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Rx Prep Key Points 2

Diabetes, Osteo, Migraine, Thyroid

QuestionAnswer
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
Created by: eyeless
 

 



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