Pharm 7 Review PDF

ANTERIOR PITUITARY GLAND Somatropin Growth hormone deficiency – underproduction, dwarfism Regulates linear bone growth AE: hyperglycemia, hypothyroidism, worsened scoliosis Monitor: glucose levels, thyroid levels, calcium levels Octreotide Growth hormone excess – overproduction,...

ANTERIOR PITUITARY GLAND Somatropin Growth hormone deficiency – underproduction, dwarfism Regulates linear bone growth AE: hyperglycemia, hypothyroidism, worsened scoliosis Monitor: glucose levels, thyroid levels, calcium levels Octreotide Growth hormone excess – overproduction, gigantism (children), acromegaly (adults) Suppresses/Inhibits growth hormone, glucagon, and insulin POSTERIOR PITUITARY GLAND Diabetes Insipidus Occurs when the pituitary gland does not produce enough ADH which causes too much fluid to be excreted by the kidneys causing dehydration Vasopressin Contracts vascular smooth muscle, ADH AE: hyponatremia, water intoxication syndrome Monitor: s/s of water intoxication → retention of too much water → overhydration/hypervolemia (pounding headache, drowsiness, confusion) ○ Think: hyponatremia (neurological) Desmopressin (DDAVP) Indicated for hemophilia A and von willebrand disease, nocturnal enuresis, DI Drug of choice (less potent than vasopressin) AE: hyponatremia, water intoxication, seizures Monitor: electrolytes (Na+, K+, BUN, Cr) Monitor: UO (1.5-2 L/day) ADRENAL GLANDS Fludrocortisone (Florinef) Replacement of mineralocorticoids Promotes increased reabsorption of Na+ and promotes loss of K+ from renal distal tubules Holds on to sodium, loses potassium AE: hypokalemia, HTN, HF, edema ○ Can lead to dangerous hypokalemia (avoid diuretics, especially potassium-wasting) Hydrocortisone Replacement of glucocorticoids Modifies the immune response of body to diverse stimuli AE: hyperglycemia, electrolyte imbalance, elevated BP, immunosuppression  Monitor: glucose levels, electrolyte levels (can cause water retention with hypernatremia and hypokalemia), increase BP, immunosuppression (fever) Do NOT administer vaccines such as influenza with treatment of glucocorticoids ○ Wait at least two weeks Glucocorticoids Patients should carry additional hydrocortisone tablets and have a vial of injectable hydrocortisone, needle, and syringe available at all times If you are on these long term and you don't feel good (sickly) and have a temp above 99.5 your daily dose may be doubled and you must carefully manage that hydration. If you start vomiting and are unable to tolerate, call providers THYROID GLAND Function of thyroid hormone: stimulant Levothyroxine Hypothyroidism medication Start low and increase as needed, narrow therapeutic window Educate to take on an empty stomach 30-60 minutes prior to breakfast or taking other medications Overtreatment symptoms: A-fib, MI, tachycardia, palpitations, hyperthyroid state (anxiety, fatigue, heat intolerance, fever, sweating, weight loss, hyperactivity, tremors) Undertreatment symptoms: hypothyroid (depression, weight gain, bradycardia, anorexia, cold intolerance, dry skin) Has cardiac stimulant effects ○ Monitor HTN, angina, ischemic heart disease → monitor apical pulse Thioamides - Methimazole Hyperthyroidism medication – graves disease Inhibits/blocks production of TH (T3/T4) Lugol’s Strong Iodine Solution Solution (ordered in drops) and mixed with water or orange juice Radioactive Iodine ○ Causes extensive tissue damage ○ Contraindicated for pregnant patients ○ Clients secretions are considered radioactive biohazard and special precautions should be taken with disposal PARATHYROID GLAND Calcitriol Vitamin D analog Reduces parathyroid hormone levels and improves calcium and phosphate homeostasis by stimulating bone resorption of calcium and increasing tubular reabsorption of calcium Alendronate Bisphosphonate Indicated for osteoporosis and paget’s disease Inhibits bone breakdown and decreases the rate of bone resorption leading to an indirect increase in bone density FEMALE REPRODUCTIVE SYSTEM Estrogens Conjugated equine estrogens Category X for pregnancy, breast feeding, clotting/circulation issues AE: thrombolytic events Systemic Side Effects: nausea Causes an increased risk of endometrial, uterine, breast cancer, stroke DVT Progesterone Medroxyprogesterone AE: thrombolytic events, liver dysfunction/jaundice Category X for pregnancy Estrogen-Progesterone Combinations Risk for thrombotic events, HTN Contraindicated in women over 35, smokers, history of cardiac or clotting events Emergency Oral Contraceptives Plan B Take one 1.5 mg tablet as soon as possible within 72 hours of unprotected sexual intercourse Oxytocin Uterine stimulant Drug for uterine motility - stimulates contractions, assists labor, induces labor Monitor moms vitals (BP, HR, fetal heart rate, labor progression) Terbutaline Tocolytic Medication Calm or slow uterine contractions, prevent preterm delivery Monitor moms VS (BP, HR, fetal heart rate) MALE REPRODUCTIVE SYSTEM Testosterone Androgens Adrenergic effects: voice deepening, weight gain, gynecomastia Given deep IM (not deltoid) 3 Black Box Warnings  ○ Significant BP increase – may be severe enough to cause major adverse cardiovascular events ○ Secondary Exposure – especially in children (virilization) Virilization: development of adult male characteristics Voice deepening edema, weight gain, high BP, development of facial hair ○ Pulmonary Microembolism from IM Injection – cough, dyspnea, chest pain, dizziness, syncope Can increase cholesterol → risk for prostate cancer Finasteride (Proscar) Used for long term BPH and prevention of male-pattern baldness No indications for female patients Contraindicated in females because of androgen effects (teratogenic) ○ Risk for absorption through skin – do not touch tablets, wear gloves Sildenafil (Viagra) Indicated for treatment of erectile dysfunction, timed in coordination with the onset of sexual activity Cannot be taken in combination with organic nitrates (nitroglycerin) or alpha-adrenergic blockers ○ Can cause potentially fatal hypotension URINARY SYSTEM Nitrofurantoin and Trimethoprim-Sulfamethoxazole Anti-infective Treats susceptible gram-positive and gram-negative pathogens Avoid use in older population (>65 years) Avoid use with warfarin Tamsulosin (Flomax) Vasodilation of arterioles and veins, relaxation of bladder and urinary tracts Used for BPH Can cause reduced BP Causes CNS problems (HA, dizziness, weakness) Causes cardiovascular problems (arrhythmias, orthostatic hypotension, edema, HF) Phenazopyridine Urinary analgesic Used to alleviate symptoms of dysuria, burning sensations, urgency, frequency, and pain related to urinary tract irritation Causes urine to turn reddish-orange Can interfere with urinalysis results