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