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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 |
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mojoshare
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