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USF Pharm Exam #2
Endocrine, ANS, CV drugs
153
Pharmacology
Undergraduate 3
09/27/2010

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Term
Diabetes Mellitus
Definition
carbohydrate metabolism disorder. symptoms result from lack of insulin or insulin resistance and resulting hyperglycemia.
Signs of DM are: polyuria, polydipsia, polyphagia
Term
polyuria
Definition
excessive production and passage of urine
Term
polydipsia
Definition
excessive thirst
Term
polyphagia
Definition
excessive eating
Term
Diabetes - Type 1
Definition
Childhood, abrupt onset. 5-10% of all DM.
Term
Type II Diabetes
Definition
Occurs in middle/old-age. Result of impaired insulin secretion and resistance to insulin's effects
Term
Diabetic Screening (Risks for)
Definition
- Family history
- Obesity
- Bore child weighting 9 or more lbs
- Recurrent skin, gential, UTI infection
- 65+yrs
- hypertension
- impaired glucose tolerance
- Hispanic, Af. Amer, Na. Amer. hertiage
Term
Diabetes Diagnostic Tests
Definition
- Fasting Plasma Glucose >126 mg/dm
- Casual Plasma Glucose >200 mg/dm
- Oral Glucose Tolerance Test >200mg/dm
-HgBA1C - hemoglobin test that is indicative of long term (90day) glucose levels. <6 is normal.
Term
Diabetes - Goals of Therapy
Definition
Maintain glucose WNL - 70-110 mg/dl via diet, excercise, SMBG, and insulin replacement
Term
Insulin Deficiency
Definition
- Puts body in catabolic states and proteins and fats are broken down to produce more energy
Term
Regular - Natural - Insulin
Definition
unmodified - rapid onsets, short duration, clear solution.
IV or SubQ.
No refrigerators.
Admin 30-60 min before meals
Term
Lispro Insulin
Definition
rapid acting. Effects in 15-30 min of aub Q inj. Lasts 3-6 hr. Adm. before eating. Used in combo with longer lasting insulins
Term
Basal Insulin
Definition
Detemir or Glargine
Term
Insulin Glulisine -Apidra
Definition
Rapid Acting
Type 1 & 2 for meal times.
IV approved or subQ or pump
Term
Neutral Protamine Hagedorn (HPN) Insulin
Definition
Regular insulin + Protamine (contains ZN) to slow absorptiion
Term
Incretin Mimetic
Definition
Exenatide - Byetta
NOT INSULIN
Only for D2.
Stimulates pancreatic cells, inhibits glucagon secretion
Term
Tight Glucose Control (pros and cons)
Definition
+: less kidney diseases, neuropathy, ophthalmic complications, less microvascular problems
-: hypoglycemia, more weight gain, patient compliance and expense
Term
Type II Diabetes - treatment
Definition
First line treatment: diet and excercise
Also, Oral Hypoglycemic Agents
Term
Oral Hypoglycemic Agents
Definition
Sulfonylureas, Meglitides, Biguanides, Thiazolidinediones, Alpha Glucosides Inhibitors, Incretin mimetics
Term
Sulfonylureas
Definition
promote insulin release
can cause hypersensitivity rxns
Peak 3-5 hr
can be used alone or in combo to control D2.
Term
Meglitides
Definition
Stimulate release of insulin, peak 1 hr.
Term
Biguanides
Definition
lowers blood glucose by suppressing gluconeogenesis at liver.
Can cause decreased appetite, nausea, vomiting, decreased absorption of b12, folic acid. Can cause lactic acidosis
Term
Thiazolidinediones
Definition
Reduce insulin resistance.
Benefits take weeks to develop.
Term
Alpha Glucosidase Inhibitors
Definition
delay absorption of carbs, reducing rise in glucose.
causes flatulence, cramps, abdominal distension, borborgymus, diarrhea
Term
Diabetic Ketoacidosis (DKA)
Definition
most severe manifestation of insulin deficit.
characterized by hyperglycemia, production of etoacids, hemoconcentration, acidosis, coma
Term
PKA Treatment
Definition
First - body fluid volume replacement, then replacement of loss K and glucose
Term
Insulin Overdose
Definition
Treated with glucagon, will cause glucose levels to rise and relax smooth muscles of GI tract
Term
*
Definition
Sulfonylureas are contraindicated for use in patients with an allergy to
sulfa, sulfonamides
Term
Pathway to Thyroid Hormones
Definition
TRH->TSH->T3 AND T4
Term
Hypothyroidism
Definition
can present with severe myxedema, lethargy, brittle hair and nails, constipation , decreased HR, cold intolerance

CAUSES: Autoimmune, insufficient iodine, thyroidectomy
Term
Treatment of Hypothyroidism
Definition
Replace missing hormones - Levothyroxine (T4)
Term
Hyperthyroidism
Definition
exopathalmose, thyrotoxicosis.

Caused by autoimmune disorder that makes IGG act as TSH. Treated by destroying, suppressing thyroid
Term
Levothyroxine (T4)
Definition
50-60mg daily
Term
Levothyroxine (T4)
Definition
Identical to natural hormone - converts to t3. Excessive dose --> hyper. PO or patenterally. Dosage by lab values.
Term
Hyperthyroidism Treatment
Definition
PKU -Propylthiouracil - inhibits thyroid hormone synthesis via two mechanisms:
1 - prevents oxide of iodide
2 - suppresses conversation of T3 to T4

Takes 3-12 weeks to take effect
Term
PTU - Proplythiouracil Indications
Definition
Graves Disease, adjuct to radiation therapy, prep for thyroid surgery, thyrotoxicosis
Term
Adv Effects of PTU
Definition
Agranulocytosis - serious toxicity c/b early sore throat and fever
Hypothyroism
Mouth Ulcers
Term
GH Functions
Definition
Acts though IGF-1 to stimulate growth of organs and tissues.
Inhibited by somatostatin
Causes serum glucose to rise by reducing cell utilization
Term
Growth Hormone Excess - Acromegaly
Definition
Treatment:
1) Surgical removal of pituitary
2) Suppression with Ocreotide (Sandostatin)
3. Pegvisomant - Somavert - GH receptor agonist
Term
GH Deficiency - Dwarfism
Definition
Treatment:
Sub Q or IM Somatrem Somatotropin
Term
Somatrem (Protropin)
Definition
GH made by recombinant DNA tech.
Approved for peds.
lyophilized powder, do not shake

SIDE EFFECTS: Hyperglycemia, hypothyroidism, autoimmune rsp to GH, interactions with glucocorticoids
Term
*
Definition
GH and Glucocorticoids OPPOSE each others' efficacy
Term
Prolactinemia
Definition
Treatment: Cabergoline (Dostinex) to suppress Prolactin release.


ADV RXN: N/HA
Term
Thyrotropin (TSH)
Definition
- Stimulates production of T3, 4
- promotes uptake of iodine
Term
Corticotropin (ACTH) - Adrenocorticotropic hormone
Definition
- produced by anterior pituitary
- stimulates adrenal glands to make more adenocortical hormone - i.e. cortisol and aldosterone
Term
Gonadotropins (FH, LSH)
Definition
Treat infertility via follicular formation and ovulation, spermatogenesis
Term
FSH
Definition
- acts on ovaries for follicular growth and development
- sperm production
Term
LH
Definition
-promotes ovulation and formation of the corpus luteum
- promotes testosterone synthesis by Leydig cells
Term
ADH
Definition
- peptide hormone that acts on kidneys conservation of water by increasing permeability of the DCT.
- vasoconstrictor
- controlled via osmolality
- deficiency = Diabetes Insipidus
- Treatment: Desmopressin
Term
Adverse Rxns to Desmopresssin
Definition
- Water intoxication - drowsiness, H/A --> coma, convulsions
- CV: vasoconstrictive --> angina/MI
Term
Adverse Rxns to Desmopresssin/Vasopressin
Definition
- Water intoxication - drowsiness, H/A --> coma, convulsions
- Vasopressin only: CV: vasoconstrictive --> angina/MI
Term
Glucocorticoids
Definition
Increases available glucose.
i.e. cortisol
- high doses result in diabetes-like symptoms
- promotes catabolism --> skin thnning, muscle wasting, negative nitrogen balance
- fat redistribution--> buffalo hump,puffy face, striae
Term
Physiological effects of cortisol
Definition
- blocks vasoconstriction, lowers BP
- increase in Hg, PMN
- supports muscle finction
- affect mood, cause excitabolity, irritability, mood lability
- increase in secretions in response to stress
Term
Mineralocorticoids - i.e Aldosterone
Definition
- influence renal processing of NA, K, H
- promotes potassium hemostasis and help maintains intravascular volume.
- promotes sodium reabsorption
Term
Aldosterone Insufficiency
Definition
Hyponatremia, hyperkalemia, cellular dehydration, reduction of ECF volume --> renal failure, circulatory collapse, death
Term
Cushing Syndrome (r/t adrenal hormone excess)
Definition
Caused by hyper-ACTH, hyper-glucocorticoids either by adrenal adenoma or administration of exogenous glucocorticoids
-Presentation: obesity, hyperglycemia, glycosuria, HTN, osteoporosis, muscle weakness & striae, hirsutism, immunosuppression
Term
Cushings Treatment
Definition
surgical removal, bilateral adrenalectomy
Mitotane
Term
Mitotane
Definition
Anticancer drug used for hypercortisolism. Selectively destroys adrenocortical cells
Term
Cortisol-inhibiting drugs
Definition
1) Mitotane
2) Aminoglutethimide
3) Ketoconozole - antifungal offlabel
Term
Primary Hyperaldosteronism
Definition
- Causes Hypo-K, Hyper-Na, HTN, metabolic alkalosis
- Trtmt: surgery, Spirnolactone (K-sparing diuretic), Captopril, Amiloride
Term
Adrenal Hormone Insufficiency
Definition
Causes: destruction of adrenal glands, inborn deficit, reduced ACTH, CRF secretion
Trtmt: replace hormones
Term
Addison's Disease - primary adrenalcortical insufficiency
Definition
- Weakness, emaciation, hypoglycemia, hyper-K, hypo-Na, bronze pigmentation
-Trtmt: HRT- hydrocortisone, cortisone, if mineralocorcoids needed - florinef, fludrocortisone
* Increase PRN for stress
Term
Acute Adrenal Crisis
Definition
- Hypotension, dehydration, lethargt, GI upset --> shock, lethal exodus
- caused by stress, inadequete replacement, abrupt withdrawal of trmt
Term
Congenital Adrenal Hyperplasia
Definition
- result of inborn deficit of enzymes needed for glucocorticoid synthesis
- Increased ACTH stimulates androgen production too -> masculinization of females
Trtmt: Ensure adequete glucocorticoids while preventing excess androgens
- hydrocortisone, cortisone
Term
Hydrocortisone
Definition
PO- chronics
IV, IM - crisis
Term
Cortisone
Definition
drug of choice for chronic insufficiency. PO, IM
Term
Fludrocortisone (Floinef)
Definition
- Preferred drug for Addison's Disease
- potent mineralocorticoid with glucocorticoid activity
-Adv. Rxns: Na/H2O retention -> edema, HTN, cardiac enlargment
Term
Parasympathetic
Definition
Lower HR, bronchoconstriction, SLUDD- salivation, lacrimation, urination, digestion, defecation
Term
Sympathetic
Definition
Dilates pupil to increase acuity, increases Hr, bronchodilation, inhibiton of secretions and peristalsis, converts glycogen to glucose, inhibits bladder contractions
Term
A-1 RECEPTOR
Definition
vasoconstriction of peripheral vessels
- E, Ne, Dopamine
Term
A-2 RECEPTORS
Definition
- reports to the CNS @ brainstem to give negative biofeedback for SNS
- NE, E
Term
B-1 RECEPTORS
Definition
Increases heart rate and strength
Activated by NE, E, Dopamine, Dobutamine
Term
B-2 Receptors
Definition
Bronchodilation and prevents uterine contractions. E, Terbutaline
Term
Dopamine Receptors
Definition
Increase kidney perfusion. Dopamine
Term
Epinephrine
Definition
Indications: Anaphylaxis, Cardiac Arrest
MOA: Stimulates a, B receptors
IM, Sub Q, or IV
ADV RXNS: Tachycardia, HTN, MI, Necrosis
EPI PEN, IV extravasion -> necrosis
Term
Norephinephrine
Definition
Indication: Shock. Will increase HR, BP
MOA: Stim A-1,2 B-1
Adv: Tachycardia, HTN, MI, tissue necrosis
IV extravasation, CV monitoring
Term
Terb
Definition
Term
Terbutaline - B2 agonist
Definition
Indications: Asthma, Preterm Labor
MOA - stim B-2 receptors
Adv: Tremors, Tachycardia - can have some corss over with B1 receptors and lead to acute heat failure bc of increased rate, strength
Term
Adrenergic Blockers
Definition
a-blockers - HTN, BPH - benign prostate hypertrophy
b - blockers - can be either non-specific and cardio selective
Term
Clonidine - Catapres
Definition
Central acting a-2 agonist.
Indications: HTN, drug withdrawal
MOA: decreased SNS outflow
Adv. Rxns: Dry mouth, fatigue, sedation, depression, rebound HTN
Term
Anticholinergics - Muscarinic Antagonists
Definition
- Decreased PNS stimulation
- Can lead to increased intraocular pressure, decreased salivation, GI, urinary. Increase HR
Term
Atropine (anticholinergic)
Definition
Indications: bradycardia, pre-op
Term
Tolterodine (Detrol)
Definition
Indication: overactive bladder
MOA: decreases detrusor/bladder contractions, m3 selective
Less side effects than other anticholinergics
Term
Electrical Conduction System
Definition
Specialized Nerve Tissue. Depolarization from ion shifts. Pulse originates at SA node (intrinsic pacemaker) travels to Av NODE -> Bundle branches-> Purkinje fibers -> ventricular contraction
Term
ECG Mechanical and Electrical Events
Definition
P- depolarization of atria
PR interval - conduction @ AV node
QRS - ventricular contraction
T - ventricular repolarizarion
(ab) U- delayed v. repolarization r/t hypo-K, digoxin toxicity
Term
Cardiac Output
Definition
HR X SV
Stroke Volume is determined by: preload, contractility, and afterload
preload: volume of blood in ventricles @ end of diastole before next contraction
contractility- ability of fibers to depolarize. force cntrl'd by ANS
afterload- peripheral resistance r/t size of ventricles, wall tension, arterial BP
Term
CV RISK FACTORS:
Definition
modifiable - HTN, hyperlipidemia, diabetes, smoking, ++ ETOH, obesity, sedentary lifestyle
NOT MODIFIABLE- Family Hx, age, race, sex
Term
A,B Receptors in Heart
Definition
a-1: increase contractility - inotropic effect
B-1: increase heart rate - chonotropic, force - inotropic
Term
Renal response to SNS stimulation:
Definition
- decreased blood flow to kidneys
- lowers blood NA
- renin release -> ang 1->ang 2-> increased blood pressure r/t vasoconstriction

- ANG II stimulates adrenal glands increases aldosterone, increase NA/H20 retention -> increase blood volume, cardiac output

- Prostaglandins - fatty acids - vasodilator of systemic circulation - decreases SVR, BP
Term
ACE INHIBITORS - "PRIL"
Definition
- MOA: blocks conversion of AngT I->II, lowering production of aldosterone-> less salt retention, more potassium retained
Indications: HTN, HF
Adv. Rxns: hypo-tn, GI distress, non-productive cough, h/a, ANGIOEDEMA
PREG D
RENAL ARTERY STENOSIS????
Lowers blood volume, reduces preload.
Term
Angiotension receptor blockers - ARB
"Sartans"
Definition
SIMILAR TO ACE INHIBITORS
Term
ARBS and ACE-INHIBITORS
Definition
Differences:
- ARBS do not reduce bradykinin
- ARBS have less incidence of angioedema
- ARBS have lower cost
- ARBS do not trigger cough
- ACE-inhibitors have more data proving that they extend life
- When either are used with high levels of potassium, a K-sparing diuretic or another anti-HTN meds -> high risk of hyperkalemia
Term
Calcium Channel Blockers CCBs
Definition
MOA: Role of CA ions - increase contractility of heart.

Dihydropyridine - works on peripheral arteries to lower vasoconstriction

vs.

Non-dihydropyridine - lowers HR, conduction speed
Term
Dihydropyridines
- Nifedipine (Procardia)
- Amiodipine (Norvasc)
Definition
CCB
INDICATIONS: HTN, angina
ADV RXNS: hypo-HTN, H/A, edema
LOWERS afterload, contractility
Term
Beta Blockers ("lol")
Definition
MOA - block B receptors to lover HR, contracility and CO
INDICATIONS: HTN,tachycardia, post MI, or myocardial ischemia
ADV RXNS: brachycardia, hypo-tn, fatigue, bronchconstriction, ED

Use cardio-selective B-blockers (vs.non) for asthma or COPD comorbidities
Term
Diuretics
Definition
Blocks reabsorption of NA from nephron, lowering Na H20 retention
-Can result in hypovolemia, hypotension, electrolyte imbalances
Term
Loop Diuretics - i.e. Furosemide (Lasix)
Definition
MOA - acts on Loop of Henle
Indications - Heart, Renal Failure
Adv Rxns: hypo-t, dehyrdration, electrolyte imbalance, low K, low CA
- IV - if pushed too fast - ototoxicity
- PO - orthostatic HTN

Indications: BUN, CREATININE, skin turgor, daily wt. chks.
Term
Thiazine Diuretics - hydrochlorithiazine
Definition
MOA - DCT
Indications : HTN
Term
Spironolactone (Aldalactone)
Definition
MOA: aldosterone blocker - less NA/h20 retention
INDICATIONS: HF, cirrhosis
Term
Arrhythmias
Definition
-abnormal rhythm of heartbeat involving issues in the conduction system and effecting cardiac output
- caused by: assc. pathways, conduction defects, MI, CAD, myocasrdial hypertrophy, acid-base imbalances, alcohol, hypoxia, thyroid disease, anti-arrhythmic meds

TRTMT: correct underlying cause, electricity, ablation of defected tissue, drugs
Term
*
Definition
ANY DRUG USED TO TREAT AN ARRHYTHMIA CAN CAUSE AN ARRHYTHMIA
Term
Lidocaine
Definition
1) anesthesitic properties
2) can cause neurotoxicity
3) IV administation
4) short half-life
Term
Amiodarone
Definition
ATRIAL AND VENTRICULAR FIBRILLATION
- highly effective
-Reduces SA activity, AV conduction velocity.
- Prolonged PR, QRS, QT. Lengthens heartbeat
-FIRST LINE OF VENTRICULAR FIBRILLATION
Term
Effects of HTN on the body
Definition
Acute: None - typically asymptomatic
Longterm: Increased strain on heart, risk of MI, stroke, renal failure, organ damage.
=> CAD, PVD, CVD, L. Ventricular hypertrophy, nephroscelrosis
Term
JNC-VII Evidence Based Care
Definition
1) Target lifestyle modifications
2) Isolated systolic HTN is especially alarming and must be controlled
3) FIRST LINE: THIAZINE DIURETICS
4) May have to use drug combos
Term
BP Classification for Adults
Definition
Normal : <120/80
Pre-HTN: <139/89
HTN I: <159/99
HTN II: 160/100+
Term
HTN emergencies
Definition
X/>120. gradually lower. IV infusion - sodium nitroprusside. requires continuous monitoring.
Term
Sodium Nitroprusside (Nitropress)
Definition
IV infusion for gradually lowering BP. Dilates both arterioles and veins to lower afterload and preload (lowers venous return). Risk of thiocyanate toxicity. BP, CNS, drug levels must be continuously monitored.
Term
Labetalol (Normodyne)
Definition
- Slow IV push a-B blocker
Term
*
Definition
Beta blockers can mask warning signs of hypoglycemia!
Term
Amiodarone Toxicities and Interactions
Definition
- Has a very long half-life and thus high potential for pulmonary, thyroid, liver, opthamologic toxicities. Causes blue-grey skin discoloration.

Increases levels of phenytoin, digoxin, diltiazem, warfarin
Term
Adenosine (Adenocard)
Definition
- First Line for Supraventricular tachycardia SVT.
- IV, rapid onset and short half life
Adv. Rxns: Sinus pause, dyspnea, hypo-t
Term
CAD - Coronary Artery Disease - Pathophysiology
Definition
Lipid deposits accumulate in the arteries and calcify over time. Platelet, thrombin, fibrin are attracted and assemble a larger mass = thrombus. Overtime this vessel is injured and platelets completely block the artery lead to infarction.
Term
Angina Pectoris
Definition
- RESULT OF INSUFFICIENT BLOOD FLOW TO THE MYOCARDIUM
- Chest pain resulting from reversible myocardial ischemia from temporary block of blood flow to muscle. Causes hypoxia, pain.
Term
Types of Angina
Definition
1) Stable - predictable, with exertion
2) Unstable - occurs @ rest, more severe and can be difficult to relieve.
3) Prinzmetal's
Term
Treatment of Stable Angina
Definition
- Increase blood flow to myocardium:
- Lifestyle changes, antiplatelets (ASA or Plavix), Statins to lower LDL, Nitroglycerin for vasodilation, B-blockers to lower HR, contractility (oxygen use), CCB (lower contractility)
Term
Adult Treatment Panel (ATP) III
Definition
- Target LDL, lifestyle mods
- low HDL <40 is a risk factor
- high HDL >60 is a protective factor
- triglycerides should be <150
Term
HMG-CoA reductase Inhibitors (STATINS)
Definition
- MAJOR: Lower LDL some: lower triglycerides, raise HDL
- Great outcomes, safe, well-tolerates
- lowers risk of MI, mortality
Term
STATINS ADV RXNS AND INDICATIONS
Definition
- Increased risk of myositis - inflammation of the skeletal muscle and rhabdomyolosis.
Risk increased with used with fibric acid
- Need to monitor liver functioning tests - AST, ALT. CPK also.
-CYP 3A4 - antibiotics, grapejuice, antifungals
- PREG X
-
Term
Fibric Acids Derivatives (Fibrates)
- Gemfibozil (Lopid)
- Fenofibrate (Tricor)
Definition
- Lower triglycerides, raise GDL
-Adv. Rxns: myositis, liver tox, gall stones
Term
Niacin
Definition
- Lowers LDL, raises HDL
- Not first line bc of ADV RXNS:
liver toxicity, flushing, hyperglycemia, hyperuricemia
Term
Nitroglycerin - Nitrates
Definition
MOA: Vasodilate coronaries, lower venous return to decrease preload and increase effusion
ADV: Hypo-t, H/A
Has a tolerance, needs withdrawal periods to remain effective.
- LIFE THREATENING INTERACTIONS WITH ED DRUGS, SUPPLEMENTS. HYPO-T.
- sublingual tablet, spray for blood stream absorption
-maintenance patch - needs withdrawal breaks
-ointments and IV too
- Patient Education: Allow sublingual tablet to dissolve naturally under tongue. If pain does not improve after 5 mins, 911 and take up to 3 more tablets Q5min. ED meds. Proper storage bc unstable - dark glass vial.
Term
Myocardial Infarction - MI
Definition
Ischemia progresses to infarction - complete block, hypoxia. Typically involves left ventricle
TRTMT: MOMA - Morphine, Oxygen, Nitroglycerin, Aspirin
Also, herparin, a-B blockers, thrombolytics
Term
Coagulation
Definition
Damage to vessel exposes collagen -> attracts platlets to plug-> Intrinstic/Extrinstic Pathways --> Factor X-> Prothrombin-> Thrombin.
Term
Anti-platelet
Definition
- primarily arterial effect to prevent MI by decreasing platelet aggregation
- Low dose asparin or Clopidogrel (Plavix)
- risk of GI bleed, hemorrhagic stroke
Term
Anticoagulants
Enoxaparin (Lovenox)
Dalteparin (Fragmin)
Fondaparinux (Arixtra)
Definition
- Prevent Intrinisic Pathway via Factor Xa (thrombin for unfractionated)
- Unfractionated Heparin
- Low molecular Weight (LMW) Heparin
Term
Unfractionated Heparin
Definition
Inhibits Intrinisic Pathway via thrombin and Xa.
- Given IV or SubQ.
- Has short half life
- aPTT (part of the clotting cascade) levels must be monitors to prevent hemorrhage
- Can cause Heparin-Induced Thrombocytopenia - patient forms antibodies vs heparin and attacks own platelets.

NEED aPTT, CBC drug levels
Term
Warfarin (Coumadin)
Definition
- Prevents extrinsic pathway to clotting r/t Vit K.
- only oral coagulant
- long half life and takes day to reach therapeutic levels so overlap dosage with heparin
- Interactions with many drugs, foods
- PREG X
- Monitor PT/INR LEVELS! SHOULD BE BETWEEN 2-3 for indications. Slightly higher for mechanical heart valves.
- Antidote for toxicity: Vitamin K (allows blood to clot), fresh frozen plasma (FFP), activated clotting facotrs.
Term
Warfarin Patient Teaching
Definition
- Observe for bleeding, higher risk for hemorrhage
- Must have PT/INR frequently assessed
- DO NOT MAKE UP MISSED DOSES
- Avoid any non-approved other drugs, foods for interactions.
- Avoid trauma, have medic alert bracelet
- use direct pressure to stop bleeding
Term
High Risk of Adverse Events r/t drugs
Definition
3 drugs =1/3 drug issues:
warfarin, digoxin, insulin
Term
Thrombolytics - Alteplase (tPA),Reteplase
Definition
Actually dissolve rather than prevent clots.
INDICATIONS: MI (w/n 6-12 hr), ISCHEMIC STROKE (w/n 3-4.5 hr), MASSIVE PE, DVT
- Labs priot. Must establish 2-3 IV line and infuse w. close monitoring for reperfusion or bleeding.
Contraindications: Active bleeding, coagulant defects, peptic ulcer disease, GI bleed w/n 6 months, past hemohaggic stroke, preg, surg w/n 3 months, aortic dissection. >180/110 BP.
Relative: Coumadin, CPR, CVA/TIA in last 12 months, renal/liver disease, hemorrhagic retinopathy
Term
HEART FAILURE
Definition
- inadequate coronary contractions, CO
heart fails to function as pump and blood goes backwards instead of forward.
Left side - hepatomegaly, peripheral edema
Right - pulmonary orthopnea, dysnpea, crackle
Term
HEART FAILURE COMPENSATORY MECHANISMS WORSE HEART DAMAGE AND NEED AN ARRAY OF DRUGS TO LESSEN
Definition
Heart attempts to increase CO via:
-Ventricular dilation
-Ventricular hypertrophy
-Increased SNS activity
-Hormonal response - Renin stimulated
- Myocardial Remodeling
Term
TREATMENT FOR HEART FAILURE
Definition
Ace-Inhibitors: block RAAS to reduce preload, afterload, mortality
B-blockers- decrease mortality by decreasing SNS stimulation
Diuretics - reduces volume, symptoms. does not increase longevity.
Dopamine - Beta 1 agonist
Dobutamine - B-1 slective
- Digoxin!
Term
Digoxin (Lanoxin) .5-20ng/mL
Definition
- Inhibits Na-K ATP-ase
- increase contractility
- decreases SA stim, AV conduction
- shortens refractory period
- narrow ther. range
- effect Na, K, Ca, Mg electrolytes
- risk of arrhythmias
Term
Digoxin Toxicities and Interactioons
Definition
Early toxicity: Anorexia, N/V, H/A, vision changes, bradycardia
Late: Heart block, ventricular arrythmia

Interactions
w. diurectic - electrolyte depletion
- B-blocks, CCBs - additive effects
- Can increase other serum levels
Term
Avoid in HF
Definition
CCBs, NSAIDS, anti-arrhythmics, glitazones
Term
COPD - Chronic Obstructive Pulmonary Disease
Definition
Encompasses:
1) Asthma
2) Emphysema
3) Chronic bronchitis
Term
COPD DRUGS
Definition
1) Anti-inflammatory glucocorticoids, leukotriene modifiers
2) Bronchodilators - B-2 Agonists
3) Bronchodilators - Methylxanthines
4) Anti-cholinergic drugs
Term
DRUGS FOR ASTHMA
Definition
Acute - epinephrine, short-acting bronchodilators, IV steroids.

Longer-last drugs are used for maintenance and to decrease number of flares
Term
Mast Cell Stabilizers
Definition
wrok to prevent mast cells from lysing and releasing pro-inflammatory cytokines.

ARE NOT RESCUE MEDS. TAKE UP TO SIX WEEKS TO REACH THERAPEUTIC EFFECT.
Term
Mast Cell Stabilizers - Cromoyln Sodium, Tildate
Definition
USED TO PREVENT COPD EXACERBATIONS, ASTHMA ATTACKS
work to prevent mast cells from lysing and releasing pro-inflammatory cytokines.

ARE NOT RESCUE MEDS. TAKE UP TO SIX WEEKS TO REACH THERAPEUTIC EFFECT.

Administered in metered dose inhalers and are taken 2-4 X/QD.

ADV. RXNS: cough, runny nose, throat irritation, unpleasant taste, H/A
Term
Cromolyn
Definition
ASTHMA PROPHYLAXIS, suppresses inflammation.

NOT A BRONCHODILATOR

Route - inhalation via metered dose or nebulizers

ADV RXN: cough, bronchospasm.

Considered safest of anti-asthma meds
Term
B-2 Adrenergic Agonists
short acting - Albuterol, Proventil, Ventolin, Xopenex, Maxair
long-acting: Serevent, Foradil
Definition
MOST EFFECTIVE RELIEF OF ACUTE BRONCHOSPASM, PREVENTION OF EXCERCISE INDUCED BRONCHOSPASM.

short-acting - "rescue" - cannot be used more than 4XQD. Overuse may indicate need for longer-lasting therapy additions.
Also long-acting formulations.

ADV RXNS (r/t overuse): tachycardia, angina, tremor, palpations, dysrythmias

Patient education: Crucial to distinguish differences between short and long acting inhalers. Long acting inhalers used alone are ineffective in emergency situations and can lead to higher incidences of mortality when used alone.

OVERUSE-->
Term
Respiratory Anticholinergics - Atrovent, Spiriva
Definition
- PREVENT MUSCLE BANDS AROUND AIRWAY FROM TIGHTENING

- Made for MDI and nebuluizers.
- Commonly used for COPD
- reduces bronchospasms
- no immediate effects, NOT A RESCUE DRUG
- Adv. Rxns: dry mouth, increased HR, decreased urine production

Note: IMPORTANT TO SPRAY INSIDE OF MOUTH TO PREVENT SPRAYING INTO EYE. WILL CAUSE PUPIL DILATION.
Term
Inhaled Glucocorticoids
Definition
- Most effective anti-asthmatic
- Decreases swelling, allergic-type reactions.
- raises blood sugar
- decreases body's ability to fight infection and to produce own glucocorticoids - must not be stopped abruptly

Adv. Rxns: OROPHARYNGEAL CANDIDASIS
, DYSPHONIA.
- gargle after administration to prevent thrush
Term
Methylxanthine (Theophylline aminophyline theodur)
Definition
IV, PO sprinkle BRONCHODILATOR
Narrow THERAPEUTIC RANGE: 10-20 mcg/mL

ADV RXNS (s/t excessive caffeine):
GI upset, heartburn, insomnia, H/A, nervousness/irritability, tachy-cardia, pnea.
TOXIC: N/V, seizures, hypoglycemia, dysrrythmia

*Requires strict adherence and outpatient blood tests to keep w/n therapeutic range
Term
Leukotriene Modifiers
Zileuton (Zyflo)
Zafirlukast (Accolate)
Montelukast (Singular)
Definition
- Suppress leukotrienes, bronchconstriction, and mucus production
Term
Upper Respiratory Symptoms TREATMENT
Definition
Antihistamines -
- 1st gen - benadryl. cause somulence
- 2nd gen - claratin - do not w. same benefit
Corticosteroid nasal sprays - Flonaz
Leukotrienne receptor antagonists
Anticholinergic sprays
Decongestants
Term
Histamine Receptors
Definition
H1 - causes vasodilation, increased capillary permeability, bronchoconstriction, CNS effects, urinary retention, somonlence
H2 - secretion of gastric acid (r/t to anti-ACH effects)
Term
Allergic RXNS and Treatment
Definition
Mild: rhinitis, itching, localized edema
Severe: Anaphylactic w. shock

TREATMENT OF SEVERE: EPINEPHRINE -
Increases HR, SV, blood sugar
Dilates pupils, skeletal muscle arterioles
Constricts peripheral, GI arterioles
Term
Decongestants
Definition
Stimulate adrengic receptors => vasoconstriction

Active ingredients: pseudoephedrine, phenylephrine - should not be taken with uncontrolled HTN bc it elevates HR, BP

Side effects: insomnia, anxiety, dizziness, excitability

Polypharmacy interactions: MAOIs, insulin, seizure meds, diet pills, asthma, HTN meds
Term
Mycobacterium tuberculosis TREATMENT
Definition
Active - INH, ethambutol, rifampin, pynzinamide
Latent - INH for 6-9
Vaccine

MEDS REQ LFTs - AST, ALT
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