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Pharm 6

Antihyperglycemics Insulin Rapid acting LOG = Rapid aspart (NovoLOG®) Onset 5-10 min, peak 1-2 hours, duration 4 hours lispro (HumaLOG®)
Antihyperglycemics Insulin Short Acting LIN regular (NovoLIN-R® Onset 30-60 min, peak 2-3 hours, duration 6-8 hours regular HumuLIN-R®,)
Antihyperglycemics Insulin Intermediate Acting NPH (contains protamine) (Humulin-N®<- Onset 2-4 hours, peak 4-14 hours, duration up to 24 hours Novolin-N <- ®)
Antihyperglycemics Insulin Long Acting glargine (LANtus®)-cannot mix, basal acting Onset 2-4 hours duration up to 24 hours
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)
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
"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
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,
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
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
Oral Hypoglycemic Agents - Glucose Absorption Inhibitors/Alpha-glucosidase Inhibitors acarbose snbtGa/grmrAMs(Precose®) miglitol (Glyset®)
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
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.
Hyperglycemics IV glucagon (Glucagen®) 50% Dextrose Solution
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
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,
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
Corticosteroids - Glucocorticoid Replacement "ONE" - cont'd 3 Uses Uses: Hormone Replacement therapy, treatment of inflammatory or allergic conditions such as arthritis, asthma, skin irritation.
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)
Hypothalmus release CRF ( Cortictropin releasing factors) which release cortisol:
Hypothalmus Factors stimulating release of CRF stress exercise, cold weather, infection, anxiety, etc
Mineralocorticoid Replacement FA = Fe fludrocortisone (Florinef®) aldosterone
Mineralocorticoid MOA To maintain (MINERAL)WATER BALANCE balance - increase reabsorption of Na++ and H20 while k+ is transported to urine
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 -
Mineralocorticoid Addison's ADDison's disease - too little steroid production - Symptoms: dehydration, hypotension, weight loss, muscle atrophy
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
Thyroid Hormone Replacement thyro levoTHYROxine T4 (LevoTHROIDd®, SynTHROID®, Levoxyl®) lioTHYROnine T3 (Cytomel®) Increase in BP and HR, increased metabolism, insomnia, tremors, HA, palpitations, diarrhea
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
Anti-thyroid Agents side effects PTU Side Effects: agranulocytosis, pruritis, urticara rash, arthralgias, fever, lupus -like syndrome (inflammation of collagen),
Anti-thyroid Agents Patient Teaching CBC must be monitored - other antithyroid treatment includes radiation ( which shrinks tumors/gland, kills overactive tissue and surgery
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
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)
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
Hormonal Cancer Therapy Just know that some cancers thrive on hormones
Meds ED sildenafil (Viagra®) vardenafil(Levitra®) NO-NO combo with nitrates - smooth muscle relaxation -> vasodilation -. Increase blood sugar flow to the penis
Oxytocin/Oxytocics oxytocin (Pitocin® ) induce labor methylergonovine(Methergine®) stop bleeding increase uterine contraction -induction /augmentation
Tocolytics - stops contractions TOC oppostie of Oxytoc terbutaline (Brethine®) magnesium sulfate Beta 2 agonist - smooth muscle relaxant: stops contractions with pre-term labor
Posterior Pituitary Replacement 2 - Regulates H2O balance; Increase AHD -> increased water reabsorption, decreased urine ouput Decrease AHD -> decreased water reabsorption, increased urine ouput
Posterior Pituitary Replacement 1 ADH replacement (Vasopressin® DDAVP®) Diabetes Insipidus: dilute, watery urine, polydipsia, dehydration
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.
NSAID - Cox-2 inhibitors celecoxib (Celebrex®) Inhibits cox2 (responsible for pain and inflammation but DOES decrease inflammation while not effecting mucosal secretion
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
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
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
Proton Pump Inhibitor SE constipation,HA, nausea, diarrhea, abdominal pain
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
SNBTGA/GRMRAMS Sulfonylureas -glyburide; Nonsulfonylureas - repaglinide; Biguanides - metformin; thiaxolidinediones - rosiglitazone; Glucose Absorption Inhib - acarbose,miglitol; Addit'l diabetic therapies - sitagliptin
Antiulcer ucral sucralfate (Carafate®) Coats the ulcer; binds to HCl, inhibits pepsin activity - allowing stomach to heal
Antacids calcium carbonate (Tums®) Neutralize aluminum hydroxide (Amphojel®)Acid already present
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)
Antiemetics metoclopramide (Reglan®) ondansetron (Zofran®) Inhibit vomiting / some help with nausea
AntiDiarrheal "loperamide " (Imodium®) diphenoxylate/atropine (Lomotil®) Loose, watery stools, not absorbing adequate H2O - too much intestinal motility - Laxatives increase muscle contraction of intestine
Laxatives bisacodyl (Dulcolax®) polyethylene glycol (MiraLAX®) Stimulus for defacation, enhance intestinal motility
Stool Softeners docusate sodium (Colace®) Adds H2O to stool
Antiflatuents simethicone Mylicon®, Mylicon Drops®, Gas-X®)
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
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
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
Adrenal Glands Suprarenal / Inner Part secretes catecholinamines adenaline, epinephrine Outer part secretes corticosteroids (glucocorticoids/minerlocoticoids
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
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.
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
Hyperthyroidism Tumors and more often by Autoimmune issues -> Grave's Disease
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
Sex Hormones Produced during puberty,; develop and maintain secondary sex characteristics, are produced by the gonads and controlled by the anterior pituitary
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),
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
Follicle Stimulating Hormone female: stimulates follicle growth and allows for estogen secretion male: maintains sperm production (spermatogenesis)
Luteinizing Hormone female: induces ovulation; stimulates corpus luteum to form; promotes progesterone secretion Male: stimulates secretion of testoserone
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
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
Estrogen - Negative effects Thrombembolism, stroke, MI, nausea, headache, breast tenderness, liver disease, gall bladder disease
Uses of Sex Hormones Hormone replacement therapy HRT; oral contraceptives; infertility FSH, Cancer Therapy
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
Progesterone fluid retention, weight gain - may take when breast feeding
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
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
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
After Digestion -> absorption; Allows for elim of solid waste material
Inhibitory enzyme - protects stomach from being eaten Stops secretion of HCL; Protective mechanism coats mucosal lining with mucus
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
Ulcers - what are they? open sore in mucosal lining Peptic Ulcers - in duodenum or stomach.
Ulcer Causes Increased HCL production, Inadaequate mucous secretion, emotional and physical distress, increase vagus nerve stimulation, alcohol stimulation, drugs, genetics,gastric bacterial infections
Ulcer Symptoms Symptoms: Gi upset, nausea, loss of appetite, abdominal pain
Potential Mechanisms for disruption of Mucosal Defense Depletion of endogenous prostagalandins (aid in mucosal secretion) Helibactor pylori
Ulcer Formation HCl and enzymes concentrated -> disrupted by drug therapy Stomach lining protected by mucous -> disrupted by drug therapy Erosion of mucosa
Ulcer treatment Decrease stress, Decrease alcohol consumption Decrease intake of spicy food Decrease smoking Drug therapy Surgical intervention
Ulcer Drug Therapy Antacids, anticholinergics, histamine 2 blockers, prostaglandins, proton pump inhibitors, antibiotic (multiple due to resistance), sUCRALfate carafate),Prevpac
Non-Pharmacological Therapy for Ulcers Decrease or avoid: chocolate peppermint spearmint fried. Fatty food coffee tomato products hot peppers onion
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
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
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
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
4. To avoid lipodystrophy, injection sites should be rotated True False True
5. Methimazole (Tapazole) is a drug used to treat: Hyperthyroidism Cushing’s Disease Addison’s Disease Type 2 DM None of the above Hyperthyroidism
6. Symptoms of hypothyroidism include: Lethargy Constipation Weight gain bradycardia All of the above All of the above
7. When drawing up insulin, NPH should be drawn up before Regular. True False False
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
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
10. Type I DM treatment involves oral medication to control blood sugar without the need to monitor diet. True False True
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
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
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
14. A patient with DM should avoid NPH insulin if allergic to protamine True False True
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
16. Methylprednisolone (Medrol): May cause hyperglycemia Can lead to immunosuppression Has anti-inflammatory properties All of the above All of the above
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
18. Propylthiouracil (PTU) is an anti-thyroid agent that may lead to agranulocytosis. True False True
19. Excessive amounts of aldosterone may cause: Hypotension Hypertension Hyponatremia Hyperkalemia Hypertension
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
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
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
31. Lente 32. Ortho-Novum 33. metformin (Glucophage) 34. glyburide (Diabeta) 35. rosiglitazone (Avandia) C. insulin B. OCP D. biguanide E. sulfonylurea A. thiazolidinediones
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;;
Created by: frovan