Pharm quiz 2 Flashcards
parathyroid
stimulates release of calcium from the bones. maintain ca in extracellular fluid
hypothyroid - 3 types
primary, secondary, tertiary
primary hypothyroidism (primary the whole thing is f’d)
abnormal thyroid gland - most common
secondary hypothyroidism (terminator is second)
pituitary gland and related to decreased secretion of TSH (TSH releases T3 and T4)
tertiary hypothyroidism (tersh is the last one releasing)
due to decreased levels of TRH (thyrotropin-releasing hormone) from hypothalamus
hashimotos -Japan autos #1)
autoimmune, primary
myxedema
severe - adult, typically primary (caused by hypothyroidism). decreased metabolism, feeling cold, swollen tongue
cretinism
infant, decreased metabolic rate, retard growth, sexual growth and mental retardation (caused by hypothyroidism)
which type is associated with iodine?
primary
s/s of hypothyroidism
cold intolerence, unintentional weight gain, depression, dry brittle hair and nails, fatigue. skin thickening. LOC.
diseases associated with hyperthyroidism (Judy was hyper with…)
graves (most common) plummers (least common), multinodular disease.
thyroid storm
life-threatening - symptoms of hyperthyroidism, caused by stress.
s/s of myxedema (my skin is firm yellow)
firm edema, yellow skin, hair loss, weight gain, lethargy, dullness of skin
hyperthyroidism
excessive thyroid hormones. increase in metabolism.
s/s of hyperthyroidism (nervous stomach and fatigue)
diarrhea, flushing, increased appetite, muscle weakness, fatigue, palpitations, irritiablility, nervousness, sleep disorders, heat intolerance, altered menstrual flow.
treatment for hypo
hormone replacement, natural or synthetic.
levothyroxine (synthro makes me skinny and enhances my glyco and protein)
(synthroid) hypo - synthetic. increases BMR. enhances glycogensis. stimulates protein synthesis.
labs for hypo - and what are normal TSH levels? (tsh it’s 4)
T3 and T4 - normal TSH levels 0.4 - 4.8 mU/L
levothryoxine - who is prescribed to? And what are the adverse affects? (Think too much thyroid)
manage thyroid cancer. highly protein bound - remains in blood = toxicity.
adverse - hyper, palpitations, A-fib, weight loss. CANT switch brands
levothryoxine - drug interactions (synthro and mom’s WIDE CAP)
digoxin, antiacids, estrogen, insulin, phenytoin. Should be reduced - warafin, catecholamines.
levothryoxine nursing actions - and best time of day to take it? With food or not? (level the TSH)
monitor TSH. replacement is lifelong. Take on empty stomach 30 before breakfast w/ water.
levothryoxine (synthroid) doses and overdose (just thyroid storm) (synthroid as early as 25)
po 25 - 200 mcg. thyroid storm - tachycardia, neurological and respiratory. metabolism goes up
how much iodide is needed a week?
1 mg
hyperthroidism treatment
radioactive iodine - destroys thyroid gland. surgery to remove it.
thioamide - hyper or hypo?
hyper
elevated levels of parathyroid cause
osteoporosis and osteomalacia.
hypoparathyroidism can cause (think too little calcium)
hyocalcema and tetany (muscle spasm)
do diabetics need to increase or decrease hypoglycemic drugs while on thyroid meds?
may need to increase hypoglycemic drugs.
antithyroid drugs (hyper) with food, or without? What time of day to take?
better with food, give at the same time each day, never stop abpruptly.
what foods to avoid on antithyroid? (antithyroid = anti-salt)
high in iodine, seafood, soy sauce, tofu, bread, iodized salt
thryoid is regulated by what hormones? and where are they released from?
TSH(thyrotropin) - Anterior pituitary and TRH - hypothalamus
posterior pituitary hormones
oxytocin and antidiuretic hormone (ADH, or vasopressin)
adrenalcortical - oversecretion (adrenaline moon)
cushings - moon face
adrenalcortical - under-secretion (addy is under-secreting)
addisons - Decrease NA & BS, increase K, dehydration & weigh loss
what route can you not give steroids?
SC
food or not with steroids?
yes, food or milk to avoid stomach upset
on steroids - avoid contact with?
ppl who have infections,
take adrenal (steroids) when? And without or with food?
same time every day, usually morning with food.
what to avoid with adrenal meds? (prednisone & hydrocortisone) (adriene is uptight - doesn’t drink, take aspirin, or NSAIDs)
can affect warafin, but avoid NSAIDs, alcohol and asprin
taper steroids to avoid (think of where steroids come from)
adrenal crisis
prediabetes numbers
fasting 100 - less than 125
HbA1c measures what? You knew the answer in class.
% of glycosylated hemoglobin - forms over lifespan of RBC - 90 days
HbA1c - non-diabetic
HbA1c < 5.7%
fasting plasma glucose less than 100
HbA1c - prediabetes
HbA1c 5.7 - 6.4%
fasting plasma glucose 100 - 125
HbA1c - diabetes
HbA1c greater or equal to 6.5
fasting plasma glucose equal or greater than 126
lispro (rapid lisps are human, but you must eat afterwards) and food when?
humalog - rapid. must eat meal afterwards
aspart (a spartan is rapid and novel)
novolog - rapid.
glulisine (glide into rapid apid)
apidra - rapid
rapid acting - how adminstered?
SC or continous SC pump - NOT IV
regular insulin (to be short and regular is human) And how administered? (check the human part)
humalin - short-acting. ONLY ONE that can be given IV bolus, IV infusion, or IM.
short-acting - how fast?
onset 30 to 60 min
rapid-acting - how fast?
5 -15 min
isophane (NPH) and clear or cloudy? (NPR is right in the middle)!
neutral protamine hagedorn - intermediate acting. CLOUDY.
glargine (gargle clear lantus for a long time) and clear or cloudy?
lantus - long-acting. clear. referred to as basal insulin.
determir (mir and mir is clear and long)
levemir - long-acting. clear. referred to basal insulin
combo insulins
NPH and regular - 70/30
or 50/50.
how to administer mixed insulin
air into intermediate acting first, then air into rapid acting. withdrawal rapid or regular first (clear) then intermediate (cloudy)
metformin MOA (decreases what and increases what - think liver)
decreases glucose production in the liver***(this is unique) decreases intestinal absoption of glucose, increases uptake of glucose by tissues.
sulfonylureas - do they stimulate insulin, or not? (sulfunny loves beta)
stimulates insulin secretion from beta cells in pancreas, thus increases insulin. Beta cells must work! improves sensitivity to insulin in tissues. Only for type 2.
meformin side effects (metformin is metallic)
metallic. abdominal bloating, nausea, cramping, diarrhea, fullness.
sulfonylureas side effects (sulfunny makes me nausous and full) and causes hypo or hyperglycemia?
hypoglycemia, nausea, fullness
if patient is hypoglycemic and conscious
give oral glucose, corn syrup, honey, fruit jouice or small sanck.
hypogylcemia if patient is unconscous or below 50 (WD 40)
give D50W (glucose) or glucagon intravenously
sulfa allergy med that can trigger allergic response (amide with urea)
sulfonamide w/ sufonylureas
effects of hyperglyemia - worst case scenario
(HHNC) hyperosmolar hyperglycemic nonketotic coma.
effects of hypoglycemia (Just coma)
diabetic coma or insulin reaction
HHNC treatment (hnc doesn’t always need insulin)
IV fluids. don’t always need insulin
DKA treatment (ketoacidosis) (DKNY needs insulin)
IV fluids w/ normal saline. Then insulin. DKA is when body breaks down fat for fuel producing ketones, which are toxic.
hypoglycemia s/s (similiar to hyperthyroidism)
sweating, tachycardia, respiratory distress, stomach pain, vomiting, agitated, coma, anxiety, confusion, nausea, personality changes, hypothermia
hypoglycemia treatment
glucose supplement, OJ, non-diet soda, oral glucose. IM/SC glucagon.
rotate injection sites how?
use one spot for about a week then move. Spots should be at least 1/2 to 1 inch apart.
simple partial seizure can you recall it or not? (you can simply recall it, thats it)
twitching, conscious and can recall event.
complex partial seizure
may have aura, lip smacking - called automatisms.
generalized onset seizures
all over the brain.
absent seizures
petite. staring and eye fluttering.
myoclonic
jerks.
tonic-clonic and loss of consciouness or not?
loss of consciousness. jerking.
tonic seizures (that tonic is stiff and I might or might not be conscious)
stiff muscles of upper body. may or may not be conscious. NO jerking.
atonic seizures (the drop was a tonic)
drop seizures.
first line therapy for antiepileptic (don’t forget carbs)
carbamazepine (tegretol), phenytoin (dilantin), Valproate/valproic acid (Depakote®)
what is #1 for seizures
dilantin (phenytoin)
longterm effect of phenytoin (dilantin)
gingival hyperplasia. and acne, histurism and osteoporosis
what seizure med causes hepatotoxicity and pancreatitis? (Val is toxic to my liver and pancreas)
valproic acid
fosphenytoin (cerybyx) vs. phenytoin dosage (phent - you want 50, or 150?)
fosphen - NTE 150mg PE/min and pheny - NS only at 50 mg/min.
phenytoin trough level
morning, 30 min before dose. wait until you get labs back before giving dose. You have 30 min wiggle room with any med.
if someone is having a seizure,
don’t restrain them. remove dangerous objects. direct them to lie down.
antiepileptics - what time to take them?
same time every day
dilantin black box warning
The rate of intravenous Phenytoin Sodium Injection administration should not exceed 50 mg per minute in adults and 1-3 mg/kg/min (or 50 mg per minute, whichever is slower) in pediatric patients because of the risk of severe hypotension and cardiac arrhythmias
phenytoin therapeutic levels
10-20 mcg/mL
dilantin toxicity s/s (toxic dilan )
Coma.
Confusion.
Staggering gait or walk (early sign)
Unsteadiness, uncoordinated movements (early sign)
Involuntary, jerky, repeated movement of the eyeballs called nystagmus (early sign)
Seizures.
Tremor (uncontrollable, repeated shaking of the arms or legs)
Sleepiness.
valproic acid - MOA (Val doesn’t like sodium and calcium)
suppresses sodium and calcium channel influx. suppresses high frequency neuronal discharge around the seizure focus.
valproic acid drug interactions (Val is at war with aspirin and anti depressants)
aspirin, tricyclic antidepressants, rifampin, lorazepam, carbamazepine, oxcarbaepine, and lamotrigine, and warafin
why aspirin for MI (myocardial infarction)
it inhibits platelet aggregation or formation. It has been shown to reduce cardiac death.
adverse effect with aspirin
GI intolerence and bleeding. also acute renal failure if patient is dehydrated.
aspirin overdose in children - signs
hyperventilation and CNS - dizziness, drowsiness, behavioral changes. can have hypogylcemia.
aspirin overdose in adults - signs
tinnititus and hearing loss. acidosis and alkolosis.
allopurinol treats what?
gout
allopurinol MOA
inhibits enzyme xanthine oxidase, which reduces uric acid synthesis.
allopurinol side effects (all side effects are AS for my initials)
stevens-johnson, aplastic anemia, agranulocytosis (low WBC), leukopenia, fever, chills, pruitus, myopathy, renal failure, jaundice, skin stuff.
gout - where does it start?
toe, ankle, knee
gout is caused by…
high levels of uric acid in the blood
allopurinol is only used to
prevent attacks, but can’t treat. it prevents formation of uric acid or oxalate calculi in kidneys. can’t use in acute bc rapid lowering of serum urate may exacerbate the attack`
Colchicine (gout) can cause (colte looks anemic, get a blood test)
aplastic anemia, agranulocytosis, decreased platelets.
Colchicine - what organs does it affect?
GI and GU bleeding and kidneys
what drugs decrease uric acid?
allopurinol and probenecid. Colchicine helps with uric acid excretion, but doens’t reduce it.
chemical mediators in inflammation
histamines first (dilation in arteries) increase permiability, kinins second - increase permiability and pain, and prostaglandins last - increase permiabiliy, vasodilation and pain and fever
inflammation overview
inflammation, reaction to injury, caused by release of chemical mediators, leads to vascular response, fluid and WBC migrate to injury
NSAID s/e
dyspepsia, heartburn, epigastic distress, nausea, gi bleeding, mucosal lesions
misoprostol (cytotec) (miso protects you)
reduces dangerous s/e of NSAIDs, like GI bleeding.
NSAID interactions (you nsaids with your PADS)
Anticoagulants
Aspirin
Corticosteroids and other ulcerogenic drugs
Protein bound drugs (NSAIDs bind to protein)
Diuretics and ACE Inhibitors
Others (Don quai, feverfew, garlic, ginger, and ginkgo, when taken with NSAIDs, may cause bleeding)
Infliximab (Remicade®) (not flexible) and how does it work?
Neutralize TNF Disrupt inflammatory process Delay disease progression
🞑 Used for rheumatoid arthritis
immunosupression, infection.
Infliximab (Remicade®) - don’t take if you have what?
Don’t take if you have COPD
reason for inflammation
to wall off, destroy, or dilute injurious agent or injured tissue.
don’t use NSAIDs if
if you are at risk for bleeding, have a vitamin K defiency, or peptic ulcer disease.
aspirin overdose signs
increased HR, tinnitius, N/V, sweating, thirst, hypo and hyper.
most specific contraindication, or syndrome, associated w/ aspirin
reys syndrome
methimazole - hypo or hyper?
hyper
propylthiouracil - hypo or hyper?
hyper
potassium iodide - hypo or hyper?
hyper
s/s of hyperglycemia (when I’m hyper on sugar I vomit and I’m confused you SOB)
Fruity-smelling breath.
Dry mouth.
Abdominal pain.
Nausea and vomiting.
Shortness of breath.
Confusion.
Loss of consciousness.
reyes ages
4 - 12 yrs
interaction with alluporin (all at war)
warafin (bleeding)
alluprinol takes how long
1-3 weeks to start working
colchincine needs how long to avoid drug accumulation (colte needs 3 days)
3 days
delantin - speed
don’t exceed 50mg/min
before IV delantin
flush and check
glucagon makes you
throw up
probenecid (pro antibiotics, anti uric acid)?
helps liver excrete uric acid. ALSO assists with reabsorption of antibiotics (penicillin and ephalosporins)
colchicine use long or short term? And why? (Colte is bad for the kidneys)
short term, Leukopenia, low WBCs. MAYBE damages kidneys.
NSAID properties (the 4 As)
🞑 Analgesic
🞑 Anti-inflammatory
🞑 Antipyretic
🞑 Anti-rheumatic
prostaglandins cause a (prostate fever)
fever and vasodilation!
cox 1
chronic
cox 2 inhibitor (NSAID) (2 is inflammation)
inflammation
Salicylates (NSAID) make platelets (salli is slippery)
slippery
aspirin overdose - antidote?
there isn’t one. give fluids.
acetic acid is ex. (acetic acid for migraines)
toradol
avoid Cox-2 inhibitors (just NSAIDs) with what group (not elderly)
3rd trimester
proprionic acids are..
ibuprofen
Misoprostol (Cytotec®)
reduces affects of NSAIDS - protects the stomach.
does metformin increase insulin?
Does not increase insulin secretion from the pancreas***does not cause hypoglycemia
diabetic ketoacidosis caused by hyper or hypo?
hyperglycemia (high blood sugar, not enough insulin)
addisonian crisis
is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium. You will need immediate medical care. People with Addison’s disease commonly have associated autoimmune diseases
anterior pit - growth hormone for deficiency (dwarfs take soma)
somatotrem, somatotropin - used for dwarfism
anterior pit - adrenocorticotropic hormone (it’s in the name)
corticotropin
ADH deficiency causes what (you have it)
diabetes insipidous
what labs test for hypothyroidism?
TSH, T3 and T4
when taking synthroid, reduce what drug? (synthroid reduces war with cats)
warafin and catecholamines (epi, dopamine)
thyroid meds might take how long to work? (think how long it takes spiro to work)
several months
thyroid meds can enhance what med?
anticoagulants
thyroid meds may decrease what med? (thryoid decreases what, can you dig?)
serum digoxin levels
medication for hyperthyroidism (meth and propyl for hyper)
methimazole and propylthiouracil
adrenal medulla
epi and norepi
cortex
glucocorticoids and mineralcorticoids - all cortex are steroid hormones
ending in “sone”
adrenocorticoids or made by the adrenal cortex
Glucocorticoids do what? (sugar is good here)
inhibit or help control inflammatory & immune responses
(HHNC) hyperosmolar hyperglycemic nonketotic coma and diabetic ketoacidosis associated with type 1 or 2?
DKA - type 1, HHNC - type 2. Usually, but either can get both.
metabolic syndrome of insulin-resistence syndrome or syndrome X
combo of:
obesity
coronary heart disease
dylipidemia
hypertension
acroalbuminemia (protein in urine)
increased risk for thrombotic events (blood clots)
gestational diabetes - give insulin or not?
you must give it to prevent birth defects
metformin does not____, but sulfonylureas do______
increase insulin, stimulate insulin.
glinides (diabetic drug) does what? (Glide into insulin)
increase insulin secrection from the pancreas
TZD (thiazolinidinediones) diabetic drug - does what? (thia is not sweet, but she decreases my insulin resistence)
decreases insulin resistence. Use with caution***
alpha-glucosidase inhibitors diabetic drug - does what? (in a glucose-a-daze due to delayed absorption)
results in delayed absorption of glucose. must be taken with meals.
amylin mimetic (diabetic drug) does what? (Amy is a slow emptier)
slows gastric emptying
incretin memetic - diabetic drug - does what? (cretins increase insulin)
enhances glucose-driven insulin secretion
glinides - adverse affects (Glenda is hypo)
hypoglycemia
thiazolidinediones - adverse affect (thia is bad for my heart)
heart failure and MI
allergy cross-sensitvitely may occur with what diabetic drugs?
loop duiretics and sulfonamide (sulfa) antibiotics
what diabetic med interacts with contrast dye?
metformin
what are focal symptoms and when do they happen?
they are twitching, and happen during sezure
complex partial seizure - can patient remember or not?
not
when do auras occur? (auras are complex like migraines)
complex partial
staring happens with complex partial and absent seizure - how to tell them apart?
absent is usually shorter and quicker recovery
ictus
actual seizure. post ictus if after the seizure.
notify nurse during seizuure if
for more than two (2) consecutive minutes or the individual experiences two (2) or more generalized seizures without full recovery of consciousness between seizures.
cytotec generic name
misoprostol - it’s a hormone
how do seizure meds work
increase threshold or decrease spread and speed
AED therapy is usually lifelong, but…
not always! Patients who are seizure free for 1 to 2 years may be able to discontinue antiepileptic therapy
black box warning anti seizure meds
suicidal thoughts
carbemazapine tegretol action and adverse affects (carb suppresses sodium and causes anemia)
Suppression of sodium influx and adverse - anemia
dilantin action (same as the others)
Suppression of sodium influx
valproic acid (depakote) action (Val is a little different)
Suppression of both sodium and calcium channel influx
valproic acid safe does ranges (older Val is 50 - 150)
Therapeutic Levels 50 – 150 mg/ml
induration, erythema, calor, dolor = rubor)
thick skin, redness, heat, pain, redness
first mediator during inflammation
histamine
what regulates inflammation (prostate is inflamed)
prostaglandin
what to do before you start colchicine?
GET CBC before starting.
3 reasons for taking NSAIDS
🞑 Analgesic
🞑 Antipyretic
🞑 Antiinflammatory
age 60 or older, should you take daily NSAID?
nope
Acetic Acid Derivatives (NSAIDS) used for? (acid for bursitis)
arthritis, bursitis
sulfurneyeas (sulfunny is made of chloro and glim)
1st generation - chlorpopamide, 2nd generation - glimepiride
macrovascular
large arteries, plaque
microvascular
capillary, blindness, neuropathy
ex of biguanides (the guan is just a phage)
metformin (also called glucophage)
ketorolac is
toradol. only use for 5 days due to renal impairment
focal onset seizures
originate in a localized region of the brain
primary epilespy
no known cause
status epilepticus
tonic-clonic seizures that occur repeatedly. True medical emergency
clonic seizures
alternating contraction and relaxation
if you have just 1 seizure, should you take meds?
no, they may not come back
anti-seizure meds, can you take generic?
yes, but should be closely monitored
don’t drink carbonated drinks with what drug? (Val can’t even have carbonated drinks)
valproic acid
phenytoin s/e when giving IV
cardiac arrhythmias, hypotension, respiratory arrest and related deaths
what regulates thryoid hormones?
TSH and TRH
in general, what lowers calcium influx?
seizure meds
NSAID black box warning
increased chance of heart attack or stroke
meds for chronic gout
allopurinol and probenecid
med for acute gout
cholchicine
why can synthroid be so toxic?
it highly protein-bound, stays in system a long time
reye’s does what? (reye’s liver)
coma and liver damage
what patients need to take lower doses of aspirin?
those taking warafin, stroke, ulcer, blood thinners
taking synthroid - what drugs to increase? (it PAIDE to increase synthroid)
Diogin, antacids, estrogen, insulin, phentyoin
treatment for cushings (amin has cushings)
aminglutethemide
recombinant insulin (recombine yeast and bacteria)
made from yeats and bacteria
increase insulin which drugs? (insulin going up is sulfunny to glenda and creatin)
sulfunnys, glinides, incretin memetic,
decreases insulin resistence drug (decrease insulin when watching TMZ)
TZD
carbemazepine MOA (carb suppresses sodium)
suppresses sodium influx
carbemazepine side effects (carb is like Al, my initials)
anemia, stevens
ALL seizure meds suppress sodium influx except
valproic acid, which also suppresses Ca
cox 1 and 2 enzymes convert
acid into prostaglandins. Cox 2 triggers pain. Block this, and you block pain.
infliximab side effect (not flexible with infection)
infection
what drugs cause metallic taste?
colchicine and metformin
antigout - with food or not?
with food.
aspirin inteacts with..
antidiabetic drugs
torodol is an
acetic acid
in a glucosadaze, so you MUST
give it with the first bite of a meal
when to give oral diabetic drugs?
usually 30 min before a meal
