GIN Exam 3

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