prototype drugs #4

human regular insulin

Class: antidiabeetic, pancreatic hormone - short-acting hypoglycemic

MOA: increases glucose uptake, stimulates glycogen storage, inhibits glucagon relase

similar drugs: humulin R, novolin R

human regular insulin #2

ADR: lipodystrophy, weight gain, hypoglycemia

Overdose treatment: IV dextrose50, glucagon, oral glucose

Considerations: store at room temp, rotate injection sites, monitor blood glucose, recognize hypoglycemia, ensure patient carries glucose supply, carry glucose, monitor for signs of lipodystrophy, wears medical alert

glyburide

Class: sulfonylurea

MOA: stimulates insulin secretion from pancratic beta cells, increasing insulin levels in the blood, thereby lowering blood glucose in T2DM patients.

glyburide #2

ADR: hypoglycemia, weight gain , N, rash, hematologic reactions, dizziness

Dont: hypersensitivity to sulfaonlureas, T1DM, DKA, severe renal or hepatic impairment

Considerations: administer oral, once or twice daily with meals, monitor glucose levels, renal and hepatic function, signs of hypoglycemia. patient education: advise to take with food and avoid alcohol

repaglinide

Class: meglitinide

MOA: stimulates insulin release from pancreatic islet cells; lower glucose in T2DM, with diet/exercise

repaglinide #2

ADR: hypoglycemia, NVD, dyspepsia, headache, URI, rhinitis, paresthesias

Dont: T1DM, DKA, hepatic impairment, pregnancy/lactation, older adults, infection, surgery, trauma

Drug-Drug: interacts with CYP3A4 inducers (barbiturates, carbamazepine) and inhibitors (erythromycon, grapefruit juice, garlic, ginseng, ketconazole)

Considerations: monitor glucose and signs of hypoglycemia, administer AC

metformin

Class: antidiabetic, biguanide

MOA: lower glucose by inhibiting gluconeogenesis, hepatic glucose production, and intestinal reabsorption; increase glucose uptake and insulin sensitivity

BLACK BOX: LACTIC ACIDOSIS (rare, fatal)

metformin #2

ADR: GI: anorexia, NV, severe diarrhea, weight loss, abdominal pain, metallic taste, Headache, dizziness, fatigue

Dont: IV contrast (stop 2 days before/after), hear failure ,CKD, hyperthyroid

Considerations:

• Give with meals

• monitor GI symptoms

• monitor renal function

• educate to take with meals

• monitor for lactid acidosis

rosiglitazone

Class: antidiabetic drug - thiazolidinedione

MOA: Lowers glucose by increasing cellular sensitivity to insulin, reduced insulin resistance, decreases, gluconeogensis by liver

BLACK BOX: WORSENS HEART FAILURE DUE TO FLUID RETENTION/ MI; banned in Europe/US

rosiglitazone #2

ADR: anemia, headache, diarrhea, URI, fatigue, can increase lipids (HDL,LDL, TRG)

Dont: heart failure, liver disease, pregnancy/lactation, T1DM, DKA

interactions: induced hepatic CYP2C8; and CYP2c8 inhibitors

Considerations: monitor for signs of heart failure and fluid retention, assess liver function regularly, educate patients on potential lipid changes and the importance of diet and exercise, ensure contraception if needed

acarbose

Class: alpha-glucosidase inhibitors

MOA: inhibits alpha-glucosidase in the GI tract, reducing carbohydrate absorption, and lowering postprandial blood glucose levels in T2DM.

acarbose #2

ADR: diarrhea, flatulence, abdominal distention, borborygmi anemia, urticaria, hyoglycemia

Dont: inflammatory bowel disease (IBD), bowel obstruction, colon ulcers, liver disorders, GI distress, pregnancy/lacation

Considerations: administer orally with 1st bite of each meal to reduce GI effects, monitor: glucose, LFTs, GI symptoms, educate patients: take with meals to lower GI effects, check glucose regularly, esp, with other anti diabetics

pramlintide

Class: amylin mimetic

MOA: mimics the action of amylin, a hormone co-secreted with insulin. it delays gastric emptying, suppresses glucagon secretion, and promotes satiety, resulting in lower blood glucose levels

pramlintide #2

ADR: nausea, vomiting, anorexia, headache, hypoglycemia

Dont: hypoglycemia, unawareness, gastroparesis, allergy to drug

Considerations: administration: subcutaneous injection before meals. monitor: blood glucose levels, especially when used with insulin, assess: for signs of N/V, patient education: administer just before meals, ensure proper timing with insulin to avoid hypoglycemia

canagliflozin

Class: Antidiabetic; SGLT2 inhibitor

MOA: inhibits SGLT2 in the kidneys, reducing glucose reabsorption, increasing glucose excretion in urine, and lowering blood glucose levels

canagliflozin #2

ADR: dehydration, hypotension, UTI, genital infections, hyperkalemia, DKA

Dont: T!DM, DKA, CKD (GFR<30), ESRD, pregnancy, lactation

Considerations: monitor: blood glucose, renal function, electrolytes, hydration status, assess: for signs of UTI, genital infections, dehydration, and DKA. Patient education: hydration is key; watch for symptoms of dehydration for infections REGULAR RENAL FUNCTION TESTING!

Exenatide

Class: GLP-1 receptor agonist

MOA: mimics GLP-1, increasing insulin secretion, inhibiting glucagon release, delaying gastric emptying, and promoting satiety, which lower blood glucose levels in T2DM.

Exenatide #2

ADR: nausea, vomiting, diarrhea, headache, hypoglycemia, pancreatitis

Dont: history of pancreatitis, severe GI disease, T1DM, DKA, pregnancy, lactation

Considerations: administer: subcutaneous injection, usually twice daily AC, monitor blood glucose, signs of pancreatitis, patient education:administer before meals, monitor for signs of nausea and hypoglycemia

sitagliptin

Class: DPP-4 inhibitor

MOA: inhibits DPP-4 enzyme, which breaks down incretin hormones, inhibition increases incretin levels, leading to enhanced insulin secretion and reduced glucagon release in response to meals, lowering blood glucose levels in T2DM

sitagliptin #2

ADR: upper respiratory infections, headache, nasopharyngitis, hypoglycemia, pancreatitis

Dont: hypersentitivity to drug, history of pancreatitis, renal impairment

Considerations: administer oral, once daily. with or without food, Monitor: renal function, blood glucose levels. patient education: report symptoms of pancreatitis and monitor hypoglycemia

omeprazole #1 (prilosec)

Class: proton pump inhibitors (PPI)

MOA: irreversibly inhibits the H+, K+ -ATPase enzyme, reducing gastric acid secretion

USE:GERD, PUD, Zollinger-ellison syndrome

omeprazole #2

ADR: headache, nausea, diarrhea, risk of C. Diff infection

Dont: hypersensitivity, caution in hepatic impairment

Consid: administer 30 minutes before meals, monitor for signs of C. diff diarrhea

famotidine #1

Class: Histamine-2 receptor antagonist

MOA: blocks histamien at H2recept

USE:

famotidine #2

ADR: dizziness, diarrhea, rarely leukopenia

Dont: hypersensitivity

Consid: administer at bedtime for nocturnal symptoms, monitor complete blood count (CBC) periodically

calcium carbonate (TUMS) #1

Class: Antacid

MOA: neutralizes gastric acid to relieve heartburn and indigestion

USE: GERD, gastritis, PUD

calcium carbonate (TUMS) #2

ADR: constipation, kidney stone

Dont: hypercalcemia, renal calculi

Consid: avoid, excessive use to rpvent rebound acidity, educate patients t otake 1-2 hours apart from other medications

octreotide #1

Class: Somatostatin analogue

MOA: inhibits hormone release and reduces splanchnic blood flow

USE:acute bleeding from esopgeal varices, acromegaly, carcinoid tumors

octreotide #2

ADR: nausea, vomiting, abdominal cramping, steatorrhea, hyerglycemia

Dont: hypersensitivity, caution in diabetes

Consid: admin as prescribed, monitor blood glucose levels, watch for GI side effects (nausea, vom, diarrhea)

vasopressin #1

Class: antidiuetic hormone (ADH) analogue

MOA: binds to V1 receptors on smooth muscle, causing vasoconstriction and reducing portal blood flow, helping control bleeding from varices

USE: acute esophageal variceal bleeding, diabetes insipidus, shock.

vasopressin #2

ADR: hypertension, bradycardia, water retention, hyponatremia

Dont: hypersensitivity, use with caution in patients with cardiovascular disease or renal dysfunction

Consid: administer IV as a continuous infusion, monitor blood pressure for potential increase due to vasoconstriction, monitor heart rate for possible bardycardia, monitor sodium for low sodium and signs for fluid retention

pancrelipase #1

Class: pancreatic enzyme replacement therapy

MOA: facilitates the breakdown of fats, proteins, and carbohydrates

USE: chronic pancreatitis, cystic fibrosis, pancreatic insufficiency

pancrelipase #2

ADR: nausea, diarrhea, abdominal cramps

Dont: hypersensitivity to pork proteins

Consid: admin with meals and snacks, monitor for steatorrhea

hyoscymanine #1

Class: antimuscarinic

MOA: inhibits muscarinic receptors int eh smooth muscles of the gastrointestinal tract, reducing spasms and cramping

USE: relief of abdominal pain and discomfort associated with IBS

hyoscymanine #2

ADR: dry mouth, blurred vision, urinary retention, constipation

Consid: monitor for dry mouth and blurred vision, encourage fluid intake, and administer with caution in patients with a history of urinary retention or glaucoma

sulfasalazine #1

class: anti-inflammatory - aminosalicylate

MOA: reduces inflammation by inhibiting prostaglandin and leukotriene synthesis in the colon

USE: mild to moderate ulcerative colitis and crohn’s disease

sulfasalazine #2

ADR: hemolytic anemia, leukopenia, liver and nephro tox, SJS, sunsensitivity

DONT: sulfa allergy, sevre renal or hepatic impairment

Consid: monitor CBC, liver and renal function, encourage hydration, assess for rah, tell to wear sunscreen and harmless urine discoloration

infliximab #1

CLass: tnf-alpha inhibitor, immunmodulator - monoclonal antibody

MOA: binds to and inhibits tumor necrosis factor-alpha, apro-inflammatory cytokine, reducing inflammation by blocking its acitivty
USE: IBD, rheumatoid arthitits, ankylosing spondylitis, psoriatic arthritis, plaque psoriasis

infliximab #2

ADR: infustion reactions (fever, chills), increased risk of infections, heptox, heart failure exacerbation, lymphoma and other malignancie, cytopenias

Consid: monitor for infusion reactions and signs of infection during treatment, screen for TB and infections before starting, monitor liver function and heart failrue, watch for malignancy signs (unexplained weight bloss)

ondansetron #1

Class: antiemetic

MOA: blocks serotonin receptors int eh chemoreceptor trigger zone and peripherally

USE: NV prevention and treatmetn, postop NV

ondansetron #2

ADR: headache, QT prolong, serotonin syndrome, fatigue

Considerations: admin IV slowly over 2-5 minutes to reduce risk of QT prolongation

• assess for signs of serotonin syndrome (agitation, hallucinations, fever, diaphoresis, tremors)

• advise patient to take oral form 30 minutes before chemo

loperamide #1

Class: antidiarrheal

MOA: slows intestinal motility by acting on opioid receptors in the gut

USe: acute nonspecific diarrhea, chronic diarrhea in IBD

loperamide #2

ADR: constipation, abdominal cramping, dizziness

DONT: infectious diarrhea, abdominal pain without diarrhea

Considerations: monitor for dehydration, avoid prolonged use

bismuth subsalicylate (pepto bismol) #1

Class: antidiarrheal, antimicrobial

MOA: reduces intestinal inflammation and inhibits bacterial growth

USE: traveler’s diarrhea, mild nonspecific diarrhea

bismuth subsalicylate (pepto bismol) #2

ADR: blood stool black tongue, constipation

Dont: allergy to salicylates, children with viral infections

considerations: educate about harmless discoloration of stool and tongue, ensure hydration

diphenoxylate/atropine #1

Class: antidiarrheal

MOA: slows intestinal motility by acting on opioid receptors and reduces cramping with atropine

USE: moderate to severe nonspecific diarrhea

diphenoxylate/atropine #2

ADR: drowsiness, dry mouth, dizziness, constipation

Dont: infectious diarrhea, severe hepatic impairment, obstructive jaundice

Consid: monitor for signs o dehydration and overuse, educate about drowiness and avoid alc

psyllium (metamucil) #1

Class: bulk-forming laxative

MOA: absorbs water into the intestine, forming a gel that promotes peristalsis and softens stool

USE: chronic constipation, IBS, to promote regular bowel movements

psyllium (metamucil) #2

ADR: bloating, may cause esophageal obstruction if not taken with enough fluid

Consid: encourage fluid intake, admin with plenty of water, monitor for signs of impaction, timing of adminiatration: don’t take with 2 hours of another med

polyethyleneglycol (miralax) #1

Class: laxative

MOA: increases water content in the stool by drawing water into the colon

USE: occasional constipation, bowel preparation for colonoscopy

polyethyleneglycol (miralax) #2

ADR: bloating, cramping, diarrhea

Consid: ensure fluid intake, can be mixed with water or juice for easier ingestion, takes 1-3 days for effect monitor for excessive diarrhea

bisacodyl (dulcolax) #1

Class: stimulant laxative

MOA: stimulates peristalsis by irritating the colonic mucosa and increasing water and electrolyte secretion into the colon

USE: acute constipation, bowel preparation for procedures

bisacodyl (dulcolax) #2

ADR: Abdominal cramping, diarrhea, electrolyte imbalances, dehydration

Consid: monitor fluid and electrolyte balance due to risk of dehyration and electrolyte imbalances, not FOR LONG-TERM USE, take on empty stomach, assess for signs of overuse

docusate sodium #1

Class: stool softener

MOA: increase water and fat absorption into the stool, making it softer and easier to pass

USE: prevention of constipation, especially in patients who should avoid straining

docusate sodium #2

ADR: abdominal cramping, diarrhea, throat irriation

Consid: encourage fluid intake, admin with full glass of water, assess for signs of overuse, takes 1-3 days to show effect so NOT FOR IMMEDIATE RELIEF

pramipexole #1

Class: dopamine receptor agonist

MOA: binds to dopamine receptors to restore dopaminergic activity in the brain

USE: parkinsons

pramipexole #2

ADR: agitation, insomnia, hypotension, constipation, anorexia, dyskinesias

DONT: antipsychotics, levodopa, ropinirole

Consid: monitor for orthostatic hypotension and sleep disturbances, asses involv movements and mental status, educate patients on the potential side effect such as constipation and anorexia, use caution for patients with renal and hepatic conditions, monitor renal function.

levodopa and carbidopa #1

Class: dopamine replacement agent

MOA: increases dopamine levels by providing levodopa and carbidopa prevents peripheral metabolism of levodopa allowing more to reach the brain

USE: parkinsons

levodopa and carbidopa #2

ADR: NV, anorexia, orthostatic hypotension, urinary retention, dry mouth, insomnia

DONT: MAOis, TCA, antihypersentives, kava, indian snake root

Consid: monitor for orthrostatic hypotension and dyskinesia, renal, hepatic, and caridac function, take with food, avoid high protein meals, monitor psychosis

entacapone #1

Class: COMT inhibitor

MOA: inhibits COMT preventing dopamine breakdown, increasing its availability in the brain

USE: parkinsons

entacapone #2

ADR: diarrhea, nausea, dykinesia, brown urine, orthostatic hypotension

Consid: monitor GI symptoms, dyskinesia, orthostatic hypotension, educate patients about potential urine disocloration

benztropine #1

Class: anticholinergic

MOA: reduces excess cholinergic effects related to dopamine deficiency = restores neurotransmitter balance

benztropine #2

ADR: sedation, constipation, blurred vision, dry mouth, urinary rentenion, sweating, paralytic ileus

Consid:

• monitor for dry mouth , constipation, urinary retnetion

• asses mental status

• monitor for paralytic ileus

• avoid alc and other cns depressants

• monitor vision due to risk of glaucoma

• assess GI/urinary obstructions before use

interferon Beta 1b #1

Class: immunomodulator

MOA: suppresses T cell activity, reduced cytokine inflammation and slows MS progression

USE: MS

interferon Beta 1b #2

ADR: flu-like symptoms, mood disorders, injection site reaction

DONT: hypersentivity, liver dysfunction

Consid: monitor flu-like symptoms

assess liver function

rotate injection site to reduce irritation

donepezil #1

Class: reversible cholinesterase inhibitor

MOA: Inhibits acetylcholinesterase, raising acetylcholine levels in the brain to improve memory and thinking.

USE: anti-alzheimers

donepezil #2

ADR: NVD, anorexia, muscle cramps, fatigue, headache, atrial fib, snus bradycardia, seizures

DONT: cyp450 enzyme drugs

Consid: monitor for bradycardia, syncope, seizures, assess for GI upset, caution in liver disease

memantine #1

Class: anti-alzheimers

MOA: NMDA receptor antagonist - Blocks NMDA receptors to decrease glutamate activity in the brain, helping to improve cognition and memory in Alzheimer’s disease

memantine #2

ADR: dizziness, headache, confusion, constipation, hypertension, fatigue. severe CNS effects (confusion, agitation)

Consid: monitor for CNS effects, assess renal function due to dose adjustment needed in renal impairment

pyridostigmine #1

Class: indirect-acting cholinergic agonist

MOA: inhibitrs ACHe - increases ACH at the junction to improve muscle strength

pyridostigmine #2

ADR: muscle twitching, nausea, vom, pupil constriction, increase salivation, bradycardia, hypotension

DONT: bowel/urinary obstruction, asthma, COPD, heart failure, MI

consid: monitor for muscle twitching, bradycardia, hypotension, cholingeric crisis (excess salivation, sweating, nausea)