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Rx Prep Key Points 2
Diabetes, Osteo, Migraine, Thyroid
| Question | Answer |
|---|---|
| Summary of treatment escalation for DM2 | Lifestyle mod --> metformin --> 3 mos still not at goal = add 2nd agent (glipizide or pioglitazone or DPP4 or GLP1 or insulin) --> 3 mos still not at goal = add 3rd agent --> 3 mos still not at goal = drop glipizide, use basal/bolus insulin regimen |
| Metformin pearls | side effects >10%: diarrhea, N/V, flatulence no weight gain, no hypo, can cause B12 deficiency hold prior to IV contrast dye and 48h p procedure Rarely lactic acidosis: weakness, fatigue, slow HR, coldness, muscle pain, SOB, light-headed |
| Sulfonylurea pearls | side effects: hypo, weight gain lower efficacy with long-term use, no glyburide in poor renal fxn |
| TZD pearls | side effects: periph edema, weight gain takes several weeks to work, with or without food, monitor liver, |
| DPP4 (Januvia, Onglyza, Tadjenta) pearls | side effects: periph edema, rash, hypo, weigh neutral Tradjenta is 3A4 substrate qam with or without food, report severe stomach pain (acute pancreatitis) |
| Rapid insulin pearls | Novolog, Humalog, Apidra Inject when sitting down to eat (up to 15 min before) |
| Regular insulin pearls | Humulin R, Novolin R 30 min before a meal clear liquid |
| Intermediate insulin pearls | NPH (Humulin N, Novolin N) once or twice daily, cloudy (including any mixes containing NPH) |
| Basal insulin pearls | Levemir, Lantus once or twice daily (if once, give at night to avoid crossover) No peak (no hypo) |
| Insulin injection pearls | Keep pens/vials in use at room temp, abdomen preferred site (avoid 1 inch of navel), alternate sites, inject insulin and count to 5 |
| Hypoglycemia signs and symptoms | Dizziness, HA, anxiety, shakiness, hunger, tremors, fast HR |
| Glucose testing pearls | Dry hands (water can disrupt result), let arm hang at side to pool blood, lance side instead of pad |
| Levothyroxine pearls | Check TSH q6-8wks until stable Pregnancy A Hepatic inducers reduce T4 Beta blockers, amiodarone, and steroids decrease conversion of T3 --> T4 and may require higher doses |
| Bisphosphonate pearls | Take first thing in morning with glass of H2O, stay upright for 30 min, no food/drugs/drink Exercise, vitamin D, calcium Side effects: GI upset, heartburn, slow teeth healing, report jaw pain |
| Triptan pearls | Triptan sensations (heaviness/pressure in chest/neck area dissipating quickly), ODT good if nausea during migraine, nasal spray/injection good if rapid onset If using >2x/week, consider prophylaxis |
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