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178 Cards in this Set
- Front
- Back
Glaucoma |
a group of disorders characterized by increased intraocular pressure (IOP). |
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Primary Open-Angle Glaucoma (POAG) |
represents 90% of those diagnosed with glaucoma. |
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Acute Angle-Closure Glaucoma |
10% of those diagnosed with glaucoma. |
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Glaucoma mechanism of action |
Aqueous humor is produced by the ciliary body and secreted into the posterior chamber of the eye. It then circulates around the iris into the anterior chamber via the trabecular meshwork and the Canal of Schlemm. If outflow of aqueous humor is impeded, increased IOP occurs. |
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Agents used to treat glaucoma |
Beta blockers, A2 agonists, Prostaglandin analogs, cholinergic agents, carbonic anhydrase inhibitors |
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Betaxolol (Betopotic) |
Beta blocker used to treat glaucoma |
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Levobunolol (Betagan) |
Beta blocker used to treat glaucoma |
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Timolol (Timoptic) |
Beta blocker used to treat glaucoma |
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Method of action of beta blockers used to treat glaucoma |
Decrease production of aqueous humor by the ciliary body. (Some are B1 selective (Betaxolol), some are non-selective for B1 and B2, the difference may be that B1 selective has lower risk of respiratory side effects) |
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Adverse Reactions of Beta blockers for Glaucoma |
Low risk of side effects due to topical application. Possibility of respiratory side effects. May cause blurred vision, may interact with calcium channel blockers. |
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Latanoprost (Xalatan) |
Prostaglandin Analog used to treat glaucoma |
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Method of action of prostaglandin analog used to treat glaucoma |
Lowers IOP by facilitating the outflow of aqueous humor through relaxation of the ciliary muscle. |
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ADR of prostaglandin analog used to treat glaucoma |
darkening of the iris, blurred vision, burning, stinging, conjunctival hyperemia, punctate keratopathy. May cause migranes. |
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Brimonidine (Alphagan) |
Alpha2 Agonist used to treat glaucoma |
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Method of action of alpha2 agonists used to treat glaucoma |
similar to beta blockers by reducing aqueous humor production. also may increase outflow. |
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ADRs for Alpha2 agonists used to treat glaucoma |
dry mouth, ocular hyperemia, burning, stinging, headache, blurred vision, foreign body sensation, ocular itching. this drug crosses the blood brain barrier and may cause hypotension, fatigue, and drowsiness. Wait 15 minutes after instilling drops before putting in lenses. |
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Echothiophate iodide (Phospholine) |
Cholinesterase Inhibitor used to treat glaucoma. |
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ADRs of cholinesterase inhibitors used to treat glaucoma |
Temporary irritation/burning/stinging of the eye, temporary blurred vision, eyelid muscle twitching, poor vision in dim light, headache, or brow ache may occur. Unlikely but serious side effects:eye pain, flushing, diarrhea, nausea, irregular heartbeat, stomach/abdominal pain orcramps, increased saliva, increased urination, unusual sweating, vision changes. Also possibly retinal detachment. |
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Dorzolamide (Trusopt) |
Carbonic anhydrase inhibitor used to treat glaucoma. |
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ADRs of carbonic anhydrase inhibitors used to treat glaucoma |
stinging, bitter taste, may also cause allergic reactions and conjunctivitis |
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Allergen mediated asthma |
Allergen binds to antibodies on mast cells in the airways. Release of mediators as well as immediate bronchoconstriction and or bronchospasm. Bronchial hyperactivity or sensitization (allergens/triggers will now have more pronounced effect). |
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Non allergen mediated asthma |
Triggers include: cold air, stress, or exercise. Airway inflammation immune response leads to edema, mucous production, smooth muscle hypertrophy. |
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Drug classes to treat asthma and COPD |
Anti inflammatory glucocorticoids immune response modifiers mast cell stabilizers, leukotriene inhibitors bronchodilators B2 agonists methylxanthine Other anticholinergic |
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method of action of glucocorticoids to treat Asthma and COPD |
suppress inflammation, suppress inflammation mediators, reduce infiltration, reduce edema, reduce mucous secretions |
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Route of Glucocorticoids to treat asthma and COPD |
inhaled (first line), PO (second line), IV (hospital use) |
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Cautions in use of Glucocorticoids to treat asthma and COPD |
Caution in pregnancy, children, and adolescents. Systemic use is not recommended while breast feeding. |
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Use of glucocorticoids in prophylaxis of asthma and COPD |
inhaled takes several days to be effective oral takes a few doses to be effective IV takes several hours to be effective |
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Inhaled: Beclomethasone diproprionate (QVAR) Oral: Prednisone IV: Solu-Medrol |
Glucocorticoid used to treat Asthma and COPD |
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Inhaled: Budesonide (Pulmicort) Oral: Prednisolone IV: Solu-cortef |
Glucocorticoid used to treat Asthma and COPD |
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Flunisolide (Aerobid) (inhaled) |
Glucocorticoid used to treat Asthma and COPD |
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Fluticasone Propionate (Flovent) (inhaled) |
Glucocorticoid used to treat Asthma and COPD |
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Triamcinolone acetonide (Azmacort) (inhaled) |
Glucocorticoid used to treat Asthma and COPD |
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Mometasone furoate (Asmanex) (inhaled) |
Glucocorticoid used to treat Asthma and COPD |
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Mometasone furoate/formoterol fumarate dihydrate (Dulera) (inhaled) |
Glucocorticoid used to treat Asthma and COPD |
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ADRs of Inhaled glucocorticoids |
Adrenal supression (with lone term use), bone loss, oropharyngeal candidiasis, dysphonia (disorders of the voice) |
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ADRs of po and IV glucocorticoids |
adrenal supression, bone loss, fluid/electrolyte imbalance, hyperglycemia, peptic ulcer disease, growth suppression, infection, psychological disturbances, myopathy |
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Cromolyn |
prophylactic drug for asthma |
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Indications for Cromolyn |
prophylaxis for chronic asthma, exercised induced bronchospasm, and allergic rhinitis (intranasal only) |
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Mechanism of action of Cromolyn |
stabalizes membrane of mast cells which prevents release of histamine, eosinophils, macrophages, and other inflammatory agents |
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Safest drug for asthma (has no systemic effect) |
Cromolyn |
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Mechanism of action of Beta2 Agonists to treat asthma and COPD |
stimulation of B2 adrenergic receptors in the smooth muscle of lungs to cause bronchodilation, also suppress histamine release and increase ciliary motility |
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Albuterol (Proventil, Ventolin) |
Short acting Beta2 agonist (SABA) (inhaled) |
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Levoalbuterol (Xopenex) |
Short acting Beta2 agonist (SABA) (inhaled) |
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Salmeterol (Serevent) Formoterol (Foradil) |
Long Acting Beta2 agonist (LABA) Inhaled Agents |
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Albuterol Terbutaline |
Oral Beta2 Agonist agents |
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only Short Acting Beta2 Agoinists (SABA) can treat |
acute asthmatic episodes |
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ADRs of inhaled SABA |
tachycardia, angina, tremors |
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ADRs of LABA |
increased risk of severe asthma |
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ADRs of Oral Beta2 Agonists |
tachycardia, angina, tremors |
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Methylxanthines |
bronchodilators used to treat asthma and COPD |
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All generic names of Methylxanthines end in |
-phylline |
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Theophylline |
a methylxanthine |
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mechanism of action of methylxanthines |
relaxes smooth muscles of lungs, stimulate the CNS & respiration, dilate foronary and pulmonary vessels, cause diuresis |
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theophylline has a _______ therapeutic range |
narrow |
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Theophylline drug interactions |
sympathomimetic agents, caffine, enhances diuretics, enzyme inducing agent (smoking) |
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steps to take when bronchodilator and inhaled glucocorticoid are the be administered at the same time |
use the bronchodilator first, wait 5 minutes, administer the glucocorticoid, rinse your mouth |
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Ipratropium (Atrovent) Tiotropium (Spiriva) |
Anticholinergics used for treating COPD |
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ADRs of anticholinergics for treating COPD |
dries secretions, tachycardia, palpitations, GI upset, headache, drowsiness, confusion, urinary retention |
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Combo agents for treatment of Asthma and COPD |
Dual action helpful when 1 agent is not sufficient. Combivent (Ipatropium and albuterol). Advair Diskus (Fluticasone and salmeterol) |
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Leukotriene inhibitors |
immune response modifiers used to treat asthma |
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zafirlukast (Accolate) zileuton (Zyflo) montelukast (Singulair) |
Leukotriene inhibitors |
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ADRs of Leukotriene inhibitors |
Common: Headache, GI disturbances, arthralgia's, myalgia's. Uncommon: Liver InjuryDoes not apply to Montelukast |
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Omalizumab (XolAir®) |
Therapeutic antibody targeted to antagonize receptors for IgE, a type of antibody. Decreases release of inflammatory mediators. Indicated for moderate to severe asthma in adults and adolescents. Only for 12+ years of age with positive skin test or in vitro reactivity to a perennial allergen. Last line, Very expensive |
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Omalizumab (XolAir®) ADRs |
Injection site reactions, Increased susceptibility to infections, Increased risk for:CancerCardiovascular events. Anaphylaxis- Observe patient after receiving dose |
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Types of medications used to treat upper respiratory disorders (allergies, cough, cold) |
antihistamines, immune response modifiers (Cromolyn, Omalizumab, Montelukast), Inhaled glucocorticoids, sympathomimetics (often used in nasal decongestants), cough and cold remedies |
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Contraindications/cautions for antihistamines |
Severe liver disease, narrow-angle glaucoma, urinary retention |
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Diphenhydramine (Benadryl) Brompheniramine (Dimetapp) Chlorpheniramine (Teldrin) |
first generation antihistamines names |
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ADRs of first generation antihistamines |
Crosses Blood Brain Barrier: Causes sedation, Acetylcholine blockages causes anticholinergic symptoms:Dry mouthConstipation & Urinary Retention |
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Certirizine (Zyrtec) Fexofenadine (Allegra) Desloratidine (Clarinex) Azelastine (Astepro) Loratadine (Claritin) |
second generation antihistamines names |
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ADRs improvements in second generation antihistamines |
Less anti-cholinergic effect Very Lipo-phobic and does NOT cross Blood Brain Barrier: Causes little to no sedation |
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Decongestants mechanism of action |
Stimulates the alpha-adrenergic receptors to cause vascular constriction of capillaries. Shrinks nasal mucous membranes and decreases nasal fluid secretions. Available as systemic or local/intranasal dosage forms. |
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Pseudoephedrine (Sudafed) Phenylephrine |
Systemic decongestants |
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Phenylephrine (Neo-Synephrine) Naphazoline (Privine) |
nasal decongestants |
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ADRs and Drug interactions of decongestants |
Rebound congestion (nasal/topical route only)CNS excitation (oral route only) Contraindicated or use with extreme caution in clients with hypertension, cardiac disease, hyperthyroidism and diabetes.May decrease the effect of beta blockers. Clients taking this medication should avoid large amounts of caffeine (coffee, tea) because it can increase restlessness & palpitations caused by decongestants. |
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beclomethasone (Beconase), fluticasone (Flonase), triamcinolone (Nasacort) |
Intranasal Glucocorticoids names |
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Intranasal Glucocorticoids Indications |
Allergic rhinitis |
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ADRs Intranasa Glucocorticoids |
Drying of nasal mucosa, Itching/Burning sensation, Bleeding |
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Antitussives Mechanism of Action |
Suppress ‘cough-control center’ in the medulla and suppress reflex to cough |
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Codeine, Guaifenesin & Codeine (Robitussin A-C), Hydrocodone (Hydrocodan) |
Narcotic antitussives names |
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benzonatate (Tessalon), dextromethorphan (Benylin), promethazine w/dextromethorphan (Phenergan) |
non-narcotic antitussives names |
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Guaifenesin (Robitussin, Anti-Tuss, Glycotuss, mucinex), Hydration |
Examples of expectorants |
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Mucolytics |
Mechanism of Action: Acts like detergents to liquefy & loosen thick mucous secretions so they can be expectorated. Includes: Acetylcysteine (Mucomyst)Used frequently for Cystic Fibrosis |
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central venous parenteral feeding required for |
greater than 12% dextrose |
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Iodine deficiency |
nutritional deficiency that causes hypothyroidism |
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Myxedema |
the name for severe hypothyroidism in adults |
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Levothyroxine (Synthroid, Levoxyl) |
Synthetic thyroid for hypothyroidism |
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ADRs of Levothyroxine |
symptoms of hyperthyroidism:(Tachycardia, palpitations, excess sweating, heat intolerance, nervousness, irritability, exophthalmos, weight loss) Nervousness, insomnia, weight loss, Tremors, headache, Nausea, vomiting, diarrhea, cramps, Tachycardia, palpitations, hypertension, Dysrhythmia, angina |
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Drug interactions of Levothyroxine |
Increased cardiac responsiveness with epinephrine and other vasopressors
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Antithyroid Drugs: Thionamides |
Includes:Propylthioruacil (PTU) methimazole (Tapazole). Mechanism of Action: Prevents incorporation of iodine tyrosine. Prevents tyrosine from coupling. Prevents production of T3 and T4. *May take up to 3-12 weeks for euythyroid state. ADR: Hypothyroidism, Rash, Nausea, Arthralgias |
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Radioactive Iodine (131I) |
Mechanism of Action: Unstable isotope of iodine that destroys Thyroid tissue as it degrades. Indication: Graves’ Disease and Thyroid Cancer. Advantages: Low cost; Alternative to surgery; Low Mortality; Selective (only affects Thyroid). Disadvantages: Takes months; Delayed hypothyroidism (90%)- need close monitoring of TFT’s. |
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Lugol’s Solution (Strong Iodine) |
Mechanism of Action: High concentrations cause paradoxical suppression of thyroid gland. Leads to decrease in T3 and T4. Indication: Short term use to prep for thyroidectomy or for thyrotoxic crisis. Decreased efficacy with long term use. Side Effects: GI (abdominal pain, diarrhea, vomiting)Oral - Brassy taste, soreness in teeth/gums/throatHeadache |
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When to administer thyroid replacement (levothyroxine) |
before breakfast |
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If a does of thyroid replacement is missed |
take two doses the next day |
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How to detect Severe Thyrotoxicosis when patient undergoes surgery OR develops a severe concurrent illness |
Go by symptoms and history alone (No lab tests)Profound hyperthermia (T > 1050F)Severe TachycardiaAgitationTremorsComa, hypotension, heart failure |
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Thyrotoxicosis Treatment |
Increased doses of K iodine (Cause suppression of TH release), Propylthiouracil (Suppresses TH synthesis), Beta blocker (For heart rate control), Sedation, Cooling blankets, Steroids, IV Hydration |
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What is the Hbg A1C test |
This test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. The test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent. |
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Oral type 2 diabetes management agents include |
Metformin, Sulfonylureas, Meglitinides, Thiazolidinediones, Alpha-glucosidase Inhibitors, DPP4 Inhibitors, and SGLT-2 Inhibitors |
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Indications for use of insulin |
Reduce blood glucose, Management of Type 1 or Type 2 DM |
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Insulin Interactions |
Increased risk of hypoglycemia with alcohol, oral hypoglycemics, and beta blockers. Decreased effectiveness with thiazides, glucocortoicoid steroids, hormonal contraceptives, thyroid drugs, and smoking |
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Insulin Side Effects |
Hypoglycemia (blood glucose <60): Headache, dizziness, confusion, slurred speech, Nervousness, anxiety, agitation, irritability, Tremors, in coordination, sweating, tachycardia, seizures |
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Hyperglycemia effects |
Blood glucose over 200. Extreme thirst, dry mucous membranes, Poor skin turgor, polyuria, fruity breath, Fatigue, tachycardia, Kussmaul respirations |
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Rapid-acting, Short-acting, Intermediate-acting, Long-acting, Combinations |
Types of insulin |
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Things to know about rapid acting Insulin |
Examples: Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra). Onset: 15 mins Duration: <5 hr Clarity of solution: clear |
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Things to know about short acting (regular) insulin |
Examples: Regular (Humulin R, NovolinR, ReliOn R). Onset: 30 mins Duration: 6 to 8 hr Clarity of solution: Clear |
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Things to know about intermediate acting insulin |
Examples: NPH (HumulinN,NovolinN,ReliOn N) Onset: 2-4 hr Duration: 6 to 10 hr Clarity of solution: Cloudy |
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Things to know about Long acting insulin |
Examples: Glargine (Lantus)Detemir (Levemir) Onset: 1 to 2 hr Duration: 18 to 24 hr Clarity of solution: Clear |
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Things to know about combination (premixed) insulin |
Examples: NPH/Reg 70/30(Humulin 70/30, Novolin 70/30,ReliOn 70/30) NPH/Reg 50/50 (Humulin 50/50) Lispro protamine/lispro 75/25 (Humulog Mix 75/25) Lispro protamine/lispro 50/50 (Humulog Mix50/50)Aspart protamine/aspart 70/30 (NovologMix70/30) Clarity of solution: Cloudy |
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rapid acting insulin |
Is used In association with meals to control postprandial blood sugar. Can be administered before or max 30 minutes after meals. |
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Short acting insulin |
Given before meals. Is the most predictable and reversible formulation of Insulin. Only formulation given IV. |
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Intermediate acting Insulin |
Mixing of insulin in same syringe is only done with NPH |
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Long acting insulin |
Glargine = 18-26 hoursDetemir = 18-24 hours Can be administered in combination with rapid acting insulin. SHOULD NOT be mixed in the same syringe. |
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Combining Insulin |
Rapid/Short & NPH Insulin can be manually mixed together prior to administration. Draw non-NPH insulin 1st and NPH 2nd.“Clear then Cloudy”
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Insulin Risks |
Lipodystrophy- change in fat distribution at injection site Somogyi effect - Rebound hyperglycemia Dawn phenomenon –Nighttime hormone surge Insulin shock- Hypoglycemia from overadministration or overdosing Diabetic ketoacidosis (DKA)- lack of administration |
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Injection Sites – Order of Best Absorption |
Upper arm, Abdomen (at least 1 inch from umbilicus), Thigh, Buttock. Injections should be at least 1” apart (Avoids lipodystrophy) |
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Metformin mechanism of action |
Increases binding of insulin to receptors; increased tissue responses to insulinDecrease glucose production by liver |
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ADRs of Metformin |
GI symptoms (nausea/diarrhea), Lactic Acidosis: (Caution with ETOH, renal insufficiency, and any renal toxic drugSymptoms include Myalgia, Malaise, and Hyperventilation) (Lactic acidosis is an amergency like diabetic ketoacidosis) |
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Metformin |
Gold standard medication management of type 2 diabetes. Does not cause Hypoglycemia or weight gain. |
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Sulfonylureas names and mechanism of action |
Stimulates beta cells to secrete more insulin –(not in type 1 diabetes). 1st generation: Tolbutamide, Tolazamide, Chlorpropamide (1st generation has more drug interactions) 2nd generation: Glipizide, Glyburide, Glimepiride |
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Sulfonylureas interactions and ADRs |
Alcohol may cause disulfram-like reaction (cause hangover like reacton to alcohol (Increased sensitivity to alcohol). Beta-blockersCan mask Hypoglycemia symptoms. Can cause Hypoglycemia and Weight gain. |
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Thiazolidinediones |
Includes: Pioglitazone (Actos) and Rosiglitazone (Avandia) Mechanism of Action: Affects insulin receptors by enhancing insulin sensitivity of cells; decreased insulin resistance ADR: Renal retention of fluid with resultant edema Caution with Heart Failure, Decrease in bone density, Increased risk for cancer, Increase lipid levels |
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All generic names of thiasolidinediones end in: |
-glitazone |
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Meglitinides |
Includes: Repaglinide (Prandin) & nateglinide (Starlix) Mechanism of Action: Stimulates release of insulin from pancreatic islets ADRHypoglycemia, Weight gain Administration: Must administer dose with each meal |
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All generic names of meglitinides end in: |
-glinide |
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Alpha-Glucosidase Inhibitors |
Acarbose (Precose) & Miglitol (Glyset) Mechanism of Action: Inhibits absorption of carbohydrates from GI tract (ONLY oral agent whose effect does not depend on presence of insulin) No risk for hypoglycemia or weight gain ADR: GI DisturbanceFlatulence, borborygmus, diarrhea, cramps, Liver dysfunction |
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DPP4 inhibitors |
Includes: Sitagliptin, Saxagliptin, Linagliptin Mechanism of Action: Inhibits DPP4 enzyme Leads to reduced metabolism of/increased concentration of incretin. Incretin is a hormone responsible for glucose regulation. ADR: Upper respiratory infections, Pancreatitis (Does not cause hypoglycemia by itself) |
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All generic names of DPP4 inhibitors end in: |
-gliptin |
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SGLT-2 Inhibitors |
Includes Canagliflozin, Dapagliflozin Mechanism of Action: Inhibits transporter in kidney responsible for re-absorption of glucose from the urine back into the bloodstream ADR: Increased frequency of urination, UTI, Orthostatic Hypotension (When used in conjunction with diuretics) |
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All generic names of SGLT-2 Inhibitors end in: |
-gliflozin |
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Exanatide (Byetta/Bydureon) |
Injectable Hypoglycemic Agent Mechanism of Action: Incretin mimetic that improves beta-cell responsiveness and enhances insulin secretion. Prevents the liver from making excess glucose when not needed. Delays gastric emptying. Reduces appetite. ADR: Pancreatitis, Renal toxicity, Anaphylaxis |
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Pramlintide (Symlin) |
Injectable Hypoglycemic agent Mechanism of Action: Amlyn mimetic that suppresses glucagon secretion and increases effects of insulin. Also delays gastric emptying & Reduces Appetite. ADR = Nausea |
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Hypoglycemia Treatment |
For Mild to Moderate Hypoglycemia (<70mg/dL) 1)Consume 15-20 grams of glucose or simple carbohydrates 2)Recheck blood glucose after 15 minutes 3)If hypoglycemia continues, repeat. 4)Once blood glucose returns to normal, eat a small snack if next planned meal or snack is more than an hour or two away. |
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Glucagon |
Natural hormone secreted by alpha cells of the islets of Langerhans in the pancreas. Mechanism of Action: Stimulates breakdown of stored glycogen to glucose in liver Indication: Medication-induced hypoglycemia Reserved for patients that are unconscious, seizing, or unable to swallow. Given IM |
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ADRs of general anesthesia |
Respiratory and cardiac depression, Nausea and Vomiting, Malignant Hyperthermia, Aspiration of Gastric contents, Hepatotoxicity |
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Halogenated Hydrocarbons include |
Isoflurane, Enflurane, Desflurane |
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All generic names of halogenated hydrocarbons end in: |
-flurane |
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Mechanism of action of halogenated hydrocarbons |
(Inhaled anesthetic) Not well understood. Theorized to work by binding to nerves to either enhance transmission at inhibitory synapses AND/OR depress transmission at excitability synapses. In order to work:Uptake from lungsDistribution to CNS and tissues. |
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ADRs of halogenated hydrocarbons |
Respiratory and cardiovascular depressionPost-operative nausea and vomiting |
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Nitrous Oxide Mechanism of action |
(Inhaled anesthetic) Inhibition of NMDA receptors Potent analgesic / Weak anesthetic Impossible to produce surgical anesthesia |
|
With Nitrous Oxide there is no risk for: |
Respiratory depression, Muscle relaxation, Malignant Hyperthermia |
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ADR of Nitrous oxide |
Nausea/Vomiting |
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Propofol mechanism of action |
Promotes release of inhibitory neurotransmitter, GABA No analgesiaSedative and hypnotic with rapid onset (60 seconds) and short duration Rapidly induce anesthesia – injected slowly Most commonly used agent for anesthesia (good for control, leaves system quickly) |
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ADRs of Propofol |
Bradycardia, hypotension Propofol infusion syndrome (rare, Seen with extended use (>48 hours) and high dosingCardiac Failure, Kidney Failure, Metabolic Acidosis, and rhabdomyolysis) |
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Barbiturates for use in anesthesia |
Cause anesthesia but with high incidence of respiratory & cardiovascular depression. Rarely used for anesthesia. Rapidly progresses (10-20 seconds) to unconsciousness. ADRHypotension, Bradycardia, Hypoventilation Agents Include:Pentobarbital, Methohexital sodium |
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Benzodiazepine for use in anesthesia |
Agents include:Alprazolam, Diazepam, Lorazepam, Midazolam Indications: Induce anesthesia (has multiple purposes) Produces peri-operative amnesia Produces sedation (Intravenous most often used) Decreases anxiety ADR: Hypoventilation |
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All generic names for benzodiazepine end in: |
-azepan or -azolam |
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Etomidate |
Hypnotic Agent for induction with no analgesic effect (Rapid, lasts about 5 minutes) ADR: Transient apnea, pain at injection site, oliguria, electrolyte disturbances, high incidence of post-op N & V (50%) Less Incidence of hypotension than barbiturates |
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Ketamine |
Dissociative anesthetic, Recovery: Adverse psychological reactions: Hallucinations |
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Neuromuscular Blocking Agents |
Includes:Succinylcholine & Pancuronium Indication: Adjunct to general anesthetics that allows lower dose of anesthetic by relaxing skeletal muscle Most surgeries require skeletal muscle relaxation ADR’s: Prevent contraction of all skeletal muscles (diaphragms, respirations)Flaccid Paralysis |
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Supportive Medications to anesthesia |
Anticholinergics – Scopolamine, Antihistimines - Diphenhydramine, Antiemetics – Ondansetron, ProchlorperazineH2, Receptor antagonist – Famotidine, Ranitidine, Gastric motility stimulants – Metoclopromide, Antacids - PRN |
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Opioids |
Agents Include:Fentanyl, Morphine, Meperidine, Codeine, Oxycodone Indications: Used to relieve pain, Also can suppress cough ADRs: Respiratory depression / HypoventilationBowel & urinary retentionNausea / Vomiting |
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Alpha2 Adrenergic Agonists |
Indications: Used in addition to other agents for anesthesia Includes:Clonidine - Tx of HTN and pain reduction (Reduces anxiety and causes sedation) Dexmedetomidine - Highly selective for alpha2 receptors. Short term, can be continued into the post operative period (esp in cardiac surgery) |
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Anticholinergic |
Indication: Decrease risk of respiratory depression during surgery Agents Include:Scopolamine, Atropine |
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Antiemetics |
Indication: Reduction or suppression of nausea and vomiting symptoms post-surgery Agents Include: Ondansetron –(Zofran), Prochlorperazine |
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H2 Receptor antagonists & Antacids |
Indication: Decrease risk of stress ulcer post surgery Agents Include:FamotidineRanitidine Note: Antacids are used PRN |
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Gastric Motility Stimulants |
Indication: relieve constipation post surgery Includes: Metoclopramide |
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Local anesthetics |
Includes: procaine, lidocaine Metabolized by blood Lidocaine is given with epinephrine |
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Lidocaine is given with _________ |
epinephrine |
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routes of administration of local anesthetics |
Epidural, Intrathecal, Nerve block, Local infiltration, Topical, Inhaled |
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ADRs of Local anesthetics |
Hypotension, Hypothermia, Headache, Drowsiness, or change in mental status (too high dose or improper placement of IV), Transient neurological issues: Radicular symptoms, including pain, a burning sensation on the buttocks, dysesthesia, and paresthesia, Urinary retention, Hematoma |
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Opiates ADRs |
Respiratory depression, Orthostatic hypotension, Urinary and Bowel retention, Elevation of ICP, Euphoria/dysphoria, Sedation or Coma, Miosis (Pinpoint pupils). Prolonged use can cause hormonal disequilibrium (Prolactin levels, LH, FSH, testosterone, estrogen) |
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Opioid Drug interactions |
CNS depressants: Intensify sedation & respiratory depression, Anticholinergic, Hypotensive drugs: Exacerbate constipation & urinary retention Agonist-Antagonist Opioids(like buprenorphine (Suboxone)): Can precipitate a withdrawal syndromeCan also suppress overdose symptoms |
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Oxycodone |
Opiate analgesic Analgesic actions equivalent to codeine. Brand NamesOxy + ASA = Percodan, Oxy + acetaminophen = Percocet, Oxy + Ibuprofen = Combunox Caution with combination formulations! |
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Hydrocodone |
Opiate analgesic Most widely prescribed drug in the US. Pain and cough suppression. |
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Codine |
Opiate analgesic Used for mild to moderate pain great cough suppressant activity |
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Hydromorphone (Diludid) |
strong opioid agonists similar to morphine |
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Methadone (Dolophine, Methadose) |
similar to morphine long duration of action check concentration |
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Fentanyl |
100X more potent than morphine Available dosage forms: parental, transdermal, transmucosal, buccal |
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Meperidine (Demerol) |
Toxic metabolite caution in renal insufficiency ADR=Seizures |
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Naloxone (Narcan) |
reversal agent competitive antagonist at opioid receptors |
|
NSAIDs include |
NSAIDs:
ASA (Aspirin) Ibuprofen Ketoprofen Naproxen Ketorolac Cycloooxygenase (COX)-2 Inhibitors: Celecoxib (celebrex) |
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NSAIDs mechanism of action |
Non-selective inhibitor of cycloxygenase (COX)Results in:Reduction of inflammation, pain and feverProtection from MI/Stroke (due to platelet aggregation)
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NSAIDs ADRs |
GI effects, bleeding, renal impairment, salicylism, Reyes’ syndrome (characterized by acute noninflammatory encephalopathy and fatty degenerative liver failure)
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COX Inhibitors-cyclooxygenase |
COX1First generation, causing reversible inhibition. Has risk for gastric ulceration COX2Second generation, little or no risk of gastric ulceration Includes:Celecoxib (Celebrex) |
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Acetaminophen (Tylenol) |
Differs from NSAIDs Does not inhibit COX Lacks anti-inflammatory effects Does not inhibit platelet aggregation Does not promote gastric ulceration, renal failure or thrombotic events InteractionsETOH OVERDOSE IS LETHAL! |
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Acetaminophen overdose is treated with |
Acetylcysteine (mucomyst) |
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Symptoms of Acetaminophen overdose |
abdominal pain, nausea, signs of liver failure (low blood sugar, low blood pH, easy bleeding, and hepatic encephalopathy), liver failure |
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Tramadol |
Mechanism of Action: Analog of codeine Moderately strong analgesic with minimal potential for dependence, abuse or respiratory depression ADR: Sedation, dizziness, headache, and constipation |
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Clonidine |
Mechanism of Action: Alpha2 adrenergic agonist Relief of severe pain via epidural infusion ADR: Hypotension, Bradycardia |