Term
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Definition
carbohydrate metabolism disorder. symptoms result from lack of insulin or insulin resistance and resulting hyperglycemia.
Signs of DM are: polyuria, polydipsia, polyphagia |
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Term
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Definition
| excessive production and passage of urine |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Childhood, abrupt onset. 5-10% of all DM. |
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Term
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Definition
| Occurs in middle/old-age. Result of impaired insulin secretion and resistance to insulin's effects |
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Term
| Diabetic Screening (Risks for) |
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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 |
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Term
| Diabetes Diagnostic Tests |
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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. |
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Term
| Diabetes - Goals of Therapy |
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Definition
| Maintain glucose WNL - 70-110 mg/dl via diet, excercise, SMBG, and insulin replacement |
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Term
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Definition
| - Puts body in catabolic states and proteins and fats are broken down to produce more energy |
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Term
| Regular - Natural - Insulin |
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Definition
unmodified - rapid onsets, short duration, clear solution.
IV or SubQ.
No refrigerators.
Admin 30-60 min before meals |
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Term
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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 |
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Term
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Definition
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Term
| Insulin Glulisine -Apidra |
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Definition
Rapid Acting
Type 1 & 2 for meal times.
IV approved or subQ or pump |
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Term
| Neutral Protamine Hagedorn (HPN) Insulin |
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Definition
| Regular insulin + Protamine (contains ZN) to slow absorptiion |
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Term
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Definition
Exenatide - Byetta
NOT INSULIN
Only for D2.
Stimulates pancreatic cells, inhibits glucagon secretion |
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Term
| Tight Glucose Control (pros and cons) |
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Definition
+: less kidney diseases, neuropathy, ophthalmic complications, less microvascular problems
-: hypoglycemia, more weight gain, patient compliance and expense |
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Term
| Type II Diabetes - treatment |
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Definition
First line treatment: diet and excercise
Also, Oral Hypoglycemic Agents |
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Term
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Definition
| Sulfonylureas, Meglitides, Biguanides, Thiazolidinediones, Alpha Glucosides Inhibitors, Incretin mimetics |
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Term
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Definition
promote insulin release
can cause hypersensitivity rxns
Peak 3-5 hr
can be used alone or in combo to control D2. |
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Term
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Definition
| Stimulate release of insulin, peak 1 hr. |
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Term
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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 |
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Term
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Definition
Reduce insulin resistance.
Benefits take weeks to develop. |
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Term
| Alpha Glucosidase Inhibitors |
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Definition
delay absorption of carbs, reducing rise in glucose.
causes flatulence, cramps, abdominal distension, borborgymus, diarrhea |
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Term
| Diabetic Ketoacidosis (DKA) |
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Definition
most severe manifestation of insulin deficit.
characterized by hyperglycemia, production of etoacids, hemoconcentration, acidosis, coma |
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Term
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Definition
| First - body fluid volume replacement, then replacement of loss K and glucose |
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Term
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Definition
| Treated with glucagon, will cause glucose levels to rise and relax smooth muscles of GI tract |
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Term
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Definition
Sulfonylureas are contraindicated for use in patients with an allergy to
sulfa, sulfonamides |
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Term
| Pathway to Thyroid Hormones |
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Definition
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Term
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Definition
can present with severe myxedema, lethargy, brittle hair and nails, constipation , decreased HR, cold intolerance
CAUSES: Autoimmune, insufficient iodine, thyroidectomy |
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Term
| Treatment of Hypothyroidism |
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Definition
| Replace missing hormones - Levothyroxine (T4) |
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Term
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Definition
exopathalmose, thyrotoxicosis.
Caused by autoimmune disorder that makes IGG act as TSH. Treated by destroying, suppressing thyroid |
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Term
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Definition
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Term
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Definition
| Identical to natural hormone - converts to t3. Excessive dose --> hyper. PO or patenterally. Dosage by lab values. |
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Term
| Hyperthyroidism Treatment |
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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 |
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Term
| PTU - Proplythiouracil Indications |
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Definition
| Graves Disease, adjuct to radiation therapy, prep for thyroid surgery, thyrotoxicosis |
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Term
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Definition
Agranulocytosis - serious toxicity c/b early sore throat and fever
Hypothyroism
Mouth Ulcers |
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Term
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Definition
Acts though IGF-1 to stimulate growth of organs and tissues.
Inhibited by somatostatin
Causes serum glucose to rise by reducing cell utilization |
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Term
| Growth Hormone Excess - Acromegaly |
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Definition
Treatment:
1) Surgical removal of pituitary
2) Suppression with Ocreotide (Sandostatin)
3. Pegvisomant - Somavert - GH receptor agonist |
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Term
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Definition
Treatment:
Sub Q or IM Somatrem Somatotropin |
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Term
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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 |
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Term
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Definition
| GH and Glucocorticoids OPPOSE each others' efficacy |
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Term
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Definition
Treatment: Cabergoline (Dostinex) to suppress Prolactin release.
ADV RXN: N/HA |
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Term
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Definition
- Stimulates production of T3, 4
- promotes uptake of iodine |
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Term
| Corticotropin (ACTH) - Adrenocorticotropic hormone |
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Definition
- produced by anterior pituitary
- stimulates adrenal glands to make more adenocortical hormone - i.e. cortisol and aldosterone |
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Term
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Definition
| Treat infertility via follicular formation and ovulation, spermatogenesis |
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Term
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Definition
- acts on ovaries for follicular growth and development
- sperm production |
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Term
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Definition
-promotes ovulation and formation of the corpus luteum
- promotes testosterone synthesis by Leydig cells |
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Term
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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 |
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Term
| Adverse Rxns to Desmopresssin |
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Definition
- Water intoxication - drowsiness, H/A --> coma, convulsions
- CV: vasoconstrictive --> angina/MI |
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Term
| Adverse Rxns to Desmopresssin/Vasopressin |
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Definition
- Water intoxication - drowsiness, H/A --> coma, convulsions
- Vasopressin only: CV: vasoconstrictive --> angina/MI |
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Term
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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 |
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Term
| Physiological effects of cortisol |
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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 |
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Term
| Mineralocorticoids - i.e Aldosterone |
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Definition
- influence renal processing of NA, K, H
- promotes potassium hemostasis and help maintains intravascular volume.
- promotes sodium reabsorption |
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Term
| Aldosterone Insufficiency |
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Definition
| Hyponatremia, hyperkalemia, cellular dehydration, reduction of ECF volume --> renal failure, circulatory collapse, death |
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Term
| Cushing Syndrome (r/t adrenal hormone excess) |
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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 |
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Term
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Definition
surgical removal, bilateral adrenalectomy
Mitotane |
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Term
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Definition
| Anticancer drug used for hypercortisolism. Selectively destroys adrenocortical cells |
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Term
| Cortisol-inhibiting drugs |
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Definition
1) Mitotane
2) Aminoglutethimide
3) Ketoconozole - antifungal offlabel |
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Term
| Primary Hyperaldosteronism |
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Definition
- Causes Hypo-K, Hyper-Na, HTN, metabolic alkalosis
- Trtmt: surgery, Spirnolactone (K-sparing diuretic), Captopril, Amiloride |
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Term
| Adrenal Hormone Insufficiency |
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Definition
Causes: destruction of adrenal glands, inborn deficit, reduced ACTH, CRF secretion
Trtmt: replace hormones |
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Term
| Addison's Disease - primary adrenalcortical insufficiency |
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Definition
- Weakness, emaciation, hypoglycemia, hyper-K, hypo-Na, bronze pigmentation
-Trtmt: HRT- hydrocortisone, cortisone, if mineralocorcoids needed - florinef, fludrocortisone
* Increase PRN for stress |
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Term
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Definition
- Hypotension, dehydration, lethargt, GI upset --> shock, lethal exodus
- caused by stress, inadequete replacement, abrupt withdrawal of trmt |
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Term
| Congenital Adrenal Hyperplasia |
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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 |
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Term
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Definition
PO- chronics
IV, IM - crisis |
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Term
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Definition
| drug of choice for chronic insufficiency. PO, IM |
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Term
| Fludrocortisone (Floinef) |
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Definition
- Preferred drug for Addison's Disease
- potent mineralocorticoid with glucocorticoid activity
-Adv. Rxns: Na/H2O retention -> edema, HTN, cardiac enlargment |
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Term
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Definition
| Lower HR, bronchoconstriction, SLUDD- salivation, lacrimation, urination, digestion, defecation |
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Term
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Definition
| Dilates pupil to increase acuity, increases Hr, bronchodilation, inhibiton of secretions and peristalsis, converts glycogen to glucose, inhibits bladder contractions |
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Term
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Definition
vasoconstriction of peripheral vessels
- E, Ne, Dopamine |
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Term
|
Definition
- reports to the CNS @ brainstem to give negative biofeedback for SNS
- NE, E |
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Term
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Definition
Increases heart rate and strength
Activated by NE, E, Dopamine, Dobutamine |
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Term
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Definition
| Bronchodilation and prevents uterine contractions. E, Terbutaline |
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Term
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Definition
| Increase kidney perfusion. Dopamine |
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Term
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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 |
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Term
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Definition
Indication: Shock. Will increase HR, BP
MOA: Stim A-1,2 B-1
Adv: Tachycardia, HTN, MI, tissue necrosis
IV extravasation, CV monitoring |
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Term
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Definition
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Term
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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 |
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Term
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Definition
a-blockers - HTN, BPH - benign prostate hypertrophy
b - blockers - can be either non-specific and cardio selective |
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Term
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Definition
Central acting a-2 agonist.
Indications: HTN, drug withdrawal
MOA: decreased SNS outflow
Adv. Rxns: Dry mouth, fatigue, sedation, depression, rebound HTN |
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Term
| Anticholinergics - Muscarinic Antagonists |
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Definition
- Decreased PNS stimulation
- Can lead to increased intraocular pressure, decreased salivation, GI, urinary. Increase HR |
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Term
| Atropine (anticholinergic) |
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Definition
| Indications: bradycardia, pre-op |
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Term
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Definition
Indication: overactive bladder
MOA: decreases detrusor/bladder contractions, m3 selective
Less side effects than other anticholinergics |
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Term
| Electrical Conduction System |
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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 |
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Term
| ECG Mechanical and Electrical Events |
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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 |
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Term
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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 |
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Term
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Definition
modifiable - HTN, hyperlipidemia, diabetes, smoking, ++ ETOH, obesity, sedentary lifestyle
NOT MODIFIABLE- Family Hx, age, race, sex |
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Term
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Definition
a-1: increase contractility - inotropic effect
B-1: increase heart rate - chonotropic, force - inotropic |
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Term
| Renal response to SNS stimulation: |
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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 |
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Term
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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. |
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Term
Angiotension receptor blockers - ARB
"Sartans" |
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Definition
| SIMILAR TO ACE INHIBITORS |
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Term
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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 |
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Term
| Calcium Channel Blockers CCBs |
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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 |
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Term
Dihydropyridines
- Nifedipine (Procardia)
- Amiodipine (Norvasc) |
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Definition
CCB
INDICATIONS: HTN, angina
ADV RXNS: hypo-HTN, H/A, edema
LOWERS afterload, contractility |
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Term
|
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 |
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Term
|
Definition
Blocks reabsorption of NA from nephron, lowering Na H20 retention
-Can result in hypovolemia, hypotension, electrolyte imbalances |
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Term
| Loop Diuretics - i.e. Furosemide (Lasix) |
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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. |
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Term
| Thiazine Diuretics - hydrochlorithiazine |
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Definition
MOA - DCT
Indications : HTN |
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Term
| Spironolactone (Aldalactone) |
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Definition
MOA: aldosterone blocker - less NA/h20 retention
INDICATIONS: HF, cirrhosis |
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Term
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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 |
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Term
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Definition
| ANY DRUG USED TO TREAT AN ARRHYTHMIA CAN CAUSE AN ARRHYTHMIA |
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Term
|
Definition
1) anesthesitic properties
2) can cause neurotoxicity
3) IV administation
4) short half-life |
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Term
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Definition
ATRIAL AND VENTRICULAR FIBRILLATION
- highly effective
-Reduces SA activity, AV conduction velocity.
- Prolonged PR, QRS, QT. Lengthens heartbeat
-FIRST LINE OF VENTRICULAR FIBRILLATION |
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Term
| Effects of HTN on the body |
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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 |
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Term
| JNC-VII Evidence Based Care |
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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 |
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Term
| BP Classification for Adults |
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Definition
Normal : <120/80
Pre-HTN: <139/89
HTN I: <159/99
HTN II: 160/100+ |
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Term
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Definition
| X/>120. gradually lower. IV infusion - sodium nitroprusside. requires continuous monitoring. |
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Term
| Sodium Nitroprusside (Nitropress) |
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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. |
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Term
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Definition
| - Slow IV push a-B blocker |
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Term
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Definition
| Beta blockers can mask warning signs of hypoglycemia! |
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Term
| Amiodarone Toxicities and Interactions |
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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 |
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Term
|
Definition
- First Line for Supraventricular tachycardia SVT.
- IV, rapid onset and short half life
Adv. Rxns: Sinus pause, dyspnea, hypo-t |
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Term
| CAD - Coronary Artery Disease - Pathophysiology |
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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. |
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Term
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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. |
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Term
|
Definition
1) Stable - predictable, with exertion
2) Unstable - occurs @ rest, more severe and can be difficult to relieve.
3) Prinzmetal's |
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Term
| Treatment of Stable Angina |
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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) |
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Term
| Adult Treatment Panel (ATP) III |
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Definition
- Target LDL, lifestyle mods
- low HDL <40 is a risk factor
- high HDL >60 is a protective factor
- triglycerides should be <150 |
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Term
| HMG-CoA reductase Inhibitors (STATINS) |
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Definition
- MAJOR: Lower LDL some: lower triglycerides, raise HDL
- Great outcomes, safe, well-tolerates
- lowers risk of MI, mortality |
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Term
| STATINS ADV RXNS AND INDICATIONS |
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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
- |
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Term
Fibric Acids Derivatives (Fibrates)
- Gemfibozil (Lopid)
- Fenofibrate (Tricor) |
|
Definition
- Lower triglycerides, raise GDL
-Adv. Rxns: myositis, liver tox, gall stones |
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Term
|
Definition
- Lowers LDL, raises HDL
- Not first line bc of ADV RXNS:
liver toxicity, flushing, hyperglycemia, hyperuricemia |
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Term
|
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. |
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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 |
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Term
|
Definition
| Damage to vessel exposes collagen -> attracts platlets to plug-> Intrinstic/Extrinstic Pathways --> Factor X-> Prothrombin-> Thrombin. |
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Term
|
Definition
- primarily arterial effect to prevent MI by decreasing platelet aggregation
- Low dose asparin or Clopidogrel (Plavix)
- risk of GI bleed, hemorrhagic stroke |
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|
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 |
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Term
|
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 |
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Term
|
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. |
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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 |
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Term
| High Risk of Adverse Events r/t drugs |
|
Definition
3 drugs =1/3 drug issues:
warfarin, digoxin, insulin |
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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 |
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|
Term
|
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 |
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|
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 |
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Term
| TREATMENT FOR HEART FAILURE |
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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! |
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Term
| Digoxin (Lanoxin) .5-20ng/mL |
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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 |
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Term
| Digoxin Toxicities and Interactioons |
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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 |
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Term
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Definition
| CCBs, NSAIDS, anti-arrhythmics, glitazones |
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Term
| COPD - Chronic Obstructive Pulmonary Disease |
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Definition
Encompasses:
1) Asthma
2) Emphysema
3) Chronic bronchitis |
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Term
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Definition
1) Anti-inflammatory glucocorticoids, leukotriene modifiers
2) Bronchodilators - B-2 Agonists
3) Bronchodilators - Methylxanthines
4) Anti-cholinergic drugs |
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Term
|
Definition
Acute - epinephrine, short-acting bronchodilators, IV steroids.
Longer-last drugs are used for maintenance and to decrease number of flares |
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Term
|
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. |
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Term
| Mast Cell Stabilizers - Cromoyln Sodium, Tildate |
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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 |
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Term
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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 |
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Term
B-2 Adrenergic Agonists
short acting - Albuterol, Proventil, Ventolin, Xopenex, Maxair
long-acting: Serevent, Foradil |
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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--> |
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Term
| Respiratory Anticholinergics - Atrovent, Spiriva |
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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. |
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Term
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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 |
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Term
| Methylxanthine (Theophylline aminophyline theodur) |
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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 |
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Term
Leukotriene Modifiers
Zileuton (Zyflo)
Zafirlukast (Accolate)
Montelukast (Singular) |
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Definition
| - Suppress leukotrienes, bronchconstriction, and mucus production |
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Term
| Upper Respiratory Symptoms TREATMENT |
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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 |
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Term
|
Definition
H1 - causes vasodilation, increased capillary permeability, bronchoconstriction, CNS effects, urinary retention, somonlence
H2 - secretion of gastric acid (r/t to anti-ACH effects) |
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Term
| Allergic RXNS and Treatment |
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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 |
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Term
|
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 |
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Term
| Mycobacterium tuberculosis TREATMENT |
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Definition
Active - INH, ethambutol, rifampin, pynzinamide
Latent - INH for 6-9
Vaccine
MEDS REQ LFTs - AST, ALT |
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