Pharm 3

Low tyramine diet and how it can impact MAOI inhibitor

Low tyramine diet is a restriction of aged, fermented, pickled foods

MAOIs block the enzyme that usually breaks down tyramine in the gut/liver, leading to excess tyramine forcing a sudden release of norepinephrine

What are MAOI’s

Block monoamine oxidase in the brain, increasing available norepinephrine, dopamine, serotonin and tyramine. Increases in these relieve depression (but tyramine causes HPTN)

used for depression, bulimia, panic disorders, anxiety, OCD, PTSD

Comps: CNS stimulation

Lithium

Causes neurochemical changes in brain that blocks serotonin receptors

used for bipolar disorder, mania, and depression

Comps: GI distress, tremors, polyuria, weight gain, renal toxicity, elecytolyte and lithium toxicity.

interactions: diuretics, NSAIDS

Addison’s disease and treatment

failure to produce sufficient cortisol and aldosterone

glucocorticoid: Hydrocortisone, prednisone

mineralocorticoid

long term affects of alcohol use

liver disease, cardiovascular damage, cancer risk, brain shrinkage and memory loss, damage to stomach lining, depression, anxiety

What is hemoglobin A1C

Measures the average amount of glucose attached to hemoglobin in your blood over the past 2-3 months

Levothyroxine

synthetic form of thyroxine (T4) for hypothyroidism

comps come from over medication

increase dose gradually

insulin

Prevents blood glucose levels from becoming too high, triggered by hyperglycemia

Promotes cellular uptake of glucose, converts glucose into glycogen ans promotes energy storage in liver

also moves potassium into cells

Types of insulin

Rapid: Lispro, Aspart, glulisine, inhaled insulin

Short acting: regular insulin

Intermediate acting: NPH, detemir

Long acting: insulin glargine

Ultra long: U-300 insulin glargine, insulin degludec

reversal agent for benzodiazepine

Flumazemil

Treatment for opioid withdrawal

Methadone substitution (replaces the opioid to which the client has a physical dependence) Clonidine (assists with withdrawal effects related to autonomic hyperactivity), Buprenorphine (It is substituted for the opioid to which the client has a physical dependence and prevents withdrawal manifestations)

Chlordiazepoxide, alprazolam - Benzodiazepine

Decrease activity of neurons by enhancing the inhibitory effects of GABA

used for anxiety, as well as seizures muscle spasms, alcohol withdrawal

comps: CNS depression

Buspirone

binds with dopamine and serotonin receptors

to treat anxiety, panic disorders, OCD, PTSD

less addictive then benzos

SSRI’s: sertraline, paroxetine

increases serotonin in system, takes time

used for anxiety, insomnia, OCD, trauma, depression

what step of synaptic transmission does SSRI’s work at

Step 5 - blocking of NT reabsorption

what is the order of mixing insulins

draw up regular then draw up NPH

push air into NPH first

If someone is having sexual dysfunction from SSRI what med they might be put on instead.

Bupropion - as it inhibits uptake of norepinephrine and dopamine without increasing serotonin

Lithium

Causes neurochemical changes in brain that block serotonin receptors, used for manic and depressive episodes of bipolar

The other meds to treat bipolar, carbamazepine, valproic acid

slowing the repolarization of neurons, and inhibitory effects of GABA and glutamic acid, which all suppress CNS excitation

Commonality between tricyclic, SSRI, and SNRI’s, and antidepressants

They all increase neurotransmitters in the brain that improve mood

They all prevent the reuptake of serotonin (and some norepi)

They all act at the synapse

They all pose risk for serotonin syndrome

Naltrexone

Suppress cravings and pleasurable effects of alcohol and opioids

meds for acute vs. chronic anxiety

Acute: Benzodiazepines (chlordiazepoxide, alprazolam)

Chronic: SSRI’s, SSNI’s, buspirone,

Rescue meds for someone with low blood sugar

Glucagon, dextrose or juice if conscious

type 1 diabetes and treatment

Body does not make insuin

treatment: Insulin

Type 2 diabetes and treatment

Body doesn’t respond to or does not make enough insulin

Treatment: Insulin, sulfonylureas, meglitinides, Biguanides, Thiazolidinediones, Alpha glucosidase inhibitors, DPP4 inhibitors, SGLT2 inhibitors, GLP 1 receptor agonists

Meds that cause hyperglycemia

Glucocorticoids, levothyroxine, epinephrine

Oral antidiabetics and the differences between them

Sulfonylureas - insulin release from the pancreas

Meglitinides - insulin release from the pancreas

Biguanides (metformin) - reduces production of glucose in liver, increases muscle glucose uptake

Thiazolidinediones - Decreases insulin resistance, increases glucose uptake and decreases glucose production

Alpha-glucosidase inhibitors - slows carb absorption and digestion

DPP-4: Augments incretin hormone - release insulin and decrease glucagon

SGLT-2 inhibitor - excretes glucose through urine, promotes weight loss

GLP-1 receptor - decrease glucose secretion, slows gastric emptying, increase satiety

Treatment for graves disease - propylthiouracil

blocks the synthesis of thyroid hormone

Bolus vs basal insulin

Basal: intermediate - long acting insulin once/twice a day

Bolus: rapid - short acting insulin before meals

treatment for hypoaldosteronism

treat hypokalemia and give fludrocortisone (a minerocoritcoid)