Pharm2 Exam 4 Study Guide PDF

Walsh -- green Ray - Red **[Hyperthyroidism]** - **Cues/Causes** - **Causes-** thyroid adenoma, excessive iodine intake, Grave's disease. - Primary Hyperthyroid= TSH is decreased - **Cues-** - Increased HR, GI motility and appetite - Cardia...

Walsh -- green Ray - Red **[Hyperthyroidism]** - **Cues/Causes** - **Causes-** thyroid adenoma, excessive iodine intake, Grave's disease. - Primary Hyperthyroid= TSH is decreased - **Cues-** - Increased HR, GI motility and appetite - Cardiac dysrhythmias - Thyroid bruit - Dec. weight and hair loss - Insomnia, fatigue, nervousness - Heat intolerance - Irregular or absent menses - Exophthalmos - Goiter - Treatments - **I-131 (Radioactive potassium iodide)** - Therapeutic use - Hyperthyroidism - Used to suppress thyroid activity - **Propylthiouracil (PTU)** - Therapeutic uses - Hyperthyroidism - Grave's disease - Pre-surgery - Patient teaching - Ok 1^st^ trimester for thyroid storm - Report signs of infection - Due to agranulocytosis - Monitor for signs of hypothyroidism - Adverse/Side effects - Hepatotoxic, agranulocytosis - Bradycardia - Nausea - Hypothyroidism - Agranulocytosis - HA - Fever - Evaluate effectiveness. - Liver function test (ALT/AST) - Normal TSH And T4 levels indicate med is effective - **Methimazole** - Therapeutic uses - Hyperthyroidism - Grave's disease - Adverse effects - Hepatotoxic - Agranulocytosis- monitor for signs of infections - Fever, palpitations, CBC - Evaluate effectiveness. - Monitor LFTs, CBC, TSH - **Lugol's solution (non-radioactive)** - Therapeutic use - Hyperthyroidism - Shrink thyroid gland 10-14 days before thyroidectomy. - Thyroid storm - Complication - Thyroid storm - Cues - High fever - Tachycardia - Agitation - Restlessness - Treatment - Lugol's solution **Hypothyroidism- TSH stimulates the release of T3, T4** **Iodine plays a key role in the synthesis of T3/T4** - Causes/Cues - Causes- - Hashimoto's- autoimmune disorder and is the most common\*\*\* - Use levothyroxine - Radioactive iodine therapy used for hyperthyroidism. - Surgery for hyperthyroid or goiter - Iodine deficiency - Meds - Cues - Low T3, T4 and High TSH - Dec energy and appetite - Fatigue, weight gain and inc. sleep - Susceptible to cold - Myxedema \*\*\* - Severe form of hypothyroid - Dec. C.O. contractility - Cardiomegaly, pericardial effusion - Bradycardia - Dec. GI motility - Constipation and distension - Hypercholesterolemia - Periorbital edema - Treatment - **Levothyroxine** - Patient Education - Take in the morning, before breakfast. Answer: Ask them when they take it - Low to high dose - Taken for life. - Do not take for weight loss. - S/sx of too much- increased HR and hot flashes - Expected outcomes. - Weight loss, improved tolerance to environmental temperature, increased activity and increased pulse rate. - Black box warning - Use of thyroid hormone in treatment of obesity or weight loss is contraindicated. - Evaluate effectiveness. - Normal T4 and TSH **Corticosteroids (hydrocortisone)** - Therapeutic Uses - Addison's disease, inflammation, immune suppression - Asthma, allergies, cancers, COPD, gout, IBD - Patient Education - Must always be tapered, usually no longer than 2 weeks - Take at the same time with food. - Take as ordered, not when symptoms present - Adverse/Side effects - Immunosuppression, hyperglycemia, osteoporosis, fractures, peptic ulcers, clots, HTN - Long term effects- moon face and weight gain Steroid- - Increase risk of infection- suppresses immune system; report low grade fever - Teaching - Maintain calcium, report signs of infection, do not stop abruptly **Ketoconazole- antifungal to decrease steroid level in the body** - Therapeutic use - Cushing's disease- causes elevated BP - Too much ACTH **Octreotide** - Therapeutic use - Acromegaly - Too much GH **Cosyntropin** - Therapeutic use - Treat adrenocortical insufficiency - Resembles ACT and used to diagnose cause of insufficiency - Addison's disease- most common cause is stopping corticosteroids without tapering - Too little ACTH Negative feedback- mechanism by which the body indicates it no longer needs a specific stimulus **[Diabetes Insipidus]** - Manifestations of DI - Polyuria - Polydipsia - Treatment - Desmopressin (DDAVP)- Given for DI - How to administer SQ steps - Prepare injection as instructed - Wash site with soap and water or alcohol wipe - Pinch site slightly between fingers - Inject needle into skin and dispel med - Remove needle and discard in puncture proof container - Therapeutic uses - Diabetes insipidus, nocturnal enuresis, hemophilia A, von Willebrand disease (blood does not clot properly) - Adverse effects - Water intoxication- manage fluid status: drowsiness, HA, listlessness, coma - Nausea, abdominal pain/cramping, HTN - Evaluate effectiveness. - Monitor BP, NA and decreased urine output. - Monitor BP and fluid intake **[Diabetes Mellitus]** - Functions of the pancreas - When glucose levels are high, the blood stimulates the release of insulin from the pancreas, which functions as a control center. - Patho for type 1 and type 2 - Type 1- insulin dependent - Type 2- insulin resistance - Role of glucagon, glucose, and insulin - Glucagon- stored glucose that acts to increase blood glucose levels. - Glucose- the body's primary energy source - Insulin- acts to decrease blood glucose levels. - Evaluating diagnostic tests - Normal glucose- 70-110 - Hypoglycemia \126 indicates diabetes. - Hemoglobin A1C \> 6.5% indicates diabetes. - Glucose over the last 6-12 weeks - DM patients want \ - Hyperglycemia - Signs/symptoms - Polyuria - glucosuria - Elevated BS - Treatment - Insulin - Hypoglycemia- deadly, more dangerous than hyperglycemia - Signs/symptoms - Tremors - Clammy - Confusion - Slurred speech - Treatments - Juice/crackers if can swallow - IV dextrose- NPO - IM glucagon- No IV - **[Type 1]** - Insulin dosing schedule - Do NOT double doses. - Sliding scale interpretation - The amount of insulin needed to take depending on how high the patient's blood glucose is. - Complication of injections and prevention - Lipohypertrophy - Rotate injection sites. - **Insulin** - Patient teaching - Assess blood glucose prior to administration. - Use only insulin syringes. - Rotate sites to prevent lipohypertrophy. - Do not massage. - Clear to cloudy when mixing insulins. - Short acting before NPH - Roll NPH, do not shake. - Refrigerate unopened insulin. - Once opened, good for 30 days - Signs of hypoglycemia - Medical alert bracelet - Route of administration - Subcutaneous- Insulin cannot be given PO - Regular insulin is the only insulin that can be given IV. - Adverse effects/side effects - Hypoglycemia - Hypokalemia - Mixing regular and NPH - Rotate vial in hands - Disinfect tops of both vials - Inject air into isophane (NPH) vial - Inject air into regular insulin- always last - Withdrawal regular insulin into syringe - Withdrawal isophane (NPH) into syringe - Insulins by onset - Lispro - Regular - Isophane (NPH) - Glargine - **Rapid insulin** - Aspart/Lispro - Therapeutic use - Used to correct spikes associated with meals - Onset, peak, duration - Onset- 10-30 minutes - Peak 1-3 hours - Duration- 3-5 hours - Timing of meals - 5-10 minutes before meals - Lispro- Peaks 0.5-1 hour - **Short (Regular)** - Therapeutic use - Diabetic ketoacidosis, HHS - Onset, peak, duration - Onset- 30-60 min - Peak- 2-4 hours - Duration- 5-8 hours - Timing of meals - 30-60 min ac - NPH can be mixed with regular but not given for sliding scale. - **NPH (isophane)** - Therapeutic use - Intermediate acting glucose control - Onset, peak, duration - Onset- 1-2 hr - Peak- 4-12 hr - Duration- 18-24 hr - Long Acting- Lantus and Levemir - Cannot be mixed with other insulins - **[Type 2]** - **Metformin \[Biguanides\] FIRST LINE** - MOA: Decreases production of glucose in liver to help decrease insulin resistance - Decreases the absorption of B12 and folic acid - Therapeutic use - Type 2 DM - PCOS - Adverse effects - GI upset, poor appetite, metallic taste - When taken with garlic and ginseng, this can cause hypoglycemia - Evaluate effectiveness. - Hb A1C levels - Black box warning - Lactic acidosis - ETOH can increase risk for lactic acidosis. - Must stop medication 72 hours prior and post procedure with dye - **Dulaglutide/Semaglutide \[incretin enhancers\]- does not cause hypoglycemia.** - **Non-insulin antidiabetic weekly injectable** - MOA - Increases the effects of incretin which stimulates release of insulin and blocks release of glucagon. - Route - Subcutaneous once a week - Side effects - GI effects, increased HR, can be used for weight loss; weight loss is also a side effect - Contraindications - CKD - **Dapagliflozin \[Misc. drugs\]** - MOA - Allows glucose to be excreted in the urine. - Additional therapeutic uses - Type 2 DM - ??????????? - **Glimepiride/Glipizide \[sulfonylureas\]** - Therapeutic use - Stimulates the release of insulin from the pancreas. - Increases sensitivity of insulin receptors on target cells - Evaluate effectiveness. - Hgb A1C - Sitagliptin - Oral DM med that does not cause hypoglycemia Vitamin D is crucial for calcium absorption **[Drugs for Hematological disorders]** - **Ferrous sulfate** - Patient Education - Take with food to prevent GI upset. - Increase dietary fiber intake. - Do not take within 1 hour of bedtime. - Evaluate effectiveness. - Hgb, Hct - **Epoetin** - Therapeutic uses - CKD, Chemo, HIV - Nursing considerations - Monitor baseline RBC, H/H, BP - Given subcu 1-3x a week. - Onset 2 weeks - Monitor CBC - Do not agitate vial. - Adverse effects - HTN, MI, CVA, N/V/D, edema - **Cyanocobalamin (B12)** - Therapeutic uses - Pernicious anemia - Route - Nasally, IM/deep subcutaneous - **Thrombocytopenia platelets less than 150,000** - Cues - Easy bruising, petechiae, epistaxis, bleeding gums, black tarry stools, hematuria - Nursing actions - bleeding precautions - Platelet count - Instruct patient and family on bleeding precautions. - Medical management - glucocorticoids - **Filgrastim** - MOA - Binds to and stimulates immature neutrophils to divide and differentiate. - Therapeutic use - Neutropenia secondary to chemotherapy - Organ transplant, AIDS, chemo, stem cell transplants, malignancies - Evaluate effectiveness. - Monitor for bone pain, CBC and ANC (absolute neutrophil count) **[Drugs for Neoplasia]** **Doxorubicin** - Adverse effects - Cardiotoxicity irreversible cardiomyopathy, dysrhythmias - N/V, reversible hair loss - Bone marrow suppression - Secondary malignancies 1-3 years later - Black box - Severe myelosuppression - May manifest as thrombocytopenia, leukopenia and anemia. - Cardiotoxicity - Severe local necrosis if extravasation occurs. - Secondary malignancies 1-3 years later **Methotrexate** - Therapeutic uses - Choriocarcinoma - Osteogenic sarcoma, leukemias - Head/neck cancer, breast cancer, lung cancer - Non- Hodgkin's lymphoma - T-cell lymphoma - RA, Crohn's disease, psoriasis - Black box - Combined with NSAIDs can cause severe or fatal myelosuppression. - Hepatotoxic- liver cirrhosis - Ulcerative stomatitis and diarrhea which can lead to hemorrhagic enteritis and death from intestinal perforation. - Pneumocystis pneumonia - Pulmonary toxicity - Stevens-Johnson syndrome - Malignant lymphomas - AKI **Vincristine** - Class- - Natural product - Adverse effects - Nerve injury, numbness and tingling - Paralytic ileus, severe constipation - Muscular weakness, loss of reflexes - Reversible alopecia **Tamoxifen** - Therapeutic use - Blocks estrogen receptors on breast cancer cells - Non cytotoxic - Black box - Increased risk of uterine cancer **Med Math -5 questions**