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Module 8

Renal, GU, Glucocorticoids, Thyroid, Diabetes

QuestionAnswer
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
Created by: smaniaci