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Pharm Test 3

Pharmacology Test 3 Module 1, 4, 5, 13

Glands of the endocrine system Hypothalamus Pituitary Thyroid Parathyroid Pancreas Adrenal Gonads
Adenohypophysis Gland portion of pituitary
Neurohypophysis Nerve portion of pituitary (also called hypothalamus)
Master gland Hypothalamus
Parathyroid function Calcium and phosphorous metabolism
Thyroid function Metabolic rate Hormones have "thryo" in the name
Adrenal function Cortex - corticosteroids Medulla - sympathetic hormones
Pancreas function Exocrine: Secretes digestive enzymes Endocrine: Control of blood sugar Islets of Langerhans - produce insulin and glucagon
Gonad function Excrete sex steroids
"dual role gland" Pancreas - it's endocrine AND exocrine
Hormone sustances made from? Small peptides / proteins Cholesterol
Hypophysis Hypophysis means pituitary made of 2 parts: neurohypophsis - hypothalamus adenohypophysis - pituitary
Hormones that affect blood sugar (general concept) Insulin decreases blood sugar All others increase blood sugar
meaning: adeno- neuro- adeno- means gland neuro- means nerve
Pituitary gland lobes anterior - secretion of hormones posterior - storage of hormones
Growth hormone deficiency causes dwarfism
Hypopituitarism decreased amounts of one of the pituitary hormones
somatropin growth hormone (give SC or IM or skin mist) SE (hypothyroidism and D.M.) Won't work if growth plates are closed
Giantism cause XS growth hormone before growth plate closure
XS growth hormone treatment octreotide (Sandostatin). lanreotide (Somatulin). bromocriptine (Parlodel). pregvisomant - SE: inj site pain ALL inhibit growth hormone- SE: GI
Acromegaly cause XS growth hormone after growth plate closure
pregvisomant (Somavert) [somatropin avert]- SE inj site pain, GI effects
ADH Prevents excretion of fluids (urine) Works in the renal tubules
ADH - SE Hypervolemia Incr. BP
Vasopressin/ADH pharmacologic equivalent desmopressin - tradename=DDAVP = synthetic ADH.
Hormones from the adrenal medulla sympathetic hormones epi & norepi
Hormones from the adrenal cortex as a class "corticosteroids" glucocorticoids, mineralocorticoids, sex steroids, androgens
glucocorticoid drugs beclomethasone, betamethasone, budesonide, dexamethasone, cortisone, flunisolide, hydrocortisone, prednisone, prednisolone, triamcinolone, methyl prednisolone
naturally occurring mineralocorticoid aldosterone
Addison's disease cortisol (natural glucocorticoid) deficiency aka adrenal insufficiency or adrenal crisis hypotension, electrolytes problems, shock, fluid shifts,
Cushing's disease XS cortisol moon faced, striae of skin, weight gain, truncal obesity, thin skin, humpback, peptic ulcers, growth retardation in children, may suppress immune system, electrolyte problems Same symptoms of prednisone XS
Nursing implications for steroids follow glucose, assess inflammation, follow lytes Take early in the morning teach client to report s/s infection
TSH in hypothyroidism TSH=High
TSH in hyperthyroidism TSH=Low
Thyroid replacement drugs for hypothyroidism levothyroxine (T4) liothyronine (T3) liotrix = both of the 2 in the same pill
Hyperthyroidism treatment (XS T3/T4) methimazole PTU KI All contraindicated when pregnant
methimazole SE bone marrow suppression - monitor CBC
Hyperthyroid drugs: nursing implications cardiac response, monitor TSH, T3, T4
PTH Phosphate trashing hormone Parathyroid hormone Decreases P, increases Ca
hypoparathyroidism increases blood calcium (which decreases bone calcium)
Drug for otsteoporosis alendronate (Fosamax) increases bone formation which (decreases blood calcium levels)
calcitriol teriparatide Vitamin D analog, makes you take up and store Ca rPTH
antihypocalcemic agents calcitriol (Rocatrol), teriparatide (Forteo)
Diabetes insipidus Too little ADH (as opposed to SIADH or too much ADH)
Diabetes mellitus Error in carbohydrate (glucose) metabolism
Insulin dependent diabetes All Type I diabetics Some Type II diabetics
Noninsulin dependent diabetes Type II Controlled with diet or oral medications
Glucose normal lab value 70-110
Insulin types Rapid: lispro, aspart Short: regular Intermediate: NPH Long lasting: detrimir, glargine
Insulin standard concentration Insulin injection route 100 Units/mL SC
Rapid acting insulin facts lispro, aspart Onset: 5-10m, Peak: 30-90m (lispro), 1-3h (aspart) Duration: 2-5h Give just before patient eats!
Short acting insulin facts Regular Onset: 30-60m, Peak 2-4h, Duration 6-8h. Client MUST eat within 30 minutes! Regular insulin is clear, and the only insulin given IV
Intermediate acting insulin facts NPH Given to control glucose levels throughout the day. Onset:1-2h, Peak: 6-12h, Duration: 18-24h. CLOUDY SOLUTION!!!! Mix gently before administering.
Long acting insulin facts glargine, detrimir Longest onset and duration. Peak not as prominent. Glargine - no real peak. Detrimir peak:3-6h. Both active for 24h. Clear soln, but cannot dilute or mix with other insulins.
Insulin onset by type lispro: 15-30m regular: 30-60m NPH: 1-2h Glargine, detrimir: long delayed onset
Insulin peak by type RAPID -lispro: 30-90m. Aspart: 1-3h. SHORT - regular: 2-4h. INTERMEDIATE: NPH: 6-12h. LONG ACTING: glargine - no real peak, detrimir: 3-6h
Insulin duration by type Aspart, lispro: 2-4h. Regular: 6-8h. NPH: 18-24h. Glargine, detrimir: 24h.
Combination insulin Usually NPH/Regular 70/30
Insulin administration tips SC, 45-90d angle, aborbed greater in deltoid / abdomial, rotate sites to avoid lipodystrophy (fat atrophy). Must have witness. When mixing: draw clear first, then cloudy.
Sliding scale insulin (SSI) Generally regular insulin.
Oral hypglycemics (5 classifications) 1st generation sulfonylureas 2nd generation sulfonylureas Biguanine
1st generation oral hypoglycemic chlorpropamide. tolbutamide Both are sulfonylureas.
2nd generation oral hypoglycemic glyburide (Micronase). glipzide (Glucatrol). glimiprimide (Amaryl). The "gly-" "gli" drugs
metformin (Glucophage) action Helps take up more insulin
acarbose (Precose) action slows down absorption of sugar
pioglitazone (Actos) helps decrease insulin resistance.
luraglutide (Victoza) Enhances insulin secretion (bid dosing)
saxagliptin (Onglyza) helps increases insulin release
pramlintide (Symlin) delays gastric emptying, which slows down glucose. Given SC.
Drugs used to treat hypoglycemia glucagon, diazoxide
NPH Classification insulin Action - intermediate Uses - to lower blood sugar Side effects hypoglycemia, confusion, shakes,anxiety, palpitations, sweating, LOC Nursing implications
Regular Classification insulin Action - short Uses - to lower blood sugar Side effects hypoglycemia, confusion, shakes,anxiety, palpitations, sweating, LOC
Aspart Classification insulin Action - rapid Uses - to lower blood sugar Side effects hypoglycemia, confusion, shakes,anxiety, palpitations, sweating, LOC
Levothyroxine (Synthroid) Classification - thyroid hormone Uses - hypothyroidism - replacement thyroid treatment Side effects - hyperthyroidism, tachycardia, incr appetite, Nursing implications - drink w full glass water 3-4h prior to other meds, access cardiac, no dairy
Somatrophin Classification - growth hormone Action - agonist to stimulate growth Uses - dwarfism Side effects - hypothyroidism, d.m. Nursing implications - thyroid function, glucose, test for GH antibodies
Potassium iodine Classification - antithyroid Action - stops thyroxin production Uses - hyperthyroidism Side effects - stains teeth Nursing implications - use straw
Cortisone, fludrocortisone Classif corticosteroids Action - dec inflam Uses - inflam Side effects - thin skin, muscle atrophy, peptic ulcer dz, growth retard in children, supp immune system, hi FSBS NI - do not stop abruptly, take in AM, FSBS assess inflam, lytes (lo K, hi Na)
KCl K-Dur Classification - mineral Action - incr K Uses - K replacement Side effects - bradycardia, oliguria, twitching, tingling Nursing implications - monitor rhythm, UOP
CaCO3-(Tums). Calcium citrate (Citracal). Classification - Antacid Uses - GERD, hypocalcemia Action - neutralize gastric acid Side effects - hypercalcemia, constipation, kidney stones Nursing implications
Mg(OH)2 - MOM Classification - antacid Action - neutralize stomach acid Uses - GERD, hypomagnesemia Side effects - hypermagnesemia, diarrhea Nursing implications - caution with renal insuff
torsemide-(Demadex) furosemide-(Lasix) bumetanide- (Bumex) Classification - loop diuretic Act - Uses - diuretic, htn,chf, edema, liver failure Side effects - HYPOKALEMIA. hypotension, lyte imbalance, n/v/d, vertigo, HA, weakness, cramps, photosensitivity, polyuria Nursing implications - ck lytes, monitor UOP
acetazolemide (Diamox) Classification - carbonic anhydrase inhibitor Action- decr carbonic acid production Uses - incr ICP, potent for glaucoma Side effects - lytes, FSBS, fever, anorexia, pruritis Nursing implications - monitor FSBS, lytes
aldactone (Spironolactone) Classification- K sparing drug Uses - diuretic Side effects - hyperkalemia, n/v/d, vertigo, HA, weakness, cramps Nursing implications - monitor lytes
Sodium bicarbonate (baking soda). Ammonium chloride (precurser to NaHCO3) Classification - Uses - kidney disease, acidosis correction, antacid, urinary alkalinizer Side effects - alkalosis, CHF, Hi Na, Seizures Nursing implications
Mannitol (Osmitrol) Classification - osmotic diuretic Uses - increased ICP, Side effects - lytes Nursing implications
Chlorothiazide Classification - thiazide diuretic Uses - htn Side effects -hyponatremia, hypokalemia (less common), rash, photophobia, pancreatitis, dizziness, impotence, HA Nursing implications - monitor lytes
Diltiazem (Cardizem) Classification- CCB Uses - htn, dysrythmias Side effects - hypotension Nursing implications -monitor vitals
Carvedilol (Coreg) Classification - B Blocker Uses - htn Side effects - bradycardia, hypotension, liver problem Nursing implications - monitor vitals, [liver function tests (LFT's) carvedilol] propranolol is nonslective B blocker
Hydralazine Classification - direct acting vasodilators Uses - htn Side effects- hypotension Nursing implications
Ramipril (Altace) Enalapril (Vasotec) Classification - ACEI Uses-htn Side effects - hypotension, hyperkalemia, cough, angioedema Nursing implications - monitor lytes (K)
Milrinone (Primacor) Classification - PDE inhibitor Uses - short term incr cardiac contractility Side effects - hypertension Nursing implications - need 2nd RN, need cardiac monitor
Amiodarone (Cordarone) Classification - antidysrythmic (K-channel blocker) Uses - dysrythmias Side effects - bradycardia, blocks myocardial excitability Nursing implications - long (100 day) halflife
Adenosine (Adenocard) Classification - antidysrthmic Uses - SVT Side effects - doomsday feeling Nursing implications - must inject REALLY STAT
Digoxin (Lanoxin) Classification - Cardiac glycoside Actions- slow down heart, strenth contractions Uses - CHF, irreg HR Side effects - dysrhythmias Nursing impl -monitor K, monitor apical HR for 1 full minute, 0.5-2=therapeutic level ANTIDOTE - digoxin immune FAB
Verapamil (Calan) Like diltiazem, but with less heart affects
Colvesevelam (Welchol) Classification bile salt sequestering agent Action - bind bile salts which lowers cholesterol Uses - hypercholesterolemia Side effects- constipation Nursing implications - separate from other drugs by a few minutes
Ezetimibe (Zetia) Classification - cholesterol absorption inhibitor Action - inhibits chol from being absorbed Uses - hypercholesterolemia (adjunct) Side effects - Nursing implications
Fenofibrate (Tricor) Gemfibrozil (Lopid) Classification fibric acid agent (name: -FIB-) Action: decr triglyceride production by liver Uses - hypertriglyceridemia Side effects - incr risks of gallstones, similar SE of statins Nursing implications-
Aspirin Pentoxifylline (Trental) Clopidogrel (Plavix) Classification - antiplatelet Action - inhibits platelet function Uses - used following MI, CVA, PVD events Side effects - bleeding, PUD, Nursing implications - must hold prior to surgery, procedures. take only 1 antiplatelet.
Heparin lab Warfarin lab PTT partial thromboplastin time PT/INR prothrombin time/INR (related to PT)
Niacin (Niac) Classification - lipid lowering agent Uses - decr lipds Side effects - flushing Nursing implications- go up on dose slowly
Pentoxifylline (Trental) Classification - antiplatelet Uses - after MI, CVA, or PVD event Side effects - bleeding Nursing implications - do not take with other antiplatelets
These compounds are lipids triglycerides cholesterol fats
Used to treat hypertriglyceridemia -fib- drugs. niacin
Use to treat hypercholesterolemia statins bile sequestering agents cholesterol absorption inhibitors (Zetia)
Direct acting vasodilators "Nitrates" this includes nitroglycerin and isosorbide mononitrate (Imdur) used for angina (chest pain). Nitroprusside - used for hypertensive crisis. Not first line drugs.
Nitroglycerin nursing implications Use under tongue q5min x 3. Aborbed thru mucosa for immed relief Causes DROP IN BP and headache. Place under tongue, should sting, if not, may be too old. 6 mo shelf life. Stored in brown bottle. Avail as sublingual tabs, spray and IV.
Isosorbide mononitrate (Imdur) Class: nitrate. This is basically a long acting form of nitroglycerin used for chest pain. Available as tablets.
Dysrythmics Class I: Na channel blockers - lidocaine, procainamide, quinidine. B blockers. Ca channel blockers - specifically diltiazem and verapamil. K channel blockers - amiodarone (Pacerone).
statin simvastatin pravastatin atorvastatin - HMG CoA reductase inhibitors - lower cholesterol
Drug name contains -fib- Fibric acid derivatives. gemfibrozil, fenofibrate - lower triglycerides
col or chol in name Bile salt binders cholestyramine, colestipol, colesevelam. Bind cholesterol in GI tract inhibiting reabsorption, thereby lowering cholesterol
Nursing implications for lipid lowering drugs monitor lipid labs (cholesterol, triglycerides). monitor LFT's liver function tests. Dietary teaching. preg test if on statins
Uses for anticlotting drugs To prevent formation of clots, or to prevent existing clots from enlarging. MI, CVA, DVT (deep vein thrombosis), afib (atrial fibrillation)
-dipine amlodipine, nefedipine calcium channel blocker
-lamide acetazolamide carbonic anhydrase inhibitor
-olol B-blocker B-adrenergic blocker sympatholytic sympathomimetic antagonist metoprolol, propanolol, atenolol, timolol, pindolol
-parin; parin anticoagulant heparin, enoxaparin, fondaparinox, these are (LMWH_ low molecular weight heparins
-pril ACE inhibitor Angiotensin converting enzyme inhibitor lisinopril, enalopril, captopril, ramipril
-sartan ARB Angiotensin II receptor blocker losartan, irbesartan, valsartan, candesartan, olmesartan
-semide Loop diuretic furosemide, torsemide
-statin HMG-CoA reductase inhibitor "statins" Cholesterol lowering drugs Antilipid drug atrovastatin, lovastatin, pravastatin, simvastatin
-terol Beta-2 agonist Beta-2 adrenergic agonist Bronchodilaters Sympathomimetic albuterol, levalbuterol, salmeterol, formoterol
-thiazide Thiazide diuretic hydrochlorothiazide (HCTZ), chlorothiazide
-zosin alpha1 blocker alpha1 adrenergic blocker sympatholytic Sympathetic antagonist doxazosin, prazosin, terazosin
Renin-Angiotensin-Alosterone []=enzyme that catalyzes conver of Angiotensinogen [renin] angiotensin I, Angiotensin I, [ACE]angiotensin II, Angiotensin II incre aldost & also incr smth muscle tone (vasc tone)ACE inhibitors, ARB - blk angiotensin rec site, K-spar diuretics blk aldost
Loop diuretics -semide furosemide = prototype Acts on ascending Loop of Henle. Hypokalemia = noted side effect
Thiazide diuretics -thiazide hydrochlorothiazide = prototype Acts in early distal convoluted tubule. May cause hyponatremia
Osmotic diuretics mannitol acetazolemide Acts in proximal convoluted tubule. May cause electrolyte disturbances
Potassium sparing diuretics spironolactone aldactone triamterene Acts in late distal convoluted tubule. -one drugs antagonize aldosterone. May cause hyperkalemia. Wastes sodium.
ACE inhibitor mode of action blocks conversion of angiotensin I to angiotensin II
B-blocker Blocks B1 (and may also block other beta receptors such as B2, causing side effects) May cause asthma flare May cause hypoglycemia
Alpha blocker (alpha1 blocker) Blocks alpha 1 sites -zosin We aren't gonna study any other alpha blockers
Alpha 2 agonist clonidine The alpha2 agonists are different. They serve as sympatholytic agents (decreases sympathetic tone - the opposite of sympathomimetic) nursing implications: abrupt discontinuation of clonidine may cause rebound hypertension
Calcium channel blockers affect on heart rate diltiazem - max control HR verapamil - mod control HR nifedipine - no control HR
warfarin anticoagulant must follow PT or INR levels Vitamin K is antidote
Heparin anticoagulant must follow PTT levels protamine is antidote
enoxaparin, fondaparinox anticoagulant affect factor Xa. protamine is partial antidote
Anticholinergic side effects Blind as a bad (mydriasis) Red as a beet (flushed skin) Mad as a hatter (altered mentation) Hot as hades (increased temp) Dry as a bone (increased temp) and the heart runs alone (tachycardic)
Anticholinergic atropine - prototype scopolamine ipratropium
anticholinergic mode of action bind with acetylcholine receptors preventing acetylcholine from binding "parasympatholytics"
anticholinergic mode of action binds to acetylcholine receptors
myasthenia gravis autoimmunie disease Body produces antibiodies that bind to acetylcholine receptors (acts like anticholinergic) Treat with cholinergics
phentolamine alpha antagonist tamsulosin alpha1 blocker used for BPH benign prostatic hypertrophy
sympatholytic adrenergic blocker
selective B blockers atenolol, betaxolol, metoprolol Blocks B1 predominantly, not as much B2 can lead to decrease libido and impotence
Created by: mojoshare