Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
79 Cards in this Set
- Front
- Back
|
rapid acting insulins
names onset, peak, duration |
lispro (humalog), aspart (novolog), glulisine (Apidra)
onset: 10-15 min peak: 1-2 hours duration 3-4 hrs |
|
|
short acting insulin
name onset, peak, duration |
regular insulin
onset: 0.5-1 hr peak: 2-4 hrs duration: 4-8 hrs |
|
|
intermediate acting insulins
names onset, peak, duration |
NPH
onset: 1-3 hrs peak: 4-10 hrs duration: 10-18 hrs |
|
|
insulin glargine (lantus)
onset, peak, duration |
onset: 2-3 hrs
peak: none duration: 24+ hours |
|
|
insulin determir (levemir)
onset, peak, duration |
onset: 1 hr
peak: none duration: up to 24hrs |
|
|
In which pt's should we use antihistamines with caution
|
narrow-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, symptomatic prostatic hypertrophy, bladder neck obstructions
|
|
|
what should be avoided when on antihistamines?
|
sunlight
|
|
|
what are some of the oral antihistamines?
|
diphenhydramine (benadryl)
loratadine (claritin) cetirizine (zyrtec) fexofenadine (allegra) desloratadine (clarinex) |
|
|
what are the intranasal antihistamines?
|
azelastine (astelin)
|
|
|
topical corticosteroids
|
intranasal
exert anti-inflammatory effects indicated for rhinitis budesonside (rhinocort) fluticasone (veramyst) mometasone (nasonex) triamcinolone (nasacort) |
|
|
intranasal cromolyn
|
stabilizes mast cells (same drug as mast cell stabilizers used in asthma)
indicated for chronic allergic rhinitis SE include sneezing, stinging, burning, irritation, PND, epistaxis, HA NasalCrom |
|
|
short acting beta 2 agonists
side effects |
headache, tachycardina, hypokalemia, hyperglycemia, tremors, and increased lactic acid
|
|
|
long acting beta 2 agonists
side effects |
tachycardia, hypokalemia, QT prolongation with overdose
|
|
|
name of long acting beta 2 agonists
which have BBW and which do not? |
salmeterol (bbw)
formoterol (bbw) arformoterol (bbw) albuterol (vospire) (no bbw) |
|
|
onset for short and long acting beta 2 agonists
|
short-- 5-15 minutes
long--30-50 minutes |
|
|
what is the BBW for long acting beta 2 agonists?
|
increased asthma related death in adolescents and kids using long acting beta 2 agonists
|
|
|
inhaled corticosteroids
|
inhibit IgE and mast cell mediated migration of inflammatory cells
for long term asthma and COPD SE include thrush, hoarsness, dry mouth, bronchospasm, cough, HPA axis suppression, adrenal insufficiency |
|
|
inhaled corticosteroids names
|
beclomethasone (q-var)
budesonide (pulmicort) ciclesonide (alvesco) fluticasone (flovent) flunisolide (aerobid) memetasone furoate (asmanex) triamcinolone (azmacort) |
|
|
oral corticosteroids
MOA indications SEs |
suppress cytokine production, airwary eosinphil recruitment and inflammotory mediator release
for severe persistent asthma and COPD exacerbation side effects include acne, hirsutism, cushingoid appearance, cataracts, deceased bone density |
|
|
oral corticosteroids names
|
prednisone
prednisolone |
|
|
mast cell stabilizers
|
stabilize mast cells and inhibit activation and release of mediators
indicated for asthma only, especialy bronchospasm due to allergen inhalation, cold air, and exercise SE include headache, cough, bronchospasm cromolyn sodium is the DOC |
|
|
leukotriene modifiers
|
prevent leukotriene synthesis (or something)
indicated for asthma and allergic rhinitis (montelukast only); for prophylaxis and chronic tx of asthma SE include headache* dry mouth, somnolence, nausea, arthralgia, chest pain etc etc, depression, SI, and suicide found post-marketing montelukast (singluair) |
|
|
methylxanthines
|
usually rx'd by pulmonologist
relaxes smooth muscles of bronchial airways for asthma and COPD SE include headache, insomnia, aggravation of ulcer or GERD, hyperactivity, hypokalemia, tachyarrythmias, seizures MANY DIs theophylline |
|
|
anticholinergics
|
inhibit effects of acetylcholine at parasympathetic sites in bronchial smooth muscle
indicated for bronchospasm of COPD and for emergency use in asthma (ED only) SE include nervousness, dizziness, and headache |
|
|
anticholinergics drug names
|
ipratropium bromide (atrovent)-- short-acting
tiotropium (spiriva)-- long acting |
|
|
combination inhaled meds
|
combivent-- albuterol/ipratropium bromide (ED use)
advair-- fluticasone/salmeterol (BBW) symbicort-- mometasone/fomoterol (BBW) |
|
|
immunomodultators
|
IgE blocker
for moderate to severe persistent asthma that has shown proven reactivity to perennial allergen in pt who are symptomatic despite long term inhaled corticosteroid **BBW** SE include injection site reaction, anaphylaxis and malignnacy, up to a year after drug's use (pt needs epipen for at-home use) |
|
|
how do we base asthma meds?
|
severity level, age, and level of control
|
|
|
COPD med choices
|
mild: PRN short-acting bronchodilator
moderate: PRN short-acting bronchodilator, long acting bronchodilatory, +/- corticosteroid |
|
|
sulfonylureas MOA
|
stimulates insulin release from beta cells
can eventually lead to pancreatic "burnout" |
|
|
sulfonylureas benefits
|
experience
improved microvasular outcomes in UKPDS low cost, some QD dosing |
|
|
sulfonylureas side effects or concerns
|
hypoglycemia (#1)
WT gain can cause pancreatic burnout |
|
|
sulfonylureas
management considerations |
shorter acting agents preferred in elderly
glyburide has active metabolites and should be avoided in RF and CRI, or hepatic impairment-- use GLIPIZIDE instead |
|
|
biguanides MOA & met
|
decreases hepatic glucose production
cleared renally, build up significant in pt with RF |
|
|
biguanides benefits
|
wt loss of wt neutrality
no hypoglycemia experience improved macrovascular outcomes QD dosing |
|
|
biguanides side effects / concerns
|
GI distress, diarrhea (resolves after several weeks)
**lactic acidosis** |
|
|
biguanides management considerations
|
qlactic acidosis rare
check LFTs, CR yearly d/c day of surgery (evening before for sustained release) & restart 48 hours after procedure #1 choice in overweight T2DM |
|
|
biguanides contraindications
|
renal insuff, dehydration, hemodynamic instability
metabolic acidosis hepatic dysfunction ETOH abuse unstable CHF old folks (>80 yrs, check Cr first) |
|
|
TZDs MOA
|
increases peripheral insulin sensitivity
|
|
|
TZDs benefits
|
addresses primary defect of T2DM
no hypoglycemia lipid benefits anti-atherosclerotic properties potential for beta-cell preservation QD dosing |
|
|
TZDs side-effects / concerns
|
bone fx in women (with both drugs)
edema heart failure in predisposed individuals weight gain slow onset of action expensive liver monitoring still advised |
|
|
TZDs management considerations
|
wt gain & edema problematic at higher doses & when used with insulin and secretagogues
possible increase risk of MI in pt on rosglitazone many MDs switching to pioglitazone both drugs still have bone fx SE |
|
|
meglitinides MOA
and names |
stimulate insulin release
repaglinide (prandin) nateglinide (starlix) |
|
|
meglitinides benefits
|
mimics physiological secretion
targets postprandial glucose decreases risk of late post-prandial hypoglycemia |
|
|
meglitinides side effects / concerns
|
hypoglycemia
weight gain new expensive frequent dosing |
|
|
DPP-4 inhibitors MOA
|
increases glucose-dependent insulin release
suppresses glucagon secretion delays gastric emptying |
|
|
DPP-4 benefits
|
low incidence of side effects
QD dosing potential beta cell preservation |
|
|
DPP-4 concerns/side effects
|
expensive, new, urticaria, angioedema
adjust dose in renal pt |
|
|
DPP-4 Inhibitors
|
Sitagliptin (Januvia)
|
|
|
GLP-1 mimetics MOA
|
glucose-dependent stimulation of insulin release
suppresses glucagon release retards gastric emptying'enhances satiety |
|
|
GLP-1 mimetics benefits
|
weight loss, no hypoglycemia, potential beta cell preservation
|
|
|
GLP-1 mimetics side effects / concerns
|
must be injected BID, NV, pancreatitis
|
|
|
GLP-1 mimetics drug names
|
Exenatide (Byetta)
|
|
|
hormones produced by the anterior pituitary
|
GH
prolactin (dependent on dopamine) LH/FSH TSH ACTH |
|
|
hormones produced by the posterior pituitary
|
vasopression
oxytocin |
|
|
GH drug
|
somatotropin for GH deficiency
|
|
|
drugs that inhibit release of GH
|
somatostatin and octreotide
somatostatin also inhibits release of glucagon, insulin, and gastrin ocreotide is more potent for GH inhibition and has less glucose derangement |
|
|
FSH/LH/HCG pharmacological uses
|
ovulating agents
hypgonadism prostate cancer endometriosis uterine fibroids |
|
|
drugs used to supress prolactin secretion
|
dopamine agonists
bromocriptine, cabergoline, pergolide |
|
|
normal TSH level
|
0.3-4.2 IU/ml
|
|
|
hypothyroid TSH and T4 levels
|
high TSH
low T4 |
|
|
hyperthyroid TSH and T4 levels
|
low TSH
high T4 |
|
|
meds for hypothyroid
|
Thyroxine (T4)
Levoxyl, Levothyroxine, Synthroid (supplemental T4 to be converted to T3) |
|
|
Cytomel
|
T3
used for myxedema coma SE include cardiac toxicity and other adverse events |
|
|
Liotrex
|
combination drug of T4 and T3 in a 4:1 ratio
|
|
|
thyroxine therapy
|
T4
take on empty stomach no vitamins do not switch drugs w/out TSH levels dosing based on age, severity of disease, and cardiac impairment 1/2 life is 5 days and onset is 3-5 days titrate dose q4-6 weeks PO to IV is 50% of PO dose myxedema pt only get IV thyroxine |
|
|
meds for hyperthyroid disease
|
PTU: inhibits conversion of T4 to T3
Methimazole (Tapazole): blocks hormone synthesis (4-wks) lugol's sol'n: blocks hormone synthesis and release (short-term) beta blockers: inhibit peripheral conversion of T4 to T3 |
|
|
hyperthyroid therapy
|
PTU in pregnancy
methimazole does not inhibit conversion peripherally (less SEs) therapy takes 4-6 weeks (PTU/Methimazole) 1/2life short in plasma but long in thyroid |
|
|
hyperthyroid drugs SEs
|
agranulocytosis (PTU)
GI symptoms hepatitis lupus-like rashes (PTU) |
|
|
glucocorticoids
short term ADRs |
hyperglycemia
peptic ulcer exacerbation platelet aggregation inhibition psychosis |
|
|
glucocorticoids
long term ADRs |
osteoporosis
fat redistribution hypertichosis addisons syndrome infections malignancy |
|
|
D/Cing glucocorticoids
|
7 days is max for cold turkey due to risk for adrenal insufficiency
|
|
|
indications for mineralcorticoid use
|
aldosterone
adrenalcorticoid insufficiency orthostatic hypotension |
|
|
glucocorticoid
indications for use |
addison's syndrome
dexamethasone suppression test angioedema/anaphylaxis connective tissue disorders autoimmune disorders dermatitis vasculitis transplant anti-emetic stress dose for septic pts |
|
|
mineralcorticoid drug
|
fludricortisone
|
|
|
mineralcorticoid anatagonist drugs and indications
|
CHF, hyperaldosteronism (cushings), ascites
Spironolactone Eplerenone |
|
|
what is vasopressin?
what is it used for clinically? |
released by PP in response to low BP or increased tonicity
nocturnal diuresis central diabetes insipidus septic shock SIADH CHF |
|
|
vasopressin drugs
|
desmopressin and vasopressin
PO, nasal, IV, or SubQ |
|
|
oxytocin indication and half-life
|
induces labor and control postpartum labor
1/2life is 5 minutes |
