Exam_2_Blueprint_and_Study_Guide.docx (3) new.docx

- - - - - **PCT:** The PCT has a high resorptive capacity. A large fraction (about 65%) of filtered sodium and chloride is reabsorbed at the PCT. In addition, essentially all of the bicarbonate and potassium in the filtrate is reabsorbed here. Solutes and water are reabsorb...

- - - - - **PCT:** The PCT has a high resorptive capacity. A large fraction (about 65%) of filtered sodium and chloride is reabsorbed at the PCT. In addition, essentially all of the bicarbonate and potassium in the filtrate is reabsorbed here. Solutes and water are reabsorbed at equal rations, so this urine remains isotonic. - **Loop of Henle:** The descending limb of the loop of Henle is freely permeable to water. Hence, as tubular urine moves down the loop and passes through the hypertonic environment of the renal medulla, water is drawn from the loop into the interstitial space. This process decreases the volume of the tubular urine and causes the urine to become concentrated (tonicity increases to about 1200 mOsm/L). - **Early segment of distal convoluted tubule:** About 10% of filtered sodium and chloride is reabsorbed in the early segment of the distal convoluted tubule. Water follows passively. - **Distal Nephron:** The distal nephron is the site of two important processes. The first involves exchange of sodium for potassium and is under the influence of aldosterone. The second determines the final concentration of the urine and is regulated by antidiuretic hormone (ADH). - **Sodium-Potassium Exchange:** Aldosterone, the principal mineralocorticoid of the adrenal cortex, stimulates reabsorption of sodium from the distal nephron. At the same time aldosterone causes potassium to be secreted. Although not directly coupled, these two processes---sodium retention and potassium excretion---can be viewed as an exchange mechanism. Aldosterone promotes sodium-- potassium exchange by stimulating cells of the distal nephron to synthesize more of the pumps responsible for sodium and potassium transport - - **Furosemide (LOOP diuretic) MOA**: acts in the thick segment of the ascending limb of the loop of Henle, blocks reabsorption of Na and Cl, preventing reabsorption of water which = profound diuresis even when renal blood flow and GFR are low. If tx is insufficient with just Lasix, it can +-----------------------+-----------------------+-----------------------+ | | | - **Hydrochlorothia | | | | zide/Microzide | | | | (Thiazide | | | | diuretic) MOA**: | | | | steroid | | | | derivative, | | | | promotes urine | | | | production by | | | | blocking | | | | reabsorption of | | | | Na and Cl in the | | | | early segment of | | | | the distal | | | | convoluted tubule | | | |  water retention | | | | in nephron and | | | | increased flow of | | | | urine | | | | | | | | - **Spironolactone/ | | | | Aldactone | | | | (Aldosterone | | | | Antagonist, | | | | potassium-sparrin | | | | g | | | | diuretic)**: | | | | blocks the action | | | | of aldosterone in | | | | the distal | | | | nephron  | | | | retention of K | | | | and excretion of | | | | Na. Diuresis is | | | | scanty because | | | | most Na has | | | | already been | | | | reabsorbed before | | | | reaching the | | | | distal tubule. | | | | | | | | - **Triamterene/ | | | | Dyrenium | | | | (non-aldosterone | | | | antagonist, | | | | potassium-sparrin | | | | g | | | | diuretic):** | | | | disrupts Na-K | | | | exchange in the | | | | distal nephron by | | | | direct inhibition | | | |  decreased Na | | | | reabsorption and | | | | reduced K | | | | secretion  Na | | | | excretion is | | | | increased K is | | | | conserved. | | | | Minimal diuresis. | | | | | | | | | | | | | | | | - - **Furosemide | | | | USE**: when | | | | rapid or | | | | massive | | | | mobilization | | | | of fluid is | | | | required such | | | | as pulmonary | | | | edema | | | | associated | | | | with CHF, | | | | edema from | | | | heart, liver, | | | | or kidney | | | | that haven't | | | | responded to | | | | other drugs, | | | | and/or HTN | | | | | | | | - - **Spirono | | | | lactone | | | | USE**: HTN, | | | | edema, CHF | | | | (blocking | | | | aldosterone | | | | creates | | | | protective | | | | effects), | | | | counteracts | | | | K-wasting | | | | diuretics, | | | | off-label: | | | | acne, hair | | | | loss, | | | | hirsutism, | | | | hormone | | | | therapy for | | | | transgender | | | | females. | | | | | | | | - **Triamterene | | | | USE**: HTN, | | | | edema, combo | | | | drug can | | | | augment Lasix | | | | and | | | | counteract K | | | | wasting | | | | effects | | | | | | | | - What factors | | | | should be | | | | considered when | | | | choosing which | | | | diuretic to | | | | prescribe a | | | | patient? Produce | | | | some example | | | | scenarios of when | | | | you would | | | | prescribe one | | | | versus the other. | | | | How does renal | | | | function come | | | | into play? | | | | | | | | - **Furosemide* | | | | *: | | | | more loss of | | | | fluid and | | | | electrolytes | | | | than any | | | | other | | | | diuretic, K | | | | wasting, do | | | | not give if K | | | | is low, beer | | | | criteria use | | | | in caution in | | | | pts over 65 | | | | who are at | | | | higher risk | | | | for | | | | hyponatremia | | | | | | | | - **Thiazide**: | | | | MUST have an | | | | adequate | | | | kidney | | | | function to | | | | work (minimum | | | | 20-30mL/min), | | | | CI with | | | | digoxin, | | | | lithium, and | | | | other HTN | | | | meds. | | | | | | | | - - - Loop & | | | | thiazide AE: | | | | hyponatremia, | | | | hypochloremia | | | | , | | | | dehydration, | | | | hypotension, | | | | hypokalemia, | | | | ototoxicity | | | | (loop), | | | | hyperglycemia | | | | , | | | | hyperuricemia | | | | , | | | | reduced HDL, | | | | increased LDL | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - **Spironolactone | | | | AE:** | | | | hyperkalemia | | | | (dysrhythmias), | | | | deep voice, | | | | impotence, | | | | menstrual | | | | irregularities, | | | | hirsutism | | | | | | | | - | | | | | | | | | | | | | | | | - How would you | | | | know if your | | | | patient was | | | | experiencing AE | | | | like ototoxicity, | | | | dehydration, hypo | | | | or hyperkalemia, | | | | and hypotension. | | | | What would be | | | | subjective and | | | | objective | | | | findings? | | | | | | | | - - - - - - | | | | - - | | | | | | | | - - - - - | | | | | | | | | | | | | | | | - RAAS: Decreased | | | | perfusion | | | | pressure in the | | | | afferent | | | | arteriole | | | | stimulates | | | | secretion of | | | | renin by | | | | juxtaglomerular | | | | cells  renin | | | | reacts with | | | | Angiotensin in | | | | liver to make | | | | Angiotensin I  | | | | Angiotensin I | | | | converts to | | | | Angiotensin II in | | | | the lungs  | | | | Angiotensin II | | | | causes | | | | vasoconstriction | | | | in the blood | | | | vessels  | | | | Angiotensin II | | | | becomes III in | | | | the adrenal | | | | cortex | | | | stimulating | | | | aldosterone | | | | release  | | | | Aldosterone | | | | increases Na and | | | | water | | | | reabsorption by | | | | kidney tubules | | | | which = increased | | | | blood volume & | | | | increased BP | | | | (slide 35) | | | | | | | | - | | | | | | | | | | | | | | | | - Drug of choice | | | | for pregnant | | | | women with mild | | | | pre-eclampsia: | | | | labetalol and | | | | methyldopa, MgSO4 | | | | used for seizures | | | | | | | | - In older adults, | | | | avoid central | | | | acting alpha | | | | agonists and | | | | peripheral alpha | | | | 1 antagonists, | | | | start low doses, | | | | risk of | | | | orthostatic | | | | hypotension is | | | | high | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - In African | | | | Americans, | | | | diuretics are | | | | 1^st^ choice. | | | | CCBs and α/β | | | | blockers are also | | | | effective. | | | | HOWEVER, | | | | monotherapy with | | | | β blockers or | | | | ACEIs is less | | | | effective in | | | | African Americans | | | | than in | | | | Caucasians. BUT | | | | for example, if | | | | pt is black and | | | | has DM I and | | | | proteinuria, give | | | | ACEI | | | | | | | | - When BP cannot be | | | | adequately | | | | controlled with a | | | | single drug, one | | | | of several | | | | two-drug | | | | combinations are | | | | recommended: an | | | | ACEI plus a | | | | thiazide | | | | diuretic, an ACEI | | | | plus a CCB, or a | | | | β blocker plus a | | | | thiazide. | | | | | | | | | | | | | | | | - HTN & CKD: ACE | | | | inhibitor + loop | | | | diuretic (avoid | | | | thiazide and | | | | potassium | | | | sparring drugs; | | | | ineffective), if | | | | intolerant to | | | | ACE, do ARB | | | | | | | | - - - - | | | | | | | | - - - - 25% | | | | decrease in | | | | stroke in | | | | patients | | | | 55-80 using | | | | losartan vs. | | | | atenolol, 20% | | | | decrease in | | | | DM with | | | | candesartan | | | | vs placebo | | | | | | | | - Compare and | | | | contrast ACE-I | | | | and ARB. What are | | | | the differences | | | | in these drugs? | | | | What are the | | | | similarities? | | | | When would it be | | | | better to | | | | prescribe one or | | | | the other? | | | | | | | | - ACEI "Prils": | | | | blocks the | | | | conversion of | | | | angiotensin I | | | | to II  | | | | vasodilation, | | | | decreased | | | | blood vol & | | | | cardiac | | | | remodeling, | | | | potassium | | | | retention and | | | | fetal injury | | | | can occur. | | | | ACEI also | | | | increase | | | | levels of | | | | bradykinin | | | | through the | | | | inhibition of | | | | Kinase II | | | | which also | | | | | | | | | | | | | | | | - How does a direct | | | | Renin inhibitor | | | | work? What | | | | patient teaching | | | | would be included | | | | with our | | | | prototype drug in | | | | this class? | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | - - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - - - ***Curren | | | | t | | | | guidelines*** | | | | recommend adding | | | | an aldosterone | | | | antagonist to HF | | | | therapy but only | | | | in pts with | | | | symptoms despite | | | | tx with ACEIs and | | | | BBs | | | | | | | | - - | | | | | | | | | | | | | | | | - MOA? Prevent | | | | calcium ions from | | | | entering cells. | | | | Biggest effect on | | | | heart, blood | | | | vessels, vascular | | | | smooth muscle | | | | (VSM).  prevents | | | | contraction  | | | | vasodilation. | | | | Similar effect on | | | | heart as Beta | | | | blockers; reduce | | | | hearts | | | | contractile | | | | force, reduce HR, | | | | suppress | | | | conduction | | | | through AV node | | | | | | | | - - CI? | | | | Hypotension, sick | | | | sinus syndrome, | | | | 2^nd^ or 3^rd^ | | | | degree HB, | | | | grapefruit juice, | | | | can intensify | | | | effects of beta | | | | blockers | | | | | | | | - - - | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | - - | +-----------------------+-----------------------+-----------------------+ - With the IR formulation, blood levels of nifedipine rise quickly; hence blood pressure drops quickly and the reflex is turned on. Conversely, with the SR formulation, blood levels of nifedipine rise slowly, so blood pressure falls slowly and the reflex is blunted. So usually the SR/ER is prescribed and coupled with beta blockers to avoid this and decrease anginal pain! - Use: Long-term use reduces the rates of overt heart failure, coronary angiography, and coronary bypass surgery but not rates of stroke, myocardial infarction, or death. Also, because nifedipine causes minimal blockade of calcium channels in the heart, the drug is not likely to exacerbate AV block, heart failure, bradycardia, or sick sinus syndrome. **Nifedipine is preferred to verapamil for patients with these disorders.** - Pt education: Record anginal episodes, BP, AE - What would you teach your patient about the use of ***hydralazine***? - MOA: dilates arterioles  decrease peripheral resistance & lowers arterial BP - Use: HTN crisis, HF (reduces afterload for a short time in CHF) - Can be used in infants 1 month - Was common in past, now it has been replaced by newer antiHTN meds - Requires combo with BB to prevent *reflex tachycardia* - CI: CAD  angina attacks - High risk for falls in older adults (polypharmacy & orthostatic hypotension) - Review patho and stages of HF (4 stages) +-----------------------+-----------------------+-----------------------+ | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - | | | | | | | | | | | | | | | | - - What is the | | | | difference | | | | between the | | | | two beta | | | | blockers | | | | presented in | | | | the modules? | | | | Consider when | | | | these drugs | | | | are CI. | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | - | +=======================+=======================+=======================+ | | | - - | | | | | | | | | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - - | | | | | | | | | | | | | | | | - What are the | | | | indications for | | | | **Ezetimibe | | | | (Zetia)**? When | | | | would you use one | | | | or the other in | | | | addition to a | | | | statin? | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | - - - | | | | | | | | - - How do you | | | | diagnose | | | | metabolic | | | | syndrome | | | | (syndrome X) | | | | -- a bunch of | | | | metabolic | | | | abdnormalitie | | | | s | | | | associated w/ | | | | high risk for | | | | AASCVD & DM | | | | II: | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - - - Nitroglyc | | | | erin | | | | (Organic | | | | Nitrate) -- | | | | acts directly | | | | on vascular | | | | smooth muscle | | | | (VSM) to | | | | promote | | | | vasodilation | | | | (mostly in | | | | veins), | | | | nitrate gets | | | | taken up by | | | | VSM & | | | | converted to | | | | Nitric oxide | | | | | | | | | | | | | | | | - Ranolazine | | | | (Ranexa) -- | | | | reduces Na & Ca | | | | in myocardial | | | | cells, used for | | | | 1^st^ line tx for | | | | chronic angina, | | | | often combined w/ | | | | nitrates, BBs, | | | | CCBs. Need EKG | | | | and renal | | | | function prior to | | | | starting due to | | | | the drug | | | | affecting the QT | | | | wave in the | | | | heart. This does | | | | not treat acute | | | | angina this is | | | | for chronic | | | | management. | | | | | | | | | | | | | | | | - - - - - - | | | | | | | | | | | | - - - | | | | | | | | - - | | | | | | | | | | | | | | | | - - What are | | | | presenting | | | | s/s of | | | | vitamin B12 | | | | deficiency? | | | | Anemia & | | | | injury to the | | | | nervous | | | | system | | | | (neurologic | | | | damage may | | | | never | | | | resolve) | | | | | | | | - In most | | | | cases, | | | | vitamin B12 | | | | deficiency is | | | | the result of | | | | impaired | | | | absorption | | | | resulting | | | | from regional | | | | enteritis, | | | | celiac | | | | disease, | | | | antibodies | | | | against | | | | intrinsic | | | | factor, and | | | | bariatric | | | | surgery and | | | | can cause a | | | | megaloblastic | | | | and | | | | macrocytic | | | | anemia | | | | | | | | - Causes | | | | demyelination | | | | of neurons | | | | causing | | | | paresthesias | | | | and reduced | | | | DTRs, later | | | | leading to | | | | loss of | | | | memory, mood | | | | changes, | | | | hallucination | | | | s, | | | | and psychosis | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - | +=======================+=======================+=======================+ | | | - - - | | | | | | | | - - - - | | | | | | | | - - - - | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - - | | | | | | | | | | | | | | | | - - - - | | | | | | | | - - Guided by | | | | person-center | | | | ed | | | | tx factors | | | | (comorbiditie | | | | s, | | | | tx goals, | | | | social | | | | determinants | | | | of health, | | | | lifestyle) | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | - An | | | | angiotensin-conve | | | | rting | | | | enzyme (ACE) | | | | inhibitor (e.g., | | | | lisinopril) or an | | | | angiotensin II | | | | receptor blocker | | | | (ARB; e.g., | | | | | | | | | | | | | | | | - Metformin or | | | | combo therapy | | | | | | | | - Early intro of | | | | insulin should be | | | | considered if | | | | there is evidence | | | | of ongoing | | | | catabolism | | | | (weight loss), | | | | hyperglycemia | | | | s/s, or when A1C | | | | levels (\>10%) or | | | | BG levels (\>300) | | | | are high. | | | | | | | | - - | | | | | | | | | | | | | | | | - What is the A1C | | | | target goal for | | | | older adults? | | | | What are older | | | | adults at risk | | | | for and how | | | | should their | | | | management be | | | | personalized? | | | | | | | | - At risk for | | | | overtreatment | | | | & | | | | polypharmacy; | | | | tx goals | | | | should be | | | | de-intensifie | | | | d | | | | and | | | | simplified to | | | | reduce | | | | hypoglycemia | | | | risk | | | | | | | | - A1C goal is | | | | individualize | | | | d. | | | | For pts with | | | | a hx of | | | | severe | | | | hypoglycemia | | | | & limited | | | | life | | | | expectancy | | | | target should | | | | be \ | | | | | | | | - - | | | | | | | | 1. Biguanides | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | 2. Sulfonylureas | | | | | | | | - | | | | | | | | | | | | | | | | 3. Meglitinides | | | | (Glinides) | | | | | | | | - | | | | | | | | | | | | | | | | 4. Thiazolidinedione | | | | s | | | | | | | | 5. Alpha glucosidase | | | | inhibitors | | | | | | | | - - - | | | | | | | | 6. Gliptins | | | | (Depeptidyl | | | | Peptidase-4 | | | | Inhibitors) | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-----------------------+-----------------------+-----------------------+ | | | 7. Sodium-glucose | | | | cotransporter 2 | | | | inhibitors | | | | (SGLT-2) | | | | | | | | - | | | | | | | | | | | | | | | | 8. Glucagon-like | | | | peptide-1 | | | | receptor | | | | antagonist | | | | (GLP-1) or | | | | (incretin | | | | mimetics) -- | | | | preferred to | | | | insulin when | | | | possible or | | | | combined with | | | | insulin for | | | | better efficacy, | | | | weight & | | | | hypoglycemia | | | | benefit | | | | | | | | - | | | | | | | | - | | | | | | | | | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ +-------+-------+-------+-------+-------+-------+-------+-------+-------+ | | | - C | | | | | | | | | | ompar | | | | | | | | | | e | | | | | | | | | | a | | | | | | | | | | nd | | | | | | | | | | c | | | | | | | | | | ontra | | | | | | | | | | st | | | | | | | | | | t | | | | | | | | | | he | | | | | | | | | | d | | | | | | | | | | iffer | | | | | | | | | | ent | | | | | | | | | | t | | | | | | | | | | ypes | | | | | | | | | | o | | | | | | | | | | f | | | | | | | | | | i | | | | | | | | | | nsuli | | | | | | | | | | n. | | | | | | | | | | K | | | | | | | | | | now | | | | | | | | | | t | | | | | | | | | | he | | | | | | | | | | o | | | | | | | | | | nset, | | | | | | | | | | p | | | | | | | | | | eak | | | | | | | | | | a | | | | | | | | | | nd | | | | | | | | | | d | | | | | | | | | | urati | | | | | | | | | | on | | | | | | | | | | o | | | | | | | | | | f | | | | | | | | | | e | | | | | | | | | | ach | | | | | | | | | | p | | | | | | | | | | rotot | | | | | | | | | | ype | | | | | | | | | | i | | | | | | | | | | nsuli | | | | | | | | | | n. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E | | | | | | | | | | ffect | | | | | | | | | | s | | | | | | | | | | o | | | | | | | | | | n | | | | | | | | | | m | | | | | | | | | | etabo | | | | | | | | | | lism, | | | | | | | | | | c | | | | | | | | | | ardia | | | | | | | | | | c | | | | | | | | | | f | | | | | | | | | | xn, | | | | | | | | | | g | | | | | | | | | | rowth | | | | | | | | | | ( | | | | | | | | | | matur | | | | | | | | | | ation | | | | | | | | | | ), | | | | | | | | | | d | | | | | | | | | | evelo | | | | | | | | | | pment | | | | | | | | | | ; | | | | | | | | | | s | | | | | | | | | | timul | | | | | | | | | | ate | | | | | | | | | | t | | | | | | | | | | he | | | | | | | | | | m | | | | | | | | | | etabo | | | | | | | | | | lic | | | | | | | | | | r | | | | | | | | | | ate | | | | | | | | | | o | | | | | | | | | | f | | | | | | | | | | m | | | | | | | | | | ost | | | | | | | | | | c | | | | | | | | | | ells | | | | | | | | | | & | | | | | | | | | | i | | | | | | | | | | ncrea | | | | | | | | | | se | | | | | | | | | | c | | | | | | | | | | ardia | | | | | | | | | | c | | | | | | | | | | c | | | | | | | | | | ontra | | | | | | | | | | ctile | | | | | | | | | | f | | | | | | | | | | orce. | | | | | | | | | | S | | | | | | | | | | timul | | | | | | | | | | ate | | | | | | | | | | e | | | | | | | | | | nergy | | | | | | | | | | u | | | | | | | | | | se, | | | | | | | | | | h | | | | | | | | | | eart, | | | | | | | | | | g | | | | | | | | | | rowth | | | | | | | | | | & | | | | | | | | | | d | | | | | | | | | | evelo | | | | | | | | | | pment | | | | | | | +=======+=======+=======+=======+=======+=======+=======+=======+=======+ | | | | | | | | | | +-------+-------+-------+-------+-------+-------+-------+-------+-------+ | | | | | | | | | | +-------+-------+-------+-------+-------+-------+-------+-------+-------+ +-------+-------+-------+-------+-------+-------+-------+-------+-------+ | | | | | | | | | | +-------+-------+-------+-------+-------+-------+-------+-------+-------+ | | | | | | | | | | +-------+-------+-------+-------+-------+-------+-------+-------+-------+ | | | | | | | | | | +-------+-------+-------+-------+-------+-------+-------+-------+-------+ | | | - K | | | | | | | | | | now | | | | | | | | | | t | | | | | | | | | | he | | | | | | | | | | M | | | | | | | | | | OA, | | | | | | | | | | u | | | | | | | | | | se, | | | | | | | | | | c | | | | | | | | | | ontra | | | | | | | | | | indic | | | | | | | | | | ation | | | | | | | | | | s, | | | | | | | | | | t | | | | | | | | | | herap | | | | | | | | | | eutic | | | | | | | | | | g | | | | | | | | | | oal, | | | | | | | | | | l | | | | | | | | | | abora | | | | | | | | | | tory | | | | | | | | | | m | | | | | | | | | | onito | | | | | | | | | | ring, | | | | | | | | | | p | | | | | | | | | | otent | | | | | | | | | | ial | | | | | | | | | | a | | | | | | | | | | dvers | | | | | | | | | | e | | | | | | | | | | e | | | | | | | | | | ffect | | | | | | | | | | s, | | | | | | | | | | p | | | | | | | | | | otent | | | | | | | | | | ial | | | | | | | | | | i | | | | | | | | | | ntera | | | | | | | | | | ction | | | | | | | | | | s, | | | | | | | | | | a | | | | | | | | | | nd | | | | | | | | | | a | | | | | | | | | | ntido | | | | | | | | | | te | | | | | | | | | | f | | | | | | | | | | or | | | | | | | | | | t | | | | | | | | | | he | | | | | | | | | | n | | | | | | | | | | on-in | | | | | | | | | | sulin | | | | | | | | | | m | | | | | | | | | | edica | | | | | | | | | | tions | | | | | | | | | | u | | | | | | | | | | sed | | | | | | | | | | t | | | | | | | | | | o | | | | | | | | | | t | | | | | | | | | | reat | | | | | | | | | | d | | | | | | | | | | iabet | | | | | | | | | | es | | | | | | | | | | i | | | | | | | | | | nclud | | | | | | | | | | ing: | | | | | | | | | | | | | | | | | | | | 1 | | | | | | | | | |. Le | | | | | | | | | | vothy | | | | | | | | | | roxin | | | | | | | | | | e | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | a. | | | | | | | | | | b. | | | | | | | | | | USE: | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | for | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | all | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | hyp | | | | | | | | | | othyr | | | | | | | | | | oidis | | | | | | | | | | m, | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | myz | | | | | | | | | | edema | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | com | | | | | | | | | | a, | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | sim | | | | | | | | | | ple | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | goi | | | | | | | | | | ter | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | c. | | | | | | | | | | d. | | | | | | | | | | LAB: | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | TSH | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | and | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | fT4 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | re | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | che | | | | | | | | | | ck | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | at | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 6-8 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | wee | | | | | | | | | | ks | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | aft | | | | | | | | | | er | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | sta | | | | | | | | | | rting | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | the | | | | | | | | | | n | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | onc | | | | | | | | | | e | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | a | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | yea | | | | | | | | | | r | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | e. | | | | | | | | | | f. | | | | | | | | | | Inte | | | | | | | | | | racti | | | | | | | | | | ons: | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Man | | | | | | | | | | y | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | dru | | | | | | | | | | gs | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | dec | | | | | | | | | | rease | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | abs | | | | | | | | | | orpti | | | | | | | | | | on | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | so | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | spa | | | | | | | | | | ce | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | out | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | fro | | | | | | | | | | m | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | oth | | | | | | | | | | er | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | dru | | | | | | | | | | gs | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | by | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 4 | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | hou | | | | | | | | | | rs, | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | foo | | | | | | | | | | d | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | als | | | | | | | | | | o | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | dec | | | | | | | | | | rease | | | | | | | | | | s | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | abs | | | | | | | | | | orpti | | | | | | | | | | on. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | i. | | | | | | | | | | ii. | | | | | | | +-------+-------+-------+-------+-------+-------+-------+-------+-------+ +-----------------------+-----------------------+-----------------------+ | | | 2. Methimazole | | | | (Tapazole) | | | | | | | | a. b. USE: | | | | graves | | | | disease, | | | | adjunct to | | | | radiation, | | | | suppresses | | | | thyroid | | | | hormone prior | | | | to thyroid sx | | | | | | | | c. d. CI: | | | | pregnancy | | | | | | | | e. | | | | | | | | - - - - | +=======================+=======================+=======================+ | | | | +-----------------------+-----------------------+-----------------------+