pharm test 3
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| Endocrine | internal secretion, pertaining to gland that secretes directly into the bloodstream
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| Secretions | hormones, chemical messengers working w/in the endocrine system to communicate w/in the body
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| Neurotransmitters & Hormones | are chemicals, react w/ very specific receptor site, immediately broken down, produced in limited quantities, act to ^ or decrease cellular processes, N-travel along neurons, H-secreted directly into the bloodstream
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| Med Administration-desmopressin(DDAVP) | pt sit upright & press finger over one nostril, w/ spray bottle held upright, have pt place tip of bottle 1.5cm into open nostril, firm squeeze- do not use excessive force or tip head back
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| desmopressin/DDAVP | Pituitary agent, replaces antidiuretic hormone(ADH) for diabetes insipidus, too much ADH results in water intoxication, monitor I&O, daily wts, watch for water intoxication, monitor VS for tachycardia and HTN, check LOC, UA spec grav
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| prednisone/Deltasone | glucocort anti-inflam horm, rplcmnt ther adrenal insuff; tx of aller and inflam disord, SE:H/A, hypoten, GI upset, fl reten,^suscept to inf, NOT for acute inf,cauti use in diab-gluc ^effcts, only taken orally-taper off-give w/food–immunosupp-can mask inf
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| levothyroxine/Synthroid | T4 thyroid replacement hormone, SE; hyperthyroidism, lifelong replacement-take in am prior to breakfast-bioavailability issues-serum TFT monitoring, decreased fatigue, BP & P
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| alendronate/Fosamax | Bisphosphonate, tx of postmenapausal osteoporosis, ^bone density, SE; esophageal erosion, Remain upright 30min after taking, take in am w/ water, lifestyle changes-aerobic exercise-proper diet-maybe HRT, bone density testing, may be taking Ca w/ vit D
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| calcitriol/Rocaltrol | Vitamin D analog, promotes intestinal absorption & renal retention of calcium, need adequate Ca intake and no other intake of OTC vitamin D
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| isophane insulin/NPH, HumulinN/NovolinN | intermediate- acting insulin, 1-1.5hours
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| salmon calcitonin/Calcimar | NOT w/ allergy to salmon or fish products, given nasal spray or inj, lifestyle changes, bone density testing, may also be taking calcium w/ vit D
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| Humulin or Novolin 70/30 | combination insulin, NPH/R
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| Novolog 70/30 | combination insulin, aspart protamine/aspart
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| metformin/Glucophage | nonsulfonylurea/biguanide, oral antidiab agent, decr prod of gluc by liver & ^uptake gluc by cells, NOT for 3 days/72hrs before/after admin contrast dye->metabol acidosis, glucose test, HbA1c test, lifestyle changes, eye check, RENAL funct test, foot care
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| glargine/Lantus, detemir/Levemir | long-acting insulin, lowers blood glucose levels over extended period of time(24hrs) also prevents conversion of glucagon to glucose in liver, monitor HbA1c periodically, give as close as possible to same time each day AM or PM
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| regular insulin/Humulin R | antidiabetic agent, lowers blood gluc levels by ^peripheral gluc uptake by inhibiting liver from changing glycogen-> glucose, emergency tx hypoglyc, correct inj tech, respond promptly hypoglycemia-glucagon/IV glucose D50%, freq blood glucose monitoring
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| isophane/NPH/Humulin N | antidiab agent,lowers blood gluc lev by ^peripheral gluc uptake esp skel musc/fat tis/inhib liver chnging glyco to gluc, daily/bid,before brkfast hypo react likely midaft/dinner,disper,midaft/hs snk, s/sx hypo;fatigue-weak-sweat-tremor-nervness-changeLOC
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| aspart/Novolog, lispro/Humalog | rapid-acting insulin, 10-15min, lowers blood glucose levels by ^peripheral glucose uptake esp by skeletal muscle & fat tissue & by inhibiting liver from changing glycogen to glucose, give w/ food
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| glipizide/Glucotrol | sulfonylurea, oral antidiabetic agent, stimulates pancreatic beta cells leading to ^insulin secretion, know how to treat hypoglycemia, a daily med, admin before first meal of day to stimulate insulin production
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| propylthiouracil/PTU | antithyroid agent for tx of hyperthyroidism or attain euthyroid state before thyroidectomy, monitor for euthyroidism
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| methylprednisolone sodium succinate/SoluMedrol | glucocorticoid, blocks &/or reduces inflammatory responses for pneumonia & respiratory issues, protect from exposure to inf, monitor BS
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| Glucocorticoid-SE | pt w/ diabetes glucose-elevating effects, associated w/ dvlpt of ulcers, suppress the immune system, ^appitite, restlessness-trouble sleeping, long term use leads to cushingoid effects
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| Glucocorticoid-Sudden Stopage | adreanal insufficiency, fatigue, muscle weakness, joint pain, fever, anorexia, nausea, SOB, dizziness, fainting, always stop in gradually tapering doses!
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| Hypothyroidism | lack of sufficient levels of thyroid hormones to maintain a normal metabolism, most common type of thyroid dysfunction, S/Sx; obesity, fatigue, vague
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| Osteoporosis | loss of bone mass that occurs throughout the skel, elderly postmenopausal woman w/ poor diet, walking is beneficial, encourage calcium & protein, hormone replacement therapy may ^cardiovascular events, women who at ^risk for breast cancer or do not take H
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| alendronate/Fosamax | strengthen bone density-prevent osteoporosis, may cause jaw breakdown, not used w/ hypocalcemia breastfeeding, pregnancy or renal dysfunction, taken w/ full glass of water, remain upright 30min, SE; h/a, nausea, diarrhea, bone pain, esophageal erosion
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| Osteoporosis and steroid use | steroids decrease inflammation, but also decrease formation of new bone, increase breakdown of old bone, and decrease absorption of calcium from food by the body
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| Parathyroid hormone(PTH) | moves calcium from bone into the blood stream
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| When Mg deficit | freq K and Ca deficit
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| When Phos deficit | freq rise in Ca
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| When Phos increase | freq a reduction in Ca
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| Hypercalcemia | excessive production of PTH leads to an elevated calcium level, associated with postmenopausal osteoporosis, Paget disease, and malignancies
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| Hypercalcemia & Hyperparathyroidism | N/V, weakness, tx Calcitonin-pushes calcium back into bone
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| Hypoparathyroidism | results in low calcium in the blood stream-tetany, tx calcium & vitamin D
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| Trousseau’s sign | low calcium, BP cuff around arm for 3min->spasm is + sign for hypocalcemia
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| Tetany | involuntary contraction of muscles-trousseau’s/chvostek’s, + signs hypocalcemia
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| Chvostek’s sign | hypocalcemia, facial nerve tapped->creates nose/lips twitch + sign
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| Type I diabetes mellitus | insulin b/c no insulin production available
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| Type II DM | sulfonylurea-glyburide/Diabeta/Micronase-stimulates insulin production, or biquanide-metformin/Glucophage-makes cells more sensitive ton insulin allowing more uptake of glucose
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| Insulin-Nursing considerations | assess for contraindications, physical assessment, assess skin, body sx changes, nutritional intake, activity level, blood glucose levels/lab tests
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| Sliding Scale/Correction Insulin | given to reduce elevated blood glucose level to a normal range, insulin designed to be given independent of nutritional intake
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| African Americans & HTN | most responsive to single-drug therapy, more responsive to diuretics, CCB’s, & alpha-adrenergic blockers
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| Beta-blockers | olol, assess P & BP, Sx of hypoglycemia, DO NOT stop abruptly!-arrythmia
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| Stepped-Care Mgmt of HTN | Lifestyle modifications->inadequate response-add drug therapy; diuretic, beta-blocker, ACE, CCB, angiotension II receptor blockers->inadequate response-change drug dose/class/combo->inadequate response-add second/third agent
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| ACE | prils-captopril/Capoten, SE; cough & angioedema
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| ARB | sartans-losartan/Cozaar, SE; cough, particularly useful for diabetics-kidney protective
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| CCB | diltiazem/Cardizem, amlodipine/Norvasc, verapamil/Calan SR, NO grapefruit juice, short-acting 4x/day, long-acting 1 or 2 x/day
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| nonselective adrenergic blocking agents | labetalol/Normodyne
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| a2 sympathomimetic | clonidine/Catapres, PRN anti-HTN
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| vasodilator | hydralazine/Apresoline
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| Fixed-Combo for HTN | Lotrel(amlodipine w/ benazepril), allows for fewer tablets or capsules each day, making it easier for pt to comply w/ drug therapy, pt stabilized on each drug first then appropriate combo product
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| Congestive Heart Failure | inability of heart to circulate blood effectively enough to meet body requirements-less than 55% of blood is ejected from LEFT ventricle during a heartbeat
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| digoxin/Lanoxin | cardiac glycoside, a bioavailability drug, narrow window of serum safety(0.5-2.0), also for tx of atrial fib +inotropic effect,-chronotropic effect, assess apical pulse 60sec, SE; h/a, GI upset, anorexia, visual disturbances, fatigue, OD-digiband is antid
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| Chronotropic | slows heart down
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| Inotropic | beats more effectively
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| Preload | amount of blood that is brought back to heart to be pumped around, diuretics reduce preload by diuresis so less blood is brought back to heart to be pumped
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| Afterload | resistance against which the heart has to beat-BP measures afterload, CCB and vasodialators decrease afterload because they reduce arterial smooth muscle tone/tension
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| arrhythmia | irregularity or loss of rhythm
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| dysrhythmia | abnormal, disordered, or disturbed rhythm
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| atrial fibrillation | lack of coordinated pumping action, blood is not effectively pumped into the ventricles, blood not pumped out tends to stagnate->stagnated blood tends to clot
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| Angina Pectoris | chest pain brought about by myocardial ischemia, stable, unstable, intractable, variant, silent
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| How to treat Angina | nitrates, beta-adrenergic blockers, calcium channel blockers
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| Nitrates | M of A-vasodialators decrease BP, take one every 5min, call 911
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| Hyperlipidemia | increase in level of lipids in the blood, caused by; excessive dietary intake of fats, genetic alterations in fat metabolism, cultural variations related to lipid levels
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| Hyperlipidemia-Tx | diet, exercise, HMG-CoA reductase inhibitors- atorvastatin(Lipitor), cholesterol absorption inhibitor- ezetimibe(Zetia)
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| Statins | Lipitor more risk for liver toxicity than Zocor-yearly LFT, rhabdomyolysis-a breakdown of muscles which can lead to ARF, NO grapefruit-heart arrhythmias/dysrhythmia, benefits of statins for diabetics, take at bedtime, should have tried diet & exercise
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| Embolism | clot that travels from where it was formed
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| Thrombus | blood clot that forms in a vessel
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| aspirin & clopidogrel/Plavix | prevention of platelets from clumping together by inhibiting enzymes and factors that normally lead to arterial clotting, primary prevention of acute MI, prevention of reinfarction, prevention of stroke
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| warfarin/Coumadin | atrial fibrillation/status post thrombosis/embolism/artificial heart valves, PT/I NR monitoring, therapeutic range 2-3, ^ GI bleeding, interacts w/ many drugs/supplements, vit K decreases effect of warfarin, antidote vit K
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| dabigatran etexilate/Pradaxa | blood-thinning medicine used to reduce the risk of stroke and blood clots in ppl w/ atrial fibrillation not caused by a heart valve problem, SE; spontaneous bleeding, doesn’t require INR monitoring, works quicker/can be restarted faster
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| rivaroxaban/Xarelto | expensive but ins does not want to pay for, DVT, non-valvular afib, bleeding, doesn’t require INR
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| heparin | acute tx and prevention of venous thrombosis and pulmonary embolism, must be injected, aPTT/PTT laboratory value monitoring
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| dalteparin/Fragmin, enoxaparin/Lovenox | prevention of clots and emboli status post-surgery/prolonged bed rest
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