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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.
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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