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Slide 1: Pharm Exam Study Guide (Cont) Chp 39 -
Slide 2: Hypothalamic Inhibiting Factors • Somatostatin • PIF (prolactin inhibiting factor)
Slide 3: Gestational Diabetes • Use insulin treatment • Insulin does not cross the placenta
Slide 4: Insulins • Lantus (glargine) 60-70 min onset 24 hr duration • (Do not mix with other insulins) • Lente (Humulin L) 1-2.5 hr onset 24 hr duration
Slide 5: Diabetic Adjuncts to Diet • Caution with beta blockers or alcohol • Sulfonylureas – Glyburide (DiaBeta) – Glimepiride (Amaryl) • Nonsulfonylureas – Metformin (Glucophage) also for children – Symlin
Slide 6: Pancreas and Insulin • Pancreas secretes hormones and sodium bicarbonate into the common bile duct to go to the small intestine – Alpha cells release glucagon – Beta cells release insulin – Delta cells produce somatostatin
Slide 7: Case Study Calcitriol • Myra, a dialysis patient, has been taking her calcitriol tablets every morning, as recommended for her hypothyroidism. • However, her calcium level is still low and she is at risk for osteoporosis. • What is your advice?
Slide 8: Calcitriol Usual dosage = 0.5-2 mcg/day PO (A.M.) Do not crush or chew tablets Myra needs to take her calcitriol AFTER dialysis because the calcium is being lost. Take with Vitamin D to be effective!
Slide 9: Thyroid Crisis • Thyroid crisis occurs when hyperthyroidism is untreated • Treated with PTU (propylthiouracil) • Initially 300-900 mg/day PO • PTH can cause nausea, vomiting, GI complaints and bone marrow suppression
Slide 10: Radiation Emergency • Thyro-Block • Potassium iodide can stain teeth so take through a straw • Adverse effect: iodism – Metallic taste – Mouth sores – Cold symptoms – Skin rash
Slide 11: Thyroidectomy Care • Surgical removal of thyroid gland • Voice change is side-effect • Replacement therapy includes: – Synthroid (levothyroxine) – Calcitonin
Slide 12: Female Reproductive system #@#^%^^&%&^ Menopause Black Cohosh, Borage, Chaste tree, Devil’s claw, dong quai, red clover, soy, wild yam Don’t forget the ‘False Unicorn root’!
Slide 13: Menopause Although the joy of menstruation won’t be missed, estrogen does provide several important systemic benefits?
Slide 14: Estrogens • • • • • Protect the heart from atherosclerosis Retain calcium in the bones Increase HDL (good)cholesterol levels Keeps skin elastic Maintain secondary sex characteristics
Slide 15: Menopausal Symptoms • Vaginal dryness, hot flashes, moodiness,loss of bone density… • HRT (hormone replacement therapy) • Estradiol, estriopipate can cause GI effects, weight gain, breakthrough bleeding and acute pancreatis
Slide 16: Lupron (leuprolide) Blocks the GnRH receptor so FSH and LH are not released • Side effects: – Hot flashes, peripheral edema, MI, constipation – Nausea, urinary frequency, increased sweating • Treats: – Prostate cancer • 1 mg/day SQ – Precocious puberty – Endometriosis • 3.75 mg IM once a month
Slide 17: Bile Acid Sequestrans • Questran (cholestryramine)
Slide 18: Infertility Drugs • Work to increase FSH/LH levels in females and males • Clomiphene • 50-100 mg/day PO • Increased risk of multiple births
Slide 19: Female Reproductive System Turn off the IV form, Go get the nasal form…. What?
Slide 20: Oxytocics • Pitocin - used to induce labor and to promote uterine contractions • Oxytocin - nasal form stimulates “milk let down” • Adverse effects: cardiac arrhythmias, hypertension, fetal bradycardia,uterine rupture, severe water intoxication
Slide 21: Androgens • Risk/Benefits Which is worse, endometriosis Or Taking danocrine?
Slide 22: Androgens • Danocrine 100-600 mg/day PO • Treats endometriosis by preventing FSH and LH release • Prevents angioedema • Adverse Effects: hirutism (increased hair distribution), deepening of voice, weight gain, sleep disorders, emotional lability, hepatocellular cancer
Slide 23: Case Study Endometriosis • OK…I’m not real interested in the danocrine option to treat my endometriosis • Any other options? Facial hair issues
Slide 24: Endometriosis • Lupron (leuprolide) treats: – Endometriosis – Precocious puberty – Antineoplastic agent Not this again! Side effects: hot flashes, joint pain, hirsutism, depression (I can see why!) Treatment is only for 6 months, although 63% of pts are symptom free after 5
Slide 25: Heart Medications • ECG detects the patterns of electrical impulses and conduction • PACs • PAT • A fib • PVCs
Slide 26: ACE inhibitors Block angiotensin I ---->angiotensis II from occurring in lungs Used for: Benazepril Hypertension Captopril And With digoxin and diuretics Enalapril For CHF And Fosinopril Left ventricular dysfunction Zestril
Slide 27: Case Study ACE inhibitors • Old Mr. Jone’s is recovering from a MI. He’s on lasix and captopril 50 mg PO tid. • The new nurse tells you she is concerned about his cough and wants to order an Xray. • His lungs sound clear, what do you suggest?
Slide 28: ACE inhibitors • Captopril works to block A I ---> A II (in the lungs) ACE inhibitors can cause a chronic cough Side effects: Empty stomach… I’m starvin’ tachycardia, chest pain, Can’t wait to GI irritation, ulcers, Have a big Mac constipation, photosensitivity Take on an empty stomach Prevent excessive sweating Cough, Cough, cough
Slide 29: Heart Medicaitons ACE inhibitors BLock AI ---> AII in lungs Cause cough "prils" Captopril Benzapril Monopril Angiotensin II Receptor Blockers prevent aldosterone "sartans" Candesartan Eprosartan Valsartan Also cause cough Calcium Channel Blockers stop muslce contraction "pines" Amlopine Felodipine Nifedipine Treat angina DO not crush, cut or chew any of these meds
Slide 30: CAD causes CHF • AH…finally I understand • CAD causes arteries to get clogged up • The heart has to work harder and harder to meet the demands • The left ventricle gets larger and larger. • Pulmonary edema occurs when blood gets backed up into the lungs.
Slide 31: CHF • How to diagnosis it? • Order a chest Xray, ECG and even direct precussion of the chest • All of these tests are looking for an enlarged left ventricle (cardiomegaly) • Also seen: heptomegaly, splenomegaly, swollen legs, dependent edema
Slide 32: CHF = Digoxin • Digoxin (cardiac glycoside) is used most often to treat CHF…no, really? Digoxin increases the force of myocardial contraction, cardiac output and renal perfusion But amazingly slows the heart rate
Slide 33: Case Study Digoxin Remember, digoxin is amazing, it slows the heart rate so before administering digoxin, every nurse will?
Slide 34: Digoixn • Rapidly absorbed • Can cause toxicity – Digibind, digifab – Digoxin immune fab Did you find the digibind? Treat serum levels > 10 ng/ml
Slide 35: Lidocaine • • • • Class Ib antiarrhythmic 300 mg 10% solution IM 50-100 mg IV bolus slowly Can cause: Used in cardiac surgery Or MI but not With CHF – Hypotension, shock – Dizziness, fatigue, – Mouth numbness, slurred speech – Rash
Slide 36: Megaloblastic anemia • Insufficient folic acid or Vit. B 12 • Red, glossy tongue • Diarrhea • Treat with Hydroxycobalamin – IM injections – Once a month for life
Slide 37: Case Study Megaloblastic Anemia Problem: two pts in rooms side by side have megaloblastic anemia. • 57 yr old alcoholic • 28 yr old female 2/3 of small intestine removed for cancer One is to have oral Folvite, the other receives an IM injection of hydrocobalamin. Who get’s what?
Slide 38: Case Study Megaloblastic Anemia • 57 yr old male alcoholic --> oral Folvite • 28 yr old female 2/3 of small intestine removed for cancer ----> IM injection Vitamin B 12 needs to be absorbed in the small intestine. The alcoholic can take oral meds, he just needs to improve his diet.
Slide 39: Intractable Hiccoughs (web says marijauna cures this….) Textbook says (p. 972) use: Chloropromazine (Thorazine) 10-25 mg PO q4-6hr
Slide 40: Postpartum Laxative • Milk of Magnesia is minimally absorbed and can be used by pregnant women and those nursing
Slide 41: Nexium (esomeprazole) • 20-40 mg.day PO for 4-8wks • Treats GERD, erosive esophagitis, duodenal ulcers, hypersecretions • Acid labile • Side effects: – Dizziness, headache, vertigo, insomnia, dream abnormalities, dry mouth, tongue atrophy, cold symptoms, rash, back pain Proton pump inhibitor- blocks acid production
Slide 42: Chronic Constipation • Laxatives are NOT recommended for long term use • Cathartic dependence occurs when the GI tract becomes dependent on the vigorous stimulation of the laxative • Wait 30 mins after administering a laxative before giving other meds.
Slide 43: Antidiarrheals • Only paregoric is indicated for children under 2 yrs old • 0.25-0.5 mL/kg PO • Paregoric is an opium derivative and can have adverse effects on a neonate
Slide 44: Case Study Androgens • Your male patient grew muscles overnight. He looks like he is probably using “products” to enhance his athletic performance. • What should you advise him about creatine?
Slide 45: Creatine • Naturally occurring substance in red meat • Interacts with NSAIDs • Can cause kidney dysfunction Drink plenty of fluids For short-term use
Slide 46: Cialis (tadalafil) • Inhibits the PDE5 receptors • Increases nitrous oxide levels • Onset of action 45 mins and a duration of 36 hours (avoid grapefruit juice and high-fat meals prior to use)
Slide 47: Viagra (sildenafil) Ladies, I recommend Viagra over Cialis, because Viagra only lasts 4 hours, Cialis last 36 hours!
Slide 48: PDE5 inhibitors Cialis, Viagra medications can cause: • Headache • Dyspepsia • UTI • Flushing • Dizziness • Rash • Optic neuropathy Blue pill Or the red pill?
Slide 49: Male Reproduction
Slide 50: Case Study Tagament • Walt, a 48 yr old male, calls the GP office where you work. He is very upset and claims “I am developing breasts!” • He is very healthy, a workaholic and has only seen the doctor once this year for an ulcer. • What do you suggest?
Slide 51: Tagamet (cimetidine) 300 mg PO qid with meals Tagamet is for short-term treatment: – active duodenal – gastric ulcers – relief of heartburn. Side effects: dizziness, confusion, headache, cardiac arrhythmias, diarrhea, impotence, rash and gynecomastia (male breasts)