Lm Pharma

I. Endocrine Disorders

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Hypothyroidism1

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Definition: Low T3, T41

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Symptoms: Everything slows down, weight increases1

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Medication: Levothyroxine (Synthroid)1

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Contraindications: Post-MI, caution with angina, CAD1

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Adverse Effects: Hyperthyroidism symptoms, HTN, increased HR, seizures, dysrhythmias, tremors, nervousness, insomnia, diaphoresis, irritability, weight loss1

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Interactions: Increases anticoagulant effect, increases insulin needs1

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Nursing/Teaching: Take PO 30-60 minutes before breakfast on an empty stomach, effects take 4-8 weeks, don't stop abruptly, lifelong therapy, hold if HR > 110, report hyperthyroidism symptoms1

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Hyperthyroidism1...

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Definition: Excessive thyroid hormone1

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Graves Disease: Bulging eyes (exophthalmos)1

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Symptoms: Palpitations, arrhythmias (HR 130-150)1

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Treatment:

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Radioactive Iodine I-131: Treatment of choice for non-pregnant adults2

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Adverse effects: Bone marrow suppression, sore throat, radiation sickness, hypothyroidism, dysgeusia2

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Contraindications: Young children, breastfeeding, shellfish allergy2

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Nursing: Limit contact (30 mins, 6 feet), use precautions with secretions2

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Patient Education: Maintain distance from others, use own bathroom and utensils, wash clothes separately, increase fluid intake2

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Anti-thyroid drugs: Methimazole, PTU (safe for pregnancy)1...

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Iodine (Lugol's Solution): Inhibits T3 and T4 synthesis and release, decreases thyroid gland vascularity, short term use only1

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Side effects: brassy taste, burning mouth, sore teeth. Dilute in juice and administer after meals through a straw because it can stain teeth2

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Beta-adrenergic blockers: Decrease HR/BP2

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Post-Thyroidectomy: Monitor calcium levels1

II. Pituitary and Adrenal Disorders

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Pituitary Deficiency1...

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Low Growth Hormone3

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Medication: Somatropin3

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Contraindications: Obesity, sleep apnea3

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Adverse Effects: Hyperglycemia, renal calculi3

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Nursing/Teaching: Monitor flank pain, increase fluids, rotate injection sites, may need to adjust insulin3

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Diabetes Insipidus1...

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ADH deficiency leading to polyuria4

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Steroids (Glucocorticosteroids)4...

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Synthetic cortisol to decrease inflammation/immune response4

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Adverse Effects: Adrenal suppression, hypokalemia, hyperglycemia, edema, fluid retention, HTN, increased risk of infection, osteoporosis, GI ulcers4

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Nursing: Monitor electrolytes, blood sugar, weight, infection signs, give Vitamin D and Calcium, caution with diuretics and digoxin, avoid live vaccines4

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Patient Education: Take with food, increase dose during stress, taper off medication, report signs of infection, monitor weight4

III. Gastrointestinal (GI) Disorders

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H. Pylori1...

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Causes peptic ulcers6

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Testing: Breath, stool, blood, scope6

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Treatment: 2-3 antibiotics (e.g., Clarithromycin, Amoxicillin, Metronidazole, Tetracycline), PPI, H2 blocker, Bismuth Subsalicylate for 2 weeks, retest in 4 weeks6

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Antacids7

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Mechanism: Neutralize stomach acid7

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Types: Calcium (Tums), Aluminum, Magnesium7

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Adverse Effects: Electrolyte imbalance, alkalosis, constipation, diarrhea7

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Nursing: Take 1 hour before/after other medications, chew thoroughly, drink 8oz water7

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H2 Antihistamines8

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Mechanism: Block histamine receptor, decrease acid production8

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Examples: Cimetidine, Famotidine, Nizatidine8

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Adverse Effects: Gynecomastia (cimetidine), erectile dysfunction, pneumonia8

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Nursing: Take 30-60 mins before eating and at bedtime, avoid smoking, ETOH, NSAIDs, increase fiber8

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Proton Pump Inhibitors (PPIs)9

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Mechanism: Stops parietal cells from secreting H+9

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Examples: Omeprazole, Pantoprazole, Lansoprazole9

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Adverse Effects: Pneumonia, osteoporosis, hypomagnesemia9

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Nursing: Take once daily 30 mins before eating in the morning, monitor B12 and Magnesium levels, taper to discontinue9

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Mucosal Protectants (Sucralfate)10

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Mechanism: Forms a barrier over the ulcer10

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Contraindications: Antacids10

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Nursing: Give 1 hour before meals on empty stomach, take other drugs 2 hours before10

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Bismuth Subsalicylate6...

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Forms a barrier over the ulcer, stimulates fluid and electrolyte absorption10

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Adverse Effects: Black tongue/stools, constipation10

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Nursing: Chew or dissolve tabs, don't swallow whole, avoid aspirin10

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Misoprostol11

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Decreases acid and increases protective mucous11

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Contraindications: Pregnancy11

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Indications: Prevention of ulcers with NSAID use11

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Nursing: Pregnancy test, watch for GI bleed11

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Laxatives11...

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Types: Bulk, Stimulant, Osmotic12

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Osmotic: Strongest, used for bowel prep12

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Antidiarrheals1...

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Diphenoxylate + Atropine: Reduce diarrhea symptoms13

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Loperamide: Decreases stool amount, slows peristalsis13

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Antiemetics1...

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Metoclopramide: Increases upper GI motility12...

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Contraindications: Obstruction, seizure history, Parkinson's, GI bleed14

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Adverse Effects: EPS, NMS, sedation, diarrhea14

IV. Diabetes

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Type 1 vs Type 21

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Insulin types and administration15

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Metformin and contrast considerations15

V. Neuromuscular Blockers (NMBs)16...

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Safety Equipment: Crash cart, BVM, suction, heart monitor16

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Adverse Effects: Drop in BP, can't blink/swallow/gag, patient is still mentally aware17

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Nursing: Give sedatives and analgesics, monitor BP, prevent pressure injuries18

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Types:

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Nondepolarizing: Atracurium, Cisatracurium, Rocuronium, Vecuronium, Pancuronium19

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Depolarizing: Succinylcholine19

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Succinylcholine Specifics:

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Adverse Effects: Malignant hyperthermia, hyperkalemia19...

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Malignant Hyperthermia Treatment: Dantrolene, ice packs, chilled IV solution20

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Reversal Medications:

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Old School: Neostigmine17

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New School: Sugammadex17

VI. Sedatives-Hypnotics20...

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Benzodiazepines: Lorazepam, Midazolam, Diazepam20...

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Adverse Effects: Respiratory depression, low BP, amnesia21...

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Reversal Agent: Flumazenil22...

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Nursing: Monitor respiratory status, avoid with other CNS depressants23

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Non-Benzodiazepines:

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Buspirone: For chronic anxiety, not PRN24

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Atypical Hypnotics (Insomnia): Ramelteon, Zolpidem25

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Melatonin Agonists: Ramelteon, zaleplon25

VII. Muscle Relaxants & Antispasmodics26...

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Centrally Acting: Baclofen, Cyclobenzaprine, Tizanidine, Carisoprodol, Metaxalone26...

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Adverse Effects: Sleepy, dizzy, weak, seizures27

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Nursing: Don't drive or use ETOH, taper off27

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Peripherally Acting: Dantrolene27

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Cyclobenzaprine: Risk for liver toxicity and photosensitivity28

VIII. Muscarinic Agonists & Antagonists28...

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Muscarinic Agonists: Bethanechol29

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Mechanism: Increases bladder pressure29

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Adverse Effects: SLUDGE DUMBBELLS, Cholinergic Crisis29

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Nursing: Administer 1 hour before or 2 hours after meals29

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Muscarinic Antagonists: Oxybutynin, Dicyclomine, Darifenacin, Solifenacin30

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Adverse Effects: Dry mouth, hyperthermia, flushing, delirium, constipation, tachycardia30

IX. Pain and Inflammation31...

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NSAIDs:

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1st Generation: Aspirin, Ibuprofen, Naproxen, Ketorolac, Indomethacin, Meloxicam31

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Adverse Effects: Kidney damage, GI ulcers, bleeding, tinnitus31

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Aspirin Overdose: Tinnitus, metabolic acidosis32

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2nd Generation (Celecoxib): Increased risk of CV events33

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Acetaminophen:

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Adverse Effects: Liver damage34

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Antidote: Acetylcysteine (Mucomyst)34

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DMARDs:

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DMARD I (Non-Biologic): Methotrexate, Hydroxychloroquine, Sulfasalazine5...

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DMARD II (Biologics): Adalimumab, Infliximab, Rituximab37...

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DMARD III (Immunosuppressants): Cyclosporine, Cyclophosphamide38

X. Gout & Fibromyalgia39...

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Gout:

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Colchicine: For acute attacks39

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Nursing: Take with food, avoid high purine foods, increase fluid intake40

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Fibromyalgia:

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Duloxetine, Pregabalin, Gabapentin41

XI. Osteoporosis41...

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Calcium Supplements: Calcium Carbonate, Calcium Citrate, Calcium Acetate, Calcium Gluconate, Calcium Chloride41...

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Bisphosphonates: Requires patient to remain upright for 30 minutes after administration42

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SERMs: Increase risk of blood clots43

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Calcitonin Salmon:43

XII. Opioids & Migraines44...

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Opioid Toxicity Triad: Pinpoint pupils, respiratory depression, decreased LOC44

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Naloxone: Reversal agent for opioid overdose23...

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Migraine Medications:

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Triptans: Contraindicated in patients with heart conditions45

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Ergotamine: Cannot take with Triptans45

XIII. Diuretics46...

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Types: Loop, Thiazide, Potassium-Sparing, Osmotic46

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Loop Diuretics: Furosemide, Bumetanide47

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Adverse Effects: Dehydration, electrolyte imbalances, ototoxicity, hyperglycemia, hyperuricemia47

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Thiazide Diuretics: Hydrochlorothiazide49

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Adverse Effects: Similar to loop diuretics, but cause hypercalcemia49

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Potassium-Sparing Diuretics: Spironolactone50

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Adverse Effects: Hyperkalemia, endocrine effects50

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Osmotic Diuretics: Mannitol53

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Used for cerebral edema and glaucoma53

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Hyperkalemia Treatment: Calcium, sodium bicarbonate, insulin, beta-agonists, loop diuretics, sodium polystyrene sulfonate, patiromer, sodium zirconium cyclosilicate51...

XIV. Other Medications & Treatments54...

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Iron Supplements: Ferrous Sulfate, Iron Dextran54

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Vitamin B12 (Cyanocobalamin): For pernicious anemia55

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Folic Acid: Prevents neural tube defects55

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Potassium Supplements: Potassium Chloride56

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IV Infiltration vs. Extravasation57...

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Magnesium Supplements: Magnesium Sulfate59

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Blood Transfusions: PRBCs60...

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Male Hormone Replacement Therapy: Testosterone62

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Erectile Dysfunction Pills64

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Estrogen64

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