaundice
- hypoglycemia in older adults
- lethargy, vertigo
-increase of cardiovascular death
sulfonylurea
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CI of ___:
-debilitated or malnourished Pt's
-impaired liver and kidney function
-unstable diabetes
-major surgery
-severe infection/trauma
-water intoxication
sulfonylurea
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which sulfonylurea generation drugs have a higher potency, shorter action duration, better tolerance -& fewer drug interactions
2nd gen
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Pt's recieving/discontinuing sufonylurea agents should be monitored closely for?
loss of diabetic control
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Alpha-glucosidase inhibitor meds
- acarbose (precose)
- miglitol (glyset)
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often used as part of a combination regimen that includes an oral sulfonylurea
Acarbose
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delays digestion of complex carbs & subsequent absorption of glucose after meals
Alpha-glucosidase inhibitors (carbose)
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SE of _____:
-high rate of GI effects (flatulance, abdominal distention/pain, loose stools) which tend to diminish with time or a reduction in dose; take at the start (first bite) of main meals
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alpha glucosidase inhibitors
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drug interactions w/ _____:
-digestive enzymes
- digoxin
-estrogens and oral contraceptives
alpha glucosidase inhibitor
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metformin (glucophage) is an example of a
biguanide
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____ work by decreasing hepatic glucose output and enhancing insulin sensitivity to muscle
biguanide
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can be used as an initial first-line monotherapy or in combination with sulfonylurea to treat type 2 diabetics
metformin
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SE of ____:
-GI effects- Lactic Acidosis (severe dehydration, cardiorespiratory insufficiency, renal dysfunction)-Hypoglycemia-rare
biguanides
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CI of ____:
- radiocontrast dye
-heart failure
-children and older adults
-impaired kidney adn liver function
biguanides
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DI w/ _____:
-increased metformin effect seen with alcohol, cephelexin, and cimetidine
-radiopaque contrast media (hold metformin day of and 48 hrs after)
biguanides
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two naturally occuring hormones that have been identified adn released by cells in the GI tract in response to food
GIP & GLP-1
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_____ activation suppresses the release of glucagon by the pancreas
GIP
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_____ activation stimulates insulin secretion in order to maintain glucose homeostasis
GLP-1
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in type 2 diabetes which enzyme rapidly inactivates GLP-1, which is already reduced in Pt's with impaired glucose intolerance
DPP-4
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incretin therapy meds
- exenatide (Byetta)
- Sitagliptin (januvia)
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given SC BID, mimics action of incretin GLP-1, decreases glucagon secretion, delays gastric emptying time, decreases food intake
exenatide (byetta)
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used as adjunctive therapy for type 2 DM pts who does not have glycemic control & are taking metformin, a sulfonylurea or both
exenatide (Byetta)
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____ is not recommended for use in Pt's with severe renal disease
Exenatide (byetta)
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given orally once daily, inhibits DPP-4 enzyme, increase GLP-1 & GIP levels, increase insulin secretions
sitagliptin (januvia)
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when recieving januvia Pt's should be monitored with what med
digoxin
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used as monotherapy in type 2 DM pts or combo w/ meformin or thiozolidinedione when adequate glycemic control has not been achieved
Sitagliptin (januvia)
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meglitinide meds
- nateglinide (starlix)
- Repaglinide (prandin)
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-stimulates pancreatic beta cells to produce insulin
-used as monotherapy or combo w/ metformin
- nateglinide (starlix)
- Repaglinide (prandin)
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SE:
-weight gain, fluid retention, edema
-URI
-myalgia
-hypoglycemia
meglitinides
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DI:
-admin prandin before meals to maximize absorption
-gemfibrozil (lopid) may enhance/prolong effects
meglitinides
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Drug IA:
BCP
Nitrates
Azole antifungals
Thiazolidinediones
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Thiazolidinediones meds
- pioglitazone (actos)
- rosiglitazone (avandia)
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meds with black box warnings for both meds, potential increase in myocardial ischemia risk
- pioglitazone (actos)
- rosiglitazone (avandia)
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