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Module 8
Renal, GU, Glucocorticoids, Thyroid, Diabetes
Question | Answer |
---|---|
Thiazides inhibit reabsorption of NA in distal convoluted tubule via... | inhibition of NaCl cotransporter |
Thiazides are the first line therapy for non complicated... | HTN |
Initially thiazides reduce circulatory volume, CO, PVR, but over time these do what? | return back to baseline except for PVR |
Thiazides are NOT effective in treating what? | Edema, they do not cause significant fluid loss |
Thiazides are not effective if what? | CrCl < 30ml/min |
High doses of thiazides may cause what? | hyperglycemia, hyperlipidemia, hypertriglyceridemia |
What is a useful thiazide medication with a low Cr? | Metolazone |
Loop diuretics inhibit... | Na-K-2CL cotransporter in ascending limb of loop of henle, they inhibit Na and Cl reabsorption and promotes Ca excretion |
uses of loop diuretics | acute and chronic CHF preipheral edema acute and chronic renal insufficiency |
loop diuretic can cause what electrolyte imbalances? | hypokalemia and hypocalcemia |
with high doses of loop diuretics you can causes what? | ototocicity |
Na channel blockers work where? | collecting duct, they block Na reabsorption leading to K retention |
What are the adverse effects of the K sparing diuretics spironolactone? | Gynecomastia |
Name 2 sodium channel blockers | triamterene and amiloride |
Name 2 aldosterone antagonists | spironolactone and eplerenone |
What is used first line? | thiazides, more effective for HTN vs edema |
What is used second line? | loop diuretics, more effective for CHF and edema |
To adjust thiazides, how long must you wait before adjusting the dose? | 4 weeks, can take 1-3 months to see full effects |
what is used first line for urge incontinence? | anticholinergics |
what is the mechanism of action for anticholinergics? | blocks muscarinic actions, inhibits the action of acetylcholine on the bladders smooth muscles, blocks contraction of bladder and increases bladder capacity |
oxybutinin has direct antispasmodic effect and anticholineric effects on what? | smooth muscle |
what are some typical anticholinergics used for incontinence? | ditropan, detrol, toviaz, and sanctura (oxybutynin, tolterodine, fesoterodine, trospium) |
what are the serious side effects of anticholinergic? | urinary retention, increased intraocular pressure, and delirium |
contraindications for anticholinergics | untreated narrow angle glaucoma, GI obstruction, ileus, colitis, uropathy, myasthenia gravis, unstable cardiovascular state |
how long can you use the urinary tract analgesic pyridium? | 2 days only |
what should you avoid pyridium? | with a CrCL <50 or glomerulonephritis |
what is the MOA of alpha 1 blockers in BPH? | relaxes bladder neck muscles and muscle fibers in the prostate |
In BPH, what do alpha 1 blockers NOT do? | that do not alter prostate growth and do not reduce the risk of acute urinary retention or the need for prostate surgery |
what is the first line treatment for BPH in patients without HTN? | a1a selective blockers flomax (tamsulosin), Uroaxatral (alfuzosin), rapaflo (silodosin) |
what can you use for BPH if the patient has HTN? | nonspecific a1 blockers cardura, hytrin, minipress |
AE of alpha blockers | orthostatic hypotension, somnolence (take at HS to minimize symptoms) |
5a reductase inhibitors MOA for BPH | block conversion of testosterone, reduces prostate size by 50%, arrests BPH progression, reduces serum PSA, takes 6 months to see full effects |
5a reductase inhibitors in BPH AE and precautions | Proscar & Avodart pregnancy category X, do not use if planning to have children decreased sex drive ejaculatory dysfunction may increase risk for high grade prostate ca |
pathophysiology of erectile dysfunction | the release of nitric oxide is blocked, or effects if nitric oxide are inhibited |
what is used first line in erectile dysfunction? | phosphodiesterase inhibitors viagra cialis levitra |
absolute contraindicaiton for phosphodiesterase inhibitors | concurrent use of nitrates, may participate hypotension with alpha blockers for BPH |
type 1 DM | autoimmune-mediated absolute insulin deficiency need insulin to survive |
type 2 DM | insulin resistance insulin deficiency |
HBA1C measures blood glucose over what period of time? | 3 months |
what is the first line tx for oral meds in DM | metformin, especially if pt is overweight |
MOA of metformin | decreases hepatic glucose decreases intentinal absorption of glucose improves insulin sensitivity |
metformin's AE | causes a lot of GI (diarrhea, cramping) vitamin b12 definiency lactic acidosis |
MOA of sulfonylureas | (glyburide, glimpiride, glipizide) stimulates pancreas to secrete insulin improves insulin sensitivity decreases hepatic glucose production |
AE of sulfonylureas | hypoglycemia and weight gain |
MOA of thiazolidinediones | (Actos and aAvandia) improves insulin sensitivity |
Major contraindication for thiazolidinediones | class III or IV heart failure |
MOA of DPP inhibitors | (Sitagliptin, saxagliptin, linagliptin, alogliptin) supresses postprandial glucagon release enhances insulin secretion in response to increased glucose |
MOA of meglitinides | (prandin and starlix) short acting stimulates insulin release from the pancreas decreases postprandial BG, up to 4 hours |
When should you consider insulin? | for all T1DM for T2DM: A1c >8-9% if not a goal on 2 po agents new dx with BG >300 pregnancy |
MOA of GLP-1 agonists (SQ agent) | (exenatide and liraglutide) enhances insulin secretion in response to increased glucose suppresses postprandial glucagon release decreases appetite |
MOA of amylin analogs (SQ agent) | (Pramlintide) supress postprandial glucose release decreases gastic emptying time decreases appetite |
Name the rapid acting insulin | "Log" novolog humalog apidra |
name the short acing insulin | "in" novolin humulin |
if postprandial BG is elevated what should you use? | use bolus insulin (rapid acting or short acting) |
if both fasting and postprandial BG is elevated what should you use? | po agent + basal insulin basal-bolus-corrention premixd insulin |
what is the most ideal correction method that mimics notmal physiology? | the basal bolus correction method it is 4 injections per day |
what is hypothyroid? | T3 and T4 deficiency (elevated TSH) |
what is hyperthyroid? | T3 and T4 excess (decreased TSH) |
what are the s/s of hypothyroid? | fatigue dry skin weight gain cold intolerance constipation |
what is the first line tx for hypothyroid? | levothyroxine (synthroid) synthetic T4 reassess after 4-6 weeks |
what is one major drug interaction with levothyroxine? | amiodarone: it inhibits T4 to T3, can falsely elevate T4 levels and cause TSH fluctuation, cna cuase hypo/hyperthyroidism |
s/s of hyperthyroidism | (Graces disease is most common) heat intolerance nervousness palpitation weight loss insomnia |
what is the first line tx for hyperthyroidism? | 1st line:radioactive iodine 2nd line: surgical intervention 3rd line: antithyroid medications |
MOA of antithyroid medications | inhibits T3 and T4 synthrsis via diversion of iodine |
Propylthiouracil (PTU) inhibits what and is used for what? | is a antithyroid med, used for hyperthyroidism and inhibits the conversion of T4 to T3 |
What should pts aviod with thyroid medication? | aviod foods/substances containing iodine such as seafood and iodized salt |