Pharm (GI, Endocrine, and DM)

Week 2

Levothyroxine (Synthroid)

Synthetic T3/T4

CI: MI, caution in CAD/angina

A/E: hyperthyroidism (HTN, tachycardia, seizures, dysrhythmia)

Pt teaching: 30-60 mins before meals, HOLD IF HR IS > 110

Hypo/Hyperthyroidism

Hypo/myxedema coma: everything goes down except for the weight (drowsiness, depression, edema, low HR, low BP, cold intolerance).

Hyper: high BP, high HR, losing weight (thyroid storm)

PTU (blocks T3/T4 production)

Methimazole (taken before thyroidectomy)

Lugol’s solution (taken before thyroidectomy)

Anti-thyroid drugs

A/E: decrease in cell production (leading to pantocypenia and agranulocytes)

Pt teaching: report if sick, sore throat, or fever

*Lugol’s solution: GI upset, stained teeth, and oral mucosa sores.

Thyroidectomy

• tracheostomy tray (in case of airway obstruction)

• IVP calcium gluconate (stabilize HR if accidental removal of PTH)

I-131 Radioactive Iodine Therapy

CI: PREGNANT, children, shellfish/sulfite allergy/iodine

Onset: 2-3 months + anti-thyroid drug

A/E: bone marrow suppression (radioactive) - report if sick, hypothyroidism

Pt teaching: avoid contact, increase fluid intake (to flush out), avoid food high in soy, calcium, gluten (interfere with absorption)

Somatropin

• synthetic GH

• pituitary deficiency

Indications: AIDS, muscle wasting, cachexia

CI: obese, sleep apnea

A/E: hyperglycemia (need to increase insulin), renal calculi (monitor flank pain)

Pt teaching: increase fluid intake (decrease UO - check for calculi)

Vasopressin (subcut, IM)

Desmopressin (nasal)

• Treat diabetes insipidus (DI) - ADH deficiency

• MOA: increase water retention - increase BP

CI: MI, CAD

A/E: constricts coronary arteries, water intoxication (increase water reabsorption causing hyponatremia/seizures and cerebral edema)

*Interaction with Lithium

RN: monitor EKG, I&O, Na+ level, urine specific gravity

Isotonic

Hypotonic

Hypertonic

Iso: NS, Lactated Ringer's, D5W

Hypo: water

Hyper: D10W or above

Glucocorticoid

• Bethomethasone

• Fluticasone

• Budesonide

A/E: adrenal gland suppression (makes cortisol)

Other A/E:

• hypokalemia

• infection

• osteoporosis

• GI ulcers

• hyperglycemia

RN: DO NOT stop abruptly, TAPER OFF, dosing Q other day

H. Pylori medications

• 2-3 ABX (Clarithromycin, Amoxicillin, …)

• H2 Antihistamine, PPI, Bismuth Subsalicylate (reduce acid)

• Probiotic (Saccharomyces Boulardii)

1. Antacids - Calcium, Aluminum, Magnesium

A/E: electrolyte imbalances, alkalosis (b/c of metals = alkali)

• Calcium compounds: hypercalcemia → constipation, decrease phosphate

• Aluminum Hydroxide (Amphojel): constipation

• Magnesium Hydroxide (MOM): diarrhea, toxic in ESRD

Pt teaching: take 1 hour before other meds due to interactions, chew and drink with 8 oz of water.

H2 Antagonist - H2 Histamine

• Cimetidine

• Famotidine

• Nizatidine

Indications: reduce acid by blocking histamines

A/E: CNS effects, reduce acid = increase infection (→pneumonia)

***Cimetidine: affects hormones (gynecomastia, ED)

Pt teaching (for GI ulcers): NO ETOH, smoking, NSAIDs → delay wound healing

PPIs = prazoles

• Omeprazole

• Pantoprazole

• Lansoprazole

A/E: increase pneumonia risks, COPD, osteoporosis, hypomagnesemia, decrease vit D (nutrient deficiency)

Pt teaching: take 30 min before meal

RN: increase vit D and calcium, monitor B12 (parietal cells cannot absorb B12/autoimmune)

Mucosal Protectant

• Sucralfate

MOA: forming a physical barrier

RN/Pt teaching: take other drugs 2 hr. before, take Sucralfate 1 hr. before meal, increase fluid (can cause constipation → tarry stool)

Misoprostol

• MOA: increases mucus production

RN: pregnancy test

CI: PREGNANT (induces labor) Category X

Laxatives:

• Bulk forming - Psyllium husk

• Surfactant laxative - Docusate sodium

• Stimulant laxative - Bisacodyl, Senna

• Osmotic laxative - MOM, PEG-3350, Lactulose, Sorbitol

RN:

• Psyllium husk: increase fluid intake

• Stimulant: monitor for hypokalemia due to diarrhea; no MILK 1 hr. with Bisacodyl

Metoclopramide

• Indications: constipation, antiemetic (radiation, chemo)

• Pro-kinetics/anti-psychotic drug

• CI: GI obstruction, seizure, Parkinson’s, Pheochromocytoma

• A/E: EPS (tardive dyskinesia), sedation, NMS (neuroleptic malignant syndrome)

• Pt teaching: NO ETOH

Antiemetics:

• Anticholinergics: Scopolamine patch

• H1 Antihistamine: dimenhydrinate

• Cannabinoids: Dronabinol

• Serotonin Antagonists: Ondansetron

• Dopamine Antagonists: Metoclopramide, Prochloperazine

RN:

• Ondansetron: CI in PKU = phenylketuria

• Metoclopramide, Prochloperazine: CI in ESP/tardive dyskinesia, Parkinson’s

• Anticholinergics: CI in BPH and glaucoma (extra dry)

TPN

A/E: infection, hyperglycemia

RN:

• central line only

• needs a filter

• do not stop abruptly

• can be replaced with D10W

To prevention infection:

• TPN: changes Q24 hr.

• Lipids: changes Q12 hr.

IBS medication:

• 1st line: Sulfasalazine

• H2 Blocker - Antihistamine

“sun”:

• CI: allergy with ASA, sulfa

• Photosensitive, sun protection

Insulin:

• Rapid: Lispro (correctional) - onset 15-30 min

• Short: Regular R (IV) - onset 30-1 hr.

• Intermediate: NPH - onset 1-2 hr.

• Long: glargine - onset 70 min - no peak, maintenance

MOA: promotes glucose and potassium into the cells

A/E: hypoglycemia, hypokalemia, lipodystrophy

RN: needs to be stored new ones in the fridge, opened ones outside for 1 month

• If BG is > 150 before bedtime, administer glargine (long acting)

Oral DM medications:

• Metformin (oral Biguanides) - 1st line

  • MOA: increases cell glucose uptake

A/E: lactic acidosis

CI: ETOH, renal impairment

RN: need to stop metformin at least 48 hr. before CT scan with contrast

Oral DM medications:

• Oral sulfonylureas: Glipizide - 2nd

  • MOA: increase insulin release from the pancreas

• Oral Thiazolidinone - glitazones

  • MOA: increase insulin sensitivity

  • A/E: fluid retention, HF

• Oral glucosidase inhibitor

  • MOA: delays glucose breakdown, decreases glycemic index

No ETOH

*Oral glucosidase inhibitor - acarbose: does not involve insulin/pancreas