Listen in as I pick Victoria Arsenault’s, PharmD, brain about two totally unrelated topics: vancomycin and oral diabetic agents.
Listen in as I pick Victoria Arsenault’s, PharmD, brain about two totally unrelated topics: vancomycin and oral diabetic agents.
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*TIL= Today I Learned* Residents & students of @ChillaPharmD posting the things they are learning on their emergency medicine pharmacy rotation.
Associated with trough levels >20 or doses > 4g/day, prolonged therapy, concomitant agents such as IV contrast, Piperacillin/Tazobactam (Zosyn), loop diuretics, and aminoglycosides.
Associated with high peaks, can be transient or permanent, concomitant aminoglycoside use. Very rare.
Studies have shown that adjusting vancomycin dosing by using the area under the curve (or AUC) can best predict efficacy and safety for vancomycin. This basically assesses vancomycin exposure to the patient.
For AUC dosing we use two data points, peak and trough, to calculate more accurate pharmacokinetics. This method allows for troughs as low as 10 in severe infections!
The AUC method of dosing presents some work flow changes for both pharmacists and nurses. Nurses will need to be meticulous about collecting the peak and trough lab draws.
THE BIG TAKEAWAY: AUC vancomycin dosing is a more accurate way to maximize the antibiotic’s efficacy while minimizing the risk of nephrotoxicity
Biguanides: Metformin | MOA: insulin sensitizer, inhibits gluconeogenesis, increases endogenous insulin post prandial Pros: Cheap, no hypoglycemia risk, weight neutral, strong A1C reduction: 1-2% Cons: Diarrhea/GI upset (taking with food can decreased GI upset), pill burden |
SGLT2 Inhibitors: Empagliflozin (Jardiance), Dapagliflozin (Farxiga), Canagliflozin (Invokana), Ertugliflozin (Steglatro) | MOA: blocks reabsorption of glucose makes you pee out your sugar Pros: no hypoglycemia risk, weight loss, CV/CHF/CKD benefit, decreases BP, moderate A1C reduction: 0.5-1% Cons: UTI risk (females>males), increased UO, dehydration, hypotension, DKA |
DPP-4 Inhibitors: Sitagliptin (Januvia), Linagliptin (Tradjenta), Saxagliptin (Onglyza), Alogliptin (Nesina) | MOA: incretin mimetic (increases insulin production) Pros: no hypoglycemia risk, weight neutral, well-tolerated, QD dosing, moderate A1C reduction (0.5 – 1%) Cons: Abdominal discomfort |
GLP-1 agonists: Trulicity, Rybelsus | MOA: slows gastric motility, increases endogenous insulin production Pros: Weight loss, no hypoglycemia risk, strong A1C reduction: 1-2% Cons: Injections (except Rybelsus), needs refrigeration, not studied extensively in HD patients, nausea, GI upset, diarrhea, constipation |
Sulfonylureas: Glipizide (Glucotrol), Glyburide (Diabeta), Glimepiride (Amaryl) |
MOA: insulin secretagogue Benefits: Cheap, strong A1C reduction (1-2%) Cons: Hypoglycemia – do not take if not eating, weight gain |
Meglitinides: Nateglinide (Starlix), Repaglinide (Prandin) | MOA: Stimulates insulin secretion Pro: Strong A1C reduction (1-2%) Cons: Hypoglycemia – do not take if not eating |
Listen in as I pick Victoria Arsenault's, PharmD, brain about two totally unrelated topics: vancomycin and oral diabetic agents.
Learn more about emergency pharmacy at TILEmergencyPharmacist *TIL= Today I Learned* Residents & students of @ChillaPharmD posting the things they are learning on their emergency medicine pharmacy rotation.
Use the promo code UMNG10 to get 10% off your order from Stoggles.
Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).
See the show notes at upmynursinggame.com.