What are the key points for the review of hypoglycemic drugs? Easy to get 5 prescriptions

*Only for medical professionals to read the reference medication prescriptions.
When you come to see my dear doctors and pharmacists, I will meet you again in the Prescription Challenge column.
In this issue, we will discuss the rationality review of the prescription of a reduced sugar medicine
.

Let us take a look at what is wrong with these "problem" prescriptions! Prescription 1 Difficulty Index ★ ★ Prescription analysis is that the usage and dosage are not suitable for the prescription
.

1.
The half-life of alendronate sodium tablets is very long.
It should be administered once a week, and once a day is unreasonable
.

2.
Levothyroxine sodium tablets should be taken with an appropriate amount of water half an hour before breakfast, once a day
.

The pharmacist recommends 1.
Alendronate has a stimulating effect on the upper gastrointestinal mucosa.
Lying down when taking the medicine will increase this irritation.
Keep the standing or sitting position within 30 minutes after taking the medicine
.

The medicine should be taken on a fixed day of the week.
If the medicine is missed, it should be taken once on the second day.
After that, the medicine should be taken according to the normal plan, not twice a day
.

2.
For postmenopausal women with increased risk of hypothyroidism and osteoporosis, levothyroxine sodium that exceeds physiological serum levels should be avoided; in addition, thyroid function should be closely monitored to adjust the dosage [1,2]
.

Prescription 2 Difficulty Index ★★★ Prescription analysis belongs to the selected drugs not suitable for prescription
.

1.
Gliquidone tablets are forbidden for those who are allergic to sulfa drugs
.

2.
Metformin is mainly excreted by the kidneys.
When renal insufficiency occurs, the renal clearance will decrease with the decrease of creatinine clearance.
At this time, the elimination half-life of metformin is prolonged, leading to an increase in plasma metformin concentration
.

Metformin is contraindicated in patients with eGFR<45ml/min/1.
73m2[3].
This patient has chronic kidney disease stage 3b.
It is recommended to switch to insulin preparations to control blood sugar
.

Pharmacists suggest that iodine-containing contrast media may cause acute changes in renal function, and lactic acidosis is more likely to occur after the use of metformin
.

Patients with normal renal function should discontinue metformin within 48 hours after the examination before the examination, and those with abnormal renal function should discontinue metformin 48 hours before the examination
.
The medication can only be continued after the renal function has recovered .

Before doing angiography, inform the doctor about the medication status in advance (click the director’s question for details: Do you want to stop metformin 48 hours before the angiography?)
.

Prescription 3 Difficulty Index ★★★ Prescription analysis belongs to the selected drugs not suitable for prescription
.

1.
Methimazole can pass through the placental barrier, and the concentration in the fetal blood is equal to the concentration in the mother's serum
.

If the dose is not appropriate, it can lead to the formation of fetal goiter and hypothyroidism, and it can also reduce the birth weight of the fetus
.

For hyperthyroidism in early pregnancy, propylthiouracil is more recommended because propylthiouracil is tightly bound to protein and passes through the placenta less [4]
.

2.
propranolol pregnancy Category C medication, if not control acute symptoms of hyperthyroidism is not recommended for long-term use may cause fetal restricted, miscarriage, premature delivery
.

Prescription 4 difficulty index ★★★★ Prescription analysis is an unreasonable prescription for combination medication
.

Sulfonylurea hypoglycemic drugs have a higher protein binding rate, and compound sulfamethoxazole has stronger plasma protein binding ability, which can increase the free-type drugs of sulfonylurea drugs, enhance the hypoglycemic effect, and cause hypoglycemia in severe cases.
, So the two cannot be used together [4]
.

The pharmacist recommends that patients can switch to other antibacterial drugs that can treat urinary system infections, such as quinolones, but some quinolones can also cause blood sugar disorders, and blood sugar should be monitored
.

Prescription 5 Difficulty Index ★★★★ Prescription analysis belongs to combination medication not suitable for prescription
.

Combination of sulfonylurea hypoglycemic drugs and aspirin can compete with each other to bind plasma proteins, which can enhance the hypoglycemic effect and lead to hypoglycemia
.

The pharmacist suggested that sulfonylureas is a commonly used oral hypoglycemic agent in clinical practice, mainly used for patients with non-insulin-dependent diabetes with surviving islet function and those who are ineffective in diet control alone.
Such drugs interact with multiple drugs (such as H2 receptor blockers, thiazide diuretics, sulfonamides, salicylic acid, etc.
)
.

In addition, sulfonylurea drugs can also increase the toxicity of ethanol, causing symptoms such as abdominal cramps, nausea, vomiting, and hypoglycemia, so you must abstain from alcohol during medication [5]
.

 Lovely doctors and pharmacists, what else do you have to review? Come and leave a message in the comment area to share! References: [1] Instructions for Alendronate Sodium Tablets, Hangzhou Minsheng Pharmaceutical [2] Instructions for Levothyroxine Sodium Tablets, Merck[3] Instructions for Metformin Tablets, Shanghai Squibb Pharmaceuticals [4] Lian Yan, Wang Xietong.
Pregnancy Diagnosis and treatment of hyperthyroidism[J].
Journal of Practical Obstetrics and Gynecology, 2015, 31(012):893-897.
[5] Zhang Weiqin.
Interaction of sulfonylurea oral hypoglycemic drugs[J].
Heilongjiang Medicine, 2001,05:370-371.
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