Pharm Exam Study Guide 1 & 2 Presentation1

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Pharm Exam Study Guide 1 & 2 Presentation1

  1. 1. Pharm Exam Study Guide (Cont) Chp 39 -
  2. 2. Hypothalamic Inhibiting Factors <ul><li>Somatostatin </li></ul><ul><li>PIF (prolactin inhibiting factor) </li></ul>
  3. 3. Gestational Diabetes <ul><li>Use insulin treatment </li></ul><ul><li>Insulin does not cross the placenta </li></ul>
  4. 4. Insulins <ul><li>Lantus (glargine) 60-70 min onset </li></ul><ul><li>24 hr duration </li></ul><ul><li>(Do not mix with other insulins) </li></ul><ul><li>Lente (Humulin L) 1-2.5 hr onset </li></ul><ul><li>24 hr duration </li></ul>
  5. 5. Diabetic Adjuncts to Diet <ul><li>Caution with beta blockers or alcohol </li></ul><ul><li>Sulfonylureas </li></ul><ul><ul><li>Glyburide (DiaBeta) </li></ul></ul><ul><ul><li>Glimepiride (Amaryl) </li></ul></ul><ul><li>Nonsulfonylureas </li></ul><ul><ul><li>Metformin (Glucophage) also for children </li></ul></ul><ul><ul><li>Symlin </li></ul></ul>
  6. 6. Pancreas and Insulin <ul><li>Pancreas secretes hormones and sodium bicarbonate into the common bile duct to go to the small intestine </li></ul><ul><ul><li>Alpha cells release glucagon </li></ul></ul><ul><ul><li>Beta cells release insulin </li></ul></ul><ul><ul><li>Delta cells produce somatostatin </li></ul></ul>
  7. 7. Case Study Calcitriol <ul><li>Myra, a dialysis patient, has been taking her calcitriol tablets every morning, as recommended for her hypothyroidism. </li></ul><ul><li>However, her calcium level is still low and she is at risk for osteoporosis. </li></ul><ul><li>What is your advice? </li></ul>
  8. 8. Calcitriol <ul><li>Usual dosage = 0.5-2 mcg/day PO (A.M.) </li></ul><ul><li>Do not crush or chew tablets </li></ul><ul><li>Myra needs to take her calcitriol AFTER dialysis because the calcium is being lost. </li></ul><ul><li>Take with Vitamin D to be effective! </li></ul>
  9. 9. Thyroid Crisis <ul><li>Thyroid crisis occurs when hyperthyroidism is untreated </li></ul><ul><li>Treated with PTU (propylthiouracil) </li></ul><ul><li>Initially 300-900 mg/day PO </li></ul><ul><li>PTH can cause nausea, vomiting, GI complaints and bone marrow suppression </li></ul>
  10. 10. Radiation Emergency <ul><li>Thyro-Block </li></ul><ul><li>Potassium iodide can stain teeth so take through a straw </li></ul><ul><li>Adverse effect: iodism </li></ul><ul><ul><li>Metallic taste </li></ul></ul><ul><ul><li>Mouth sores </li></ul></ul><ul><ul><li>Cold symptoms </li></ul></ul><ul><ul><li>Skin rash </li></ul></ul>
  11. 11. Thyroidectomy Care <ul><li>Surgical removal of thyroid gland </li></ul><ul><li>Voice change is side-effect </li></ul><ul><li>Replacement therapy includes: </li></ul><ul><ul><li>Synthroid (levothyroxine) </li></ul></ul><ul><ul><li>Calcitonin </li></ul></ul>
  12. 12. Female Reproductive system Black Cohosh, Borage, Chaste tree, Devil’s claw, dong quai, red clover, soy, wild yam #@#^%^^&%&^ Menopause Don’t forget the ‘False Unicorn root’!
  13. 13. Menopause <ul><li>Although the joy of menstruation won’t be missed, estrogen does provide several important systemic benefits? </li></ul>
  14. 14. Estrogens <ul><li>Protect the heart from atherosclerosis </li></ul><ul><li>Retain calcium in the bones </li></ul><ul><li>Increase HDL (good)cholesterol levels </li></ul><ul><li>Keeps skin elastic </li></ul><ul><li>Maintain secondary sex characteristics </li></ul>
  15. 15. Menopausal Symptoms <ul><li>Vaginal dryness, hot flashes, moodiness,loss of bone density… </li></ul><ul><li>HRT (hormone replacement therapy) </li></ul><ul><li>Estradiol, estriopipate can cause GI effects, weight gain, breakthrough bleeding and acute pancreatis </li></ul>
  16. 16. Lupron (leuprolide) <ul><li>Blocks the GnRH receptor so FSH and </li></ul><ul><li>LH are not released </li></ul><ul><li>Side effects: </li></ul><ul><ul><li>Hot flashes, peripheral edema, MI, constipation </li></ul></ul><ul><ul><li>Nausea, urinary frequency, increased sweating </li></ul></ul><ul><li>Treats: </li></ul><ul><ul><li>Prostate cancer </li></ul></ul><ul><ul><ul><li>1 mg/day SQ </li></ul></ul></ul><ul><ul><li>Precocious puberty </li></ul></ul><ul><ul><li>Endometriosis </li></ul></ul><ul><ul><ul><li>3.75 mg IM once a month </li></ul></ul></ul>
  17. 17. Bile Acid Sequestrans <ul><li>Questran (cholestryramine) </li></ul>
  18. 18. Infertility Drugs <ul><li>Work to increase FSH/LH levels in females and males </li></ul><ul><li>Clomiphene </li></ul><ul><li>50-100 mg/day PO </li></ul><ul><li>Increased risk of multiple births </li></ul>
  19. 19. Female Reproductive System Turn off the IV form, Go get the nasal form…. What?
  20. 20. Oxytocics <ul><li>Pitocin - used to induce labor and to promote uterine contractions </li></ul><ul><li>Oxytocin - nasal form stimulates “milk let down” </li></ul><ul><li>Adverse effects: cardiac arrhythmias, hypertension, fetal bradycardia,uterine rupture, severe water intoxication </li></ul>
  21. 21. Androgens <ul><li>Risk/Benefits </li></ul><ul><li>Which is worse, endometriosis </li></ul><ul><li>Or </li></ul><ul><li>Taking danocrine? </li></ul>
  22. 22. Androgens <ul><li>Danocrine 100-600 mg/day PO </li></ul><ul><li>Treats endometriosis by preventing FSH and LH release </li></ul><ul><li>Prevents angioedema </li></ul><ul><li>Adverse Effects: hirutism (increased hair distribution), deepening of voice, weight gain, sleep disorders, emotional lability, hepatocellular cancer </li></ul>
  23. 23. Case Study Endometriosis <ul><li>OK…I’m not real interested in the danocrine option to treat my endometriosis </li></ul><ul><li>Any other options? </li></ul>Facial hair issues
  24. 24. Endometriosis <ul><li>Lupron (leuprolide) treats: </li></ul><ul><ul><li>Endometriosis </li></ul></ul><ul><ul><li>Precocious puberty </li></ul></ul><ul><ul><li>Antineoplastic agent </li></ul></ul><ul><ul><li>Side effects: hot flashes, joint pain, hirsutism, depression (I can see why!) </li></ul></ul><ul><ul><li>Treatment is only for 6 months, although </li></ul></ul><ul><ul><li>63% of pts are symptom free after 5 years </li></ul></ul>Not this again!
  25. 25. Heart Medications <ul><li>ECG detects the patterns of electrical impulses and conduction </li></ul><ul><li>PACs </li></ul><ul><li>PAT </li></ul><ul><li>A fib </li></ul><ul><li>PVCs </li></ul>
  26. 26. ACE inhibitors <ul><li>Block angiotensin I ---->angiotensis II </li></ul><ul><li>from occurring in lungs </li></ul><ul><li>Benazepril </li></ul><ul><li>Captopril </li></ul><ul><li>Enalapril </li></ul><ul><li>Fosinopril </li></ul><ul><li>Zestril </li></ul>Used for: Hypertension And With digoxin and diuretics For CHF And Left ventricular dysfunction
  27. 27. Case Study ACE inhibitors <ul><li>Old Mr. Jone’s is recovering from a MI. He’s on lasix and captopril 50 mg PO tid. </li></ul><ul><li>The new nurse tells you she is concerned about his cough and wants to order an Xray. </li></ul><ul><li>His lungs sound clear, what do you suggest? </li></ul>
  28. 28. ACE inhibitors <ul><li>Captopril works to block A I ---> A II </li></ul><ul><li>(in the lungs) </li></ul><ul><li>ACE inhibitors can cause a chronic cough </li></ul><ul><li>Side effects: </li></ul><ul><li>tachycardia, chest pain, GI irritation, ulcers, constipation, photosensitivity </li></ul><ul><li>Take on an empty stomach </li></ul><ul><li>Prevent excessive sweating </li></ul>Empty stomach… I’m starvin’ Can’t wait to Have a big Mac Cough, Cough, cough
  29. 29. DO not crush, cut or chew any of these meds
  30. 30. CAD causes CHF <ul><li>AH…finally I understand </li></ul><ul><li>CAD causes arteries to get clogged up </li></ul><ul><li>The heart has to work harder and harder to meet the demands </li></ul><ul><li>The left ventricle gets larger and larger. </li></ul><ul><li>Pulmonary edema occurs when blood gets backed up into the lungs. </li></ul>
  31. 31. CHF <ul><li>How to diagnosis it? </li></ul><ul><li>Order a chest Xray, ECG and even direct precussion of the chest </li></ul><ul><li>All of these tests are looking for an enlarged left ventricle (cardiomegaly) </li></ul><ul><li>Also seen: heptomegaly, splenomegaly, swollen legs, dependent edema </li></ul>
  32. 32. CHF = Digoxin <ul><li>Digoxin (cardiac glycoside) is used most often to treat CHF…no, really? </li></ul><ul><li>Digoxin increases the force of myocardial contraction, </li></ul><ul><li>cardiac output and renal perfusion </li></ul><ul><ul><li>But </li></ul></ul><ul><ul><li>amazingly slows the heart rate </li></ul></ul>
  33. 33. Case Study Digoxin <ul><li>Remember, digoxin is amazing, it slows the heart rate so before administering digoxin, every nurse will? </li></ul>
  34. 34. Digoixn <ul><li>Rapidly absorbed </li></ul><ul><li>Can cause toxicity </li></ul><ul><ul><li>Digibind, digifab </li></ul></ul><ul><ul><li>Digoxin immune fab </li></ul></ul>Treat serum levels > 10 ng/ml Did you find the digibind?
  35. 35. Lidocaine <ul><li>Class Ib antiarrhythmic </li></ul><ul><li>300 mg 10% solution IM </li></ul><ul><li>50-100 mg IV bolus slowly </li></ul><ul><li>Can cause: </li></ul><ul><ul><li>Hypotension, shock </li></ul></ul><ul><ul><li>Dizziness, fatigue, </li></ul></ul><ul><ul><li>Mouth numbness, slurred speech </li></ul></ul><ul><ul><li>Rash </li></ul></ul>Used in cardiac surgery Or MI but not With CHF
  36. 36. Megaloblastic anemia <ul><li>Insufficient folic acid or Vit. B 12 </li></ul><ul><li>Red, glossy tongue </li></ul><ul><li>Diarrhea </li></ul><ul><li>Treat with Hydroxycobalamin </li></ul><ul><ul><li>IM injections </li></ul></ul><ul><ul><li>Once a month for life </li></ul></ul>
  37. 37. Case Study Megaloblastic Anemia <ul><li>Problem: two pts in rooms side by side have megaloblastic anemia. </li></ul><ul><li>57 yr old alcoholic </li></ul><ul><li>28 yr old female 2/3 of small intestine removed for cancer </li></ul>One is to have oral Folvite, the other receives an IM injection of hydrocobalamin. Who get’s what?
  38. 38. Case Study Megaloblastic Anemia <ul><li>57 yr old male alcoholic --> oral Folvite </li></ul><ul><li>28 yr old female 2/3 of small intestine removed for cancer ----> IM injection </li></ul><ul><li>Vitamin B 12 needs to be absorbed in the small intestine. The alcoholic can take oral meds, he just needs to improve his diet. </li></ul>
  39. 39. Intractable Hiccoughs <ul><li>(web says marijauna cures this….) </li></ul><ul><li>Textbook says (p. 972) use: </li></ul><ul><li>Chloropromazine (Thorazine) </li></ul><ul><li>10-25 mg PO q4-6hr </li></ul>
  40. 40. Postpartum Laxative <ul><li>Milk of Magnesia is minimally absorbed and can be used by pregnant women and those nursing </li></ul>
  41. 41. Nexium (esomeprazole) <ul><li>20-40 mg.day PO for 4-8wks </li></ul><ul><li>Treats GERD, erosive esophagitis, duodenal ulcers, hypersecretions </li></ul><ul><li>Acid labile </li></ul><ul><li>Side effects: </li></ul><ul><ul><li>Dizziness, headache, vertigo, insomnia, dream abnormalities, dry mouth, tongue atrophy, cold symptoms, rash, back pain </li></ul></ul>Proton pump inhibitor- blocks acid production
  42. 42. Chronic Constipation <ul><li>Laxatives are NOT recommended for long term use </li></ul><ul><li>Cathartic dependence occurs when the GI tract becomes dependent on the vigorous stimulation of the laxative </li></ul><ul><li>Wait 30 mins after administering a laxative before giving other meds. </li></ul>
  43. 43. Antidiarrheals <ul><li>Only paregoric is indicated for children under 2 yrs old </li></ul><ul><li>0.25-0.5 mL/kg PO </li></ul><ul><li>Paregoric is an opium derivative and can have adverse effects on a neonate </li></ul>
  44. 44. Case Study Androgens <ul><li>Your male patient grew muscles overnight. He looks like he is probably using “products” to enhance his athletic performance. </li></ul><ul><li>What should you advise him about creatine? </li></ul>
  45. 45. Creatine <ul><li>Naturally occurring substance in red meat </li></ul><ul><li>Interacts with NSAIDs </li></ul><ul><li>Can cause kidney dysfunction </li></ul><ul><li>For short-term use </li></ul>Drink plenty of fluids
  46. 46. Cialis (tadalafil) <ul><li>Inhibits the PDE5 receptors </li></ul><ul><li>Increases nitrous oxide levels </li></ul><ul><li>Onset of action 45 mins and a duration of 36 hours </li></ul><ul><li>(avoid grapefruit juice and high-fat meals prior to use) </li></ul>
  47. 47. Viagra (sildenafil) Ladies, I recommend Viagra over Cialis, because Viagra only lasts 4 hours, Cialis last 36 hours!
  48. 48. PDE5 inhibitors <ul><li>Cialis, Viagra medications can cause: </li></ul><ul><li>Headache </li></ul><ul><li>Dyspepsia </li></ul><ul><li>UTI </li></ul><ul><li>Flushing </li></ul><ul><li>Dizziness </li></ul><ul><li>Rash </li></ul><ul><li>Optic neuropathy </li></ul>Blue pill Or the red pill?
  49. 49. Male Reproduction
  50. 50. Case Study Tagament <ul><li>Walt, a 48 yr old male, calls the GP office where you work. He is very upset and claims “I am developing breasts!” </li></ul><ul><li>He is very healthy, a workaholic and has only seen the doctor once this year for an ulcer. </li></ul><ul><li>What do you suggest? </li></ul>
  51. 51. Tagamet (cimetidine) <ul><li>300 mg PO qid with meals </li></ul><ul><li>Tagamet is for short-term treatment: </li></ul><ul><ul><li>active duodenal </li></ul></ul><ul><ul><li>gastric ulcers </li></ul></ul><ul><ul><li>relief of heartburn. </li></ul></ul><ul><li>Side effects: </li></ul><ul><li>dizziness, confusion, headache, cardiac arrhythmias, diarrhea, impotence, rash </li></ul><ul><li>and gynecomastia (male breasts) </li></ul>

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