Exam 3 Flashcards
1
Q
What is the function of the Autonomic nervous system?
A
Regulation of the heart, secretory glands and smooth muscles
2
Q
What are the two components of the Autonomic nervous system?
A
The parasympathetic and sympathetic nervous systems
3
Q
What does the parasympathetic nervous system do?
A
Slows Heart Rate
Increases Gastric Secretion
Emptying of the bladder
Emptying of bowels
Constricting the pupils
Contracting bronchial smooth muscle
4
Q
What does the sympathetic nervous system do?
A
Increases heart rate
Increases blood pressure
Dilates bronchi
Vasoconstriction
Dilates pupils
Flight of fight
Shunting blood from skin to muscles
5
Q
What is the baroreceptor reflex?
A
Feedback loop between spinal cord and brain that regulates BP and maintains homeostasis
6
Q
What are molecules that activate receptors?
A
Agonists
7
Q
An agonist’s action depends on the?
A
receptor
8
Q
What is the method of action of an Agonist?
A
Agonists bind to the receptor and mimic the body’s own molecules
9
Q
What are the two types of agonists?
A
There are full agonists and partial agonists
10
Q
What are molecules that prevent or block receptors?
A
Antagonists
11
Q
What kind of effect does an antagonist have on their own receptors?
A
Antagonists essentially have no effect on their own on receptors but their action is the prevention of receptor activation by agonists
12
Q
What are the two types Adrenergic receptors?
A
Adrenergic and Cholenergic
13
Q
What do adrenergic drugs mediate?
A
responses to epinephrine and norepinephrine
14
Q
What locations are Alpha 1 receptors located?
A
Eye
Arterioles (skin, viscera, mucous membranes)
Veins
Penis
Prostate Capsule
Bladder
Every Apple Valiantly Prevents Poisonous Bugs
15
Q
What is the response to receptor activation for the Alpha 1 receptor in the eye?
A
Contraction of iris muscle increases pupil diameter (mydriasis-pupil dilation)
16
Q
What is the response to receptor activation for the Alpha 1 receptor in the arterioles and were are these arterioles located?
A
Vasoconstriction
Skin, viscera, mucous membranes
17
Q
What is the response to receptor activation for the Alpha 1 receptor in the veins?
A
Constriction
18
Q
What is the response to receptor activation for the Alpha 1 receptor in the penis?
A
Ejaculation
19
Q
What is the response to receptor activation for the Alpha 1 receptor in the prostate capsule?
A
Contraction
20
Q
What is the response to receptor activation for the Alpha 1 receptor in the bladder?
A
contraction of sphincter (prevents voiding)
21
Q
Where are the alpha 2 receptors located?
A
The presynaptic nerve terminals
22
Q
What is the response to receptor activation for the Alpha 2 receptors in the presynaptic nerve terminals?
A
inhibition of transmitter release
23
Q
Where are the Beta 1 receptors located?
A
The heart and kidney
24
Q
What is the response to receptor activation for the Beta 1 receptors in the heart?
A
Increased rate, contractile strength, conduction velocity over AV node
25
What is the response to receptor activation for the Beta 1 receptors in the Kidney?
Release of Renin
26
Where is the location of the Beta 2 receptors?
Arterioles (heart, lung, skeletal muscle)
Bronchi
Uterus
Liver
Skeletal muscle
A Big Umbrella Leans Securely
27
Where is the location of the Beta 2 receptors?
Arterioles (heart, lung, skeletal muscle)
Bronchi
Uterus
Liver
Skeletal muscle
A Big Umbrella Leans Securely
28
Where are the location of dopamine receptors?
in the kidney
29
What is the response to receptor activation for the Beta 2 receptors in the arterioles and where are these arterioles located?
Dilation
Located in the heart, lung and skeletal muscles
30
What is the response to receptor activation for the Beta 2 receptors in the bronchi?
Dilation
31
What is the response to receptor activation for the Beta 2 receptors in the uterus?
relaxation
32
What is the response to receptor activation for the Beta 2 receptors in the liver?
Glycogenolysis
33
What is the response to receptor activation for the Beta 2 receptors in the skeletal muscle?
Enhanced contraction, glycogenolysis
34
What is the response to receptor activation for the Dopamine receptors in the kidney?
Dilation of kidney blood vessels
35
What is the span of receptor coverage of epinephrine?
Alpha 1
Alpha 2
Beta 1
Beta 2
36
What is the span of receptor coverage of Norepinephrine?
Alpha 1
Alpha 2
Beta1
37
What is the span of receptor coverage of Phenylephrine?
Alpha1
38
What is the span of receptor coverage of Dopamine?
Alpha1
Beta 2
Dopamine
39
What is the span of receptor coverage of Isoproterenol?
Beta 1
Beta 2
40
What is the span of receptor coverage of Dobutamine?
Beta 1
41
What is the span of receptor coverage of Albuterol?
Beta 2
42
The adrengergic agonists have what direct method of binding?
Direct receptor binding
43
The theraputic uses for Alpha 1 Activation are?
mostly based on vasoconstriction
44
What are the reasons to activate Alpha 1 receptors to promote vasoconstriction?
Nasal Decongestion
Hemostasis (topical application)
Adjunct to local anesthesis
Mydriasis (pupil dilation)
BP elevation
45
What are the adverse effects of Alpha 1 Agonists?
HTN (can be severe with IV administration)
Bradycardia (baroreceptor reflex)
Tissue necrosis
46
What occurs when an IV extravates?
Medicine is released from the IV site causing necrosis of the tissue
47
What are the therapeutic effects of Beta1 activation?
Heart Failure
Shock
AV heart blocks
Restarting heart after cardiac arrest
48
What are the adverse effects of Beta 1 activation?
Tachycardia
Dysrhymias
Agina Pectoris
49
What are the therapeutic effects of Beta 2 activation?
Occur in the lungs and uterus
Asthma
Delay of preterm labor
50
What are the adverse effects of Beta 2 Activation?
Hyperglycemia
Muscle tremors
51
If using an Beta 2 adrenergic agonist on a diabetic patient, what nursing interventions should be taken?
Blood sugar should be checked frequently
52
Dopamine has a special quality unlike the other receptors. What is it?
Dopamine is both the receptor and the drug
53
What are the pharmacokinetics of dopamine administration?
Given IV, weight based and very short half life
54
Dopamine is considered to be 'dose dependent'. What does this mean?
Effects depend on how much of drug is given
55
What are the effects of dopamine in low doses?
Dilation of blood vessels
Improves GFR and urine output
Maintains kidney function
56
What is the effect of dopamine if given in high doses?
Beta 1 and Alpha 1 effects:
Vasoconstriction
Increased BP & HR
Improved cardiac output
Used for hemodynamic support:
Shock
Advanced Heart failure
57
What are the adverse effects of high doses of Dopamine Receptor activation?
Dysrhymias/tachycardia (activation of Beta 1)
Angina pectoris (activation of beta 1)
Tissue necrosis if IV extravastes
58
What type of receptors does epinephrine activate?
Activates all alpha and beta receptors
Treatment of Anaphylaxis/anaphylactic shock
59
What are the Alpha 1 activation effects of epinephrine?
Delays absorption of local anesthetic
Controls bleeding
Raises BP
Induces mydriasis
60
What are the Beta 1activation effects of epinephrine?
Reverses AV heart block
Restores rhythm during cardiac arrest
61
What are the Beta 2 activation effects of epinephrine?
Bronchodilation
(not the preferred drug)
62
How is epinephrine administered and how is concentration determined?
Absorption: Topically or by injection
Different concentrations for different routes
63
What are the Pharmocokinetics of epinephrine metabolism?
Metabolized in liver and intestine and has a very short half life
64
What are the adverse effects of epinephrine?
HTN crisis
Dysrhythmias/tachycardua
Angina Pectoris
Necrosis (if iv exravation)
Hyperglycemia
Interacts with A1 and Beta blockers
65
How is epinephrine concentration determined?
By the administration route
Oral inhalation = Highest
SC/IM
IV/intracardiac
Combined with local=Lowest
66
What must you do before administering epinephrine?
Must confirm the concentration and intended route before administering especially in emergency situations
67
What do adrenergic antagonists do?
These drugs block the activation of a and b receptors
68
What are the therapeutic uses for Alpha 1 blockers?
Essential HTN
Benign prostatic hypertrophy
Renal stones
Pheochromocytoma
Raynaud's Disease
Reversal of overdose/toxicity of A1 agonists
69
What are the Adverse effects of Alpha 1 Blockers?
Orthostatic hypertension
Reflex tachycardia
Nasal Congestion
Inhibition of ejaculation
Na retention and increased blood volume
70
What is Pheochromocytoma?
Tumor in adrenal glands
71
What is Phentolamine?
A non selective alpha blocker (antagonist)
72
What are the therapeutic uses for Phentolamine?
Pheochromocytoma
Treatment of tissue necrosis (after extravasion of an a1 agonist, it's the antidote)
73
What are the adverse effects of Phentolamine?
Same as the a1 antagonists
Significant reflex tachycardia (may need to be given a beta blocker)
74
What are the therapeutic uses for Beta 1 blockers?
Hypertension
Stable Angina
Tachycardia
Post-MI
Heart Failure
Migraines
Stage Fright/anxiety
Glaucoma
Happy Susan Takes Pies Home on Monday, Satisfying Grandma
75
What are the adverse effects of Beta1 Blockers?
Bradycardia
Reduced cardiac output
Precipitation of heart failure
AV heart block
Rebound cardiac excitation
Fatigue/Depression
Can mask hypoglycemia
Big Rabbits Prefer A Really Fast Hop
76
What are the therapeutic uses for Beta 2 blockers?
NONE
Some non-selective Beta blockers can block B2, but never give for a therapeutic use
77
What is the first generation beta blocker?
Propanolol
78
What is the method of action of propanolol?
Blocks both Beta 1 and Beta 2 receptors
79
What are the therapeutic uses of propanolol?
HTN
Angina Pectoris
Tachycardiac dysrythmias
Myocardial infarction
Stage Fright
Can cause depression
80
How can propanolol cause depression in some patients?
Because it is highly lipid soluble, it can cross the membrane to CNS causing depression
81
What are the adverse effects of propanolol?
Beta 1 and Beta 2 blocking adverse effects
Big Rabbits Prefer A Really Fast Hop
82
What is the second generation Beta blocker?
Metoprolol
83
What is the method of action of metoprolol?
Cardioselective, blocking beta 1 receptors
84
What are the therapeutic uses for metoprolol?
HTN
Angina pectoris
Tachycardic dysrythmias
Myocardial infarction
Heart Failure
Crosses CNS
85
What are the therapeutic uses for metoprolol?
HTN
Angina pectoris
Tachycardic dysrythmias
Myocardial infarction
Heart Failure
Crosses CNS
86
What are the adverse effects of metoprolol?
Beta 1 only
87
What are the differences between propanolol and metoprolol?
Propanolol is a nonselective blockade, so it blocks both Beta 1 and 2 receptors
Propanolol is used to treat stage fright
Metoprolol is a Beta 1 blocker, and it is also used to treat Heart failure and not stage fright
88
What is the 3rd generation Beta Blocker?
Carvedilol
89
What is the method of action of Carvedilol?
Nonselective blockade of Beta 1 and 2 plus alpha 1 blockade
90
What are the therapeutic uses of carvedilol?
HTN
Angina Pectoris
Tachycardic dysrhythmias
Myocardial infarction
Heart failure
91
What are the adverse effects of carvedilol?
Beta 1 blockage effects
Beta 2 blockage effects
Alpha 1 blockage effects
92
Cholinergic drugs mediate responses to?
Acetylcholine
93
What is acetylcholine?
Aceytlcholine is the chief neurotransmitter of the Autonomic nervous system that:
Contracts smooth muscle
Dilates blood vessels
Increases bodily secretions
Slows heart rate
94
The response of a Cholinergic drug depends on?
The type of receptor that is activated or blocked
95
Cholinergic Drug Receptors:
Muscarinic receptors in the eye
Contraction of the lens and iris to focus
96
Cholinergic Drug Receptors:
Muscarinic receptors in the eye
Contraction of the lens and iris to focus
97
Cholinergic Drug Receptors:
Muscarinic receptors in the eye
Contraction of the lens and iris to focus
98
Cholinergic Drug Receptors:
Muscarinic receptors in the heart
Decreases heart rate
99
Cholinergic Drug Receptors:
Muscarinic receptors in the lungs
Contraction of bronchi and promotion of secretions
100
Cholinergic Drug Receptors:
Muscarinic receptors in the bladder
Contraction of detrusor muscle
Relaxation of sphincter
Coordination of these two actions
101
Cholinergic Drug Receptors:
Muscarinic receptors in the GI Tract
Salivation
Gastric secretion increase
Intestinal tone, motility and defecation increase
102
Cholinergic Drug Receptors:
Muscarinic receptors in the sweat glands
Generalized sweating
103
Cholinergic Drug Receptors:
Muscarinic receptors in the sex organs
Erection
104
Cholinergic Drug Receptors:
Muscarinic receptors in the blood vessels
Vasodilation
105
What are the two subcategories of Cholinergic medications?
Agonists and Antagonists
106
What is Bethanechol?
A muscarinic agonist
107
What are the therapeutic uses for Bethanechol?
Non-obstructive urinary retention
Off label for GERD
108
What are the pharmacokinetics of bethanechol?
Absorbed rapidly PO
Given on an empty stomach (food decreases absorption and can cause N/V)
109
What is the metabolism of bethanechol?
A short T1/2
Metabolized by cholinesterase at the cholinergic sites in the plasma and liver
110
What are the adverse effects of Bethanechol?
Cardiovascular: Bradycardia, hypotension
Respiratory: Shortness of breath (bronchioconstriction)
GI/GU: Increased salivation and GI motility
111
What are the contraindications for muscarinic agonists?
Toxicology: Can OD on too much
Patients with gastric ulcers, asthma or heart failure
112
What are the contraindications for muscarinic agonists?
Toxicology: Can OD on too much
Patients with gastric ulcers, asthma or heart failure
113
What are the nursing considerations for muscarinic agonists?
Advise to take 1 Hr before or 2 hrs after meals
Monitor HR and BP
Watch for SLUDGE
114
What does SLUDGE stand for?
It's the signs of toxicity from muscarinic agonists
S-Salivation
L-Lacrimation
U-Urination
D-Defication
G-Gastric upset
E-Emesis (vomiting)
115
What is overactive bladder?
Defined as urgency, frequency, nocturia and/or urge incontinence
116
What causes overactive bladder?
It is usually due to involuntary contractions of detrusor muscle or bladder and is more common with increasing age and/or multiple pregnancies
117
What are the non-pharmocological therapies for overactive bladder?
Scheduled voiding
Timing Fluid intake
Kegel Exercises
Avoid caffine
118
An anticholinergic is?
A muscarinic antagonist
119
What is the MOA of an anticholinergic?
Blocks acetylcholine at muscarinic receptors
120
What is an anticholinergice used to treat?
Overactive bladder
Bradycardia (atropine)
Eye disorders/Eye exams
Intestinal hypertonicity and hypermotility disorders
Motion sickness
Asthma/COPD
121
What is an easy way to remember what anticholinergics do?
Can't think (confusion)
Can't blink (dry eyes)
Can't see (blurred vision)
Can't pee (Urine retention)
Can't spit (dry mouth)
Can't shit (constipation)
122
What is Oxybutynin?
A muscarinic antagonist that is the top therapy for overactive bladder
123
What is the MOA of Oxybutynin?
Blocks the muscarinic receptors on the bladder detrusor muscle which inhibits bladder contraction which decreases the urge to void
124
What are the pharmacokinetics of Ocybutynin?
PO (IR/ER), patch, gel
Crosses BBB
Metabolized by CYP enzymes
Short half life
125
What are the adverse effects of Oxybutynin?
Causes typical anticholinergic effects
Contraindicated to be given with other anticholinergic drugs
126
What is atropine?
A muscarinic antagonist that is a common drug given for diverticulitis, eye exams and is an antidote to muscarninic agonists
127
What is the method of action of Atropine?
Prevents receptor activation from acetylcholine
128
What are the uses for atropine?
Bradycardia (ACLS drug)
Eye Exams
Diverticulitis
Cholinergic overdose
129
What are the pharmacokinetics of atropine?
PO, Eye drops or IM/IV/SC
If given IV, begins to work immediately and is metabolized by the liver and excreted by the kidneys
130
What are the adverse effects of Atropine?
CNS: mild excitation at therapeutic doses
Eyes: Blurred vision/increase in intracellular pressure/photophobia
Cardiovascular:Tachycardia
GI: Decreased secretions/constipation
Misc: Decreased sweating
131
What is Ipratropium bromide (Atrovent)?
A muscarinic antagonists that is an inhaler/nebulizer or nasal spray
132
What are the two types of histamines?
H1-dilates small vessels, constriction of bronchi smooth muscle, CNS effects, itching, pain in nerves, secretion of mucus
H2: Increases in gastric acid
133
An antihistamine is?
A H1 antagonist/blocker that relieves itching, sneezing or rhinorrhea
134
What is the MOA of a antihistamine?
Selectively binds to H1 histamine receptors blocking their action
Does not bind to H2 receptors
Blocks some muscarinic receptors
135
Can an antihistamine be used in pregnancy?
It is not advised, especially in the 3rd trimester because it crosses the blood brain barrier and could cause sedation and a decreased apgar score
136
What are the differences between the first generation antihistamines and the second generation of antihistamines?
First Gen (Benadryl): Sedating effect, CNS effects, anticholinergic effects, paradoxical excitation in some
Second Gen (zyrtec): Not sedating, no anticholinergic effects
137
What is allergic Rhinitis?
Approved medical diagnosis of seasonal allergies that is an inflammation of the eyes, upper and lower airways
138
What are the symptoms of allergic Rhinitis?
Sneezing, rhinorrhea, pruritus, nasal congestion, conjunctivitis, possible asthma
139
What are intranasal antihistamines?
They are part of the second gen. of antihistamines and in theory, have less systemic adverse effects
140
What are the adverse effects of intranasal antihistamines?
Nasal dryness, epistaxis (nose bleed), headaches
141
What type of medication is Aselastine and Olopatadine?
Intranasal antihistamines
142
What are the most effective medications for allergic rhinitis due to their anti-inflammatory action?
Intranasal glucocorticoids
143
What are the adverse effects of intranasal glucocorticoids?
Dry mucosa, epistaxis and headache
144
Fluticasone and Mometasone are both what kind of drug?
Intranasal glucocorticoids
145
What type of drugs are decongestants?
Sympathomimetics/Alpha 1 agonists
146
What is the method of action of decongestants?
Reduces the swelling of the nasal mucosa
147
What are the adverse effects of decongestants?
Nasal: Rebound congestion (wean with glucocorticoid)
Oral: Restlessness, anxiety, insomnia, vasoconstriction
148
What are some examples of common decongestants?
Phenylephrine
Psuedoephedrine
Oxymetazoline
149
How long should you take decongestants?
Do not take for longer than 3 days or just at bedtime 4x
150
B2 agonists, methylxsnthines and anticholigergics all fit into what category of respiratory drugs?
Bronchodilators
151
Glucocorticoids and leukotriene modifers and what type of respiratory drugs?
Anti-inflammatory medications
152
Inhaled Corticosteroid is used for?
An Asthma controller
It is used prophalatically to prevent asthma attacks. NOT for PRN use
153
What is the method of action of a inhaled corticosteroid?
It decreases:
Bronchial hyperactivity
Airway edema
Synthesis of inflammatory mediators
It increases:
# of Beta 2 receptors
Responsivness to Beta 2 agonists
154
What are the pharmacokinetics of a glucocorticoid?
Usually inhaled, can be given PO in severe cases for a brief duration
155
What are the adverse effects of a glucocorticoid?
Oropharyngeal candidiasis
Dysphonia (horseness)
Increase in glucose level
Adrenal suppression possible with long term use
Bone loss possible
Slowing of growth in children
156
What is a SABA?
A short acting Beta 2 adrenergic Agonist that is used as a rescue inhaler PRN or before exercise
157
What are the adverse effects of a SABA?
tachycardia
Angina
Tremor
158
What kind of drugs are Albuterol and Levalbuterol?
SABA
159
What is a LABA?
A long-acting Beta 2 Adrenergic Agonist that is used as a controller, not a rescue inhaler with fixed schedule dosing that must be combined with a ICS
160
What drug must be combined with a inhaled corticosteroid?
A LABA
161
Salmeterol and Aformoterol are what kinds of drugs?
LABAS
162
Step 1 in the asthma treatment scale is?
The use of an inhaled short acting Beta 2 agonist PRN (SABA)
163
Step 2 of the asthma treatment scale is?
A inhaled corticosteroid is added to the short acting B2 agonist (SABA
164
Step 3 of the asthma treatment scale is?
An inhaled long acting B2 agonists (LABA) is added to SABA and inhaled corticosterioid
165
Step 4 of the asthma treatment scale is?
Increasing the dosage of already administered drugs, or constider the addition of a fourth drug
166
Step 5 in the asthma treatment scale is?
The use of a daily steroid tablet on top of LABA, SABA and inhaled corticosteroid
167
Oral B2 agonists are used for?
Long term control of asthma, not an acute attack because they take a while to take effect if given orally but have significantly more adverse effects because they are absorbed systemically
168
What are the pharmacokinetics of oral B2 agonists?
Short half life so multiple doses
169
Dry-powder inhalers have?
no propellant and are breath activated
170
What dose a nebulizer do?
Its a machine that converts medication into a mist
171
With a spacer, a metered dose inhaler receives how much more medication to the mouth and throat and lungs?
With a spacer, the Mouth and throat get 22% of the medication while 21% reaches the lungs.
Comparitively, without a spacer the mouth and throught get 81% of the medication and the lungs only get 9%
172
Budesonide (Pulmicort) and Fluticasone propionate (flovent) are both what type of drug?
Inhaled corticosteroids
173
What type of drug is Montelukast (singulair)?
A leukotriene modifier
174
What is the MOA of Montelukast?
Blocks the leukotriene receptors therefore decreasing both bronchioconstriction and inflammatory response
175
What are the uses for Montelukast?
Asthma, EIB, Allergic Rhinitis
176
Montelukast is not a _____________ ____________ ____________ but is used in combination with a glucocorticoid to lower steroid dose..
first line treatment
177
Theophylline is what type of drug?
A Methylxanthine is a group of drugs derived from xanthine (Caffeine) that was the first line asthma drug before the development of inhaled glucocorticoids
178
What does Theophylline cause?
CNS stimulation
Cardiac Stimulation
Bronchial dilation
179
What are the pharmacokinetics of Theophylline?
Only available as sustained release
PO
Wide variation in half life, so indivual dosing is required
NTI Drug: Levels between 10-20 mcg/mL are therapeutic
180
What are the NTI levels of Theophylline?
10-20 mcg/mL
181
Ipratroprium (Atrovent) and Tiotropium (Spriva) are what types of drugs?
Anticholinergics that are used for COPD and off label for asthma by blocking muscarinic receptors in the bronchi and prevent bronchoconstriction
182
In regards to insulin, what is the difference between Type 1 and Type 2 diabetes?
Type 1 diabetes requires insulin replacements
Type 2 will likely start with oral medication and may eventually need insulin replacement over time
183
How is Diabetes monitored?
With Fasting blood glucose levels
Glycosylated hemoglobin
Continuous glucose monitoring
184
What is an HbA1C?
The Glycosylated hemoglobin in the blood, it shows a 3 month average percent
185
What is a goal number for an HbA1C?
Goal is <7% (150) but <8% if hypos or limited life expectancy
186
A HbA1C of 12% would be?
300
187
What is the goal range for continous glucose monitoring?
Over 70%
188
All types of insulin are given _________________, why?
Parentally because of the first pass effect
189
All insulins carry some risk of?
Which type has the most risk?
Hypoglycemia
Shorter acting insulins carry more risk
190
The concentration of insulin is measured in?
Units
191
Insulin is a high alert drug, what does this mean?
You may need two RN signatures before administering
192
Insulin:
What is the onset, peak and duration of insulin lispro?
onset: 15-30 min
Peak: 0.5-2.5 hr
Duration: 3-6 hr
193
Insulin:
What is the onset, peak and duration of regular insulin?
Onset: 30-60 min
Peak: 1-5hr
Duration: 6-10hr
194
Insulin:
What is the onset, peak and duration of NPH insulin?
Onset: 60-120 min
Peak: 6-14 hr
Duration: 16-24ht
195
Insulin:
What is the onset, peak and duration of insulin glargine (100)?
Onset: 70min
Peak: None
Duration: 18-24 hr
196
Insulin:
What is the onset, peak and duration of insulin determir
Onset: 60-120min
Peak: None
Duration: 12-24hr
197
Insulin:
What is the onset, peak and duration of insulin glargine (300)?
Onset: 360min
Peak: None
Duration: >24hr
198
Insulin:
What is the onset, peak and duration of insulin degludec?
Onset: 30-90min
Peak: None
Duration: >24hr
199
What insulin is NEVER given IV?
insulin lispro
insulin lantus
insulin levimir
200
Why would a patient need a different concentration of insulin?
to reduce the volume of the injection
201
Which insulin in considered the rapid prototype and can be used for both meals and basal control?
insulin lispro
202
U-500 regular insulin is only available in which form?
pen form
203
What is the only insulin given IV?
U-100 regular insulin
204
Which insulin has a cloudy suspension?
NPH insulin
205
How is NPH insulin mixed before drawing?
by gently rolling in hands
206
When injecting a patient with a long acting insulin and a NPH, which insulin should be drawn first?
Clear before cloudy as to not contaminate the regular insulin with NPH insulin
207
Which two insulins are both long acting, normally given once per day at night and are the best insulins for basal control?
Insulin Lantus
Insulin Levimir
208
What are the major differences between insulin glargine and insulin degludec?
Both ultra long acting insulins but:
insulin glargine is available in U-300 prefilled pens, effects begin within 6 hrs
Insulin degludec is available in U-100 and U-200 prefilled pens and effects begin in under 90 minutes
209
What are the major similarities between insulin glargine and insulin degludec?
Both are good for someone who is busy or inconsistent with administration
Both are used once daily
Both mimic basal control
Both have no significant peak and are steady all day
Both are only given subq
210
Which site is the fastest for insulin administration?
The abdomen
211
Which site is slowest for insulin administration?
The thigh
212
What the the 'magic number' for blood sugar?
70
213
What are the side effects from a rapid fall in BS?
increased HR, sweating, shakeness
214
What are the side effects from a slow fall in BS?
HA, confusion, fatigue, drowsiness
215
What are the interventions for hypoglycemia?
For a conscious patient:
glucose tabs, OJ, soda, candy
For an unconscious patient:
D50 or glucagon SQ/Iv
216
What patients are at the highest risk of hypoglycemia?
Patients with:
Decreased food intake
vomiting/diarrhea
Increased exercise activity
Alcohol intake
Uncontrolled diabetes
217
What are the oral medications for Type 2 diabetes?
Biguantide (metformin)
Sulfonylureas
Thiazolidinedones (glitazones)
Alpha-glucosidease inhibitors
SGLT-2 inhibitors
Gliptins (DPP-4 inhibitors)
GLP-1 receptor agonists
Big Green Snakes go through alot
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What is the first line oral therapy for diabetes and pre-diabetes?
Biguantide (Metformin)
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What are the pharmacokinetics of Biguantide (Metformin)?
Inhibits glucose production in the liver
Increases insulin sensitivity in the tissues
Lowers blood glucose but DOES NOT cause hypoglycemia****
Taken with meals 1-2 times a day
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What are the adverse effects of Biguantide (Metformin)?
GI effects (taken with food)
B12 deficency
Toxicity with lactic acidosis so no alcohol
Kidney excretion (so watch out for renal issues)
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What are the oldest class of oral anti-hypoglycemics?
Sulfonylureas
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What are the pharmacokinetics of Sulfonylureas?
Stimulates insulin secretion in pancreas
Increases insulin sensitivity
With means 1-2 times per day
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What are the adverse effects of Sulfonylureas?
Hypoglycemia (especially in hepatic or renal impairment)
No alcohol (flushing, palpitations, N.V)
Beta blockers (can mask effects of hypoglycemia)
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What are the pharmacokinetics of Thiazolidinediones/Glitazones?
Increases insulin sensitivity
Inhibits glucose production
Half life of 16-24hrs
Metabolized by CYP enzyme *
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What are the adverse effects of Thiazolidinediones/Glitazones?
Fluid rention (not for use in HF patients)
Drug interactions with CYP inhibitors/inducers
Risk of bladder cancer (watch for blood in urine)
Risk of fractures in women
Possibly hepatotoxic
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What are the pharmacokinetics of Alpha glucosidase inhibitors?
Delays carb absorption in the gut
With meals 3x per day
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What are the adverse effects of Alpha glucosidase inhibitors?
Frequent GI distress (gas, bloating, cramps, diarrhea, borborygmus)
Delayed iron absorption
Possible liver dysfunction
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What are the pharmacokinetics of Dipeptiyl Peptidase-4 (DPP-4) inhibitors such as sitagliptin?
They enhance incretin hormone that stimulates insulin secretion in the pancreas
Supress post-prandial release of glucagon
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What are the adverse effects of DPP-4 inhibitors?
RARE Pancretitis
Severe and persistant upper abdominal pain
Vomiting
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What are the pharmacokinetics of Sodium-Glucose co-transporter 2 (SGLT-2) inhibitors such as canaglifozin?
Inhibits SGLT-2 in the kidneys
Decreases reabsorption of glucose
Increases urinary glucose excretion
Glucosuria->caloric loss->modest weight loss
Half life of 12 hr
Shown to prevent CV events
Basically you pee out the glucose
CanaglifOZIN->helps urine flow!
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What is the non-insulin injectable?
Glucagon-like Peptide 1 (GLP-1)
Known as Ozempic
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There are two types of Glucagon-like Peptide 1 (GLP-1), what are they?
Short acting: Exenatide (Byetta) 1/2x per day
Long acting: Exentide (Bydureon) 1x per week
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What are the pharmacokinetics of Glucagon-like Peptide 1 (GLP-1)?
Mimics incretin hormones by:
Stimulating insulin secretion
Supresses post prandial release of glucagon
Slows gastric emptying
Supresses Appetite (promotes weight loss)
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What are the adverse effects of Glucagon-like Peptide 1 (GLP-1)?
GI effects (reflux, N/V, diarrhea)
Hypoglycemia
Pancreatitis (rare)
Renal impairment (rare)
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What is the treatment for diabetic ketoacidosis?
Replace fluids
Slow adjustment of plasma glucose
Potassium Issues (expect to give replacement)
Sodium Bicarb
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What is the treatment for Hyperosmolae Hyperglycemic (nonketotic state)
Replace fluids
Slow adjustment of plasma glucose
Potassium issues corrected
(the only difference is no bicarb)
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How does the hypothalamic-pituitary thyroid axis work?
On a negative feedback loop
Thyroid uses iodine in body to produce T3 and T4
Increase in T3 & T4 will decrease TSH and vice versa
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What are the fuctions of thyroid hormones?
Regulates metabolic rate
Regulates body heat production
Maintains Growth hormone and skeletal maturation
CNS development
Maintains cardiac rate, force and output
Maintains secretion of GI tract
Affects Respiratory rate and O2 use
Affects RBC production
Metabolism, Heat, Growth, Bones, Heart, GI, Lungs
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What occurs when there is not enough circulating T3 and T4, or any other issue with the negative feedback loop?
Hypothyroidism
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What are the causes of hypothyroidism?
Gland malfunction
Pituitary Tumor
Removal of gland
Iodine deficency
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What are some of the symptoms of hypothyrodism?
Everything is sluggish, tired, poor memory, dry skin, brittle hair and nails, bradycardia, constipation, heavy menses, cold intolerant, weight gain
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What drug is the mainstay treatment for hypothyroidism?
Levothyroxine (Synthroid)
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What is an important consideration in the prescribing of Levothyroxine (Synthroid)?
The brand name and the generic are not the same and therefore dosing must be made for the specific drug that the patient is using
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What is the MOA of Levothyroxine (Synthroid)?
Synthetic T4 is converted to T3
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What are the pharmacokinetics of Levothyroxine (Synthroid)?
Oral or IV
Food, especially calcium can interfere with absorption
Very highly protein bound (long half-life)
NTI drug (several strengths available)
SAFE IN PREGNANCY
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What hypothyroid drug is safe in pregnancy and why is if in fact good to take in pregnancy?
Levothyroxine (Synthroid)
Untreated hypothyroid can cause unintentional miscarrage, and therefore is necessary to take if pregnant to protect the pregnancy
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What are the adverse effects of Levothyroxine (Synthroid)?
Side effects are rare if within the therapeutic range->
Overdose is thyrotoxic crisis which involves:
Hyperthermia
Tachycardia
Restlessness
Tremor
Weight loss
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What is the patient education for Levothyroxine (Synthroid)?
It's a 'picky little pill'
-Needs to be taken on an empty stomach
-Generic/Brand consistancy
-Regular lab monitoring
-Report any thyrotoxic symptoms
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Hyperthyroidism occurs when?
There is excess T4 in the body
250
What are the causes of hyperthyroidism?
Graves Disease
Toxic nodular goiter (pt develops nodules on thyroid gland that start to produce their own T4)
251
What are the symptoms of hyperthyroidism?
Everything is revved up
Anxious, poor concentration, hungry, tachycardia, chest pain, hyper defication, irregular to no menses, heat intolerance, weight loss
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What are the drugs to treat hyperthyroidism?
Methimazole and Propylthiouracil (PTU)
253
What is the MOA of Methimazole and Propylthiouracil (PTU)?
They are thionamides that
inhibit thyroid synthesis
PTU also supresses conversion of T4 to T3 in the body
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What are the pharmacokinetics of Methimazole and Propylthiouracil (PTU)?
PO
Slow onset (3-4 weeks)
Methimazole has longer half life
Short or long term use
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Out of Methimazole and Propylthiouracil (PTU), which is preferred in pregnancy and why?
PTU is preferred because it does not cross the placenta
256
What are the adverse effects of Methimazole and Propylthiouracil (PTU)?
Methimazole is teratogenic
Too much can cause hypothyroidism
Frequent lab monitoring is required
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What is the main function of the Adrenal Cortex?
Maintain glucose availability (glucocorticoids)
Cortisol
258
What are the prototypes for Corticosteroids/glucorticould/mineralocorticoid?
Hydrocorisone and Prednisone
259
What are the pharmacokinetics fo hydrocorisone and prednisone?
PO/IV/IM/Rectal/Topical
Metabolized in liver
Excreted in urine
260
What are the adverse effects of physiologic levels vs pharmcological levels of glucocorticoids?
Minimal adverse effects for physiological levels
Higher risk of adverse effects for pharmacological levels
261
When would you use pharmacological levels of glucocorticoids?
Allergic reactions
Lung conditions
Inflammation
Dermatological conditions
262
What is Addison's Disease?
Chronic adrenocorticoid insuffciency
263
What are some of the symptoms of Addison's Disease?
Bronze pigmentation of the skin
Changes in body hair distribution
Hypoglycemia
Postural hypotension
Weight loss
GI disturbances
Weakness
264
In an adrenal crisis, what occurs?
Profound fatigue
Dehydration
Vascular collapse
Renal shutdown
Decreased serum Na
Increase serum K
265
What is the treatment for Addison's Disease
Lifelong supplementation with glucocorticoid
Needs extra steroids during times of physical stress like fever, illness, surgery
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What is Cushing's Syndrome?
It is a syndrome that can occur when someone is on a steroid med for a long time
267
What are the symptoms of Cushing's syndrome and how are they managed?
Hyperglycemia-focus effort of diet and exercise
Adrenal suppression-taper after long periods of time
Osteoporosis-Wt bearing exercise, Calcium & Vit D
Suseptibility to infection: screen and prevent
Psychological issues: Educate
Peptic ulcers and Hypertension: Avoid NSAIDS
