gi
this phase of eating is the best time to give PPI
cephalic phase, ready to eat
targets suppression of hepatic glucose
contraindications: decreased renal function
MOA beta lactam ABX
competes for pcn binding proteins which are used in cell wall synthesis
The cell wall is composed of peptidoglycan strands, the final step in the synthesis of the cell wall is a cross-linking of these strands to adjacent strands (transpeptidation)
blocks transpeptidation
includes: PCN, cephalosporins, primaxin, azactam
when to suppress cough reflex
when it affects oxygenation, otherwise cough is a protective mechanism
this pain medication can be associated with seizures when used recreationally
Tramadol/Ultram: promotes GABA and inhibits Glutamate, lowers seizure threshold
this class of medications is the treatment of choice for treatment of GERD
PPI
this drug for diabetes has an active metabolite and can cause hypoglycemia in patients with renal insufficiency
sulfonylureas (glipizide, glyburide, glimperide)
this class of ABX interferes with reproduction by targeting the PABA pathway
DNA synthesis inhibitors. DNA replication requires bases, bases require folate. Bacteria can synthesize folate using the PABA pathway, which is where these medications work
Meds include bactrim
the only class of medication to immediately produce bronchodilation
beta blockers:
Short acting: albuterol. Acts like epi and binds to beta2 receptors causing immediate bronchodilation
Rescue inhalers:
Albuterol
Levalbuterol
Proventil
Ventolin
proair
NSAIDS safety concerns/adverse effects
GI intolerance and/or ulcers, blockage of platelet aggregation, prolonged gestation, inhibition of propagandist-mediated renal function, vasomotor rhinitis
potentiates anticoagulation, increased lithium and methotrexate toxicity (r/t impaired renal function and narrow therapeutic window), reduces effect of antihypertensives
Labs: monitor for hyperkalemia
these two things are the more common causes of peptic ulcer diseases and determine course of action for treatment
NSAID use, H.pylori
NSAID use should be D/c in case of PUD
H. pylori involves use of PPI as well as ABX
to be able to use this class of drugs for diabetes, the patient must be able to make their own GLP-1
DPP4 Inhibitors: (Sitagliptin/Januva, Saxagliptin/Onglyza, Linagliptin/Trajenta)
DPP4 is an enzyme that degrades naturally occurring GLP-1, the inhibitor blocks it. The result is enhanced actions of natural GLP-1.
The difference between GLP-1 agonists and DPP4 inhibitors is that GLP-1 is a synthetic GLP-1 and will not work on a client who does not produce their own GLP-1.
Do not affect weight since they do not produce satiety or fullness like GLP-1 agonists
DPP4 inhibitors enhance naturally occurring GLP-1.
The patient must be able to produce their own GLP-1
Adverse effects: nausea, endocrine cancers, pancreatitis, gastroparesis
Safety considerations: not to be given with hx of pancreatitis or active pancreatitis, hx of endocrine malignancy or current endocrine malignancy
Nucleotide Reverse Transcriptase Inhibitors (NRTI)
NRTI: competitively binds to viral DNA and does not contain enzymes needed to replicate, leaving the virus unable to finish dna strand which becomes terminated. Used for prophylaxis before a cell has become infected. Blocks acute infection of cells. Useful after HIV + because there are still T cells which have not become infected and can keep them from becoming infected. After the cell has become infected they don’t do anything.
antiepileptics moa
MOA: believed to be potentiate of GABA receptors and inhibition of glutamate
Similar structure to TCA’s
Reduces synaptic transmission of pain
tx for PUD with h.pylori
Quadruple therapy:
for pts recently taking macrolides and allergic to pcn, good choice is PPI+bismuth+metronidazole+tetracycline for 14 days
triple therapy:PPI +clarithromycin+ amoxicillin or metronidazole
sequential therapy: PPI and abx at different times
salvage therapy: consider quadruple therapy is not already used, PPI + amoxicillin + levofloxacin (not first choice due to adverse effects)
When using fludrocortisone for aldosterone replacement, it is important to be observant for s/s of what?
fluid retention since it is the hormone that encourages the body to retain sodium
med should be used transientlybounding pulses, rales, htn, edema, electrolyte abnormalities
watch for hypernatremia and hypokalemia
this HIV antiviral medication builds resistance quickly. skin rash is a significant side effect
non-nucleotide reverse transcriptase inhibitors
NRTI
Nevirapine (Viramune)
Delavirdine (Rescriptor)
Efavirenz (Sustiva)
Etravirine (Intelence)
Rilpivirine (Edurant)
this med is indicated for depression and diabetic peripheral neuropathy
Duloxetine
this mucosal protective agent has been shown to decrease instances of aspiration pneumonia if gastric contents are aspirated but is not always practical
sucralfate
this class of drugs is used to control symptoms r/t hyperthyroidism
beta blockers (atenolol and propanolol)
this is the only macrolide antibiotic that is not a cyp450 inhibitor
azithromycin
NSAIDS renal implications
NSAIDS prevent the synthesis of the prostaglandins responsible for maintaining and regulating renal blood flow, retention of sodium and water and may cause edema