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101a Vocab > Pharm-DM. chemo, opioids > Flashcards

Pharm-DM. chemo, opioids Flashcards

1
Q

who are oral antidiabetic agents used for?

A

Stable Type 2 diabetics with NO KETONES who can’t control BG with diet alone

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2
Q

never use oral antidiabetics in

A

pts who make no inuslin (Type 1) Pt must make their won insulin to use oral agents

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3
Q

Sulfonylurea action

A

Bind to Beta cells of pancreas and stimulate insulin release

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4
Q

second generation sulfonylureas are better than 1st generation because

A

more potent, less interactions, less side effects

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5
Q

2nd gen sulfonylureas end in

A

-ide

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6
Q

glimepiride

A

Amaryl; sulfonylurea

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7
Q

glipizide

A

Glucotrol; sulfonylurea

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8
Q

glyburide

A

Micronase, DiaBeta,

sulfonylurea

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9
Q

major adverse effect of sulfonylureas

A

Hypoglycemia

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10
Q

side effects of sulfonylureas besides HoG

A

itchy rash, increased sun sensitivity

heartburn, anorexia, n/v

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11
Q

sulfonylureas should be taken

A

30 minutes before a meal

except Glucotrol XL and Amaryl-qday

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12
Q

Glucotrol + metformin

A

Metaglip

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13
Q

gluburide +metformin

A

Glucovance

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14
Q

sulfonylurea + biguanide combo drugs (2)

A

Metaglip and Glucovance

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15
Q

sulfonylurea + TZD combo drugs (2)

A

Avandaryl and Duetact

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16
Q

Amaryl + Avandia

A

Avandaryl

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17
Q

Amaryl + Actos

A

Duetact

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18
Q

Meglitinides action

A

“jumper cables”
stimulate insulin release from pancreas, faster and shorter duration than sulfonylureas
esp good for controlling ppBG

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19
Q

Major adverse effect of meglitinides

A

hypoglycemia

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20
Q

Meglitinide use contraindicated in

A

pregnancy and breastfeeding

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21
Q

Admininster meglitinide when?

A

within 15 minutes of meal; only give if meal is eaten

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22
Q

metformin and Januvia

A

Januvamet

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23
Q

metformin and Avandia

A

Avandamet

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24
Q

Biguanide action

A

decreases hepatic glucose production (gluconeogenesis) and

increases cellular uptake of glucose

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25
Q

Adverse effects of biguanides are rare if

A

pt has good renal and hepatic function

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26
Q

Potentially fatal AE of biguanide use

A

Lactic Acidosis

due to excess drug accumulation

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27
Q

Labs before and every 6 months with biguanide use

A

Liver and Kidney function tests

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28
Q

Stop biguanide use immediately if

A

dehydration, severe infection, surgery
contrast dye use (stop 48 hours prior)
excessive Etoh
hepatic or renal disease

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29
Q

s/s Lactic acidosis

A

fatigue, weakness dizzyness
dyspnea
GI discomfort
bradycardia, arrythmia

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30
Q

Most common side effect of biguanide use

A

GI symptoms: diarrhea, n/v, bloating, anorexia, metallic taste
SO: take with meals

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31
Q

HoG can result from biguanide use if

A

it is taken with a sulfonylurea, excessive alcohol

elderly and/or malnourished pt

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32
Q

alpha-glucosidase inhibitors action

A

“Starch Blockers”

slow CHO digestion and glucose absorption by blocking carbohydrase enzyme; prevents surges in BG

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33
Q

Side effects of alpha-glucosidase inhibitors

A

GI: diarrhea, gas, abd pain (“gas pills”

HoG when used with sulfonylureas

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34
Q

acarbose

A

Precose

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35
Q

miglitol

A

Glyset

starch blocker

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36
Q

when HoG is cause by starch blocker use, treat with

A

oral glucose or milk, NOT sucrose because its digestion will be slowed

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37
Q

Administer starch blockers

A

with first bite of meal.

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38
Q

metformin

A

Glucophage

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39
Q

TZDs action

A

Insulin sensitizers; decrease insulin resistance at the cellular level by increasing uptake of glucose by skeletal muscle and decreasing glucose production by the liver. Overall: increases effectiveness of circulating insulin, DOES NOT stimulate secretion of insulin

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40
Q

TZD taken off market in 2000

A

Rezulin

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41
Q

TZD generic names end in

A

-glitazone

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42
Q

rosiglitazone

A

Avandia

TZD

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43
Q

pioglitazone

A

Actos

TZD

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44
Q

indication for TZD use

A

Type 2 DM pt on insulin >30 units/day still with inadequate BG control

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45
Q

TZDs don’t cause HoG but can damage

A

the liver. LFTs monthly at first, then q6mos

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46
Q

decreases action of oral contraceptives and can cause ovulation in premenopausal anovulatory pts

A

Actos

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47
Q

avoid in severe cardiac disease bc can worsen HF

A

TZDs

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48
Q

exenatide

A

Byetta; incretin mimetic

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49
Q

incretin hormones released by/action

A 
GI tract; in response to food.  They:
Stimulate insulin secretion
decrease pp glucagon production
slow gastric emptying
increase satiety to decrease intake
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50
Q

incretin mimetic action

A

improves glycemic control in Type 2 DM pt by decreasing fasting and pp BG by mimicking incretin hormone action

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51
Q

indication for incretin mimetic use

A

Type 2 DM pt adjunct to metformin or sulfonylureas when pt is still not getting enough BG control

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52
Q

Admin of incretin mimetic

A

SubQ injection within 1 hour of am and pm meals

53
Q

side effects of Byetta

A

decreased appetite, intake, and weight

nausea, especially with first use

54
Q

DDP-4 inhibitor action

A

enhance incretin system

(DDP-4 enzyme inactivates incretins)

55
Q

DDP-4 inhibitors generic names end in

A

-gliptin

56
Q

sitagliptin

A

Januvia

DDP-4 inhibitor

57
Q

saxagliptin

A

Onglyza

DDP-4 inhibitor

58
Q

indications for use of DDP-4 inhibitors

A 
with metformin (Januvamet) or TZDs or solo
Adjunct to diet and exercise to increase glycemic control
59
Q

Side effects of DDP-4 inhibitors

A

Headache
URIs, sore throat
diarrhea

60
Q

Do not use these with sulfonylureas because of increase risk of HoG

A

DDP-4 inhibitors

61
Q

Admin of DDP-4 inhibitors

A

PO qday

62
Q

injecable med for Type 1 and Type 2 pts; used with insulin to help lower ppBG by slowing food movement through stomach

A

pramlintide (Symlin)

63
Q

administer Symlin

A

dont mix with insulin, prepare two different syringes

64
Q

side effects of Symlin

A

HoG, nausea

65
Q

glucagon action

A

pancreatic hormone that raises BG by stimulating glycogen breakdown

66
Q

glucagon use

A

treat HoG when oral treatment isn’t possible

67
Q

to admin glucagon

A

reconstitute, not stable in liquid form

IM or SubQ injection, repeat 1x in 20 min

68
Q

who must have glucagon on hand at all times?

A

Type 1 pt or meds that have risk of HoG

69
Q

class of controlled pain mgmt meds; natural or synthetic chemicals based on morphine

A

opioids

70
Q

narcotic

A

any drug capable of causing physical dependence

71
Q

opioid action

A

stimulate opioid receptors in CNS causing a combo of analgesia, sedation, mood change and euphoria specific to the receptor involved

72
Q

opioid receptor that causes analgesia, sedation, and euphoria and whose major side effect of stimulation is respiratory depression

A

M (mu)

73
Q

opioid receptor whose stimulation causes mainly analgesia and drowsiness and whose main side effect is decreased GI motility

A

K (kappa)

74
Q

opioid receptor stimulated by endogenous endorphins

A

delta

75
Q

specific effects of each opioid are determined by

A

it’s particular affinity for the different opioid receptors

76
Q

indications for opioid use (5)

A

Pain relief: mod-severe
Cough suppression (medullary center inhibition)
Cardiac-decreased workload due to claming effect and peripheral vasodilation
Antidiarrheal-bind intestinal opioid receptors
Anxiety decreased

77
Q

agonist action

A

binds receptor to activate and produce a response

78
Q

partial agonist (agonist-antagonist) action

A

mixed effects result in a weaker response than agonist; used when max effects would be dangerous

79
Q

antagonist action

A

Blocks receptor response

80
Q

opioid antidote

A

naloxone (Narcan)
naltrexone (Trexan)
given if RR <8 usually, precipitates withdrawal in dependent patients

81
Q

why are oral morphine doses higher than IV/IM?

A

First Pass Effect in Liver

82
Q

Analgesic standard for potency to which all opioids are compared

A

morphine

83
Q

methadone use and action

A

used for detox and maintenence of heroin or other opioid addicts; decreases intensity of withdrawal symptoms

84
Q

advantage of buprenorphine (Suboxone, Subtrex) over methadone

A

can give prescription to go home instead of regular visit to clinic

85
Q

antihistamines are used as adjuvant meds with opioids because

A

sedation, potentiate analgesia

86
Q

antidepressants are used as adjuvant meds with opioids because

A

decrease pain perception and induce sleep

87
Q

anxiolytics are used as adjuvant meds with opioids because

A

decrease anxiety, induce sleep, promote amnesia

88
Q

antipsychotics are used as adjuvant meds with opioids because

A

decrease pain perception, induce sleep, counter delerium

89
Q

anticonvulsants are used as adjuvant meds with opioids because

A

stabilize neuronal membranes and potentiate analgesia
Often used for chronic pain
Ex-Neurontin

90
Q

opioid contraindications

A 
acute respiratory distress
decreased liver or kidney function
Head injury (increased risk of respiratory depression)
91
Q

opioid side effects

A 
*Respiratory Depression
n/v
drowsiness
dry mouth
miosis (pupil constriction)
orthostatic HoTN
diaphoresis
pruritis (some histamine release, not true anaphylaxis)
urinary retention (esp. morphine)
constipation
92
Q

adverse reactions of opioids

A 
seizures
tinnitus (often concurrent with Tylenol)
jaundice
facial Edema
confusion
tachycardia
severe respiratory depression (give Narcan)
93
Q

dependence

A

response to ongoing exposure that can produce withdrawal syndrome

94
Q

early s/s opioid withdrawal

A

anxiety
tearing and runny nose
clammy skin and goosebumps

95
Q

late s/s opioid withdrawal

A

irritability
n/v and diarrhea
involuntary leg movement

96
Q

very late s/s opioid withdrawal (can last months)

A

agitation, insomnia, fatigue

97
Q

tolerance

A

adaptation; need increased dose for same effect

98
Q

addiction

A

drug seeking for euphoriia, not pain mgmt

99
Q

when to admin opioids before a painful activity

A

PO: 30 min before

IV/IM: 3-5 min before

100
Q

anaplasia

A

absence of normal cellular differentiation

101
Q

myelosuppression

A

suppression of bone marrow function, which can result in dangerously low levels of rbs, wbcs, and plts

102
Q

normal plt count

A

150-400

103
Q

normal Hgb

A

males: 14-18
females: 12-16

104
Q

normal Hct

A

males 42-52%

females 37-47%

105
Q

normal wbc count

A

4200-12500 (4.2-12.5)

106
Q

nadir

A

lowest wbc count after count had been depressed by chemo; time to nadir can be reduced and duration can be increased in subsequent rounds of chemo

107
Q

carcinomas are malignant neoplasms of

A

epithelial tissue (skin, GI lining, bronchial lining, other linings)

108
Q

sarcomas are malignant neoplasms of

A

connective tissue (bone, fibrous, fatty, muscle, vascular, neuro). often present as painless swellings

109
Q

leukemia

A

cancers that arise from bone marrow; marrow cells replaced by leukemic blasts resulting in abnormal numbers and forms of immature wbs.

110
Q

goal of chemo

A

find best combination of meds for that particular cancer cell type to achieve the highest cell kill ratio possible.

111
Q

induction therapy

A

first dose of chemo

pt reponse often dictates course of treatment

112
Q

standard insulin units/mL

A

100 units/mL

113
Q

never dilute or mix

A

Lantus

114
Q

insulin coverage is always with

A

rapid-acting or short-acting

115
Q

draw venous blood sample to confirm BG if it is

A

500

116
Q

the only insulin given IV is

A

short-acting (regular)

117
Q

insulin syringe specs

A

1/2-5/8 inch

25-30 G

118
Q

when mixing insulins draw up

A

regular first, then NPH (RN)

119
Q

systematic rotation of injection sites is necessary

A

to prevent scar tissue formation and ensure adequate absorption

120
Q

insulin injection sites separated by ? and use not more than?

A

1 inch

every 3 weeks

121
Q

medications that can increase hypoglycemic effects of insulin

A

alcohol; MAOIs; salicylates

122
Q

two types of lipodystrophy

A

lipoatrophy–loss of subq fat; seen as dimpling

lipohypertrophy—development of fatty masses at injection site

Both caused by prolonged use of the same site, not rotating properly

123
Q

complication sometimes seen after diabetic control is suddenly established in a client who has prolonged uncontrolled DM

A

Insulin Edema–generalized retention of fluid

124
Q

most common cause of insulin resistance

A

obesity

125
Q

true insulin resistance is a daily insulin requirement of

A

200+ units

126
Q

treatment for insulin resistance

A

purer preparation

prednisone treatment

127
Q

an opened bottle of insulin is good for

A

28 days at rt

128
Q

insulin pumps use only

A

rapid-acting insulin

129
Q

get accucheck within ? minutes of meals

A

30 minutes

101a Vocab (9 decks)

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