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Liraglutide brand
Victoza, Saxenda
Liraglutide class
GLP-1 agonist
Liraglutide MOA
Activates glucagon-like-peptide-1 (GLP-1) receptor, increasing insulin secretion, decreasing glucagon secretion, and delaying gastric emptying (incretin mimetic)
Liraglutide side effects
Hypoglycemia, nausea, diarrhea, headache, vomiting
Liraglutide dose
1.2-1.8 mg SQ qD
Liraglutide contraindications
No IM/IV admin, type 1 diabetes, medullary thyroid CA, multiple endocrine neoplasia type 2
Liraglutide BBW
Contraindicated in patients with certain thyroid or endocrine cancers
Sitagliptin brand
Januvia
Sitagliptin class
DPP-4 enzyme inhibitor
Sitagliptin MOA
Increases the level of incretin, increases insulin synthesis and release, decreases glucagon levels
Sitagliptin side effects
Headache, diarrhea, abdominal pain, arthralgia, pancreatitis
SItagliptin dose
100 mg PO qD
Sitagliptin contraindications
Type 1 diabetes, ketoacidosis, heart failure
Linagliptin brand
Tradjenta
Linagliptin class
DPP-4 enzyme inhibitor
Linagliptin MOA
Increases the level of incretin, increases insulin synthesis and release, decreases glucagon levels
Linagliptin side effects
Hypoglycemia, diarrhea, nasopharyngitis, cough, pancreatitis, arthralgias
Linagliptin dose
5 mg qD
Linagliptin contraindications
Type 1 diabetes, ketoacidosis, heart failure
Phentermine brand
Adipex-P, Lomaira
Phentermine class
Anorexiant, anti-obesity agent
Phentermine MOA
Sympathomimetic amine that also stimulates the hypothalamus to release norepinephrine, causing a reduction in appetite
Phentermine side effects
Palpitations, tachycardia, dizziness, tremor, headache, diarrhea, impotence, primary pulmonary hypertension
Phentermine dose
15-37.5 mg PO qAM
Phentermine contraindications
MAOi use, pregnancy, breastfeeding, CV disease
Propranolol brand
Inderal
Propranolol class
Non-selective beta blocker
Propranolol MOA
Non selectively antagonizes beta 1 and beta 2 adrenergic receptors
Propranolol side effects
Peripheral edema, fatigue, nausea, palpitations, dizziness, diarrhea, bronchitis, cold extremities, nightmares, agitation
Propranolol dose
80-240 mg/day divided qD ER- TID
Propranolol contraindications
Asthma, sinus bradycardia, AV block
Propranolol BBW
Do not stop abruptly, taper dose
Carvedilol brand
Coreg
Carvedilol class
Selective alpha and non selective beta blocker
Carvedilol MOA
Selectively antagonizes alpha 1 adrenergic receptors and non-selectively antagonizes beta 1 and beta 2 adrenergic receptors
Carvedilol side effects
Dizziness, fatigue, diarrhea, bradycardia, hypotension, nausea, headache, edema, visual disturbances
Carvedilol dose
6.25-25 mg PO BID
Carvedilol contraindications
Bradycardia, asthma, sick sinus syndrome, 2nd/3rd degree heart block
Spironolactone brand
Aldactone
Spironolactone class
Potassium sparing diuretic
Spironolactone MOA
Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium and water excretion while conserving potassium and hydrogen ions
Spironolactone side effects
Gynecomastia, hyperkalemia, N/V, abdominal cramps, diarrhea, headache, dizziness, confusion
Spironolactone dose
25-100 mg PO divided qD or BID
Spironolactone contraindications
Hyperkalemia, pregnancy
Furosemide brand
Lasix
Furosemide class
Loop diuretic
Furosemide MOA
Inhibits loop of Henle and PCT sodium and chloride resorption
Furosemide side effects
Dizziness, nausea, muscle cramps, hypokalemia, rash, hypomagnesemia
Furosemide dose
40-120 mg PO divided qD or BID
Furosemide contraindications
Anuria, hepatic coma, electrolyte imbalance
Furosemide BBW
In excess amounts can cause profound water and electrolyte depletion
Prednisone class
Corticosteroid
Prednisone MOA
Inhibits multiple inflammatory cytokines, produces multiple glucocorticoid and mineralocorticoid effects
Prednisone side effects
Hirsutism, weight gain, erythema, abdominal discomfort, rash, nausea, vomiting, fluid retention, dizziness, anxiety, depression
Prednisone dose
5-60 mg PO qD
Prednisone contraindications
Systemic fungal infection, avoid abrupt withdrawal in high or long term use
Methylprednisolone brand
Medrol
Methylprednisolone class
Corticosteroid
Methylprednisolone MOA
Inhibits inflammatory cytokines, producing multiple glucocorticoid and mineralocorticoid effects
Methylprednisolone side effects
Hirsutism, weight gain, erythema, abdominal discomfort, rash, nausea, vomiting, fluid retention, dizziness, anxiety, depression
Methylprednisolone dose
4-48 mg PO divided qD-QID
Methylprednisolone contraindications
Systemic fungal infection, avoid abrupt withdrawal in high or long term use
Prednisolone brand
Orapred, Pediapred
Prednisolone class
Corticosteroid
Prednisolone MOA
Inhibits multiple inflammatory cytokines, produces multiple glucocorticoid and mineralocorticoid effects
Prednisolone side effects
Hirsutism, weight gain, erythema, abdominal discomfort, rash, N/V, fluid retention, dizziness, anxiety, depression
Prednisolone dose
5-60 mg divided qD-QID
Prednisolone contraindications
Systemic fungal infection, avoid abrupt withdrawal in high or long-term use
In general, what occurs with IBS?
Altered somatovisceral motility with abnormal CNS processing of visceral pain signals
What are some factors that can lead to IBS?
Genetics, motility factors, inflammation, colonic infections, mechanical irritation to nerves, psychological factors
What are the major neurotransmitters in the gut and what are they responsible for?
5-HT3 and 5-HT4, responsible for secretion, sensitization, motility
What does increased expression of 5-HT lead to?
Diarrhea predominant IBS due to increased secretion, pain, and motility
What occurs with IBS-D?
Increased contractions and shorter GI transit, movement is fast
What occurs with IBS-C?
Decreased contractions and longer GI transit, movement is low
Which type of IBS has a lower threshold for pain and why?
IBS-D, enhanced sensitivity due to greater 5-HT stimulation
What are some symptoms of IBS-C?
Straining, hard/lumpy bowel movements, incomplete evacuation, abdomen bloating, < 3 bowel movements per week
What are some signs and symptoms of IBS-D?
Lower abdominal pain, bloating, rectal distension, diarrhea, extreme urgency, mucus passage
In general what occurs with IBS?
Reduced health-related QOL
What are diagnostic criteria for IBS?
Disturbed defecation, absence of structural or biochemical factors
What is the therapeutic goal of IBS treatment?
Focus on the patient’s primary complaint
What should we always track, monitor, and manage with IBS symptoms?
Depression and anxiety symptoms
What is the general non pharmacological treatment for IBS?
Diet with fementable sugars
What will fiber help with for IBS-C?
Constipation but not pain
What should a patient expect when they take high doses of fiber for IBS-C?
Gas, nausea, cramping
When is senna indicated for IBS-C?
Only for severe cases where a patient hasn’t had a bowel movement in weeks, use smallest dose for least amount of time
What would occur if you give a dehydrated patient osmotic laxatives?
Excessive cramping
How do osmotic laxatives help with IBS-C?
Draws water into GI tract which increases motility and decreases transit time
What is the MOA of lubiprostone (Amitiza)?
Chloride channel activator that acts as a prostaglandin E1 analog, enhances intestinal fluid and electrolyte concentrations in the intestine
What is the dose of lubiprostone (Amitiza)?
8 mcg PO BID for severe constipation with food and water
What are adverse effects of lubiprostone?
Headache, nausea, diarrhea, abdominal pain/distention, dyspnea
What is the MOA of linaclotide (Linzess) and plecanatide (Trulance)?
Guanylate cyclase-C agonists that increase the release of chloride and bicarb into the lumen which accelerates intestinal transit time
What are adverse effects of GC-C agonists?
Severe diarrhea, dizziness, hypotension
How should Linzess be administered?
30 minutes before breakfast on an empty stomach
When do we use GC-Cs in patients with IBS?
Persistent IBS-C despite the use of osmotic laxatives
What are the BBWs for Linzess?
Contraindicated in patients <2 years old and dehydration
What is the dose of plecanatide (Trulance)?
3 mg PO qD
What are some counseling points for plecanatide (Trulance)?
Stop taking if severe diarrhea, contraindicated in patients <6, death due to dehydration
What is the MOA of tegaserod (Zelnorm)?
5-HT4 partial agonist, increases motility, secretions, and decreases visceral sensation
What are adverse effects of tegaserod (Zelnorm)?
Headache, abdominal pain, diarrhea
What do we have to monitor with tegaserod (Zelnorm) use?
Cardiac events, significant diarrhea
