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Pharm 6

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Antihyperglycemics Insulin Rapid acting LOG = Rapid   aspart (NovoLOG®) Onset 5-10 min, peak 1-2 hours, duration 4 hours lispro (HumaLOG®)  
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Antihyperglycemics Insulin Short Acting LIN   regular (NovoLIN-R® Onset 30-60 min, peak 2-3 hours, duration 6-8 hours regular HumuLIN-R®,)  
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Antihyperglycemics Insulin Intermediate Acting   NPH (contains protamine) (Humulin-N®<- Onset 2-4 hours, peak 4-14 hours, duration up to 24 hours Novolin-N <- ®)  
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Antihyperglycemics Insulin Long Acting   glargine (LANtus®)-cannot mix, basal acting Onset 2-4 hours duration up to 24 hours  
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Antihyperglycemics - Combination Insulin Mix regular and NPH -> Rapid onset with prolonged effect     Humulin-N <- ® and Humulin-R® <- “premix” (Humulin 70/30 – 70%NPH, 30% Reg)  
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Oral Hypoglycemic Agents Sulfonylureas (secretagogues) Increase Insulin Secretion / ANTABUSE   glyburide Snbtga/Grmrams(Diabeta®, Micronase®) Help bring down blood sugar levels - enter beta cells of pancreas, causing release of insulin. Binds to K++ channels of beta cells, allow influx of Ca+ across membrane triggering insulin release. Hypogly  
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"Oral Hypoglycemic Agents Nonsulfonylureas (AKA Meglitinides, also secretagogues) - Meglitinides " Increase Insulin Secretion   repaglinide sNbtga/gRmrams" (Prandin®) " Stimulates insulin secretion from beta cells of pancreas - quicker onset that sulfanyloureas; duration less than glyburdide hypoglycemia, weight gain, cold sweats Take 15 minutes prior to meal  
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Oral Hypoglycemic Agents - Biguanides (insulin resistance reducers) reduce insulin resistance   metformin snBtga/grMrams(Glucophage®) Inhibits hepatic gluconeogenesis and intestinal glucose absorption; increase insulin receptor sensitivity in muscles and adipose tissue, does not effect insulin secretion, enhances glucose utilization by tissues,  
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Oral Hypoglycemic Agents - Biguanides (insulin resistance reducers) cont'd   even distribution of glucose to tissues - Lactic cidesis???, GI disturbances, weight gain, metaliic taste Take with food  
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Oral Hypoglycemic Agents - Insulin Sensitizers (thiaxolidinediones)   rosiglitazone snbTga/grmRams(Avandia®) Increase insulin sensitivity, decrease insulin resistance; decrease hepatic gluconeogenesis Weight gain, hepatoxity, nausea, diarrhea, HA, fatigue  
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Oral Hypoglycemic Agents - Glucose Absorption Inhibitors/Alpha-glucosidase Inhibitors   acarbose snbtGa/grmrAMs(Precose®) miglitol (Glyset®)  
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Oral Hypoglycemic Agents - Glucose Absorption Inhibitors/Alpha-glucosidase Inhibitors contd   delay Digestion and absorption of CHO in small intestine by inhibiting enzyme Malabsorption, stomach discomfort, bloating, diarrhea, abdominal pain, flatulenceTaken with each meal  
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Oral Hypoglycemic Agents - Additional diabetic therapies   sitagliptin snbtgA/grmramS(Januvia® Get more release - suppress glucagon secretion, inhibits enzyme that stops release of insulin from beta cells.  
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Hyperglycemics   IV glucagon (Glucagen®) 50% Dextrose Solution  
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Corticosteroids - Glucocorticoid Replacement "ONE"   hydrocortisone OTC Topical (Cortef® and Cortaid®) methylprednisolONE Dose Pack (Medrol®) triamcinolONE Topical/Injection (Aristocort and Kenalog®) betamethasONE (Celestone®) dexamethasONE (Decadron®) prednisONE  
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Corticosteroids - Glucocorticoid Replacement "ONE" - cont'd   Cortisol and cortisone - regulates metabolism of CHO and proteins, potent anti-inflammatory effects - 1) Works at Lipase Site - stimulating fat breakdown - inhibiting uptake of glucose by fat. 2) Promotes Cortisol production - Gluconeogenesis,  
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Corticosteroids - Glucocorticoid Replacement "ONE" - cont'd 2   Gluconeogenesis, which increases the production of glucose for use by injured tissue, or by the brain, - Protein Catabolism proteins to amino acids to make glucose 3) Supresses immune system 4) Anti-inflammatory  
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Corticosteroids - Glucocorticoid Replacement "ONE" - cont'd 3 Uses   Uses: Hormone Replacement therapy, treatment of inflammatory or allergic conditions such as arthritis, asthma, skin irritation.  
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Corticosteroids - Glucocorticoid Replacement "ONE" - cont'd 4 Effects   Adverse effects of long term therapy: Increased gluconeogenesis -> obesity , DM (hyperglycemia) Increased Protein Catabolism -> muscle weakness, thinning of skin, osteroporosis, decreased wound healing, increased infections (leukopenia)  
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Hypothalmus   release CRF ( Cortictropin releasing factors) which release cortisol:  
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Hypothalmus Factors stimulating release of CRF   stress exercise, cold weather, infection, anxiety, etc  
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Mineralocorticoid Replacement FA = Fe   fludrocortisone (Florinef®) aldosterone  
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Mineralocorticoid MOA   To maintain (MINERAL)WATER BALANCE balance - increase reabsorption of Na++ and H20 while k+ is transported to urine  
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Mineralocorticoid effects   Moon face due to water retention, euphoria, muscle weakness and wasting, GI upset, depression, insomnia, menstrual irregularities, Na++ and H20 retention -. HTN and edema, hypolkalemia -> muscle weakness, fatigue, cramps, dizziness, arrythmia -  
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Mineralocorticoid Addison's   ADDison's disease - too little steroid production - Symptoms: dehydration, hypotension, weight loss, muscle atrophy  
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Mineralocorticoid Cushing's   CUSHings's disease - too much cortisol production - Symptoms: hypertension, edema, moonface, buffalo hump in back (fat), protruding abdomen, thinning of arms and legs  
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Thyroid Hormone Replacement thyro   levoTHYROxine T4 (LevoTHROIDd®, SynTHROID®, Levoxyl®) lioTHYROnine T3 (Cytomel®) Increase in BP and HR, increased metabolism, insomnia, tremors, HA, palpitations, diarrhea  
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Anti-thyroid Agents   propylthiouracil (PTU) methimAZOLE (anti) (TapAXOLE®) MOA: Blocks thyroid hormone synthesis, destroys thyroid gland - bet blockers may be used for sx control for increased HR and BP  
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Anti-thyroid Agents side effects   PTU Side Effects: agranulocytosis, pruritis, urticara rash, arthralgias, fever, lupus -like syndrome (inflammation of collagen),  
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Anti-thyroid Agents Patient Teaching   CBC must be monitored - other antithyroid treatment includes radiation ( which shrinks tumors/gland, kills overactive tissue and surgery  
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HRT/Birth Control   estrogen and progestin (Orthonovum®, Norinyl®, Seasonals®, Ortho-Evra®, Nuva-Ring®) progestin (Micronor®, Depo-Provera®, Norplant®) Increased risk for breast cancer and endometrial CA  
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HRT/Birth Control - testosterone   (Testoderm®)-male Male sex characteristics; sperm production; hypogonadism - decreased sex hormones; oligospermia, cryptochidism, breast cancer weight gain, increase protein synthesis w/in cells (steroids)  
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Fertility   clomiphene citrate (Serophene® or Clomid®)?? Caused by low estrogen levels in the blood induces release of FSH and LH - may cause more than one egg to be released  
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Hormonal Cancer Therapy   Just know that some cancers thrive on hormones  
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Meds ED   sildenafil (Viagra®) vardenafil(Levitra®) NO-NO combo with nitrates - smooth muscle relaxation -> vasodilation -. Increase blood sugar flow to the penis  
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Oxytocin/Oxytocics   oxytocin (Pitocin® ) induce labor methylergonovine(Methergine®) stop bleeding increase uterine contraction -induction /augmentation  
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Tocolytics - stops contractions TOC oppostie of Oxytoc   terbutaline (Brethine®) magnesium sulfate Beta 2 agonist - smooth muscle relaxant: stops contractions with pre-term labor  
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Posterior Pituitary Replacement 2   - Regulates H2O balance; Increase AHD -> increased water reabsorption, decreased urine ouput Decrease AHD -> decreased water reabsorption, increased urine ouput  
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Posterior Pituitary Replacement 1   ADH replacement (Vasopressin® DDAVP®) Diabetes Insipidus: dilute, watery urine, polydipsia, dehydration  
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NSAID - Cox-1 inhibitors   ibuprofen (Motrin®) naproxen (Anaprox®) Inhibits action of Cox1 enzymes responsible for pain and inflammation and for mucosal secretion, can reduce inflammation - may also reduce the natural production of mucous lining of the stomach.  
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NSAID - Cox-2 inhibitors   celecoxib (Celebrex®) Inhibits cox2 (responsible for pain and inflammation but DOES decrease inflammation while not effecting mucosal secretion  
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H-2 Receptor Antagonists   cimetidine (Tagamet®) ranitidine (Zantac®) decreases acid secretion and pepsin secretion - works on histamine receptors ranitidine (Zantac®) decreases acid secretion and pepsin secretion - works on histamine receptors  
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Prostaglandins (Agonist) prost   misoprostol (Cytotec®) coat stomach w/sodium bicarb promote mucous secretion and alkaline mucus production /cramps, diarrhea, HA,flatulence, nausea Also causes uteriine contractions and is therefore contraindicated during pregnancy  
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Proton Pump Inhibitor   lansoprazole (Prevacid®) esomeprazole (Nexium®) Inhibits acid production by inhibiting H needed to make HCl When nothing else is working for the management of ulcers and GERD  
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Proton Pump Inhibitor SE   constipation,HA, nausea, diarrhea, abdominal pain  
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Nexium vs Prilosec:   Nexium - > oral bioavailability 1 week Nexium = 4 weeks of Prilosec; N has > half life; N has a faster heal rate for ulcers; prilosec has a drug interaction with warfarin(coumadin), Dilantin, and Valium -> elevates levels & Nexium is more expensive  
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SNBTGA/GRMRAMS   Sulfonylureas -glyburide; Nonsulfonylureas - repaglinide; Biguanides - metformin; thiaxolidinediones - rosiglitazone; Glucose Absorption Inhib - acarbose,miglitol; Addit'l diabetic therapies - sitagliptin  
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Antiulcer ucral   sucralfate (Carafate®) Coats the ulcer; binds to HCl, inhibits pepsin activity - allowing stomach to heal  
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Antacids   calcium carbonate (Tums®) Neutralize aluminum hydroxide (Amphojel®)Acid already present  
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PUD therapy Prevpak®   clarithromycin (Biaxin®) amoxicillin (Trimox®) lansoprazole (Prevacid®) antibiotic used to prevent recurrance of ulcers & to eradicate H pylori penicillin antibiotic proton pump inhibitor (decrease acid)  
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Antiemetics   metoclopramide (Reglan®) ondansetron (Zofran®) Inhibit vomiting / some help with nausea  
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AntiDiarrheal   "loperamide " (Imodium®) diphenoxylate/atropine (Lomotil®) Loose, watery stools, not absorbing adequate H2O - too much intestinal motility - Laxatives increase muscle contraction of intestine  
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Laxatives   bisacodyl (Dulcolax®) polyethylene glycol (MiraLAX®) Stimulus for defacation, enhance intestinal motility  
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Stool Softeners   docusate sodium (Colace®) Adds H2O to stool  
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Antiflatuents   simethicone Mylicon®, Mylicon Drops®, Gas-X®)  
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Hypoglycemina   hunger/irritability, headache, blurred vsioin, anxiety, - nervouseness, fatigue, swaeting, jittery , tachycardia, confusion **non-pharm therapy: diet, exercise, maintain wieght control, education, self-monitoring of blood sugars, compliance is a big issue  
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Hypothalmus   Located in brain, controls activity of pituitary gland (PG), produces hormone known as releaseing factor (RF) that stimulates release of hormones that are produced in the PG  
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Anterior Lobe Adenohypopysis   Tropic hormone - released by adenohypophysis,: Thyroid Stimulating Hormone (TSH),Prolactin for milk, Adrenocorticotropic Hormone (ACTH) for corticotropin production & secretion of cortical, Foll. Stimulating Hormone (FSH)sperm/ova Leteinizing -> sex horm  
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Adrenal Glands   Suprarenal / Inner Part secretes catecholinamines adenaline, epinephrine Outer part secretes corticosteroids (glucocorticoids/minerlocoticoids  
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Thyroid Gland   Secretes T3 and T4 - Thyroid hormone is needed for growth and development of muscle and nerve tissue. T3 and T4 controlled by TSH which is secreted by Ant pituitary. T# and T4 increase metabolism of all cells, decrease serum cholestorol levels -> weight g  
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Hypothyroidism - causes   Causes: gland destruction by disease or radiation; pituitary disorder that inhibits TSH secretion; hypothalmus lacks the ability to secrete TRF (thyrotropin releasing factor) which secretes T# and T4.  
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Hypothyroidism - SYMPTOMS   slow metabolism, constipation, lethargy, forgetfulness, cold intolerance, weight gain, dry skin, pallor Decreased HR, myxedema-dry, puffy skin, musclecramops, irregular or heavy menses, coarse hair, decrease BP, depression-moody  
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Hyperthyroidism   Tumors and more often by Autoimmune issues -> Grave's Disease  
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Grave's Disease SYMPTOMS:   exophthalmia (fat deposit behind eyes), weight loss due to increased metabolism, increased BP/HR, insomnia, tremors, HA, diarrhea, increased temperature, nervouseness, fine, brittle hair, increased sweating, goiter in both hyper and hypo  
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Sex Hormones   Produced during puberty,; develop and maintain secondary sex characteristics, are produced by the gonads and controlled by the anterior pituitary  
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Female Sex Hormones   Reproduction, Secondary sex characteristics ( voice, skin texture, breast dev, dist of body fat, body hair), Insulin sensitivity, Bone formation, Cardiac (increase HDL),  
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Menstrual Cycle   Days 1-5 Menses occurs, shedding of uterine lining Days 6-12 FSH is released causing follicle to mature Days 13-14 LH is released - there is a surge in luteinizing hormone Days 15-17 Egg passes into fallopian tube and meets with sperm Days 18-23 Ruptu  
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Follicle Stimulating Hormone   female: stimulates follicle growth and allows for estogen secretion male: maintains sperm production (spermatogenesis)  
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Luteinizing Hormone   female: induces ovulation; stimulates corpus luteum to form; promotes progesterone secretion Male: stimulates secretion of testoserone  
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Estrogen What does it do?   Starts the development of uterine ling (endometrium); causes fallopian tubes to contract; Plays role in mammary gland stimulation for milk production; secondary sex characteristics  
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Estrogen - Positive effects   Estrogen oral positive effects, osteoporosis protection, CAD protection, decerease vaginal atrophy disturbances, hot flashes, helps with menopausal symptoms except most psych symptom  
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Estrogen - Negative effects   Thrombembolism, stroke, MI, nausea, headache, breast tenderness, liver disease, gall bladder disease  
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Uses of Sex Hormones   Hormone replacement therapy HRT; oral contraceptives; infertility FSH, Cancer Therapy  
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Menopausal Syptoms   Very tired hot flashes nervouseness dry skin vaginal dryness anxiety - irritibility, moodiness depression weight bearing bones compromised vaginal thinning, bleeding infections dysuria urinary incontinence mood swings dec concentration insomnia, CAD  
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Progesterone   fluid retention, weight gain - may take when breast feeding  
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Hormones Released from Neurohypophysis (posterior pituitary)   OCYTOCIN/OXYTOCICS ->increase uterine contraction(induction/augmentation),Milk production,Stops post partum bleeding slows uterine conctraction, Induces abortion TOCOLYTICS ->stop contractions (Smooth relaxant); ADH  
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ADH   Regulates H2O balance Increase ADH -> increased water reabsorption, decreased urine ouput Decrease ADH -> decreased water reabsorption, increased urine output Diabetes Insipidus: dilute, watery urine, polydipsia, dehydration  
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Digestion (mech and chemical) proteins to amino acids CHO to simple sugars, ie glucose Lipids/triglycerides to fatty acids   (mech and chemical) proteins to amino acids CHO to simple sugars, ie glucose Lipids/triglycerides to fatty acids Acid secretion though vagus nerve (parasympathetic/cholinergic) - HCL Thought, smell, site of food; Pepsin - Enzyme that breaks down protein  
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After Digestion   -> absorption; Allows for elim of solid waste material  
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Inhibitory enzyme - protects stomach from being eaten   Stops secretion of HCL; Protective mechanism coats mucosal lining with mucus  
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Gastroesophageal Reflux Disease (GERD)   Burning behind sternum, worsens laying down, regurgitation of digestive juices into esophagus; lower esophageal sphincter relaxes and allows acid build-up  
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Ulcers - what are they?   open sore in mucosal lining Peptic Ulcers - in duodenum or stomach.  
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Ulcer Causes   Increased HCL production, Inadaequate mucous secretion, emotional and physical distress, increase vagus nerve stimulation, alcohol stimulation, drugs, genetics,gastric bacterial infections  
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Ulcer Symptoms   Symptoms: Gi upset, nausea, loss of appetite, abdominal pain  
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Potential Mechanisms for disruption of Mucosal Defense   Depletion of endogenous prostagalandins (aid in mucosal secretion) Helibactor pylori  
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Ulcer Formation   HCl and enzymes concentrated -> disrupted by drug therapy Stomach lining protected by mucous -> disrupted by drug therapy Erosion of mucosa  
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Ulcer treatment   Decrease stress, Decrease alcohol consumption Decrease intake of spicy food Decrease smoking Drug therapy Surgical intervention  
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Ulcer Drug Therapy   Antacids, anticholinergics, histamine 2 blockers, prostaglandins, proton pump inhibitors, antibiotic (multiple due to resistance), sUCRALfate carafate),Prevpac  
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Non-Pharmacological Therapy for Ulcers   Decrease or avoid: chocolate peppermint spearmint fried. Fatty food coffee tomato products hot peppers onion  
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Antihyperglycemics Insulin   Rapid: Onset 5-10 min, peak 1-2 hours, duration 4 hours Short: Onset 30-60 min, peak 2-3 hours, duration 6-8 hours Intermediate: Onset 2-4 hours, peak 4-14 hours, duration up to 24 hours Long: Onset 2-4 hours duration up to 24 hours  
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1. The endocrine system helps regulate: Metabolism Growth and development Fluid and electrolyte balance Female and male sexual characteristics All of the above   All of the above  
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2. Stool softeners and laxatives work by: Reducing quantity of stool Increasing GI motility and keeping H2O in the stool Absorbing more water into the bloodstream Increasing stool bulk   Increasing GI motility and keeping H2O in the stool  
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3. Antibiotics treat PUD because Bacteria can lead to ulcer formation Antibiotics will get rid of normal flora Sterility promotes the healing process They often lead to diarrhea which decreases GI acidity   Bacteria can lead to ulcer formation  
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4. To avoid lipodystrophy, injection sites should be rotated True False   True  
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5. Methimazole (Tapazole) is a drug used to treat: Hyperthyroidism Cushing’s Disease Addison’s Disease Type 2 DM None of the above   Hyperthyroidism  
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6. Symptoms of hypothyroidism include: Lethargy Constipation Weight gain bradycardia All of the above   All of the above  
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7. When drawing up insulin, NPH should be drawn up before Regular. True False   False  
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8. Oxytocin (Pitocin) is: A tocolytic A drug that stimulates uterine contractions A drug used to treat Cushing’s Disease Treatment for Graves’ Disease None of the above   A drug that stimulates uterine contractions  
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9. Functions of insulin include: Promoting glycogenolysis Increasing blood glucose levels Preventing storage of fats and protein Unlocking channels to allow glucose to enter cells for energy All of the above   All of the above  
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10. Type I DM treatment involves oral medication to control blood sugar without the need to monitor diet. True False   True  
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11. The purpose of mixing regular insulin and NPH is: Having no peak Having a delayed onset Having 24 hour coverage Having a quick onset and prolonged effect Having a delayed onset with a short duration of action   Having a quick onset and prolonged effect  
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12. Oxytocics are: Used for induction Used for augmentation of labor Used for tocolysis All of the above A and B are correct   A and B are correct  
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13. Lantus: Is human DNA insulin Provides a patient with 24 hour coverage Does not have a peak Should not be mixed with other insulin in a syringe All of the above are correct   All of the above are correct  
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14. A patient with DM should avoid NPH insulin if allergic to protamine True False   True  
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15. Progesterone is: Used to thin the uterine lining Provides a stable environment for an embryo to implant Is not available in OCPs None of the above   Provides a stable environment for an embryo to implant  
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16. Methylprednisolone (Medrol): May cause hyperglycemia Can lead to immunosuppression Has anti-inflammatory properties All of the above   All of the above  
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17. Important patient teaching with sulfonylureas would include: This category of drugs may cause hypoglycemic episodes; This drug group is contraindicated in patients with sulfa allergies; Disulfiram (Antabuse) type reaction may occur. A and C only; all   All of the above  
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18. Propylthiouracil (PTU) is an anti-thyroid agent that may lead to agranulocytosis. True False   True  
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19. Excessive amounts of aldosterone may cause: Hypotension Hypertension Hyponatremia Hyperkalemia   Hypertension  
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20. Fludrocortisone (Florinef) is responsible for: Maintaining metabolism Regulation of female hormones to control irregular menstrual cycles Maintaining fluid and electrolyte balance Increasing secretion of insulin from beta cells in the pancreas   Maintaining fluid and electrolyte balance  
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21. sucralfate (Carafate) 22. Prevpac 23. metoclopramide (Reglan) 24. ondansetron (Zofran) 25. dephenoxylate/ atropine (Lomotil)   A. antiulcer agent to coat the ulcer/stomach B. combo drug regimen for H. pylori eradication C. antiemetic D. laxative E. antidiarrheal  
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26. celecoxib (Celebrex) 27. levothyroxine (Synthroid) 28. cimetidine (Tagament) 29. docusate sodium (Colace) 30. lansoprazole (Prevacid)   C. COX-2 inhibitor A. thyroid replacement B. Histamine receptor blocker D. stool softener E. Proton pump inhibitor  
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31. Lente 32. Ortho-Novum 33. metformin (Glucophage) 34. glyburide (Diabeta) 35. rosiglitazone (Avandia)   C. insulin B. OCP D. biguanide E. sulfonylurea A. thiazolidinediones  
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cox1s: Motrin/Anaprox;; H2 Antagonist: TAGamet/ZanTAC(Hist receptors);; Prostaglandin Agonists: misoPROSTal;; Proton Pump Inhibitor: PrevACID/Nexium;;Antiulcer: sUCRALfate;; Antacids: Tums/Amphojel;;   PUD Therapy pack: clarithromycin, amoxicillin, Prevacid;; Antiemetics: ReglAN/ ZofrAN;; Antidiarrheal iMODium/loMOTil;; Laxatives: DulcoLAX/MiraLAX;; Stool Softeners: Colace;; Antiflatulents:Mylicon/Gas-X;;  
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