Pharm exam 4

hypothyroidism

underactivity of the thyroid gland

intolerance to cold, bradycardia, lethargy

hyperthyroidism

overactivity of the thyroid gland; intolerance to the heat, tachycardia, increased blood pressure

thyroid function tests

hypothyroid: increased tsh, decreased t3/t4

hyperthyroid: decreased TSH, increased t3/t4

levothyroxine

treats hypothyroidism

synthetic preparation of t4

should be taken in the morning 30-60 min before breakfast

thyrotoxicosis: tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance, sweating

methimazole

treats hyperthyroidism

adjunct to radiation therapy until effects of radiation become manifest

suppresses thyroid hormone synthesis in preparation for thyroid gland surgery

causes agranulocytosis (infection); not recommended in pregnancy/breastfeeding

Propylthiouracil

treats hyperthyroidism, adjunct to radiation therapy, preparation for thyroid gland surgery; short half life; causes severe liver injury

propranolol

beta blocker

suppresses symptoms of grave's disease like tachycardia

type 1 diabetes mellitus

pancreatic beta cells are destroyed; body makes no insulin at all

type 2 diabetes mellitus

insulin resistant or their pancreas does not secrete enough insulin

pre diabetes

patients at risk for developing type 2 diabetes mellitus

gestational diabetes

placenta produces hormones that antagonize the actions of insulin

short term complications of diabetes

hypoglycemia (fatgie, sweating, pallor)

hyperglycemia (polyuria, polydipsia)

ketoacidosis (persistent severe hyperglycemia with production of ketoacids, rotten smelling urine/fruity breath; can cause hemoconcentration, acidosis, and coma)

long term complications of diabetes

macrovascular damage (heart disease, htn, stroke)

microvascular damage (retinopathy, nephropathy, neuropathy, gastroparesis, amputations secondary to infection, ED)

goals of treatment

prevent long term complications, tighten blood glucose control, control blood pressure and blood lipids

monitoring treatment

Self-monitoring of blood glucose (SMBG) (weekly for patients on oral medications for T2DM)

Hemoglobin A1C (goal is below 7, or below 8 for severe hypoglycemia history/decreased life expectancy)

blood glucose target

80-130 before meals, <180 1-2 hrs after meals, 100-140 at bedtime

hypoglycemia

blood glucose <70, rapid treatment with glucose/glucagon is mandatory

other complications with insulin

lipohypertrophy, allergic reactions, hypokalemia

types of insulin

short duration rapid acting (lispro/aspart)

short duration slower acting (regular insulin) intermediate duration (NPH)

long duration (insulin glargine)

insulin storage

- Do not heat/freeze

- In use vials may be left at room temp up to 4 weeks

- Extra insulin should be refrigerated

- Avoid exposure to direct sunlight

insulin lispro

short duration rapid acting (15-30 min onset) peaks 1/2-2 1/2 hours; duration 3-6 hours; administered immediately before eating or after eating

insulin aspart

short duration rapid acting; 10-20 min onset; 1-3 hr peak, 3-6 hr duration; should be injected 5-15 minutes before meals (aspart as part of your appetizer)

regular insulin

short duration slower acting; 30-60 min onset, 1-5 hr peak, 10 hr duration, can be given IV

NPH insulin

intermediate duration, 60-120 min onset, 6-14 hr peak, 16-24 hr duration, only suitable insulin to mix with short acting ones, allergic reactions are possible

insulin glargine

long duration, 360 min onset, no peak, lasts more than 24 hours, usually given once a day at bedtime

insulin detemir

long duration, 60-120 min onset, no peak, lasts longer than 24 hours, onset is faster than glargine but is otherwise similar

metformin

biguanide

gi effects, weight neutral, severe renal failure with IV radiocontrast media that contain iodine

glipizide

sulfonylurea,treats type 2 diabetes causes weight gain (glizzies cause weight gain)

repaglinide and nateglinide

weight gain, taken with each meal, treats t2d

pioglitazone

thiazolidinedione; usually combined with additional therapy, can cause unintended pregnancy due to ovulation, treats t2d

acarbose

alpha glucosidase inhibitor;treats t2d causes increased flatulence and liver dysfunction (carbs make me gassy)

sitagliptin

DPP-4 inhibitor, usually combined with other therapies, causes URI/UTI (usually does not sit alone); treats t2d

canagliflozin

SGLT-2 inhibitors, improves cv/renal outcomes in pts with history of CV disease, causes weight loss, treats t2d

exenatide

GLP-1 receptor antagonist, weekly injections, reduces appetite and causes weight loss

pharmacological birth control methods

oral, etonogestrel implants, injectable medroxyprogesterone acetate, IUD, vaginal ring

non pharmacological birth control methods

surgical sterilization, mechanical devices, avoiding intercourse

oral contraceptives

inhibition of ovulation (combination OC or progestin only OC)

ethinyl estradiol/norethindrone

combination oc; causes thromboembolic disorder, hypertension, cancer, stroke in patients with migraine, nausea, breakthrough bleeding; contraindicated in heavy smokers, women with history of thromboembolism, women with other risk factors for thrombosis; (decrease risk for ovarian/endometrial cancer, ovarian cysts, BPH, anemia, favorable effect on menstrual cycles, diminished cramps)

missed combination OC

more than one in first week: take 1 ASAP, use another method for 7 days

1-2 in second/3rd week: take 1 ASAP, skip placebo week and go straight to next pack

more than 3 second or third week: same instructions, use extra method for 7 days

progestin only OCs

do not cause thromboembolic disorders, slightly safer, decrease efficacy, increase irregular bleeding

transdermal contraceptive patch

1 per week for three weeks, followed by one week off; causes breast discomfort, headache, local irritation, nausea, menstrual cramps

vaginal contraceptive ring

1 per month, left in place for three weeks then removed for one week, replace after one week

causes vaginitis, headaches, URI, leukorrhea, sinusitis, weight gain, nausea (wash in warm water if it falls out, if it falls out for more than 3 hours use backup contraceptive for 7 days)

subdermal etonogestrel implants

nexplanon

daily release of etonogestrel

gradually declines over 3 years

replaced after 3 years

irregular bleeding, weight gain

depot medroxyprogesterone acetate

IM or subQ injection, protects against pregnancy for 3+ months, causes menstrual irregularities, bone loss, and weight gain

Intrauterine device

amongst most reliable form of reversible birth control, placed within seven days of onset of menses, replacement can be inserted during any phase of menstrual cycle, good for 5-10 years

testosterone male sex characteristics

pubertal transformation, spermatogenesis

testosterone female sex characteristics

clitoral growth, maintenance of normal libido, overproduction of androgens (virilization)

other testosterone effects

anabolic: skeletal muscle

erythropoietic effects: synthesis of erythropoietin, men have higher hematocrit than women

testosterone therapeutic uses

male hypogonadism, replacement therapy, delayed puberty, gender affirming treatment

testosterone adverse effects

virilization in women, girls, and boys

premature epiphyseal closure

hepatotoxicity

effects on cholesterol levels

use in pregnancy

prostate cancer

edema

hypogonadism preparations

oral androgens, intramuscular ester, transdermal patch/gel, implantable pellets

impotence (ED) treatments

lifestyle measures, drug regimens (remove drugs that cause ED) drug therapy (PDE5 inhibitors)

sildenafil

PDE5 inhibitor, plasma levels peak in one hour, high fat meals slow absorption, causes hypotension and priapism (painful erection lasting 6+ hours, immediate medical intervention is required at 4 hours); nitrates can cause life threatening hypotension, take 24 hours in between each other

tadalafil

PDE5 inhibitor, effects last up to 36 hours, causes headache, dyspepsia, back pain, myalgia, limb pain, flushing, and nasal congestion; do not take with nitrates

finasteride

5-alpha-reductase inhibitor

treats benign prostatic hyperplasia

decrease ejaculate volume and libido, causes gynecomastia, decrease levels of prostate specific antigen

alpha 1 adrenergic antagonists

treats dynamic obstruction (-zosin, tamsulosin, silodosin)

asthma

chronic inflammatory disorder of airway

SOB, chest tightening, wheezing, dyspnea, cough; caused by immune mediated airway inflammation

COPD

chronic progressive largely irreversible disorder characterized by airflow restrictions and inflammation

chronic cough, excessive sputum, wheezing, dyspnea, poor exercise tolerance; caused by smoking cigarettes

treatments for asthma/copd

anti inflammatory agents (glucocorticouds, leukotriene modifiers, cromolyn, omalizumab) bronchodilators (SABA/LABA, methylxanthines, anticholinergic drugs)

inhalation drug therapy benefits

therapeutic effects are enhanced, systemic effects are minimized, relief of acute attacks is rapid

MDIs

metered dose inhaler, separate puffs by one minute

spacers

increase MDI delivery to lungs, decrease risk for thrush

glucocorticoids

most effective drugs available for long term control of airway inflammation; used as prophylaxis to prevent exacerbations

Inhaled glucocorticoids

first line therapy, used daily if persistent, safer than systemic; adverse effects: oropharyngeal candidiasis/dysphonia, rinse mouth with water and gargle, use a spacer

oral glucocorticoids

should be used only when symptoms cannot be controlled with safer medication, brief as possible; adverse effects: adrenal suppression, osteoporosis, hyperglycemia, pud, growth suppression, d/c must be done slowly

leukotriene modifiers

reduce bronchoconstriction and inflammatory responses such as edema and mucous secretions

monteluksat

leukotriene modifier; prophylaxis of maintenance therapy of asthma, prevention of EIB, well tolerated, neg behavior changes in kids

cromolyn

prophylaxis of inflammation, not quick relief, in patients with mild to moderate asthma; safest of all

omalizumab

ages 12+, subQ, can cause life threatening anaphylaxis

bronchodilators

provide symptomatic relief but do not alter inflammation, should also be taking glucocorticoid for long term suppression of inflammation

B2 Adrenergic Agonists

activate b2 receptors in the smooth muscle of the lung, promote bronchodilation, relieve bronchospasm

SABA

short acting b2 agonist (albuterol), taken PRN, hospitalized patients undergoing severe attack should used nebulized form, delivery with MDI outpatient

LABA

long acting b2 agonist (salmeterol) long term control, taken on a fixed basis not PRN, treats stable COPD, must always be combined with glucocorticoid if treating asthma

theophylline

methylxanthine; used for maintenance therapy of chronic stable asthma, narrow therapeutic index (10-20), interacts with caffeine, tobacco, marijuana

theophylline toxicity

20-25: nausea, vomiting, diarrhea, insomnia, restlessness

above 30: severe dysrhythmias, convulsions

treatment: stop theophylline, activated charcoal and cathartic (dysrhythmias respond to lidocaine), IV diazepam may help with seizures

ipraproprium

anticholinergic; improves lung function by blocking muscarinic receptors in the bronchi, causes anticholinergic effects, therapeutic effects begin in 30 minutes, peak n 3 hours, persist for 24 hours (improves with subsequent truth, should see improvement within a week)

tiotropium

long acting inhaled anticholinergic approved for maintenance therapy of bronchospasm associated with COPD, not approved for asthma, therapeutic effects begin in 30 min, peak in 3 hours, persist about 24 hours

glucocorticoid LABA combos

fluticasone/salmeterol, budesonide/formoterol, mometasone/formoterol (indicated for long term maintenance in adults and children)

acute asthma exacerbation

requires immediate attention; give SABA, oxygen,ipratropium, glucocorticoid

COPD exacerbation

SABAs, systemic glucocorticoids, antibiotics, supplemental o2 (88-92%)

peptic ulcer disease

group of upper GI disorders, degrees of erosion to the gut wall that can cause hemorrhage and perforation; caused by H.pylori, NSAID use, smoking

PUD treatment goals

alleviate symptoms, promote healing, prevent complications, prevent recurrence

treatment for PUD

h pylori ulcer: antibiotics and antisecretory agents

NSAID induced ulcer: PPI for prophylaxis, histamine blockers (no antacids, sucralfate, and h1 blockers)

non drug treatment for PUD

smaller more frequent meals; avoid smoking, aspirin, nsaids, and alcohol; reduce stressors

h pylori treatment

tetracycline, amoxicillin, clarithromycin, metronidazole, bismuth (2-3 prescribed) (B-MATC)

histamine 2 receptor antagonists

treats gastric and duodenal ulcers, promote healing by suppressing secretion of gastric acd

famotidine

h2 receptor antagonist, causes confusion, hallucinations, CNS depression, and CNS excitation; elevation of gastric pH may increase risk of pneumonia

proton pump inhibitors

omeprazole, esomeprazole, pantoprazole; most effective drugs for suppressing secretion of gastric acid; can increase risk of serious adverse events, including fracture, pneumonia, acid rebound, intestinal infection with c.diff

sucralfate

mucosal protectant; creates a protective barrier for up to 6 hours; administering antacids at least 30 minutes apart from sucralfate; take 1 hour before meals and at bedtime

aluminum hydroxide/magnesium hydroxide

take other medications at least an hour before or 2 hours after; antacids

medications for allergic rhinitis

glucocorticoids (intranasal) antihistamines (oral/intranasal) sympathomimetics (oral/intranasal)

intranasal glucocorticoids

budesonide, fluticasone, triamcinolone; first choice- most effective for treatment and prevention of rhinitis; can cause drying of mucosa, sore throat, epistaxis, headache

oral antihistamines

diphenhydramine, fexofenadine; for allergic rhinitis, do not reduce nasal congestion, most effective if taken prophylactically and regularly throughout the season, 1st gen is more sedating

intranasal antihistamines

azelastine, olopatadine; indicated for allergic rhinitis in 12+ years, systemic absorption can be sufficient to cause somnolence

intranasal cromolyn sodium

prophylaxis, administer before symptoms start, response develops in 1-2 weeks

sympathomimetics

phenylephrine, pseudoephedrine; reduce nasal congestion (not rhinorrhea, sneezing, itching) causes rebound congestion, CNS stimulation, CV effects/stroke, abuse, do not use more than 5 days in a row

antitussives

suppress cough; opioid antitussives: codeine and hydrocodone; non opioid antitussives: dextromethorphan, benzonatate

expectorants

renders cough more productive by stimulating flow of respiratory tract secretions; guanifecin

functions of histamine

stimulates secretion of acid, acts as a neurotransmitter, dilates small blood vessels and increases capillary permeability, constricts smooth muscle

h1 antagonists MOA

block the actions of histamine at h1 receptors, do not block h2 receptors, some bind to muscarinic receptors