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Generic: Calcitriol
Brand: Rocaltrol
Vitamin
Management of secondary hypothyroidism and resultant metabolic bone disease in those with renal failure, and for management of hypocalcemia
Usual dosage: 0.5-2 mg daily
Active form of vitamin D3
Contraindicated in patients with hypercalcemia and vitamin D toxicity
Side effects: related to vitamin D toxicity and include hypercalcemia syndrome and calcium intoxication (weakness, headache, somnolence, nausea, vomiting, dry mouth)
Pearls: do not take OTC vitamin D during therapy, do not exceed prescribed amount of calcium, do not take OTC magnesium/antiacids
Generic: Canagligozin
Brand: Invokana
Antidiabetic
As an adjunct to diet and exercise in adults with type II diabetes
Start with 100mg before the first meal of the day
Sodium- Glucose Cotransporter 2 Inhibitor
Contraindicated in patients with severe renal impairment
Avoid in pregnancy
Side Effects: UTI, genital myotic infections, and increased urination, increased thirst, constipation, nausea
Pearls: take before first meal of the day, closely follow recommended diet and exercise, monitor blood glucose, promptly report urinary pain/dizziness, keep well hydrated, avoid excessive alcohol, avoid salt subs with K
Generic: Dapaglifozin
Brand: Farxiga
Antidiabetic
As an adjunct to diet and exercise in adults with type II diabetes
One tablet daily in the morning
SGLT2
Use is contraindicated in patients with severe renal impairment
Correct hypotension before starting therapy
May precipitate ketoacidosis
Side Effects: UTI, genital mycotic infection, increased urination, dyslipidemia, discomfort in urination, constipation
Pearls: follow diet and exercise recommendations, quarterly HbA-1c testing, do not use urine glucose testing, promptly inform physician if you become pregnant, contact doctor with signs of ketoacidosis
Generic: Dulaglutide
Brand: Trulicity
Antidiabetic
As an adjunct to diet and exercise in adults with type II diabetes
0.75-1.5 once weekly
GLP-1
Reduces gastric emptying which may change rate and extent of orally administered drugs
Contraindicated in patients with a personal or family history of medullary thyroid carcinoma and MES type II
Side Effects: nausea, diarrhea, vomiting, abdominal pain, decreased appetite, dyspepsia, fatigue
Pearls: report signs of thyroid carcinoma and pancreatitis, if dose is missed admin as soon as possible if there are at least 3 days until next scheduled dose, if less than 3 days remain skip and admin on regularly scheduled day, store unused pens in the fridge, opened pens may be stored below 30C for 14 days, do not store pens with a needle attached, use new needle for each dose
Generic: Empagligozin
Brand: Jardiance
Antidiabetic
As an adjunct to diet and exercise in adults with type II diabetes, to reduce risk of cardiovascular death in adults with type II diabetes
SGLT2
Use with insulin increases risk of hypoglycemia
Contraindicated in patients with severe renal impairment
Avoid use during the second and third trimesters of pregnancy
Side Effects: UTI, genital myotic infections, increased urination, dyslipidemia, discomfort when urinating
Pearls: follow diet/exercise, quarterly HbA1c testing should be preformed, do not use urine glucose tests, inform doctor if you become pregnant, contact doctor if signs of ketoacidosis
Folic Acid
Vitamin
For treatment of megaloblastic anemias due to deficiency, anemias during pregnancy/lactation, anemias in infancy/childhood
Up to 1 mg a day
Water soluble
Contraindicated in anemias where B12 is deficient
Side effects: rarely allergy
Pearls: do not discontinue without checking with physician
Generic: Glimepiride
Brand: Amaryl
Antidiabetic
As an adjunct to diet and exercise in adults with type II diabetes, for use in combo with insulin to lower blood glucose in patients whose hypoglycemia cannot be lowered by diet/exercise
The usual maintenance dose is 1-4mg daily with a max of 8mg daily
Sulfonylurea: stimulates insulin release from beta cells
Contraindicated in patients with diabetic ketoacidosis, patients should be warned about hypoglycemia
Side Effects: dizziness, asthenia, headache, nausea
Pearls: take with breakfast, compliance with therapy is essential, follow prescribed diet closely, avoid excessive use of alcohol, be aware of signs of hypoglycemia
Generic: Glipizide
Brand: Glucotrol, Glucotrol XL
Antidiabetic
As an adjunct to diet in the treatment of non-insulin dependent stable or maturity onset type of mild to moderately severe diabetes
Normal dosage range is 5-20 mg per day
Sulfonylurea
Contraindicated in juvenile, unstable, or complicated diabetes mellitus as the sole therapy, in patients allergic to sulfa drugs, and diabetic ketoacidosis
Side effects: nausea, diarrhea, heartburn, pruritus, and urticaria, mild hypoglycemic reaction
Pearls: take 30 min before meals, compliance essential, follow diet, avoid excessive alcohol
Generic: Glyburide
Brand: Micronase, Diabeta
Antidiabetic
As an adjunct to diet in treatment of non-insulin dependent stable or maturity onset type of mild to moderate diabetes
Normal dosage range is 2.5-5 mg given once or twice daily
Sulfonylurea
Contraindicated in juvenile, unstable, or complicated diabetes mellitus as the sole therapy, and in diabetic ketoacidosis
Use caution in patients with serious renal, hepatic, thyroid function, or in pregnant or nursing
Side Effects: nausea, heartburn, pruritus, urticaria, mild hypoglycemia reactions
Pearls: take with breakfast, follow diet, avoid excessive diet
Generic: Insulin Aspart (rDNA Origin)
Brand: Novolog
Antidiabetic
Treatment of type I and type II diabetes
Dosage must be individualized
Drugs that may decrease hypoglycemia effects: corticosteroids, diltiazem, epinephrine, OC
Increase hypoglycemia effects: alcohol, anabolic steroids, beta blockers
Do not mix novolog with lantus
Side Effects: hypoglycemia, hypersensitivity (redness, swelling, itching)
Pearls: follow diet, admin 5-10 min before eating, do not change syringe brands/dose without notifying, consult physician during illness, continually monitor blood or urine glucose, wear or carry diabetic identification, store in fridge
Generic: Insulin Degludec
Brand: Tresiba
Antidiabetic
To improve diabetic control in adults with diabetes
Dosage must be individualized
Drugs that may decrease hypoglycemia effects: corticosteroids, diltiazem, epinephrine, OC
Increase hypoglycemia effects: oral antidiabetic drugs, ACE inhibitors, fluoxetine, MAOs
Contraindicated during episodes of hypoglycemia
Side Effects: injection site rxn, lipodystrophy, weight gain, edema, nasopharyngitis, headache, upper respiratory tract infection, diarrhea
Pearls: dosing technique is important, leave needle in for 6 seconds, follow diet carefully and monitor glucose, do not mix with other insulin products, product should be clear and colorless, unopened vials should be refrigerator, wear diabetic ID
Generic: Insulin Glargine (rDNA Origin)
Brand: Lantus, Troujeo, Basaglar
Antidiabetic
Indicated for once daily subcutaneous admin at bedtime
Dosage must be individualized
Drugs that may decrease hypoglycemia effects: corticosteroids, diltiazem, epinephrine, OC
Increase hypoglycemia effects: alcohol, anabolic steroids, beta blockers
Side effects: pain at injection site, allergic reactions, hypoglycemia reactions
Pearls: follow diet, do not change brands/syringes, do not dilute/mix, consult physician during illness, should be colorless/clear, unopened vials should be refrigerator, wear diabetic ID
Generic: Insulin Lispro (rDNA Origin)
Brand: Humalog
Antidiabetic
Treatment of type I or II diabetes
Dosage must be individualized
Drugs that may decrease hypoglycemia effects: corticosteroids, diltiazem, epinephrine, OC
Increase hypoglycemia effects: alcohol, anabolic steroids, beta blockers
Side effects: hypoglycemia, hypersensitivity
Pearls: follow diet, admin 15 min before eating, do not change syringe brands, contact doctor with any illness, continually monitor blood glucose or urine glucose, wear diabetic ID
Generic: Linagliptin
Brand: Tradjenta
Antidiabetic
As an adjunct to diet/exercise in type II diabetes
5 mg taken once daily
DDP-4 inhibitor
Contraindicated in patients with known or suspected hypersensitivity
Side effects: nasopharyngitis, diarrhea, cough, with other DDP-4 inhibitors: joint pain
Pearls: closely follow diet, quarterly HbA-1c testing
Generic: Liraglutide (rDNA Origin)
Brand: Victoza, Saxenda
Antidiabetic
As an adjunct to diet and exercise to improve glycemic control in adults with type II
One dose administered once daily
GLP-1
Contraindicated in patients with a personal or family history or medullary thyroid carcinoma
Increases the risk of medullary thyroid carcinoma
Side effect: nausea, diarrhea, vomiting, constipation, headache
Pearls: report symptoms of thyroid carcinoma/pancreatitis, read and understand med guide, no not store pens with needle attached
Generic: Metformin Hydrochloride
Brand: Glucophage (XR)
Antidiabetic
Used as adjunct to diet to lower blood glucose in patients with non-insulin dependent diabetes mellitus, used concomitantly with sulfonylurea
Usual starting dose is one 500mg tablet given twice a day with meals or one 850mg tablet given with the morning meals
Biguanide
Alcohol may potentiate the effect
May cause lactic acidosis resulting in death, hypothermia, hypotension, and resistant bradyarrhythmias, risk factors include advanced age, radiological studies with contrast, surgery, hypoxic states, excessive alcohol use, and hepatic impairment
Side effects: decreased vitamin B12 absorption, lactic acidosis, diarrhea, vomiting, nausea, flatulence, anorexia, bloating, lactic acidosis
Pearls: should be taken with meals, avoid excessive alcohol, closely follow diet/exercise, keep well hydrated
Generic: Methotrexate Sodium
Brand: Trexall
Antimetabolite
Treatment of gestational choriocarcinoma, treatment of breast cancer, symptomatic control of severe, recalcitrant, disabling psoriasis, severe active rheumatoid arthritis
10-25 mg per week until adequate response is achieved
Antineoplastic Agent, Antimetabolite (Antifolate); Antirheumatic, Disease Modifying; Immunosuppressant Agent
Because of the possibility of serious toxicity reactions (which can be fatal), methotrexate should only be used in life-threatening neoplastic diseases, or in patients with psoriasis or rheumatoid arthritis with severe, recalcitrant, disabling disease which is not adequately responsive to other forms of therapy
Side effects: ulcerative stomatitis, leukopenia, nausea, abdominal distress, malaise, fatigue, chills, fever, dizziness, sun sensitivity, decreased resistance to infection
Pearls: take on empty stomach, keep hydrated, avoid prolonged exposure to sunlight, follow appropriate contraceptives, have periodic lab work
Generic: Phentermine Hydrochloride
Brand: Adipex-P, Ionamin
Weight management
Short term weight reduction
The usual adult dose is one tablet/capsule before breakfast or 1-2 hours after breakfast
Central nervous system stimulant
Use with MONAMINE OXIDASE INHIBITORS may precipitate a hypertensive crisis
Use with FENFLURAMINE OR DEXFLENFLURAMINE may cause primary pulmonary hypertension
Side effects: primary pulmonary hypertension, hypertension, tachycardia, restlessness, dizziness, insomnia, euphoria, dysphoria
Pearls: best taken early to avoid insomnia, WARNING: this medication may be habit forming, take doses as prescribed
Generic: Pioglitazone Hydrochloride:
Brand: Actos
Antidiabetic
As an adjunct to diet/exercise for type II diabetes
15-30mg given once daily
PPAR
Contraindicated in patients with congestive heart failure
Side effects: upper respiratory tract infection, headache, sinusitis, myalgia, tooth disorder, aggravation of diabetes
Pearls: follow dietary/exercise, quarterly HbA-1c testing, call doctor if you experience sudden dysuria or urinary urgency
Generic: Semaglutide
Antidiabetic and weight management
Ozempic: adjunct to diet and exercise to improve type II diabetes
Wegovy: adjunct to reduce calorie diet and physical activity for chronic weight management, 2.4 mg once weekly
GLP-1
Hypoglycemia may occur with insulin or sulfonylurias
Contraindicated with thyroid carcinoma/MES type II
Side effects: nausea, vomiting, diarrhea, abdominal pain, constipation, headache, fatigue, dyspepsia, dizziness, education
Pearls: doses should be injected subcut, never share opened pen, stay hydrated
Generic: Sitagliptin Phosphate
Brand: Januvia
Antidiabetic
Adjunct to diet and exercise to improve glycemic control in patients with type II diabetes
Normal adult dose is 100mg once daily
DDP-4
May increase concentration of digoxin
Side effects: nosopharyngitis
Pearls: follow recommended diet/exercise, quarterly HbA-1c testing
Generic: Sitagliptin Phosphate with Metformin Hydrochloride
Brand: Janumet XR
As an adjunct to diet and exercise to improve glycemic control in patients with type II diabetes
Once tablet twice a day with meals or one XR tablet
Metformin may cause lactic acidosis resulting in death, hypothermia, hypotension, and resistant bradyarrhythmias. Risk factors include advanced age, radiological studies.
Side effects: diarrhea, upper respiratory tract infection, headache, nausea, abdominal pain, vomiting
Pearls: taken with meals, keep hydrated, avoid excessive alcohol, follow diet/exercise, quarterly HbA-1c
Vitamin D, Ergocalciferol: Drisdol
Vitamin D2
For treatment of refractory rickets/vitamin D resistant rickets, for treatment of hypoparathyroidism
Non-FDA: vitamin D def
50,000 IU weekly for eight weeks
Mineral oil interferes with fat absorption
Contraindicated in patients with hypercalcemia malabsorption syndrome
Side effects: range between therapeutic and toxic doses are narrow, toxicity: renal function, mental retardation, bone demineralization, calcification of soft tissue, nausea, anorexia, constipation, anemia, weight loss