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Antidiabetic Medications Overview Exam Review, Exams of Medicine

A comprehensive overview of various antidiabetic medications, including their mechanisms of action, dosing, side effects, and monitoring requirements. It covers a wide range of drug classes such as xanthine oxidase inhibitors, steroids, nsaids, antiarrhythmic drugs, antihypertensive medications (ace inhibitors, arbs, beta blockers, diuretics, calcium channel blockers), heart failure treatments (arni, cardiac glycosides), anticoagulants, lipid-lowering agents, and antidiabetic drugs (insulin, metformin, glp-1 agonists, dpp-4 inhibitors, sglt2 inhibitors, sulfonylureas, meglitinides). The document also highlights important considerations for medication use, including drug interactions, contraindications, and adverse effects. This information would be highly valuable for healthcare professionals, particularly those involved in the management of patients with diabetes, cardiovascular conditions, and other related disorders.

Typology: Exams

2022/2023

Available from 10/22/2024

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Antidiabetic Medications Overview Exam Review Solution
Xanthine Oxidase Inhibitors - ANS-Medications like colchicine, allopurinol, and febuxostat used to treat
gout
Colchicine Dosing - ANS-Initial dose of 1.2 mg at first sign of flare, then 0.6 mg 1 hour later (MAX: 1.8
mg/hour)
Colchicine Side Effects - ANS-Diarrhea, malabsorption of B12, hepatotoxicity, renal stone development,
myopathy, neuropathy
Allopurinol Usage - ANS-Prophylactic treatment of gout, not for acute flares
Steroids Mechanism - ANS-Inhibits arachidonic acid metabolism, stabilizes biologic membranes, impairs
phagocytosis, lymphocytes, and tissue repair
Steroids GI Side Effects - ANS-GI bleeding, peptic ulcer disease, ulcerative colitis, nephrotic syndrome,
hepatic disease
Steroids Skin Side Effects - ANS-Thinning of skin, alopecia, acne, purpura, striae, hirsutism, muscle
wasting
Steroids Skeletal Side Effects - ANS-Osteoporosis, skeletal fractures; treated with alendronate or
risedronate
Steroids Ocular Side Effects - ANS-Subcapsular cataracts, glaucoma, optic nerve damage
NSAIDs Black Box Warning - ANS-GI bleed, ulceration, cardiovascular events (MI, stroke)
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Antidiabetic Medications Overview Exam Review Solution

Xanthine Oxidase Inhibitors - ANS-Medications like colchicine, allopurinol, and febuxostat used to treat gout

Colchicine Dosing - ANS-Initial dose of 1.2 mg at first sign of flare, then 0.6 mg 1 hour later (MAX: 1. mg/hour)

Colchicine Side Effects - ANS-Diarrhea, malabsorption of B12, hepatotoxicity, renal stone development, myopathy, neuropathy

Allopurinol Usage - ANS-Prophylactic treatment of gout, not for acute flares

Steroids Mechanism - ANS-Inhibits arachidonic acid metabolism, stabilizes biologic membranes, impairs phagocytosis, lymphocytes, and tissue repair

Steroids GI Side Effects - ANS-GI bleeding, peptic ulcer disease, ulcerative colitis, nephrotic syndrome, hepatic disease

Steroids Skin Side Effects - ANS-Thinning of skin, alopecia, acne, purpura, striae, hirsutism, muscle wasting

Steroids Skeletal Side Effects - ANS-Osteoporosis, skeletal fractures; treated with alendronate or risedronate

Steroids Ocular Side Effects - ANS-Subcapsular cataracts, glaucoma, optic nerve damage

NSAIDs Black Box Warning - ANS-GI bleed, ulceration, cardiovascular events (MI, stroke)

Ibuprofen Side Effects - ANS-GI bleeding, peptic ulcers, antiplatelet effect, compromised kidney function

Aspirin Toxicity Sign - ANS-Tinnitus is an early sign of aspirin toxicity

Acetaminophen Overdose Symptoms - ANS-Nausea, vomiting, confusion, liver tenderness, renal failure

Opioids Mechanism - ANS-Bind to Mu receptors in the brain and spinal cord, enhancing antinociceptive pathways

Mu1 Receptor Location - ANS-Outside the spinal cord, responsible for central interpretation of pain

Mu2 Receptor Function - ANS-Throughout the CNS, responsible for respiratory depression, spinal analgesia, physical dependence

Opioid Side Effects - ANS-Euphoria, nausea, constipation, respiratory depression, tolerance, physical and psychological dependence

Opioid Toxicity Symptoms - ANS-Coma, pinpoint pupils, depressed respiration

Opioid Withdrawal Symptoms - ANS-Rhinorrhea, lacrimation, chills, muscle aches, anxiety, diarrhea

Opioid mixed agonist-antagonists - ANS-Drugs like butorphanol, nalbuphine, buprenorphine

Mixed opioid agonist-antagonists - ANS-Have fewer side effects than agonists

Opioid antagonist - ANS-Reversal agent like naloxone, naltrexone

Amiodarone side effects - ANS-Include skin discoloration, lung disease, eye problems, bradycardia, and liver issues

Amiodarone precautions - ANS-Use cautiously with certain heart conditions, thyroid issues, and in pregnancy

Amiodarone interactions - ANS-Interacts with warfarin and digoxin

Amiodarone monitoring - ANS-Includes TSH, chest x-ray, PT/INR

Missed dose of amiodarone - ANS-Take the next day due to long half-life

Antihypertensive drugs - ANS-Include ACE inhibitors, ARBs, beta blockers, diuretics, calcium channel blockers

ACE inhibitors suffix - ANS--pril; prevent angiotensin conversion

ACE inhibitors side effects - ANS-Dry cough, angioedema, hypotension, hyperkalemia

ACE inhibitors monitoring - ANS-Renal function, liver tests, electrolytes

ACE inhibitors avoid - ANS-NSAIDs due to reduced effect

ACE inhibitors in pregnancy - ANS-Contraindicated

ARBs suffix - ANS--sartan; prevent angiotensin II binding

ARBs side effects - ANS-Hypotension, hyperkalemia, angioedema, renal failure

ARBs in pregnancy - ANS-Contraindicated

Beta blockers suffix - ANS--olol; block beta-1 receptors

Beta blockers side effects - ANS-Hypotension, bradycardia, fatigue, impotence, asthma worsening

Beta blockers severe side effects - ANS-Include agranulocytosis, SJS, anaphylaxis

Diuretics for hypertension - ANS-Decrease preload and afterload

Thiazide diuretics - ANS-Act on distal renal tubule to inhibit sodium reabsorption

Thiazide diuretics side effects - ANS-Hyperlipidemia, hypotension, tinnitus

Loop diuretics - ANS-Inhibit sodium reabsorption in the ascending loop of Henle

Loop diuretics side effects - ANS-Electrolyte abnormalities, hypotension, glucose intolerance

Spironolactone type - ANS-Potassium-sparing diuretic

Spironolactone use - ANS-For severe heart failure and post-MI with resistant HTN

Spironolactone side effects - ANS-Include hyperkalemia, hypotension, gynecomastia

ARNI Drugs - ANS-Sacubitril and Valsartan combination (Entresto)

Sacubitril Function - ANS-Inhibits natriuretic peptide breakdown, promoting vasodilation

Valsartan Action - ANS-Blocks angiotensin II receptors, causing vasodilation

Neprilysin - ANS-Enzyme degrading natriuretic peptides and vasoactive substances

Neprilysin Washout - ANS-36-72 hours with ACE or ARB use

Cardiac Glycosides - ANS-Digoxin, digitoxin; improve contractility, no mortality effect

Cardiac Glycoside Indication - ANS-When other meds at optimal doses fail

Digoxin Toxicity Effects - ANS-Noncardiac: anorexia, visual disturbances; Cardiac: dysrhythmias

Digoxin Toxicity Risk Factors - ANS-Hypokalemia, elderly with kidney impairment

Nitrate Mechanism - ANS-Increases O2 supply to coronary arteries

Nitrate Side Effects - ANS-Headache, hypotension, tolerance with continuous use

Anticoagulant Drugs - ANS-Warfarin, dabigatran, rivaroxaban, apixaban

Warfarin Action - ANS-Inhibits vitamin K reductase to prevent thrombosis

Warfarin Side Effects - ANS-Bleeding, red/brown urine, GI symptoms

Warfarin Reversal - ANS-Vitamin K

Warfarin Monitoring - ANS-INR levels

Dabigatran - ANS-Oral IIa inhibitor for non-valvular A-fib

Dabigatran Reversal - ANS-Idarucizumab (Praxbind)

Rivaroxaban Use - ANS-Oral factor Xa inhibitor for A-fib, DVT, PE

Apixaban - ANS-Oral Xa inhibitor for a-fib, DVT, PE

Plavix Mechanism - ANS-Blocks ADP receptors to inhibit platelet aggregation

Plavix Side Effects - ANS-Bleeding, GI bleeding, tinnitus

Aspirin Toxicity Effects - ANS-Tinnitus, GI symptoms, mental confusion

Statins Mechanism - ANS-Lower cholesterol, increase LDL receptors

Statins Side Effects - ANS-Hepatotoxicity, myopathy, dark urine

Methimazole - ANS-Used for hyperthyroidism; inhibits synthesis of thyroid hormones

Insulin - ANS-Increases peripheral glucose uptake; stimulates glucose entry into cells

Metformin - ANS-Decreases hepatic glucose production; increases insulin sensitivity

Alpha-glucosidase inhibitors - ANS-Inhibit absorption of complex carbs from the small intestines

Thiazolidinediones (TZDs) - ANS-Increase insulin sensitivity; decrease hepatic glucose output

GLP-1 agonists - ANS-Increase insulin secretion; decrease gastric emptying; aid weight loss

DPP-4 inhibitors - ANS-Inhibit DPP-4 enzyme; increase insulin secretion

Sodium-glucose cotransporter 2 inhibitors - ANS-Cause glucose excretion in urine; weight loss effect

Sulfonylureas - ANS-Bind to potassium channels; increase insulin secretion

Meglitinides - ANS-Bind to potassium channels; increase insulin secretion

A1c goal - ANS-Target of < 8% for patients with extensive comorbid conditions

Tachycardia - ANS-Side effect of levothyroxine; rapid heart rate

Agranulocytosis - ANS-Side effect of PTU; low white blood cell count

Hypoglycemia - ANS-Side effect of insulin; low blood sugar

Lactic acidosis - ANS-Rare side effect of metformin; build-up of lactic acid in the body

Necrotizing fasciitis - ANS-Black box warning for SGLT2 inhibitors; severe infection of the perineum

Weight gain - ANS-Side effect of TZDs and sulfonylureas; increase in body weight

Pancreatitis - ANS-Risk associated with GLP-1 agonists and DPP-4 inhibitors; inflammation of the pancreas

Renal insufficiency - ANS-Side effect of SGLT2 inhibitors; impaired kidney function

Hepatic necrosis - ANS-Black box warning for PTU; severe liver damage

Thyroid storm - ANS-Life-threatening condition requiring immediate treatment in hyperthyroidism

Insomnia - ANS-Side effect of levothyroxine; difficulty falling or staying asleep

Gastric upset - ANS-Common side effect of metformin; gastrointestinal discomfort

Injection site reactions - ANS-Common side effect of insulin; rash or swelling at injection site

Cardiac function - ANS-Parameter to monitor with TZDs; assess heart health