Pharmacology Final

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Author:
Rx2013
ID:
82327
Filename:
Pharmacology Final
Updated:
2011-04-27 19:45:33
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Oral Hypoglycemics
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Oral Hypoglycemics
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  1. ADEs with sulfonylureas
    less in 2nd generation than first, but still few
  2. Most common ADE with sulfonylureas
    hypoglycemia
  3. Sulfonylurea drugs
    • chlorpropamide
    • tolazamide
  4. Chlorpropamide & Tolazamide ADEs
    • hypoglycemia
    • jaundice
    • N/V
    • Anorexia
    • Pruitis
    • Disulfiram Like reactions
  5. Meglitinides
    • only effective in pt w functioning beta cells
    • may be used in pt with sulfa allergy
  6. Meglitinide MoA
    stimulate release of insulin from beta cells by blocking atp dependant K+ channels
  7. Meglitinide metabolism
    • rapid absorption
    • recommended pre-prandial administration
    • hepatic metabolism
  8. major adverse effect of meglitinides
    hypoglycemia
  9. Caution with meglitinides
    renal or hepatic insuficiency
  10. Drug interactions with meglitinides
    • ketoconazole
    • miconazole
    • erythromycin
    • decrease biotransformation => hypoglycemia
  11. ex. drug of meglitinide
    repaglinide
  12. Repaglinide can be used with
    • sulfonylureas
    • metformin
    • thiazolidinediones
  13. Biguanide
    • Metformin
    • Only biguanide in the US
  14. Metformin perks
    • does not cause hypoglycemia
    • pt do not gain weight
    • action does not depend on functioning beta cells
  15. Metformin and food
    Food decreases absorption
  16. ADEs with metformin
    • NVD
    • anorexia
    • flatulence
    • lactic acidosis
  17. Contraindications with metformin
    renal or hepatic impairment
  18. Metformin mechanism of action
    • Increases glucose uptake in the muscles
    • Decreases gluconeogenesis in the liver
  19. Repaglinide and Metformin combo MoA
    • Repaglinide lowers BG by stimulating insulin release
    • Metformin improves glucose tolerance by lowing basal and postprandial BG
  20. Additional contraindications for repaglinide/metformin
    • pt. receiving gemfibrozil and itraconazole
    • pt receiving contrast dye
  21. Caution with metformin/repaglinide
    • alcohol potentiates effect of metformin
    • should not be used with NPH insulin
    • may cause B12 deficiency
    • Hepatic impairment
  22. Drugs that compete with metformin for excretion in the kidney
    • cationic drugs
    • amiloride
    • digoxin
    • procainamide
  23. Repaglinide metabolized by
    CYP2C8 and 3A4
  24. Prandimet (repaglinide/metformin) should be taken ____ meals
    with
  25. Thiazolidinediones
    • pioglitazone
    • rosiglitazone
  26. TZD MoA
    • increase insulin sensitivity in tissues
    • decrease hepatic gluconeogenesis
  27. TZD metabolism
    • take with or without food
    • metabolized by CYP450
  28. Drug interactions with TZDs
    • decreases plasma concentrations of oral contraceptives => pregnancy
    • not recommended with insulin
    • not recommended with nitrates

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