Term
|
Definition
glimepiride
longest acting SU
1-8 mg QD with breakfast
titrate q 1-2 weeks |
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Term
|
Definition
glipizide
SU
2.5-40mg daily (BID if >15mg)
titrate q 1-2 weeks
food delays absorption- take 30 minutes before eating.
No active metabolites |
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Term
|
Definition
glipizide XL
SU
2.5-20mg QD with breakfast
no active metabolites |
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Term
|
Definition
glyburide
SU
1.25-30mg QD or BID if <10mg
titrate q 1-2 weeks
needs renal/hepatic dosing because active metabolites are exreted renally.
Take 30 minutes before food or with food. |
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Term
|
Definition
repaglinide
meglitinide (stim. insulin release)
0.5-5mg TID (max 16mg/24hrs)
take 15 minutes prior to food, skip if a meal is missed. |
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Term
|
Definition
nateglitinide
meglitinide (stimulates insulin release)
60-120mg TID 15minutes prior to meals, skip if meal is missed
titrate weekly |
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Term
|
Definition
acarbose
alpha-glucosidase inhibitor
25-100mg TID with first bite of meal, skip if you skip meals
titrate q 4-8 weeks
effects post prandial most
CI in IBD
if hypoglycemic, must tx with glucose (extends carb time in gut)
extreme gas/diarrhea |
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Term
|
Definition
pioglitizone ( TZD)
15-45mg daily w/o regard to meals
titrate q 3 months
bladder cancer risk |
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Term
|
Definition
rosiglitazone (TZD)
restricted access (existing therapy and not able/willing to take Actos)
4-8mg daily or BID
titrate q 3 months
risk of MI/CV events |
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Term
|
Definition
metformin (biguanide)
1000-2550mg QD-BID with food to decrease AE
dc gluconeogenesis in liver overnight
CI in Scr >1.4,1.5, liver disease
GI effects minimized with titration (weekly) |
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|
Term
| Glucophage XR/ Glumetza XR |
|
Definition
metformin XR-
1000-2000mg QD with evening meal
shell may be present in stool |
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Term
|
Definition
glipizide/metformin
BID with food
max 20/2000 QD
titrate q 2 weeks |
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Term
|
Definition
glyburide/metformin
BID with food
max 20/2000mg QD
titrate q 2 wks |
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Term
|
Definition
pioglitizone/metformin
BID with food
max dose 45/2000mg QD |
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Term
|
Definition
rosiglitizone/metformin
BID with food
max dose 8/2000mg daily |
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Term
|
Definition
sitagliptin (DPP-IV inhibitor)
100mg QD (adjust if CrCL <50)
may cause pancreatitis/angioedema |
|
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Term
|
Definition
saxagliptin (DPP-IV Inhibitor)
2.5-5mg daily (dose adjustment with CrCL <50 and 3A4 Inhibitors) |
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Term
|
Definition
linagliptin (DPP-IV Inhibitor)
5mg QD (no renal dosing!) |
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Term
|
Definition
pramlintide (amylin analog)
only w/ insulin-dependent pts (I/II)
probably need to decrease insulin dose
CI: gastroparesis, hypoglycemic unawareness
nausea!
Type I: 15mcg SQ premeal up to 60
Type II: 60mcg SQ premeal up to 120 |
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Term
|
Definition
exenitide (GLP-1 agonist)
5-10mcg SQ BID before meals
incretin mimetic
N/V/D- and pancreatitis
skip if meals missed |
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Term
|
Definition
liraglutide (GLP-1 receptor agonist)
0.6mg QD x 1 wk then 1.2 mg SQ QD
CI h/o thyroid carcinoma
N/V/D, pancreatitis |
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Term
|
Definition
insulin lispro/protamine suspension
(75/25, 50/50)- cloudy
15 minutes prior to morning/evening meal |
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Term
|
Definition
insulin lispro
0-15 minutes prior to meals |
|
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Term
|
Definition
insulin R & insulin N
(70/30, 50/50)
30 min prior to morning/evening meals |
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Term
|
Definition
regular insulin
30 minutes prior to meals |
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Term
|
Definition
NPH (intermediate, cloudy)
QD but usually BID |
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Term
|
Definition
insulin glargine
QHS usually
decrease dose by 20% if switching from NPH |
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Term
|
Definition
insulin detemir
QD-BID (no dosing % change)
QHS or 12 hours apart |
|
|
Term
|
Definition
insulin aspart
0-15 minutes prior to meals |
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Term
|
Definition
aspart/protamine (70-30) cloudy
15 minutes prior to morning/evening meals |
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Term
|
Definition
insulin glulisine
0-15 minutes prior to meals |
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|
Term
|
Definition
rabeprazole (PPI)
GERD 20mg daily x 8wks
MT- 20mg daily
h.pylori-20mg BID x 14 days |
|
|
Term
|
Definition
esomeprazole (PPI)
1 hour before food
GERD- 20-40mg QD x 4-8wks
MT- 20mg QD
h.pylori- 40mg daily x 14days |
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|
Term
|
Definition
lansoprazole (PPI)
GERD- 30mg daily x 8 wks
MT- 15mg daily
h.pylori- 30mg BID x 14 days
food decreases absorption so take on empty stomach.
Has granules (NG tube) |
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Term
|
Definition
omeprazole (PPI)
GERD- 20mg QD x 4-8 weeks
MT- 20mg daily
h.pylori- 20mg BID x 14 days
watch with Plavix, warfarin
take before food |
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Term
|
Definition
pantoprazole (PPI)
GERD- 40mg daily x 8 weeks
MT-40mg daily
also IV formula
without regard to meals |
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Term
|
Definition
dexlansoprazole (PPI)
GERD- 60mg daily x 8 weeks
MT- 30mg daily
has 2 peaks
without regard to meals and can sprinkle over food |
|
|
Term
|
Definition
famotidine (H2A)
Uclers- 20mg BID or 40mg qhs
MT- 20mg qhs
GERD- 20-40mg BID x 6-12wks
MT- 20mg qhs
headache
also IV |
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Term
|
Definition
cimetidine (H2A)
GERD 400mg QID x 12wks
DI- benzos (except LOT), carbamazepine, BB, phenytoin, theophylline, warfarin, Plavix.
Take with food
Cannot take with antacids. |
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Term
|
Definition
ranitidine (H2A)
Ulcers- 150mg BID
MT-150mg QHS
GERD-150mg QID
MT-150mg BID
also has effervescent tablets |
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Term
|
Definition
sucralfate
ulcers- 1g QID x 4-8 wks
MT-1g BID
watch in renal impairment (increase AL)
can cause constipation and ingestion
Take 1 hour before meals and at bedtime
avoid antacids
DI: digoxin, warfarin, phenytoin, theophylline, Synthroid, quinolones, TCNs, antacids bc of altered absorption |
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|
Term
|
Definition
misoprostol (prostaglandin)
200mcg QID
Pregnancy Category X
GI side effects |
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|
Term
|
Definition
mesalamine (5-ASA)
UC-2t TID x 6wks
all delayed release
CI in ASA allergy |
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Term
|
Definition
balsalazide (5-ASA)
UC (active)- 3caps TID x 8-12wks
regular release
CI in ASA allergy |
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|
Term
|
Definition
olsalazine
UC (MT)- 2 caps BID
regular release
CI in ASA allergy
take with food |
|
|
Term
|
Definition
sulfasalazine (5-ASA)
UC-2000-4000mg daily (TID)
MT-2000mg daily (TID)
CI in ASA/sulfa allergy |
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|
Term
|
Definition
dicyclomine (antispasmodic)
IBS- 20-40mg TID-QID 30 min prior to meals
anticholinergic symptoms
may cause drowsiness/avoid alcohol |
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|
Term
|
Definition
hyoscyamine (antispasmodic)
anticholinergic (belladonna alkaloid)
take on an empty stomach/ no alcohol
Levsin IBS- 0.125mg tabs 1-2q 4hrs prn
max 12 daily
Levbid- 0.375mg tabs 1-2 q 12 hrs |
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|
Term
|
Definition
chlordiazepoxide/clidinium
IBS 1-2t TID-QID before food/qhs
benzo withdrawal symptoms- dont DC abruptly
anticholinergic symptoms |
|
|
Term
|
Definition
prochlorperazine (PTZ derivative)
N/V 5-10mg (TID/QID)
CI: use with CNS depressants, children <2 or 20lb
watch for tardive dyskinesia, dowsiness, dizziness
dopamine antagonist |
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Term
|
Definition
granisetron (5-HT3 antagonist)
CI N/V- 1mg BID 60 min prior to chemo
also good for post op N/V
HA/fatigue/constipation |
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|
Term
|
Definition
ondansetron (5-HT3 antagonist)
CINV- 8mg BID (30 min prior to chemo)
PONV- 16mg pre-anesthesia |
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Term
|
Definition
metoclopramide (GI stimulant)
CI in GI obstruction
BBW-tardive dyskinesia
Must limit to <12wks
DM gastroparesis 5-10mg QID 30min AC/HS
GERD- 5-15mg up to QID |
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|
Term
|
Definition
trimethobenzamide (anticholinergic)
N/V: 300mg PO TID/QID
capsule
EPS also with this med
avoid alcohol |
|
|
Term
|
Definition
atropine/scopolamine/hyscyamine/phenobarbital (antisposmodic)
1-2 TID/QID max 8 tabs/24hrs
IBS/acute enteric colitis
CI in anticholinergic disorders/elderly |
|
|
Term
|
Definition
diphenoxylate/atropine
CI in pseudomembranous colitis
DC if no response in 48hrs
D: 2T/1tsp QID then QD-BID |
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Term
|
Definition
PEG 3350
Constipation: 1 scoop in 8oz daily
may take 2-4 days |
|
|
Term
|
Definition
PEG/electrolyte
bowel cleansing pre-procedure
8oz q10min until clear BM or 4L
Don't eat within 3-4hrs |
|
|
Term
|
Definition
stool softener
do not combine with mineral oil
Na:50-100mg BID (250mg QD)
Ca: 240mg daily |
|
|
Term
|
Definition
Chronulac brand
Constipation: 15-30ml daily
PSE: 30-45ml daily |
|
|
Term
|
Definition
chlorhexidine gluconate
oral hygiene rinse
1/2oz for 30sec BID after brushing
do not swallow, avoid food/water after |
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|
Term
|
Definition
naproxen sodium (proprionic acid)
pain: 1650mg daily in 3-4 doses
arthritis: 550-1100mg BID
275/550mg tabs |
|
|
Term
|
Definition
naproxen base (proprionic acid)
pain- 1250mg daily (TID/QID)
arthritis (EC): 500-1000mg BID
250/375/500mg tabs |
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|
Term
|
Definition
ibuprofen (proprionic acid)
pain: 1600-2400mg daily (3-4 doses)
arthritis: 1200-3200mg daily
max 800 QID |
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|
Term
|
Definition
oxaprozin (proprionic acid)
arthritis: 600-1800mg QD 9or BID)
comes in 600mg caplet |
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|
Term
|
Definition
etodalac (acetic acid)
arthritis: 600-1200mg BID/TID |
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|
Term
|
Definition
etodalac (acetic acid)
arthritis: 600-1200mg daily |
|
|
Term
|
Definition
diclofenac (acetic acid)
arthritis: max 200mg daily (BID-QID) |
|
|
Term
|
Definition
diclofenac (acetic acid)
arthritis: 100-200mg daily (or BID)
100mg tablet |
|
|
Term
|
Definition
sulindac (acetic acid)
prodrug-maybe less renally toxic, but must lower dose with livere disease
arthritis: 300-400mg BID |
|
|
Term
|
Definition
piroxicam (oxicam)
more GI effects
arthritis: max 20mg daily
capsule |
|
|
Term
|
Definition
indomethacin (acetic acid)
more GI effects
arthritis: 200mg BID/TID
CR is 150mg daily
capsule/suppository/suspension |
|
|
Term
|
Definition
ketorolac (acetic acid)
CI with pentoxifylline, probenacid, severe renal impairment
severe GI/renal toxicity
not for elderly
NMT 5 days total |
|
|
Term
|
Definition
nabumetone (acetic acid)
decrease dose in hepatic impairment and CrCl <50
arthritis: 500-2000mg daily (BID) |
|
|
Term
|
Definition
celecoxib (cox II inhibitor)
2C9 substrate, 2D6 inhibitor
CI in sulfa allergy
DI: warfarin, fluconazole, etc
OA: 200mg daily (BID)
RA: 200-400mg daily (BID) |
|
|
Term
|
Definition
meloxicam (oxicam)
arthritis: 7.5-15mg daily |
|
|
Term
|
Definition
salsalate (inhibits prostaglandin synthesis, no platelet effect)
not as helpful for pain
arthritis/pain: 3000mg daily (TID) |
|
|
Term
|
Definition
diclofenac/misoprostol
CI in pregnancy
greater GI effects than diclofenac alone
take with food
200mg/800mcg 2-4x daily (TID ideal) |
|
|
Term
|
Definition
BBW: marrow depression, hepatotoxicity
pregnancy category X
N/V/D stomatitis (mouth), photosensitivity
folic acid may decrease AE
RA: 7.5mg weekly or 2.5mg q 12 hrs x3 weekly |
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|
Term
|
Definition
cyclobenzaprine
CI: CHF, arrhythmias, acute MI
anticholinergic
15-30mg daily (TID)
some CV risk with this med |
|
|
Term
|
Definition
methocarbamol
drowsiness, dizziness, N
3-4g daily (QID) |
|
|
Term
|
Definition
orphenadrine (SR always) CI with anticholinergic dx
100mg BID |
|
|
Term
|
Definition
metaxalone
CI in renal/hepatic disease
on BEERS list
3200mg daily (TID/QID) |
|
|
Term
|
Definition
carisoprodol
2C19 metabolized to meprobamate
dependence, drowsiness, N
up to 1400mg daily (QID) |
|
|
Term
|
Definition
tizanidine (alpha2 agonist)
muscle spasticity
CI with cipro, fluvoxamine
can cause hypotension
anticholinergic
give with food to decrease GI effects
12-36mg daily (TID)
2,4,6 mg capsules
2,4mg tablets |
|
|
Term
|
Definition
baclofen
spasticity
DO NOT DC ABRUPTLY
15-80mg daily (TID/QID) |
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