Test 2 Topic List Units 5-9 (incomplete) Flashcards
Addison’s disease
Addison’s: adrenal glands don’t produce sufficient steroid hormones
(Can occur from corticosteroid withdrawal)
Use of high dose steroids >2 wks begins suppression of pt adrenal glands b/c exogenous glucocorticoids suppress CRH and ACTH.
With prolonged suppression, adrenal glands atrophy and can take months to recover after glucocorticoids discontinued.
Important to taper of steroids after 2 weeks of therapy !!
Tx. Replace absent hormones (PO hydrocortisone or fludrocortisone)
Addiction
The overwhelming obsession with obtaining and using a drug for a non-medically approved purpose.
- a patient in pain should not be deprived of adequate pain relief b/c of fear of addiction.
Adjuvant pain medication
Adjunctive drugs, which are medications developed for purposes other than analgesia, use different pain pathways for reducing pain.
*Useful particularly in neuropathic pain when given in conjunction with NSAIDs or opioids.
Ex. Gabapentin and newer anticonvulsants first line choice (fewer side effects than older tricyclics)
duloxetine (Cymbalta) SNRIs have proved effective.
Androgen replacement, males, side effects
testosterone is a schedule III controlled substance.
Indication: hypogonadism
S/E: increased RBCs, acne, gynecomastia, aggressive behavior
Can impair spermatogenesis and can cause infertility
potential to disrupt hypothalamic-pituitary-gonadal axis in a way that shuts down sperm production (irreversible change)
Assessment tools, cognitive functioning
**The most common used standardized assessment tool is the Folstein Mini-Mental State Exam (MMSE).
Global Deterioration scale: stages dementia based of functional ability.
The Katz assessment of ADLs monitors improvement or decline in function.
Asthma
Asthma is a chronic inflammatory disease classified based on symptoms, risks for exacerbation, and pulmonary function.
Intermittent : symptoms < 2 days/wk.
Mild persistent: symptoms >2 days/wk. but not daily
Moderate persistent: daily daytime symptoms but not nightly
Severe persistent: continuous night and day, limited activity
Atomoxetine
atomoxetine (Strattera): Norepinephrine reuptake inhibitor (NRI)
Indication: AD/HD only (Only FDA approved drug in pts who can’t tolerate stimulants) low potential for abuse: not a controlled substance.
give to the AD/HD pt with a hx. of substance abuse
Increases extracellular concentrations of norepinephrine.
MOA: selective reuptake of presynaptic norepinephrine. Doesn’t bind with monoamine receptors in the brain thereby decreasing risk of adverse reactions compared with other NRIs.
(Antidepressants are used occasionally in children who have failed to respond to other therapy)
Atrophic vaginitis
Cause: woman doesn’t make enough estrogen (mainly post menopausal)
S/S: dry,thin,inflamed vagina, painful sex, predisposes to UTIs
Tx. estrogen therapy: oral, vaginal, or transdermal forms decrease it.
(Local vaginal estrogen provides more rapid relief than systemic alternatives)
Attention deficit hyperactivity disorder (AD/HD)
Heterogenous disorder of unknown cause diagnosed with a documented hx. of in attention, impulsivity, with or without hyperactivity causing impairment in at least 2 settings.
Counseling for parents,guardians, and teachers first
Drug tx. of choice : methylphenidate (Ritalin)
Give a TCA for pts with hx. of substance abuse (atomoxetine)
Bupropion for hx. of cardiac disease
Benzodiazepines
Diazepam (Valium) is only benzodiazepine indicated for muscle spasm.
Direct skeletal muscle relaxant action in the brainstem and spinal cord, enhancing the action of GABA. Increased neuronal inhibition, CNS depression, sedation (watch elderly = increased risk for falls)
Can be used for anxiety/depression in combo. with SSRI but must be tapered off. Used for muscle strain and spasticity. Used for insomnia. Inhibits seizure activity. High abuse potential-> Don’t use in alcoholic or drug abuser. Short term basis only! Must be tapered to avoid withdrawal.
Ex. clonazepam, diazepam, clorazeprate
Biguanides
Biguanides: metformin (Glucophage)
MOA: decreases hepatic glucose production. No effect on pancreas.
First step Pharmacologic treatment in Type II DM !!
Metformin is antihyperglycemic drug not hypoglycemic: therefore hypoglycemia is not a side effect.
Watch creatinine & contrast media (kidneys) -> lactic acidosis
Bisphosphonates
alendronate sodium (Fosamax), risedronate (Actonel), ibandronate sodium (Boniva), zoledronic acid (Reclast) MOA: inhibit osteoclastic bone resorption by reducing osteoclast number and function.Tx/prevent of osteoporosis first line drug therapy! **levels of Vitamin D and Calcium must be WNL prior to starting bisphosphonate therapy**
Calcium supplementation
1000 to 1500mg/day for adults to help prevent osteoporosis.
Main function is to grow, support, maintain bone structure
Food sources: bony fish, green leafy vegetables, soybeans, tofu
Vitamin D formation
Obtained by 15 minutes in sun or by diet.
25-hydroxycholecalciferol: represents stored supplies of Vitamin D
Parathyroid hormone stimulates release of enzyme. When calcium levels decrease, PTH secretion increases resulting in Vitamin D converted to its active form. (Requires activation to work)
Vitamin D mechanism of action
Primary purpose: enhances intestinal absorption of Calcium and phosphate
All osteoporosis therapy must have good vitamin D establish first.
