Exam 3 Pharmacology

What is a genotype?

the genetic constitution of an individual organism. (what you cant see, gene for eye color)

What is a phenotype

an individuals observable traits (how it is displayed physically, blue eyes)

What are the basic principles of genetic inheritance?

* Nucleic acids
* DNA and RNA
* Chromosomes (in nucleus, carry DNA, carry genes)
* Genes
* Alleles (specific variation within a gene)
* Dominant and Recessive (dominant always trumps the recessive)
* Genotype
* Phenotype

What are the four bases that make up DNA?

Adenine (A)

Thymine (T)

Guanine (G)

Cytosine (C)

What is a Human Genome Project?

* Started in 1990; completed in 2003.
* Identified the estimated 30,000 genes and 3 billions base pairs in the DNA of an entire human genome
* Developed new tools for genetic data analysis and storage 

What is gene therapy?

* experimental technique using a genetic material to treat or prevent disease
* Replacing a mutated gene with a healthy copy of a gene
* Introducing a new gene into the body to help fight a disease
* Inactivating a mutated gene that is functioning improperly

Hypothyroidism

* Results from a poorly functioning thyroid gland (low thyroid hormone hypo- slow)
* Destruction of the thyroid gland due to an autoimmune thyroiditis

What are symptoms of hypothyroidism?

* Myxedema
* weakness
* muscle cramps
* dry skin
* intolerance to cold
* lethargy
* constipation

Lab results for hypothyroidism

Elevated TSH with low TS and T4 levels

Hyperthyroidism

hyper-secretion of thyroid hormone, low TSH (too much thyroid hormone- fast)

Symptoms of hyperthyroidism

* an overall increase in metabolism
* Finger clubbing
* diarrhea
* tachycardia
* intolerance to heat
* facial flushing
* bulging eyes

What is Grave’s Disease- autoimmune disease?

* body develops antibodies against its own thyroid gland
* most often occurs between age 30 to 40

Treatment for hyperthyroidism

* surgery and diminish the secretion of thyroid gland
* Methimazole- works by not letting body create thyroid hormones
* Proplythiourcil- destroys the thyroid
* Radioactive iodine

What is thyroid storm?

life- threatening condition, high fever, cardiovascular events, CNS effects

Symptoms for diabetes

* Glucosuria- sugar in urine (glucose)
* Hyperglycemia- high blood sugar
* Thirst- polydipsia
* Frequent urination- polyuria
* Weight loss- more common in type 1
* Fatigue

If you do not manage your diabetes what may it cause?

* Retinopathy- damage to retina
* Neuropathy- fingers, toes, hands, feet
* Nephropathy- damage to kidneys
* Cardiac damage

Type 1 Diabetes

* Autoimmune destruction of pancreatic beta cells
* Autoimmune, born with it, may present in early childhood or even early adulthood (can’t prevent it)
* DKA is complication (presence of ketones with hyperglycemia)
* Treatment: Insulins

Type 2 Diabetes

* Insulin resistance and insensitivity
* Can be prevented/controlled, usually presents later in life (can be sooner depending on lifestyle)
* HHS is complication (hyperglycemia without ketones)
* Treatment: Biguanides (first line), Sulfonylureas, misc other classes, eventually insulin

What are the early signs and symptoms of hypoglycemia (low blood sugar,

* confusion
* irritability
* tremor
* sweating
* Give patients orange juice or candy or buccal tablets

What are the late signs and symptoms of hypoglycemia (low blood sugar,

* hypothermia
* seizures
* coma and death if not treated

What is the first line anti-diabetic for Type 2?

Metformin

MOA for Biguanide: Metformin

* decreased production of glucose by the liver
* decrease intestinal absorption of glucose
* increases uptake of glucose by tissues
* do not increase insulin secretion from the pancreas (does not cause hypoglycemia)

Adverse effects for Metformin

primary affects gastrointestinal tract: abdominal bloating, nausea, cramping, diarrhea, feeling of fullness (interacts with contrast dye)

MOA Sulfonylureas: glimepiride

Stimulates insulin secretion from the beta cells of the pancreas, thus increases insulin levels

Adverse effect for glimepiride

* hypoglycemia
* hematologic effects

MOA Thiazolidinediones: Pioglitazone

* Decreases insulin resistance
* “Insulin sensitizing drugs”
* Increase glucose uptake in use and skeletal muscle
* Inhibit glucose and triglyceride production in the liver

Adverse effect for Pioglitazone

* Weight gain (fluid retention and increased adipose tissue)
* Decreased bone marrow density with increased risk for fractures

MOA for Alpha-glucosidase inhibitors: Acarbose

Reversible inhibit the enzyme alpha glucosidase in the small intestines

Side effects for Acarbose

* flatulence, diarrhea, abdominal pain
* do not cause hypoglycemia

MOA Dipeptidyl peptidase-IV (DPP-IV) inhibitors: Sitagliptin

Delay breakdown of incretin hormones by inhibiting the enzyme DPP-IV

Side effects Sitagliptin

Upper respiratory tract infection

MOA Glucagon-Like Peptide- 1 (GLP-1) Agonists: Semaglutide

Enhance glucose- dependent insulin secretion, suppress elevated glucagon secretion

Side effect for Semaglutide

Black box warning: risk of developing thyroid C-cell tumors (do not give with someone who has hyperthyroidism)

MOA Sodium Glucose Cotransporter Inhibitors (SGLT2 Inhibitors): dapagliflozin

Work independently of insulin to prevent glucose reabsorption from the glomerular filtrate, resulting in a reduced renal threshold for glucose and glycosuria

Side effect for dapagliflozin

* genital yeast infection
* urinary tract infections

Basal versus bolus?

Basal- long acting= constant

Bolus- rapid acting= instant

Rapid Acting Insulin

Insulin lispro

* Most rapid onset of action: 5 to 15 minutes


* Peak: 1 to 2 hours
* Duration: 3 to 5 hours

Rapid Acting Insulin- inhaled

Afrezza

* Black box warning regarding the risk of acute bronchospasms

Short Acting Insulin

Regular insulin (only insulin given IV)

* Onset: 30 to 60 minutes
* Peak: 2.5 hours
* Duration: 6 to 10 hours

Intermediate Acting Insulin

Insulin isophane suspension (NPH)

* cloudy appearance
* Onset: 1 to 2 hours
* Peak: 4 to 8 hours
* Duration: 10 to 18 hours

Long Acting Insulin

Insulin glargine

* Onset: 1 to 2 hours
* Peak: none
* Duration: 24 hours

What complication is associated with Type 1 diabetes?

diabetic ketoacidosis DKA (has ketones present)

What complication is associated with Type 2 diabetes?

hyperosmolar hyperglycemia syndrome HHS (no ketones present)

Treatment for DKA or HHS

insulin given IV (regular insulin- short acting)

What signs and symptoms do patients exhibit on initial diagnosis of diabetes?

* Polyuria, polydipsia, polyphagia (extreme thirst, hunger, and pee a lot)


* fasting gluecose- greater than 126
* hemoglobic A1C- greater than 6.5% (with type 2 want patients at 7%)

What is the pathophysiology of Type 1 Diabetes?

lack of insulin production or production of defective insulin. (autoimmune disruption to Beta cells)

What is the pathophysiology of Type 2 Diabetes?

caused by insulin deficiency and insulin resistance, many tissues are resistant to insulin, insulin receptors are less responsive. (Reduced number of insulin receptors, insulin receptors less responsive)

How do we treat hypothyroidism?

Levothyroxine (synthetic thyroid hormone that they are missing)

* TSH is elevated
* Side effect: things you see with hyperthyroidism

How does the body know to release insulin?

Beta cells in the pancreas in response to rising glucose in your bloodstream

What is the pathophysiology of cancer?

Cellular transformation, uncontrolled and rapid cellular growth, invasion into surrounding tissue, metastasis to other tissues and organs**.**

What are CCS drug classes (cancer)?

drugs that are cytotoxic during a specific cell cycle phase

What are CCNS drug classes (cancer)?

cytotoxic during any cell cycle phase

What are antimetabolites (chemotherapy) adverse effects?

Hair loss, nausea and vomiting, myelosupression (suppression of bone marrow)

How are mitotic inhibitors administered?

IV use only. Fatal if given intrathecally (spinal route)

Mitotic Inhibitors MOA

Can work in various phases of the cell cycle (late S phase, throughout G2 phase, and M phase)

Adverse effects for mitotic inhibitors

Hair loss, nausea and vomiting, myelosuppresion

Extravasation (several different antidotes can be used

Alkylating drug (cancer)

Cisplatin

Adverse effect for Alkylating drug: Cisplatin

Alopecia

Cytotoxic Antibiotics adverse effects

Cardiomyopathy is associated with large amounts of doxorubicin

Miscellaneous Antieoplastics

Bevacizumab- blocks blood supply to the growing tumor

What is extravasation?

Leaking of an antineoplastic drug into surrounding tissues during intravenous administration

What is hematopoiesis?

formation of new blood cells (RBC, WBC, platelets)

What is erythropoiesis?

the process of forming new red blood cells

What is iron deficiency anemia?

A condition in which blood lacks adequate healthy red blood cells

* eat meats, veggies, and grains

What is folic acid deficiency?

Occurs when a lack of vitamin B12 or folate cause the body to produce abnormally large RBCs that cant function properly

iron deficiency anemia treatment

oral: ferrous sulfate

IV: venofer

Iron adverse effects

* most common cause of pediatric poisoning deaths
* cause black, tarry stools
* liquid oral preparations may stain teeth

Why do you keep iron supplements away from children?

May look like candy

Why do you take liquid iron through a straw?

Can cause staining to tooth enamel

When should oral forms of iron be taken?

Should be taken between meals for maximum absorption. Given with juice not with milk or antacids.

How should you administer oral folic acid?

with food

What is Addison’s disease?

decreased blood sodium and glucose levels, increased potassium levels, dehydration, weight loss

* Not enough adrenal hormones

What are the two types of immunity?

Humoral immunity

Cellular immunity

What are the 5 different immunoglobulins?

A, D, E, G, and M

What is RA?

Autoimmune disorder causing inflammation and tissue damage in joints

What is the treatment for RA?

NSAIDs and DMARDS (Methotrexate)

What are antigens?

Antigens- foreign or toxic proteins from an invading organism.( virus)

What are antibodies?

Immunoglobulin molecules that have antigen-specific amino acid sequences.(created to fight off antigen)

What is artificial active immunization?

Body is clinically exposed to a relatively harmless form of an antigen that does not cause an actual infection

What is natural active immunization?

Person acquires immunity by surviving the disease itself and producing antibodies to the disease-causing organism

What is artificial passive immunization?

Administration of serum or concentrated immunoglobulins

What is natural passive immunizations?

Antibodies are transferred from the mother to her and fit in breastmilk or through the bloodstream via the placenta during pregnancy

What are immunosuppressants?

Drugs that decrease or prevent an immune response, thus suppressing the immune system, used to prevent or treat rejection of transplant and organs

Adverse effects for immunosuppresents

All immunosuppressed patients have a heightened susceptibility to opportunistic infections

What are health-care acquired infections?

Contracted in a hospital or institutional setting, we're not present or incubated in the patient or admission to the facility, occurs more than 48 hours after admission, more difficult to treat because cursive microorganisms are often during resistant and most virulent.

What are community acquired infections?

An infection that is required by a person who has not been hospitalized or had a medical procedure within the past year (dialysis, surgery, catheterization)

MOA for Antibiotics: Sulfonamides- Sulfamethoxazole combined with trimethoprim

* bacteriostatic action
* Prevent synthesis folic acid required for synthesis of purines in nucleic acids
* Used for UTI, upper respiratory infection

What do you educate patients on when taking antibiotics?

take whole prescription, can cause bacterial resistance

MOA for Penicillins: Penicillin G, Amoxicillin, Piperacillin

* Penicillins enter the bacteria via the cell wall
* Inside the cell, they buying to penicillin binding proteins
* Once bound, normal cell wall synthesis is disrupted

Adverse effect for Penicillins

* allergic reactions occur often
* uricaria, pruritus, angioedema

Cephalosporin first generation drugs

* Cefazolin
* Cephalexin

Cephalosporin third generation drugs

* Cefdinir


* Ceftriaxone

What are Cephalosporins used for?

CNS infection (mennigitis)

Carbapenems antibiotic

Meropenem

Macrolides antibotics

* Azithromycin
* Fidaxomicin

What is Fidaxomicin used for?

C-diff

Tetracyclines antibiotic

Doxycycline

Why should you not use tetracyclines in children?

Should not used in children younger than age 8 years or pregnant or lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth.

* Sunlight and tanning beds
* No dairy before and after use

Aminoglycoside antibiotic

Gentamicin

Quinolones antibiotics

* Ciprofloxacin
* Levofloxacin