gi
this medication is used to replace prostaglandins inhibited by NSAID use
misoprostol
this thyroid condition is self-limiting and is believed to be viral in origin
subacute thyroiditis
also known as Quervain thyroiditis
thyrotoxic phase lasting 4-10 weeks followed by period of hypothyroidism
treat symptoms with beta blockers and possible short term iodine therapy
adrenal or cortisol excess is usually caused by
tumor
Tx of bacterial URI
open to interpretation with this one since there was no clear answer?
cover streptococcus pneumoniae (gram +) (most common and least likely to resolve)
haemophilius influanzae (gram -) (more common in smokers and most produce beta lactamases)
moraxella catarrhalis (gram negative)
Much less common and usually resolves spontaneously
>90% are beta lactamase producing
must cover gram + and - and possible beta-lactamase producers
macrolides (azithromycin, clarithromycin)
lubisterone moa and adverse effects
Lubiprostone (Amitiza) now indicated for IBS-C at 8mcg BID
MOA: selective chloride channel activator. Activation of sodium chloride channels increases fluid secretion into the lumen of small bowel and stimulates GI motility
May cause benign chest tightness/shortness of breath which will resolve within 3 hours of administration
if pt has cardiac history, possibly consider different medication due to that side effect
this class of drugs used to manage diarrhea forms a jelly-like stool
bulk formers:
Calcium polycarbophil (fibercon)
Mechanism of action: absorb water in the large bowel, produces gel-like stool
this class of anti-diabetic meds can have side effects similar to lactose intolerance
Alpha Glucosidase Inhibitors: (Acarbose, Miglitol)
MOA: prevents enzymatic hydrolysis of disaccharides in the gut. Blocks the absorption of sucrose
Good additive to another anti-diabetic agent
Similar to making the patient lactose intolerant but it is sucrose intolerant instead
Do not cause hypoglycemia
Adverse effects: GI effects similar to lactose intolerance
Safety considerations: not to be used with patients who have inflammatory bowel disease, ulcerative colitis, intestinal obstruction
this opioid medication cannot be crushed or chewed and wont liquify to be injected, it was developed to prevent abuse
Long acting Hydrocodone (Hysingla ER)
tx of community-acquired pneumonia
macrolide, doxycycline, (protein synthesis inhibitors) unless pt is at high risk for drug-resistant strep or poor outcomes, then beta-lactam and 2nd antibiotic to cover atypicals (including fluoroquinolone)
important teaching points for thyroid medication
potential for overmedication and toxicity (tremulous, tachycardia, htn, anxiety, diarrhea). Observe for s/s of excess thyroid hormone. must be taken on an empty stomach, and binds easily with other things. Normal adults take 1.6mcg/kg/day at 50% estimated dose. elderly 1mcg/kg/day, children 4mcg/kg/day, higher metabolic rate. and that it can take months to regulate
This class of antacids can cause side effects such as dizziness, drowsiness, abdominal discomfort, confusion and diarrhea
H2 Receptor antagonists
MOA: inhibits the binding of histamine at the receptor site on parietal cells. Inhibition of binding sites reduces the pumping of H+ ions from parietal cells into lumen of gut. Reduces acidic irritation.
Cimetidine
Famotidine
Nizatidine
Ranitidine
UTI is an uncomfortable possible side effect of this class of medications since it excretes glucose through urine
Sodium Glucose Cotransporters: (Canagliflozin/Invokana, Dapaglifozin/Farxiga, Empagliflozin/Jardiance)
MOA: facilitate renal excretion of sodium via the renal tubules. Acts mostly on postprandial hyperglycemia. Excretes glucose in the urine, decreases reabsorption of sodium and also causes diuresis which can lower systolic b/p. Not indicated as HTN treatment
Adverse effects: urinary symptoms and genital fungal infection. (Yeast, bacteria and fungus loves sugar), hypotension in patients on diuretics or the elderly
Safety considerations: avoided in patients with renal dysfunction
this medication can be used for tx of menopausal symptoms but is not as effective as HRT (hormone replacement therapy)
Brisdelle (paroxetine with new name and dosing)
Venlafaxine
why give augmentin as opposed to amoxicillin? specifically in children
augmentin contains amoxicillin and clavulanic acid protects the amoxicillin from the degradation of beta-lactamase enzymes
for recurrent infections or immune impaired children augmentin covers strep, h.flu and beta lactamase producers
graves disease causes, tx, sx
An autoimmune disorder characterized by the development of TRAb and other antibodies
sx: exophthalmos, heat intolerance, increased energy, difficulty sleeping, diarrhea, anxiety
Treat with propranolol for symptoms
Radioactive iodine (RAI) is the curative treatment of choice, admin with propranolol use (thyroid is only thing in body that uses iodine), but not everyone is a candidate
In extreme cases, either CV disease or elderly should be pretreated with anti-thyroid drugs (Propylthiouracil (PTU) and Methimazole (Tapazole) most common)
Mild forms may be treated with ATD and long term remission can be possible without definitive intervention
Surgery is the treatment of choice for pregnant women with graves disease who to not respond to PTU
serotonin is implicated for involvement with this GI condition
IBS
cortisol excess presents with these characteristics
hyperglycemia, htn, obesity
organism most commonly found in urine
e. coli.
treated with Bactrim, urinary fluoroquinolone, cephalosporin
risk for gram + bacteria with recent urinary catheterization
contraindications to GLP-1 agonist
not to be given with hx of pancreatitis or active pancreatitis, hx of endocrine malignancy, or current endocrine malignancy
adverse effects include: significant nausea, endocrine malignancies, pancreatitis, gastroparesis
IBD vs IBS, symptoms and treatments
treatment includes monoclonal antibodies that block receptors TNF-Alpha, the inflammatory mediator, adalimumab, certolizumab, infliximab and mesalamine (5-amiosalyscilic acid to reduce inflammation)
agranulocytosis is a side effect of these anti-thyroid medications
Propylthiouracil (PTU) and Methimazole (Tapazole)
Inhibit organification, coupling and proteolysis
PTU inhibits peripheral conversion of T4 to T3
Possibility of recurrence after d/c meds
May be used long term for mild cases
organisms of the skin
cellulitis is usually caused by strep
abscess usually caused by staph
can occur either way
abscesses treat with i&d and cover with bactrim ds (double strength), clindamycin, zyvox or vanco.
watch for elevated wbc or signs of systemic infection, streaking, fever
cellulitis drugs better suited to strep, PCN, dicloxacillin (MSSA sensitive)erythromycin, cephalosporins, fluoroquinolones
concerns/adverse effects of PPI use
concerns: medication interactions r/t alteration of gastric ph. cannot take with food, and must take 30-60 minutes prior to eating.
pt may state the medication is not working because they are taking it with food, or require an additional dose in the evening
adverse effects: interferes with absorption of B-12, may interfere with absorption of calcium carbonate, not recommended to be given with clopidogrel as it prevents conversion to active metabolite, can cause diarrhea, hypomagnesemia and increased instances of pneumonia