Endocrine
DI meds: ___ Antidiuretic Hormone: ADH; Drug to treat? Causes low ____; Monitor what? Risk for ___
Deficiency: Diabetes Insipidus (DRY INSIDE): pees all the urine/water out
- Drug of choice: DesmoPressin: Decreases urine output, Pressing the BP up
- Causes low sodium – risk for seizures
- Monitor for HA, strict I/O, urine specific gravity, DAILY weight
Hyperthyroid: 3 meds? Which is preferred? Which has bad metallic taste and stains ___? SE's for each of the 3?
1) Methimazole: Preferred drug, 10 times more potent
- SE: HA, drowsiness, vertigo, GI distress, hepatotoxicity
2) Propylthiouracil (PTU): required dosing several times per day
- SE: Blood dyscrasias, GI distress, rash, hepatotoxicity
3) Potassium Iodine (Lugol’s Solution): absorbed by thyroid gland to inhibit production and release of hormones
- SE: Bad, metallic taste, stomatitis, severe GI distress (Stains the teeth, drink with a straw)
Expectorants: Drug? Action? SE's? Give with what? Watch ___ if N/V/D
Guaifenesin
- Reduces the thickness, adhesiveness, and surface tension of mucous making it easier to clear from the airways
- SE's: N/V/D/ Abdominal pain, Drowsiness, HA, and Skin rash/hives
- Administer with a full glass of water to loosen mucus
- Watch hydration status if vomiting/diarrhea
* GUAIFenesin sounds like cough, so is used for a non-productive cough *
Decongestants:What may occur with overuse? How long should you take these in days and why? ___ ____vasoconstrict when applied directly; Systemic absorption is ____
NEGLIGIBLE
- Nosebleeds may occur with overuse
- Limit nasal spray use to 3-5 days ONLY – longer will cause rebound nasal congestion
- Topical decongestants vasoconstrict when applied directly to swollen mucous membranes of the nose and they provide immediate relief from nasal congestion
SIADH meds: _____ Antidiuretic Hormone: ADH; Treatment? Med? Monitor? SE's?
Excess: SIADH (SOAKED INSIDE): water is stuck inside the body
- Treatment: Limit po fluids, give hypertonic saline solution (Sodium is low/diluted)
- Meds: Vaptans: Vasopressor receptor antagonists
- SE: Thirst, dry mouth, constipation, electrolyte imbalances
- Monitor: Strict I/O, urine specific gravity, DAILY weights
Aldosterone: What drug mimics aldosterone and is used to treat HYPOadrenal gland (Addison's)? ____ feedback loop
- These patients are treated with fludrocortisone
- It helps flood(“flud”) the body with more salt and water
- Fludrocortisone mimics aldosterone in the body
- Negative feedback loop
Expectorants/Mucolytics: 2 examples? Which is used for cystic fibrosis? Which is used for acetaminophen overdose?
1) Acetylcysteine – dual purpose
- Used po and IV for acetaminophen overdose treatment
- May be used intranasal and nebulized to decrease thickness of mucous
- Can be given 5 minutes after a bronchodilator to loosen thick mucous
2) Dornase Alpha (Pulmozyme)
- Used for patients with Cystic Fibrosis as a mucolytic
- This is given by nebulizer treatment, actually “digests” DNA in thick sputum
Antihistamines: Uses? Which gen is sedating? Examples from both Gens?
Uses: Allergic rhinitis, allergic conjunctivitis, urticaria (hives), angioedema (swelling of face, hands, and feet), insomnia, motion sickness, antiemetic
1) First Generation (older, SEDATING)
- Diphenhydramine (Benadryl)
- Brompheniramine
2) Second Generation (less sedating)
- Cetirizine (Zyrtec)
- Fexofenadine (Allegra)
- Loratadine (Claritin)
Hypothyroid: ___ TSH and ___ T3 and T4; Drug? When to take this drug? Food? Is this drug okay for pregnancy? BBW?
Low T3 and T4
High TSH
*** Levothyroxine ***
- BBW: Thyroid replacement is not to be used to treat obesity
- Early morning
- No food
- Safe for pregnancy
Aldosterone: What are the 7 side effects of the drugs used to treat hypo adrenal gland (Addison's)?
Swollen (moon face, buffalo hump), Sepsis (increased risk of infection), Sugar (hyperglycemia), Skinny muscle and bone (osteoporosis), Sight (risk for cataracts), Slowly taper (dangerous to abruptly stop) and Stress/Surgery (need to increase the dose temporarily)
Antitussives: Contradiction? Do not use with what 2 AD's? Opioid Antitussives (Codeine) are reserved for treating ____ ___
- It is CONTRAINDICATED in patients with COPD
- It should NOT be used with SSRI’s or MAOI’s
- Treating intractable coughing
Antihistamines: Contraindication? What to watch out for with Benadryl? Take with or without food? Avoid what?
- CONTRAINDICATED with glaucoma and asthma
Diphenhydramine can help with the EPS of Parkinson’s disease; causes sedation (fall precautions)
- Take with meals to avoid GI S/S
- Avoid caffeine, nicotine, and alcohol
Hypothyroid: SE's? How long does it take to start working? Cure? Mnemonic to remember key facts?
*** Levothyroxine ***
- SE: None, unless too much hormone is replaced, then you would see symptoms of hyperthyroidism: Anxiety, GI distress, sweating, weight loss, and heat intolerance
- Thyroid replacement meds take a while to achieve effects – up to six weeks
- NOT a cure
** LEVO **
L= Lifelong drug; Long onset (3-4 weeks)
E= Early morning; Empty stomach
V= Very hyper (Report symptoms of hyperthyroidism)
O= Oh the baby is fine = safe for pregnancy
Bisphosphonates: Ending? Used for what 2 things? 2 big SE's?
- Used to treat osteoporosis and HYPERparathyroidism
- End in “dronate”
- 2 big side effects: Jaw necrosis and SEVERE esophagitis
Antitussives: Examples? Use? What to report? What is the most widely used cough suppressant... does it sedate?
Benzonatate (Tessalon Pearls), Codeine (Schedule II), Dextromethorphan (Robitussin, Delsym)
- Suppresses or inhibits coughing
- Report worsening cough to HCP
- Dextromethorphan is the most widely used cough suppressant and has BETTER antitussive activity than codeine.. It does NOT sedate, cause respiratory depression or addiction
Hyperthyroid: How to fix (not meds)? How long do anti-thyroid drugs take to work?See ____ disease
• Surgical removal of the thyroid
• Radioactive therapy (RAIU) – destroys thyroid in one dose
• Treat symptoms with a beta blocker
- Antithyroid meds take a while to achieve effects…2-4 months
- Grave's disease
Bisphosphonates: Need adequate... With or without food? In AM or PM? What to do after taking the med?
- Take on an empty stomach with a full glass of water
- Take first thing in the morning
- Remain upright for at least 30 minutes
- Necessary to have adequate intake of Vitamin D and Calcium, inhibits resorption of the bones
Decongestants: Examples? Uses? Caution with what pt's? SEVERE hypertension when taken with ___
Oxymetazoline (Afrin), Phenylephrine (Sudafed PE), Pseudoephedrine(Children’s Sudafed), and Tetrahydrozoline
- Uses: Rhinitis, sinusitis, the common cold: Drains sinuses, clears nasal passages and opens eustachian tubes
- SEVERE hypertension when taken with MAOI’s
- Use with extreme caution for pts with HTN, cardiac disease, hyperthyroidism and diabetes
* Pseudoephedrine: you are FED up with the congestion so you take it *