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578 Cards in this Set
- Front
- Back
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What is allergic rhinitis?
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Highly prevalent allergen-induced upper airway inflammatory disease
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What is the most common atopic disease in the US?
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Allergic Rhinitis
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Risk factors for allergic rhinitis (5)
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-Increase age
-Early food exposure -Heave maternal smoking -Indoor allergen exposure -Parental allergic disorder |
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During what times of the year is allergic rhinitis prevalent?
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Seasonal
Perennial |
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What is the goal of treatment for allergic rhinitis?
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Decrease symptoms, increase quality of life
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True or False: Allergic rhinitis is curable.
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False. Currently, there is no cure.
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What are two routes of treatment for allergic rhinitis?
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-Lifestyle changes
-Pharmacologic Therapy |
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What is the MOA of H-1 Antihistamines?
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H-1 antagonists/inverse agonists
Bind to and stabalize H-1 receptor Inhibit mast cell and basophil mediator release |
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What are the desired effects of H-1 antihistamines?
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Reduced sneezing, itching, ocular irritation
Reduces/eliminates effects of histamine |
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How would you classify the effects of H-1 antihistamines?
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Anti-cholinergic
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True or False: Second generation H-1 antihistamines have more adverse effects than first generation H-1 antihistamines.
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False. First generation has more adverse effects.
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What are some common side effects of H-1 antihistamines?
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Pupil dilation, blurred vision, double vision, decrease mucus production, dry/sore throat, dry-mouth, urinary retention, constipation, decreased sweating, increased temperature
**Can't see, can't spit, can't see, can't sh*t** |
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Name 4 first generation antihistamines.
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-Diphenhydramine
-Meclizine -Hydroxyzine -Promethazine |
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Do first generation antihistamines cross the BBB?
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Yes.
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How often are first generation antihistamines dosed? Why?
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Every 4-6 hours; short half life
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True or False. First generation Antihistamines cause CNS adverse effects.
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True.
Dry mouth, dry eyes, constipation, urinary retention |
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Name 2 second generation antihistamines.
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-Fexofenadine
-Desloratadine |
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Are second generation antihistamines sedating or non-sedating?
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Non-sedating
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Do second generation antihistamines cross the BBB?
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Not really...poor penetration
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Do second generation antihistamines have more or less CNS adverse effects than first generation antihistamines?
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Less
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Are second generation antihistamines available over-the-counter?
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Some are.
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Name the indications of antihistamines. (9)
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-allergic rhinitis
-allergic conjunctivitis -allergic dermatological conditions -urticaria -angioedema -pruritus -anaphylactic reactions -N/V -sedation (1st gen. only) |
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What is urticaria?
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Hives
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True or False. Diphenhydramine enters breast milk.
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True
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Name 3 side effects of Diphenhydramine.
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Drowsiness
Fatigue Diarrhea |
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How is diphenhydramine dosed? (How much, how often?)
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5 mg/kg/day
Every 6-8 hours |
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Is Diphenhydramine indicated for mild, moderate, or severe allergic reactions?
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Moderate or severe.
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What drug class does Diphenhydramine belong to?
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Antihistamines
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True or False. Phenergan is available with or without codeine.
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True
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What drug class(es) does Promethazine belong to?
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Antiemetic
Antihistamine Sedative |
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What form(s) is Promethazine available in?
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Tablet
Syrup Suppository Injection |
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Name 3 adverse effects of Promethazine.
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-Drowsiness
-Dizziness -Dry mouth |
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What is Promethazine use indicated for? (4)
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-Allergic reactions
-Sedative -Motion sickness -Post-operative pain |
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Should you refrigerate Promethazine suppositories or keep them at room temperature?
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Refrigerate
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How long does it take for the onset of action of Promethazine?
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15-20 minutes
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True or False. It is safe to give a 22 month old child Promethazine.
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False. Not for children under 2 years old.
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What is the purpose of coughing?
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Keep airways clear
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True or False. A cough is both a symptom and a disease.
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False. It is only a symptom, NOT a disease.
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What are some ways to classify a cough? (4)
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-Dry
-Productive -Acute -Chronic |
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What are some causes of a cough? (10)
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-Allergies
-Asthma -Lung infections/disease -COPD -Sinusitis -GERD -Smoking/Second hand smoke exposure -Air pollutants -ACE inhibitors -Croup |
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What drug class can cause a cough?
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ACE inhibitors
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What agents are used to treat a cough? (6)
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-Mucolytics
-Expectorants -Suppressants -Decongestants -Antihistamines -Pain Relievers |
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What do mucolytics do?
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Break down mucus
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What agents help bring up mucus and other material from lungs, bronchi, and trachea?
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Expectorants
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What is the FDA recommendation for OTC cough and cold medication use for children under the 2 years old?
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FDA: should NOT be used
However, some say not to use in children under 4 unless under the guidance of a health care professional. |
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How is Guaifenesin categorized?
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Expectorant
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What is/are the desired effects of Guaifenesin?
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-Loosen phlegm
-All for productive cough -Decreased chest congestion |
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Does Guaifenesin increase or decrease the lubrication of your lungs?
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Increases
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What is one main patient education point you should make about Gauifenesin?
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Drink lots of water.
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What drug class is Tussionex classified?
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Antitussive
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What is Tussionex's indication for use?
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Relief of cough
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What are the main adverse effects of Tussionex? (2)
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Drowsiness
Constipation |
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What are 2 key things to be included during patient education concerning Tussionex use?
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-Shake well
-Avoid alcohol |
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In what populations should Tussionex not be used?
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-Asthmatics
-Children under 6 years old |
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Name 2 antitussive agents.
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Chorpheniramine and Hydrocodone
Benzonatate |
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What is the goal of antitussives?
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Relief of cough
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Patients allergic to tetracaine or procaine should avoid what drug?
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Benzonatate
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What are 3 adverse effects of Benzonatate?
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HA
constipation Nausea |
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Is codeine found in cough products?
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Yes; in many
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Is codeine a narcotic or an opiod?
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Trick question!...it is both
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What is the MOA of codeine?
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Binds to opiate receptors in CNS
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How does codeine cause cough suppression?
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Direct central action in medulla
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True or False. Codeine produces generalized CNS depression.
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True
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What is the brand name for Desloratadine?
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Clarinex
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What is the generic name for Benedryl?
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Diphenhydramine
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What is the generic name for Antivert?
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Meclizine
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What is the brand name for Hydroxyzine?
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Atarax
Vistaril |
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What is the generic name for Phenergan?
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Promethazine
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What is the generic name for Allegra?
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Fexofenadine
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What is the generic name for Tussionex?
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Chlorpheniramine and Hydrocodone
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What is the generic name for Tessalon Perles?
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Benzonatate
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What is urinary incontinence?
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Involuntary loss of urine
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What populations have an increased incidence of urinary incontinence?
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Females
Obesity (BMI>30) Age (>50) Poor function status |
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How is chronic urinary incontinence characterized?
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Muscle/tissue weakness
Urinary tract abnormality Increased during menstrual cycle Nerve damage Idiopathic |
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If a patient experiences urinary incontinence from a medication they are taking, how would this be classified?
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Acute Urinary Incontinence
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True or False. Constipation can cause urinary incontinence.
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True
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Can UTIs cause urinary incontinence?
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Yes
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What are the 5 types of urinary incontinence?
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-Urge (overactive bladder)
-Stress -Mixed -Overflow -Functional |
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What may cause an overactive bladder?
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Increased bladder muscle contraction or nerve problems
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Urinary urgency with increased frequency and nocturia with or without urinary incontinence.
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Overactive bladder
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What is nocturia?
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Abnormally excessive urination during the night
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What is the relationship between bladder and urethral pressure in stress caused urinary incontinence?
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Bladder pressure > Urethral pressure
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Can stress cause urine loss during exertion, sneezing, or coughing?
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Yes
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What are some treatments for UI? (7)
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-Lifestyle modifications
-Kegel exercises -Bladder training -Intravaginal devices -Medications -Nerve stimulation -Surgery |
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What are Kegel exercises?
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Pelvic floor muscle training (PFMT)
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What are pessaries?
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Intravaginal devices
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What is the purpose of Kegel exercise?
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Tone pelvic muscles
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What muscle do you squeeze during Kegel exercises?
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Pubococcygeus muscles (PC)
*Contract ONLY pelvic muscles |
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How often should you perform Kegel exercises?
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Squeeze muscle and hold for 10 seconds
10-15 repetitions three times a day |
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Name a drug used for UI.
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Tolterodine
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Is Tolterodine an antimuscarinic?
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Yes
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Does Tolterodine have increased or decreased selectivity for bladder receptors?
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Increased
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How often is Tolterodine administered?
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Once (ER) or twice (IR) daily
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When should you reduce dosing for Tolterodine?
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Hepatic/renal insufficiency
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Name 5 side effects of Tolterodine.
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-Dry mouth
-Headache -Constipation -Blurred vision -Dizziness |
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True or False. Full efficacy for Tolterodine is seen within 1-2 weeks.
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False. May take weeks to months to see full efficacy.
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How does an enlarged prostate cause urination and bladder problems?
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Presses on urethra
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Is prostate size affected by age?
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Yes. Prostate size increases with age.
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What are some symptoms of BPH? (6)
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-Dribbling at end of urination
-Urinary retention -Incomplete bladder emptying -Incontinence -Nocturia -Slowed/delayed/strained urination |
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Can BPH be treated with lifestyle changes? If so, how?
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Yes.
-Urinate with initial urge -Avoid alcohol, caffeine, drinking close to bedtime, OTC decongestants/antihistamines Regular/Kegel exercises Reduce stress |
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Name 3 pharmacologic treatments for BPH. (Drug categories)
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-Alpha 1-blockers
-5 alpha Reductase Inhibitors -Muscarinic blockers |
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Name 3 alpha 1-blocker approved for BPH treatment.
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-Tamsulosin
-Hytrin -Cardura |
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Name one 5-alpha reductase inhibitor approved for BPH treatment.
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Finasteride
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Is Tamsulosin available? Or is only the brand name drug available?
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Generic is available.
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True or False. Tamsulosin can only be used alone.
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False. Tamsulosin can be used alone or in combination with 5-alpha reductase inhibitor
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Combination therapy of Tamsulosin and 5-alpha reductase inhibitor results in what?
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Increased urine flow rate
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Name some side effects of Tamsulosin. (8)
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-Orthostatic hypotension
-Dizziness -Weakness -Decreased libido -Insomnia -Rhinitis -Abnormal ejaculations/ejaculatory problems -Intraoperative floppy iris syndrome |
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When should Tamsulosin be administered?
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30 minutes after the SAME meal each day.
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What is Finasteride used for?
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Treatment of symptomatic BPH
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Can Finasteride be used in combination with an alpha adrenergic blocker?
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Yes; can also be used alone
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What is the purpose of Finasteride?
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Decrease prostate size
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What does Finasteride and alpha adrenergic blocker combination therapy result in?
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Increased symptom relief and increased urine flow rate
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Name 4 side effects of Finasteride.
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-Erectile dysfunction
-Decreased libido -Increased breast size/tenderness -Rash |
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What Pregnancy category does Finasteride fall under?
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Pregnancy Risk Category X
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True or False. Pregnant females should not ingest Finasteride, but it is not harmful for them to handle it.
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False. Pregnant females should not handle crushed or broken tablets.
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What is erectile dysfunction?
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Inability to achieve or maintainan erection
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What age group does ED affect 65% of men?
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40-70 years old
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What is the MOA of an erection (and yes, I mean the scientific MOA)?
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Arousal-->Ach released-->NO released from cavernosal nerves-->smooth muscle relaxation-->increased arterial inflow/decreased venous outflow-->penile rigidity
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Where is Ach and NO released from during and erection?
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Ach from pelvic muscle
NO from cavernosal nerves |
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What causes decreased NO production in ED?
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Endothelial damage
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What are the risk factors of ED? (10)
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-Medications
-CV disease -Diabetes -Depression -Alcoholism -Smoking -Penile trauma -Neurologic disease -Obesity -Renal disease |
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What are the 3 goals of ED treatment?
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-Increased sexual function
-Improve quality and quantity of erections suitable for intercourse -Maintain adequate erection for patient and partner satisfaction |
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What are 3 treatment options for ED?
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-Lifestyle modifications
-Medications -Surgical/Procedural |
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What are some lifestyle modifications to improve ED? (3)
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-Increased physical activity
-Dietary changes -Disease state management |
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What types of medications treat ED?
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-Phosphodiesterase type 5 (PDE5) inhibitors
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What are 3 types of surgeries/procedures treat ED?
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-Vasoactive injection therapy
-Vacuum pump devices -Penile prosthesis |
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What is the MOA of PDE5 inhibitors?
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Inhibit cGMP-->cGMP builds up-->smooth muscle relaxation-->increased inflow of blood
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True or False. Tadalafil has similar effectiveness to PDE5 inhibitors but with delayed effect/longer acting.
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True
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Name 9 side effects of PDE5 inhibitors.
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-Headache
-Flushing -Dyspepsia -Rhinitis -Impaired color discrimination -Dizziness -Hypotension -CV effects -Sudden hearing loss |
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What medications are contraindicated with use with PDE5 inhibitors?
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Nitrates
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What might increase concentration of PDE5 inhibitors?
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Grapefruit juice
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Shoud Viagra be taken with or without food? How soon before intercourse? How often?
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Without food; 30-60 minutes before intercourse; Once daily
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What should be avoided while taking Viagra?
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-high fat foods
-nitrates -Caution with alpha blockers and some antibiotics/antifungals |
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Should Cialis be taken with or without food? How soon before intercourse? How often?
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With OR without food; 30 minutes before intercourse; Once daily
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How long does Viagra's effect last? Cialis?
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Viagra: up to 4 hours
Cialis: 24-36 hours |
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Should nitrates be avoided while taking Cialis?
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Yes
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Is Yohimbine a recommended treatment for ED?
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No
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What is Yohimbine?
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Herbal product; tree bark; selective alpha 2 adrenergic blocker
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What type of effect does Yohimbine produce?
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Vasodilatory response
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Has Yohimbine's efficacy been proven?
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No
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What side effects does Yohimbine cause? (7)
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-Dizziness
-Anxiety -Flushing -Headache -Hypertension -Tachycardia -Tremor |
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What is the generic name of Detrol LA? Drug classification?
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Tolterodine
Antimuscarinic for UI |
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What is the brand name for Tamsulosin? Drug classification?
|
Flomax
Alpha-1 adrenergic blocker for BPH |
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What is the generic name for Proscar? Drug classification?
|
Finasteride
5 alpha reductase inhibitor for BPH |
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What is the generic name for Viagra? Drug classification?
|
Sildenafil
Phophodiesterase type 5 inhibitor for ED |
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What is the generic name for Cialis? Drug classification?
|
Tadalafil
Phosphodiesterase type 5 inhibitor for ED |
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What is osteoporosis? Characteristics?
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Skeletal disorder characterized by loss of bone tissue, deterioration of bone architecture, and increased bone fragility leading to increased risk of fractures
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Does osteoporosis mean porous bone?
|
Yes
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Are men or women more likely to have osteoporosis?
|
Women are 4 times more likely to have
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What bones cause the most concern with osteoporosis?
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Hips and spine
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What are the risk factors for osteoporosis? (3)
|
-low bone mineral density
-advanced age -history of adult fracture |
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What complications do fractures have?
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Chronic pain, deformity, disability, deconditioning, depression, NH placement, death
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What is the difference between primary and secondary osteoporosis?
|
Primary: no know cause
Secondary: disease related or medication induced Prevalence varies by age, gender, ethnicity |
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What populations are most likely to have osteoporosis?
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-white or asian
-female -advanced age -small body frame (<127 pounds) |
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Can too much caffeine cause osteoporosis?
|
Yes
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How much calcium and vitamin D should a 25 year old intake daily?
|
1000 mg calcium
600 IU vitamin D |
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How much calcium and vitamin D should a 65 year old intake daily?
|
1200 mg calcium
800-1000 IU vitamin D |
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What are 2 vitamin D supplements?
|
-Ergocalciferol (vit. D2)
-Cholecalciferol (vit. D3) |
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What are the treatment goals for osteoporosis?
|
-Prevent fractures by improving bonde strength and reducing risk of falling and injury
-Relieve symptoms of fractures and skeletal deformity -Maximize physical function |
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What are 3 classes of bone formation modifiers?
|
Bisphosphonates
SERM (selective estrogen receptor molecules) Monoclonal antibody (RANKL) |
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True or False. SERMs can be given to any patient with osteoporosis.
|
False. SERMs are for post menopausal women only
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What is the MOA of bisphosphonates?
|
Inhibit osteoclast activity and reduce bone resorption and turnover
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Do bisphosphonates have a long or short half life?
|
Long
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What are 3 common side effects of bisphosphonates?
|
-Heartburn
-Ingestion -Jaw bone pain |
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What proper administration techniques MUST be followed when taking bisphosponates? (4)
|
-Take first thing in the morning
-Take with a FULL glass of water -Don't take anything other than water within 30 minutes -Remain sitting up right or standing for at least 30 minutes |
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Name 3 bisphosphonates.
|
-Alendronate
-Risedronate -Ibandronate |
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Which bisphosphonate drug(s) is used to treat osteoporosis in men?
|
-Fosamax
-Actonel |
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Should bisphosphonates doses be avoided or adjusted during renal insufficiency?
|
Avoided
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Which bisphosphonate drug(s) come in a combo form with vitamin D?
|
Fosamax
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What is the route of administration for bisphosponate drugs?
|
Alendronate: PO
Risedronate: PO Ibandronate: PO, IV |
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Which bisphosphonate is administered with APAP when given as IV treatment?
|
Boniva
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Does is matter if you eat after taking Boniva?
|
Yes; must not eat and remain upright for 60 minutes after dose
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What does SERM stand for?
|
Selective Estrogen Receptor Modulators
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Name 1 SERM.
|
Raloxifene
|
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What is Evista used for?
|
Osteoporosis, breast cancer, hormone replacement therapy
|
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What does Evista act like on the bones?
|
Estrogen
|
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What are 4 common side effects of SERM's?
|
-Hot flashes
-Night sweats -Leg cramps -Blood clots |
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What is menopause?
|
Permanent cessation of menses due to the dysfunction of the ovaries
|
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When does menopause usually occur?
|
Age 47-53
|
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True or False. Studies show that menopause treatment causes increased breast cancer risks.
|
True and False...Some do show increased risk, others show decreased risk
|
|
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What are some symptoms of menopause? (9)
|
-Hot flashes/night sweats
-Abnormal uterine bleeding -Vaginal dryness -Incontinence -Sleep disturbances -Mood changes -Depression -Sexual changes -Concentration/Memory Problems |
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Name 1 Estrogen derivative.
|
Premarin
|
|
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What is Premarin?
|
-conjugate estrogens
-pregnant mare urine |
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What are estrogen derivatives the most effective therapy for?
|
Relief of moderate to severe vasomotor symptoms
|
|
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What are 3 common side effects of estrogen derivative?
|
-Vaginal bleeding
-Venous thromboembolism -Stroke |
|
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True or False. In women with a uterus, unopposed estrogen decreases risk of endometrial cancer.
|
False. It increases the risk.
|
|
|
When are estrogen derivatives contraindicated?
|
In women with history of breast cancer
|
|
|
What are oral contraceptives agents widely used for?
|
-To prevent pregnancy
-To regulate menstrual cycles -To treat acne |
|
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Are most oral contraceptives considered to safe or unsafe?
|
Safe
|
|
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What are oral contraceptives?
|
Combined form of progestins and estrogens
|
|
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Do oral contraceptives protect from HIV or other STDs?
|
No
|
|
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What are 2 things oral contraceptives do/prevent/alter?
|
-Prevent ovulation
-Alter endometrium lining |
|
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What are some side effects of oral contraceptives?
|
Upset stomach, vomiting, stomach cramps/bloating, diarrhea/constipation, gingivitis, increased/decreased appetite, weight gain/loss, brown/black skin patches, acne, unusual hair growth, intermittent bleeding/spotting, change in menstrual flow, painful/missed periods, breast tenderness/enlargement/discharge, swelling/redness/irritation/burning/itching of vagina, which vaginal discharge
|
|
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What risks are faced when taking oral contraceptives?
|
-Women with pre-existing cardiovascular disease or risk: DVT, pulmonary embolism, stroke, MI
|
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Do higher estrogen containing oral contraceptive pills possibly increase or decrease risk of breast cancer?
|
Increase
|
|
|
What are 6 benefits of taking oral contraceptives?
|
-PCOS treatment
-Endometriosis treatment -Dysmenorrhea treatment -Decrease ovarian cancer risk (40%) -Decrease endometrial cancer risk (50%) -Increase breast size |
|
|
What is PCOS?
|
Polycystic Ovarian Syndrome
Hormone imbalance leading to overproduction of follicles each month by ovaries without producing an egg |
|
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What are 6 signs of PCOS?
|
-Irregular/no periods
-Depression -Excessive weight gain -Acne -Abnormal hair growth -Infertility |
|
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True or False. PCOS is a permanent condition.
|
False; often temporary
|
|
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What other condition is often paired with PCOS?
|
Insulin resistance
|
|
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What does the body do during PCOS?
|
Begins to make more androgens
|
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What is endometriosis?
|
Endometrial tissue develops outside the uterus
|
|
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Where does endometrial tissue commonly develop during endometriosis?
|
Lining of pelvis, ovaries, uterus
|
|
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What is the process of endometriosis?
|
Tissue implants-->proliferates-->thickens-->sheds with each menstrual cycle
|
|
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What happens if endometrial tissue becomes trapped?
|
Scar tissue formation
|
|
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What are 2 symptoms of endometriosis?
|
-Pelvic pain
-Infertility |
|
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What are estrogenic compounds?
|
Ethinyl estradiol
|
|
|
What are Progestational compounds?
|
-Corgestimate
-Drospirenone -Norelgestromin -Norethindrone |
|
|
How often and when is NuvaRing inserted?
|
Inserted every 3 weeks on day 1 of cycle
|
|
|
When should you use backup protection if the NuvaRing is removed?
|
If removed for longer than 3 hours
|
|
|
What kind of activity does Yaz produce?
|
Anti-mineralcorticoid
|
|
|
When should Yaz administration be avoided?
|
During renal or adrenal insufficiency
|
|
|
Complaint: Nausea, breast tenderness, increased BP, headache, melasma (dark skin discoloration of face)
|
Too much estrogen
|
|
|
Complaint: early or mid-cycle breakthrough bleeding, increased spotting, hypomenorrhea
|
Too little estrogen
|
|
|
Complaint: Breast tenderness, headache, fatigue, mood changes
|
Too little progestin
|
|
|
Complaint: increased appetite, weight gain, acne, oily skin, hirsutism (excess facial/body hair on woman), increased LDL, decreased HDL
|
Too much androgen
|
|
|
I missed the first pill in my OC pack. Is it ok for me to have sex?
|
Yes; use extra protection; take as soon as you remember
|
|
|
I missed a pill during the second week of my OC pack. Is it ok for me to have sex?
|
Yes, take as soon as you remember
|
|
|
Is it ok to store my birth control pills in the bathroom?
|
Store OC in dry place
|
|
|
I'm spotting between cycles. Is this normal?
|
bleeding between periods can sometimes be caused by something as simple as not taking birth control pills at the exact same time each day.
|
|
|
This month, my period didn't start until Saturday. I'm supposed to start a new pack on Sunday. What do I do?
|
Start new pack as normal.
|
|
|
Do I have to take the sugar pills included in my pill pack?
|
No you do not have to take your sugar pills they are just there to keep you on schedule and you don't forget to take your regular pill when you get a new pack
|
|
|
What is the generic name for Fosamax? Drug classification?
|
Alendronate
Bisphosphonate |
|
|
What is the generic name for Actonel? Drug classification?
|
Risedronate
Bisphosphonate |
|
|
What is the generic name for Boniva? Drug classification?
|
Ibandronate
Bisphosphonate |
|
|
What is the generic name for Evista? Drug classification?
|
Raloxifene
SERM |
|
|
What is the generic name for Premarin? Drug classification?
|
Estrogens Conjugated
Hormones |
|
|
What is the generic name for Yaz/Ocella? Drug classification?
|
Ethinyl Estradiol/Drospirenone
Oral Contraceptive |
|
|
What is the generic name for TriNessa? Drug classification?
|
Ethinyl Estradiol/ Norgestimate
Oral Contraceptive |
|
|
What is the generic name for Loestrin 24 Fe? Drug classification?
|
Ethinyl Estradiol/Norethindrone
Oral Contraceptive |
|
|
What is the generic name for NuvaRing? Drug classification?
|
Ethinyl Estradiol/Etonogestrel
Oral Contraceptive |
|
|
What is GERD?
|
Symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus
|
|
|
How can gastric content be dangerous to the esophagus?
|
It can inflame and damage the lining of the esophagus --> esophagitis
|
|
|
What does regurgitated liquid from the stomach contain?
|
Acid and pepsin
|
|
|
Is GERD acute or chronic?
|
Chronic
|
|
|
How is GERD diagnosed?
|
No gold standard in diagnostic criteria; focus on symptom severity
|
|
|
Why is GERD common in pregnancy?
|
-Increased hormone production
-Growing fetus causes pressure |
|
|
What are the 3 categories of GERD?
|
-Erosive esophagitis
-Non-erosive reflux disease -Barrett's esophagus |
|
|
Which GERD category is more common in women?
|
Non-erosive reflux disease
|
|
|
What happens during Barrett's esophagus?
|
Epithelial cells change into dense columnar cells
Increases cancer risk |
|
|
What are 4 goals of GERD treatment?
|
-Alleviate symptoms
-Decrease frequency of recurrent disease -Promote healing of mucosal injury -Prevent complications |
|
|
Name 4 ways to treat GERD.
|
-Lifestyle changes
-Pharmacologic intervention -Surgery -Endoscopic therapies |
|
|
What is LES?
|
Lower esophageal sphincter
Specialized ring of muscle that surrounds lower-most end of esophagus where it joins the stomach |
|
|
What is the most important factor for preventing reflux?
|
LES
|
|
|
Is the LES active all the time, some of the time, or rarely?
|
Most of the time
|
|
|
When does the LES contract and relax?
|
Contracts to close off passage from esophagus into stomach to prevent reflux
Relaxes when food/saliva is swallowed to allow it to pass from esophagus into the stomach, then closes again |
|
|
What causes decreased LES pressure?
|
Fatty/fried foods, coffee, soda, garlic, onions, chili peppers, peppermint, tomato, citris, chocolate, alcohol, anticholinergics, caffeine, nicotine, nitrates, benzos, narcotics, aspirin
|
|
|
What about the LES causes GERD?
|
Laxity of the LES
Easier opening of the LES allows for a greater backward flow of acid into the esophagus |
|
|
True or False. Increased number/severity of GERD symptoms equals greater severity of disease.
|
False. Severity of symptoms does NOT correlate to severity of disease.
|
|
|
What are 3 typical symptoms of GERD?
|
-Heartburn **hallmark symptom
-Belching -Regurgitation |
|
|
What are 8 atypical symptoms of GERD?
|
-Cough
-Asthma -Hoarseness -Chest pain -Pharyngitis -Dental erosions -Metallic taste in mouth -Nausea |
|
|
What lifestyle changes can improve GERD?
|
-Upper body elevation sleeping
-Smaller/less fatty meals -Lose weight -Smoking cessation -Avoid alcohol -Earlier evening meals -Avoid injurious foods |
|
|
When elevating the upper body to improve GERD, is simply adding an extra pillow efficient?
|
No, head of bed needs to be elevated
|
|
|
What type of GERD do antacids treat?
|
Mild
|
|
|
How do antacids work?
|
Neutralize acid in stomach so no acid to reflux
Only a temporary fix |
|
|
What is Alginic Acid?
|
Protective barrier that floats on surface of gastric contents
|
|
|
What do aluminum based antacids cause?
|
Constipation
|
|
|
What do magnesium based antacids cause?
|
Diarrhea
|
|
|
What do calcium based antacids stimulate?
|
Gastrin release; Acid production
|
|
|
Which antacids can cause rebound heartburn?
|
Calcium based
|
|
|
What do Histamine (H2) antagonists treat?
|
Mild to moderate GERD
|
|
|
How do Histamine (H2) antagonists work (MOA)?
|
Bind H2 receptors on parietal cell preventing histamine-induced activation
|
|
|
When should you take Histamine (H2) antagonists?
|
30 minutes before a meal
|
|
|
Do Histamine (H2) antagonists treat or heal inflammation?
|
Treat
|
|
|
Are Histamine (H2) antagonists treat heart-burn, inflammation, or damage?
|
Heart-burn
|
|
|
How long should Histamine (H2) antagonist therapy last for symptomatic improvement?
|
12 weeks
|
|
|
What is the generic name for Zantac? Drug classification? OTC or Rx?
|
Ranitidine
H2 Antagonist OTC |
|
|
What is the generic name for Pepcid? Drug classification? OTC or Rx?
|
Famotidine
H2 Antagonist OTC |
|
|
When should Pepcid dosing be adjusted?
|
Renal insufficiency
|
|
|
True or False. Zantac can be used in children less than 1 year old.
|
True
|
|
|
What do PPI's treat?
|
Moderate to severe GERD
|
|
|
How do PPIs work (MOA)?
|
Proton Pump Inhibitors
blocks the secretion of acid into stomach by acid-secreting parietal cells shuts off acid produciton for longer periods of time |
|
|
Do PPIs promote healing?
|
Yes; protect esophagus so it can heal
|
|
|
When should PPIs be taken?
|
1 hour before meals
|
|
|
Can PPIs strengthen the LES?
|
Yes
|
|
|
What should be avoided while taking PPIs? Why?
|
Alcohol; causes GI irritation
|
|
|
What is the generic name for Prilosec? Drug classification? OTC or Rx?
|
Omeprazole
PPI OTC |
|
|
What is the generic name for Nexium? Drug classification? OTC or Rx?
|
Esomeprazole
PPI Rx |
|
|
What is the generic name for Prevacid? Drug classification? OTC or Rx?
|
Lansoprazole
PPI OTC |
|
|
What is the brand name for Pantoprazole? Drug classification? OTC or Rx?
|
Protonix
PPI Rx |
|
|
What is the generic name for Aciphex? Drug classification? OTC or Rx?
|
Rabeprazole
PPI Rx |
|
|
Which PPI(s) can be sprinkled on applesauce?
|
Prilosec, Nexium, Prevacid
|
|
|
Which PPI(s) must be swallowed whole?
|
Protonix, Aciphex
|
|
|
What are ulcers?
|
Breaks in the lining of the esophagus that occur in areas of inflammation causing severe damage
|
|
|
How does the body respond to acid reflux?
|
Acid reflux into the esophagus damages the cells that line the esophagus
Body responds with inflammation (esophagitis) |
|
|
What happens if ulcers erode into the esophageal blood vessels?
|
May cause bleeding into esophagus
|
|
|
What is H-pylori? What does it commonly cause?
|
Bacteria that infects the mucus lining of stomach and upper intestines
Commonly causes ulcers, gastritis |
|
|
True or False. Most H-pylori sufferers are asymptomatic.
|
True
|
|
|
What primary therapy options are available for H-pylori treatment?
|
Clarithromycin Triple Therapy for 14 days
Bismuth Quadruple Therapy for 10-14 days |
|
|
What is Clarithromycin Triple Therapy?
|
-Clarithromycin
-PPI -Amoxicillin or Metronidazole |
|
|
What is Bismuth Quadruple Therapy?
|
-Bismuth
-PPI or H2 antagonist -Metronidazole -Tetracycline |
|
|
What is the pathophysiology of N/V?
|
Emetogenic stimuli to chemoreceptor trigger zone (CTZ) through blood or CSF
Direct irritation of GI tract sending stimuli to vomiting center in brain and CTZ |
|
|
What causes motion sickness?
|
Vestibular stimuli
|
|
|
What is associated with CNS stimulation in N/V?
|
Psychiatric disorders
Stress Anticipation |
|
|
What is the generic name for Phenergan? Drug classification?
|
Promethazine
Antiemetic |
|
|
What is Phenergan's MOA?
|
H1 antagonist
Anticholinergic |
|
|
How is Phenergan administered?
|
PO, IM, PR
|
|
|
Is IV administration of Phenergan recommended? Why or why not?
|
No; extravasation
|
|
|
What do pro-motility drugs do?
|
Increase the pressure in the LES and strengthen the contractions (peristalsis) of the esophagus
|
|
|
Do pro-motility drugs increase or decrease the speed of stomach emptying?
|
Increase
|
|
|
When should pro-motility drugs be taken?
|
30 minutes before meals and at bedtime
|
|
|
Do pro-motility drugs heal inflammation?
|
No
|
|
|
What is the generic name for Reglan? Drug classification?
|
Metoclopramide
Pro-motility drug |
|
|
How does Reglan work?
|
Dopamine antagonist
|
|
|
What are 3 indications for pro-motility drug use?
|
-GERD
-N/V -Gastroparesis |
|
|
What are 2 common and 2 serious adverse effects of pro-motility drugs?
|
-Weakness
-Somnolence -Tardive dyskenesia (serious) -Neuroleptic malignant syndrom (serious) |
|
|
Why do many patients take muscle relaxants?
|
To help aid in pain management
|
|
|
What type of muscles to muscle relaxants work on?
|
Striated
|
|
|
Skeletal muscle relaxants can be used for relief of spasticity in what type of diseases?
|
Neuromuscular
-MS, spinal cord injury, stroke Also used for minor strain injuries |
|
|
What is the generic name for Flexeril? Drug classification?
|
Cyclobenzaprine
Muscle relaxant |
|
|
What is the generic name for Soma? Drug classification?
|
Carisoprodol
Muscle relaxant |
|
|
What is the brand name for Metaxalone?
Drug classification? |
Skelaxin
Muscle relaxant |
|
|
What is the brand name for Tizanidine? Drug classification?
|
Zanaflex
Muscle relaxant |
|
|
What is the brand name for Methocarbamol? Drug classification?
|
Robaxin
Muscle relaxant |
|
|
What is Alzheimers?
|
Progressive brain disorder
Most common form of dementia |
|
|
What does Alzheimers destroy?
|
Brain cells
Memory, learning ability, reason, judgement, communication skills, ability to carry out normal daily functions |
|
|
Can Alzheimer's be cured?
|
No
|
|
|
How long does it take for Alzheimer's to progress?
|
3-20 years
|
|
|
What is the hallmark of Alzheimer's disease?
|
Memory loss
|
|
|
What does Alzheimer's eventually lead to?
|
Complete loss of brain function; then death
|
|
|
How much help is needed in early stages of Alzheimer's versus late stages?
|
Early: minimal help
Late: help with normal daily functions |
|
|
What are 3 treatment options for Alzheimer's?
|
-Cholinesterase Inhibitors
-Uncompetitive low-to-moderate affinity NMDA receptor antagonist -Vitamin E |
|
|
What do cholinesterase inhibitors do?
|
Increase levels of acetylcholine
|
|
|
What is the generic name for Aricept? Drug classification?
|
Donepezil
Cholinesterase Inhibitor |
|
|
What is the generic name for Namenda? Drug classification?
|
Memantine
Uncompetitive low-to-moderate affinity N-methyl-D-aspartate (NMDA) receptor antagonist |
|
|
What are some different causes of headaches?
|
Eye strain, sinusitis, tension/stress, brain tumors, idiopathic, head injury, medication induced, dehydration, caffeine withdrawal, food triggers, environmental triggers
|
|
|
Do migraines always occur with an aura?
|
No
|
|
|
What are 5 types of headaches?
|
-Vascular
-Muscular -Cervicogenic -Traction -Inflammatory |
|
|
What are vascular headaches?
|
cluster, migraine
|
|
|
What are muscular headaches?
|
Tension
|
|
|
What are cervicogenic headaches?
|
Neck disorder
|
|
|
What are traction headaches?
|
Eye strain
|
|
|
What are inflammatory headaches?
|
Sinusitis
|
|
|
How can headaches be treated? (4)
|
-Lower body temperature
-Chiropractic care -Preventative therapy -Medications |
|
|
What medication classes can treat headaches? (5)
|
-NSAIDS
-Triptans -BP meds -Antidepressants -Muscle relaxers |
|
|
How do Triptan medications work?
|
Serotonin receptor agonists
5-HT1B and 5-HT1D Bind to serotonin receptors in brain Inhibit pro-inflammatory neuropeptide release |
|
|
What do Triptan medications treat?
|
Migraine and cluster headaches
|
|
|
What are the first line drugs for patients with moderate to severe migraines?
|
Triptans
|
|
|
What is the generic name for Imitrex? Drug classification? Administration?
|
Sumatriptan
Triptan Injection, nasal, oral |
|
|
What do anti-inflammatory medications treat? (3)
|
-Inflammation
-Mild to moderate pain -Fever |
|
|
Can anti-inflammatory medications affect platelets?
|
Yes
|
|
|
What are NSAID's?
|
Non Steroidal Anti-Inflammatory Drugs
|
|
|
What do NSAID's do? (4)
|
-Decrease inflammation
-Decreased pain -Treat fever -Most inhibit Cox-1 and Cox-2 enzymes |
|
|
What is Cycloxgenase?
|
An enzymes that catalyzes the conversion of free essential fatty acids to prostaglandins
|
|
|
What are prostaglandins?
|
Mediators of inflammatory reactions
|
|
|
Are there different types of prostaglandins or just one?
|
Different types; good and bad
|
|
|
What does inhibition of COX provide?
|
Relief from symptoms of inflammation and pain
|
|
|
How many COX are there?
|
1, 2, and 3
|
|
|
Which COX is the good COX?
|
COX-1
|
|
|
Where is COX-1 normally produced?
|
Various body tissues
Gastric mucosa, kidney, platelets |
|
|
Does COX-1 speed up or slow down the production of prostaglandins?
|
Speed up
|
|
|
What does COX-1 promote production of in order to preserve the integrity of the GI mucosa?
|
Natural mucus lining that protects the inner stomach
|
|
|
What mediates platelet aggregation?
|
COX-1
|
|
|
What COX is the bad COX?
|
COX-2
|
|
|
Is COX-2 normally produced in the same place as COX-1?
|
No; COX-2 is not normally produced in most tissue
|
|
|
When does COX-2 production increase?
|
In the presence of inflammation and tissue injury
|
|
|
What does COX-2 production lead to?
|
Prostaglandin synthesis involved in pain and inflammation (different from COX-1)
|
|
|
Inhibition of which COX leads to beneficial effects?
|
COX-2
|
|
|
What are the main COX inhibitors?
|
NSAIDs
|
|
|
What types of COX do NSAIDs inhibit?
|
All COX; they are non-selective
|
|
|
What are 2 main adverse effects of NSAIDs?
|
-peptic ulceration
-Dyspepsia |
|
|
What is "dual-insult" of NSAIDs?
|
Direct irritation of the gastric mucosa and inhibition of prostaglandin synthesis by COX-1
|
|
|
Are many NSAIDs acids or bases?
|
Acids
|
|
|
Where are prostaglandins protective in the body?
|
In the GI tract
Prevent acid-insult to the mucosa |
|
|
Inhibiting COX-1 has been shown to increase what? Why?
|
GI side effects; decreases GI protective enzymes
|
|
|
What two disease states can NSAIDs cause?
|
-Renal insufficiency
-Hyperkalemia |
|
|
What do NSAIDs reduce?
|
Reduce inflammation, thus reducing pain
|
|
|
What are NSAIDs used to treat (5)?
|
-Arthritis
-Back pain -Heavy periods -Sprains/strains -Migraine |
|
|
True or False. All NSAIDs exert anti-inflammatory and analgesic effects.
|
True
|
|
|
Do all NSAIDs exert antipyretic effects?
|
Yes
|
|
|
Do all NSAIDs exert gastric side effects?
|
Yes
Selective COX-2 lesser effects |
|
|
Can all NSAIDs cause renal toxicity? If not, which ones do not?
|
All can cause renal toxicity
|
|
|
What is Ibuprofen indicated for (4)?
|
-Inflammatory disease
-Rheumatoid disorders -Mild to moderate pain -Fever |
|
|
What are 3 adverse effects of Ibuprofen?
|
-Indigestion
-Abdominal pain -Constipation |
|
|
Should you take Ibuprofen with or without food?
|
With food or milk
|
|
|
What medicine should be avoided while taking Ibuprofen?
|
Aspirin
|
|
|
What is the maximum adult dose of Ibuprofen in a day?
|
3.2 grams
|
|
|
What is the youngest age person that can use Ibuprofen?
|
6 months
|
|
|
Ashley has a fever of 101.5. What dose of Ibuprofen should she be give?
|
Temperature is less than 102.5
5mg/kg/DOSE every 6-8 hours |
|
|
Ashley has a fever of 103. How should Ibuprofen be dosed?
|
Temperature is higher than 102.5
10mg/kg/DOSE every 6-8 hours |
|
|
How often is Ibuprofen dosed?
|
Every 6-8 hours
|
|
|
What is the maximum pediatric dose of Ibuprofen in a day?
|
40mg/kg/DAY
|
|
|
What is the normal body temperature maintained at a relatively constant level?
|
98.6
|
|
|
Where is the thermoregulatory center? What does it do?
|
In the hypothalamus
Receives information about body temperature from thermosensitive neurons located in the CNS and skin |
|
|
Where are thermosensitive neurons located?
|
CNS and skin
|
|
|
How do increased temperature levels cause a response?
|
Trigger physiologic and behavioral mechanisms
|
|
|
What does the body do to reduce a fever? (4)
|
-Sweating
-Vasodilation -Increased peripheral blood flow -Hyperventilation |
|
|
What is fever often a sign of?
|
The body mounting an immune response to infection or immunization
|
|
|
True or False. Fevers are only present during bacterial infections.
|
False. Viral infections can also cause a fever
|
|
|
What is the most common symptom of disease in children?
|
Fever
|
|
|
What is the most frequent reason for office visits by children under 2 years of age?
|
Fever
|
|
|
How often do children visit the ER for fevers?
|
1 out 5 ER visits
|
|
|
True or False. Fevers are very dangerous to the patient.
|
False. Fevers usually pose little danger to the patient.
|
|
|
Can fevers be beneficial?
|
Yes
|
|
|
Why is antipyretic therapy indicated?
|
Mainly to aid in patient discomfort and parent anxiety
|
|
|
How is a mild fever classified?
|
100-102 degrees
|
|
|
How is a high fever classified?
|
103-105 degrees
|
|
|
What is a very high fever? Is this common?
|
>106 degrees
This is when serious complications can occur Rare |
|
|
What is the recommendation for when parents should immediately call their pediatrician concerning their child's fever? (6)
|
-Is 2 months old or younger with a rectal temp. of >100.2
-Looks very ill, unusually drowsy, very fussy -Also has stiff neck, severed headache, sore throat, ear pain, rash, vomiting, diarrhea -Has a condition that suppresses immune response -Is taking steroids -Has had a seziure |
|
|
A parent should notify their doctor of their child's fever if the fever has persisted for how many days?
|
Greater than 3 days
|
|
|
What is Naproxen indicated for?
|
-Inflammatory disease
-Rheumatoid disorders -Mild to moderate pain -Fever |
|
|
What are 3 adverse effects of Naproxen?
|
-Indigestion
-Abdominal pain -Constipation |
|
|
Should Naproxen be taken with or without food?
|
Take with food or milk
|
|
|
What should be avoided while taking Naproxen?
|
Aspirin
|
|
|
What is the maximum adult dose of Naproxen?
|
1200-1650 mg/day
|
|
|
True or False. Naproxen is typically not given to children.
|
True
|
|
|
What was the first NSAID?
|
Aspirin
|
|
|
What is Aspirin indicated for? (5)
|
-Treat mild to moderate pain
-Inflammation -Fever -Prevent MI/heart conditions -Inhibits prostaglandin synthesis |
|
|
What is Aspirin use contraindicated with?
|
-Hypersensitivity
-Bleeding disorders (taking Coumadin) -Caution with OTCs |
|
|
I am a 13 year old with a headache. Can I take Aspirin?
|
No; only used if older than 16 years old
|
|
|
What are 4 adverse effects of Aspirin?
|
-Bleeding
-Fatigue -Rash -Abdominal pain |
|
|
What symptoms can show toxic doses of Aspirin?
|
Salicylism - vomiting, vertigo, tinnitus
|
|
|
What disease state has been associated with Aspirin use in children under 16?
|
Reye's Syndrome
|
|
|
Can Aspirin be used during pregnancy? Why or why not?
|
No; crosses the placenta and enters fetal circulation
|
|
|
What can Aspirin use during the third trimester of pregnancy cause?
|
Premature closure of the ductus arteriosus in the fetus
|
|
|
What is Meloxicam indicated for?
|
Relieve symptoms of osteo, rheumatoid, and juvenile rheumatoid arthritis
|
|
|
What are 3 adverse effects of Meloxicam?
|
-Edema
-HA -Dizziness |
|
|
How should Meloxicam be taken?
|
With food or milk
|
|
|
What should be avoided while taking Meloxicam?
|
Aspirin
|
|
|
What is Diclofenac Sodium indicated for?
|
Relief of osteo and rheumatoid arthritis
|
|
|
What are 3 adverse effects of Diclofenac Sodium and Diclofenac Potassium?
|
-Nausea
-Indigestion -Constipation |
|
|
What is Diclofenac Potassium indicated for?
|
-Treatment of osteo and rheumatoid arthritis
-Pain management |
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How should Diclofenac Potassium be taken? What should be avoided?
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Take with food or milk
Avoid aspirin |
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What are Etodolac and Nabumetone indicated for?
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Relief of osteo and rheumatoid arthritis
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What are 3 adverse effects of Etodolac and Nabumetone?
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-Abdominal pain
-Constipation -Nausea |
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How should Etodolac and Nabumetone be taken? What should be avoided?
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Take with food or milk
Avoid Aspirin |
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True or False. COX-2 Inhibitors are newer NSAIDs.
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True
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True or False. COX-2 inhibitors are clinically more effective than other NSAIDs.
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False
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Why have some COX-2 inhibitors been voluntarily withdrawn from the market?
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Increased risk of cardiovascular disorders
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What is the MOA of COX-2 inhibitors?
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Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, COX-2, which results in decreased formation of prostaglandin precursors
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True or False. Celecoxib inhibits COX-1 at therapeutic concentrations.
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False
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What is Celecoxib indicated for?
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Relief of osteo and rheumatoid arthritis
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What are 2 adverse effects of Celecoxib?
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-GI irritation
-HA |
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What important information should you tell a patient about Celecoxib use?
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Other similar products have been taken off the market due to increased risk of heart attack and stroke
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True or False. Tylenol is an anti-inflammatory.
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False
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What Tylenol dosing should be used for children under 12 years old?
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10-15 mg/kg/dose
Dosed every 4 hours as needed |
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What is the maximum amount of Tylenol doses for children in 24 hours?
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5 doses = 2.6 grams
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What Tylenol dosing should be used for adults?
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325-650 mg every 4 hours
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What is the maximum amount of Tylenol an adult should take in one day?
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4 grams
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What is Tylenol indicated for?
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Relief of mild to moderate pain and fever
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True or False. Tylenol has very weak COX-1 and COX-2 inhibitory effects.
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True
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Why is alcohol use while taken Tylenol dangerous?
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Increases risk of APAP induced hepatotoxicity
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What is the generic name for Celebrex? Drug Classification?
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Celecoxib
COX-2 Inhibitor, NSAID |
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What is the generic name for Aspirin? Drug Classification?
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Asprin, Acetylsalicylic Acid
Analgesic, NSAID |
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What is the generic name for Mobic? Drug Classification?
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Meloxicam
NSAID, Analgesic |
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What is the brand name for Ibuprofen? Drug Classification?
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Motrin
NSAID |
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What is the generic name for Naprosyn? Drug Classification?
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Naproxen
NSAID |
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What is the generic name for Voltaren? Drug Classification?
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Diclofenac Sodium
NSAID |
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What is the generic name for Cataflam? Drug Classification?
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Diclofenac Potassium
NSAID |
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What is the brand name for Etodolac? Drug Classification?
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Lodine
NSAID |
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What is the generic name for Relafen? Drug Classification?
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Nabumetone
NSAID |
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How many people with diabetes are undiagnosed?
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1/4 of sufferers
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How many types of diabetes are there? What are they?
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4
-Type 1, Type 2, Type 1.5, Gestational |
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How is pre-diabetes classified?
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Glucose levels 100-125 mg/dL
Fasting levels >126 mg/dL |
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What is diabetes?
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Metabolism disorder
Blood levels higher than desired |
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What is required for glucose use?
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Insulin must be present
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Where is insulin produced?
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Pancreas islet/beta cells
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What happens to glucose when insulin is not present?
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Glucose builds up in blood and overflows into urine
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How is food converted to energy?
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First converted to glucose
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Where is glucagon released from? Why is it released?
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From alpha cells of pancreas in response to low blood glucose
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What organ releases glucose into the blood in response to low blood glucose?
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Liver
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What takes in glucose from the blood in response to high blood glucose?
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Fat cells
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What does Type 1 diabetes result from?
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Beta cell destruction leading to absolute insulin deficiency
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What kind of disease is Type 1 diabetes?
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Autoimmune
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What does Type 2 diabetes result from?
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A progressive insulin secretory defect on the background of insulin resistance
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When is gestational diabetes diagnosed?
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During pregnancy
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What are two ways to measure glucose levels?
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Glucometers
Hemoglobin A1c |
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What is a normal blood glucose level?
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70-110 mg/dL
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What does Hemoglobin A1c measure?
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Glycosylated hemoglobin
Average amount of glucose in the blood over the last 2-3 months |
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What does glucose bind to for the life the cell?
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Hemoglobin A
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What is the goal A1c level?
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<6.5%
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What 4 criteria are needed for the diagnosis of diabetes?
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-A1c > (or equal to) 6.5%
-FPG >(or equal to) 126 mg/dL -2-h plasma glucose > (or equal to) 200 mg/dL Random plasma glucose >(or equal to)200 mg/dL |
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What is fasting defined as?
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No caloric intake for at least 8 hours
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What is hyperglycemia?
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Blood glucose levels are elevated
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What are some symptoms of Hyperglycemia? (7)
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-Increased thirst
-Headaches -Difficulty concentrating -Blurred vision -Frequent urination -Fatigue -Weight loss |
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What is hypoglycemia?
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Low blood glucose levels
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Hypoglycemia stimulates what on the body?
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Stress
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What are some symptoms of hypoglycemia? (6)
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-Hot
-Sweaty -Shaky -Dizzy -Headache -Pale skin |
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How is hypoglycemia treated?
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Get glucose on board (glucose tablets, candy)
In emergency situation, use a glucagon kit |
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True or False. Glucagon kits are stored in the refrigerator.
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False. They are stored at room temperature
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What is included in a glucagon emergency kit?
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1 mg of freeze-dried glucagon
1 mL of water for reconsitution |
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What should be avoided in patients with diabetes?
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Alcohol
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Why is alcohol dangerous to diabetics?
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Increases risks of low blood sugar
Liver won't produce glucose until it has taken care of the alcohol |
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How many Americans have Type 1 diabetes?
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5-10%
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When is Type 1 diabetes diagnosed?
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In children or young adults
<20 years old |
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How do Type 1 diabetics typically present?
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-Thin
-Polyuria -Polyphagia -Polydipsia -Fruity breath |
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What is polyuria?
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Excessive urination
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What is polyphagia?
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Excessive hunger
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What is polydipsia?
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Excessive thirst
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What does fruity breath symptomize?
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Ketoacidosis
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How many pregnant women are affected by gestational diabetes?
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4%
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True or False. Gestational diabetes always goes away after the baby is born.
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False. It often goes away but in a small percentage of women it continues after giving birth
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What is Diabetes 1.5?
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Latent autoimmune diabetes in adults
Type 1 diabetes developed in someone older than 20 years old |
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True or False. Type 1.5 diabetics present in the same fashion as Type 1 diabetics.
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True; they have all the same symptoms, just older age.
Also present as fatigued |
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What is the most common form of diabetes?
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Type 2
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When does Type 2 diabetes typically occur?
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In obese patient later in life; older than 40
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True or False. All diabetics produce too little insulin.
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False. Type 2 diabetics can either fail to make enough insulin or make enough or too much insulin
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What happens when the body produces too much insulin.
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Can lead to insulin resistance
Cells won't take up the insulin for use |
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True or False. All types of diabetes are irreversible.
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False. Type 2 diabetes can be reversed by losing a small amount of weight
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How do Type 2 diabetics present?
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-Obese
-May be asymptomatic -Polydipsia -Polyphagia -Polyuria |
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Is insulin a hormone or a protein?
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Both
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Why does insulin bind to cells?
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To allow glucose from the body to be absorrbed
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How does excess insulin cause you to gain weight?
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Excess insulin stimulates your fat cells to store more fat
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What oral medications are used for Type 2 diabetes?
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-Sulfonylureas
-Biguanides -Thiazolidinediones (Glitazones) -Alpha-glucosidase inhibitors -DPP-IV inhibitors -Meglitinides -Incretin mimetics -Combination therapy |
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What drugs sensitize the body to insulin and/or control liver glucose production?
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TZDs
Biguanides |
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What drugs stimulate the pancreas to make more insulin?
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Sulfonylureas
Meglitinides DPP-IV inhibitors Incretin mimetics |
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What drugs slow the absorption of glucose from the gut?
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Alpha-glucosidase inhibitors
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What drugs reduce glucose production?
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DPP-IV inhibitors
TZDs Biguanides Sulfonylureas (rate) |
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How do sulfonylureas work?
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Increase endogenous insulin secretion
Reduces the rate of hepatic flucose production |
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What is generally the least expensive class of diabetic medications?
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Sulfonylureas
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What are two adverse effects of sulfonylureas?
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-Hypoglycemia
-Weight gain |
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Name 3 sulfonylureas.
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-Glyburide
-Glimepiride -Glipizide |
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How do TZDs work?
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Decrease insulin resistance by making muscle and adipose cells more sensitive to insulin
Suppress liver glucose production |
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How long does it take to see maximum effect from TZDs?
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6 weeks
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What lab values are altered by TZDs (other than glucose levels)?
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-Improves HDL cholesterol
-Improves plasma triglycerides (LDL levels neutral) |
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What are 3 adverse effects of TZDs?
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-Weight gain
-Edema -Hypoglycemia (if taken with insulin or agents that stimulate insulin release) |
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When are TZDs contraindicated?
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In patients with abnormal liver function or CHF
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Name 2 TZD medications.
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-Pioglitazone
-Rosiglitazone |
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How do Biguanides work?
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Decrease liver glucose production
Increase insulin-mediated peripheral glucose uptake |
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What are 3 adverse effects of Biguanides?
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-Diarrhea
-Abdominal discomfort -Lactic acidosis (if improperly prescribed) |
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Name 1 Biguanide medication.
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Metformin
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How do Meglitinides work?
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Stimulate insulin secretion (rapidly/short duration) in the presence of glucose
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True or False. Meglitinides stimulate insulin secretion for long periods.
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False
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True or False. Glucose presence is required for Meglitinides to work.
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True
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What are 2 adverse effects of Meglitinides?
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-Hypoglycemia (less than with sulfonylureas if patient has a variable eating schedule)
-Weight gain |
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Name 1 Meglitinide.
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Repaglinide
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How do Alpha-glucosidase Inhibitors work?
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Block the enzymes that digest glucose in the small intestine (delays glucose uptake)
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Should Alpha-glucosidase inhibitors be taken with or without food?
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With food
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What are 2 adverse effects of Alpha-glucosidase inhibitors?
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-Flatulence
-Abdominal discomfort |
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Name 2 Alpha-glucosidase inhibitors.
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-Acarbose
-Miglitol |
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How do DPP4 inhibitors work?
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Dipeptidyl-Peptidase 4 inhibitors
Stimulate beta cells to release insulin Decrease liver glucose production |
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How is DPP4 inhibitor efficacy shown?
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-Decrease in fasting blood glucose 10-15 mg/dL
-Decrease in A1c 0.5-0.6% -Decrease in post-prandial glucose 50 mg/dL |
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What are some adverse effects caused by DPP4 inhibitors?
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GI side effects
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Name 1 DPP4 inhibitor.
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Sitagliptin
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What is incretin?
|
Hormone in the gut which acts on the pancreas to increase insulin production
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How do Incretin mimetics work?
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-Stimulates the pancreas to make more insulin
-Increases B-cell growth/replication |
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Do Incretin mimetics treat Type 1 or 2 diabetes?
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Type 2
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Name 1 Incretin mimetic.
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Byetta
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How are incretin mimetics administered?
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Subcutaneously
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What is the generic for Amaryl? Drug Classification?
|
Glimepiride
Antidiabetic - Sulfonylureas |
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What is the generic for Glucotrol? Drug Classification?
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Glipizide
Antidiabetic - Sulfonylureas |
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What is the brand for Glyburide? Drug Classification?
|
Micronase, Diabeta, Glynase
Antidiabetic - Sulfonylureas |
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What is the brand for Glucovance? Drug Classification?
|
Glyburide with Metformin
Antidiabetic - Biguanide |
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What is the brand for Metformin? Drug Classification?
|
Glucophage
Antidiabetic - Biguanide |
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What is the generic for Actosl? Drug Classification?
|
Pioglitazone
Antidiabetic - Thiazolidinedione (TZD) |
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What is the generic for Avandia? Drug Classification?
|
Rosiglitazone
Antidiabetic - Thiazolidinedione (TZD) |
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What is the generic for Januvia? Drug Classification?
|
Sitagliptin
Antidiabetic - Dipeptidyl-Peptidase 4 (DPP4) Inhibitor |
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What is the generic for Byetta? Drug Classification?
|
Exenatide
Antidiabetic - Incretin mimetic |
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What is insulin made from? What did it used to be made from?
|
Used to be made from pork/beef
Now made from recombinant DNA (Biosynthetic, semisynthetic) |
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|
What are 5 different types of Insulin?
|
-Rapid acting
-Short acting -Intermediate acting -Long acting -Combination products |
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|
How is insulin given?
|
Subcutaneous, can be given IV (only regular insulin)
Proper injection is key! |
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True or False. Any insulin can be given IV.
|
False. Only regular insulin.
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Is insulin stored in the fridge or at room temperature?
|
Both.
Unopened vials kept in fridge. Opened vials good at room temperature for 30 days. |
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What type of diabetes requires insulin administration?
|
Type 1
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How does rapid acting insulin work?
|
Absorbed more quickly than short-acting insulin, but effects wear off sooner
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How does short acting insulin work?
|
Works quickly, but effects don't last as long as intermediate-acting insulin
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How does intermediate acting insulin work?
|
Starts working later than short-acting insulin, but effects last longer
|
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How does long acting insulin work?
|
Takes several hours to work, but provides insulin at a steady level for up to 24 hours
|
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Name 2 rapid-acting insulins.
|
Insulin aspart.
Insulin lispro |
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Name 1 short-acting insulin.
|
Insulin regular
|
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Name 1 intermediate-acting insulin.
|
Insulin NPH
|
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Name 1 long-acting insulin.
|
Insulin glargine
|
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|
How long does it take for rapid-acting insulin to begin working?
|
10-30 minutes
|
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|
How long does it take for short-acting insulin to begin working?
|
30-60 minutes
|
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|
How long does it take for intermediate-acting insulin to begin working?
|
1-2 hours
|
|
|
How long does it take for long-acting insulin to begin working?
|
1-5 hours
|
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When do rapid-acting insulins have the most effect on your blood sugar?
|
30 minutes-3 hours
|
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When do short-acting insulins have the most effect on your blood sugar?
|
2-5 hours
|
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When do intermediate-acting insulins have the most effect on your blood sugar?
|
4-12 hours
|
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When do long-acting insulins have the most effect on your blood sugar?
|
No clear peak
|
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How long do the overall effects of rapid-acting insulins last?
|
3-5 hours
|
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How long do the overall effects of short-acting insulins last?
|
Up to 8 hours
|
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How long do the overall effects of intermediate-acting insulins last?
|
16-24 hours
|
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How long do the overall effects of long-acting insulins last?
|
Up to 24 hours
|
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What is the brand for Insulin Aspart?
|
Novolog
|
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What is the generic for Humulin?
|
Insulin Regular
|
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What is the brand for Insulin Lispro?
|
Humalog
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What is the generic for Lantus?
|
Insulin Glargine
|
