Pharmacology

Using Nursing Process

PharmakokineticsADME

A- AdministrationOral- safest route; generally best on empty stomach; decrease absorption when exerciseParental- influence by blood supply; exercise, temperature

D- DistributionHepatic First Pass Effect- pass through liver- reduce Bioavailability- active form of the drug'- lipid solubleHighly Protein BoundT- ThophalineD- DigoxinC- CoumadineE- Erythromycin

M- MetabolismBiotransformation

E- Excretions- Kidney, GI tract, Respiratory- MEC- Minimum Effective Concentration or Critical Concentration- Bolus/Loading Dose: used to reach the critical concentration time faster- Therapeutic Index- margin toxic levels and therapeutic levels

Dosage Interval: 6-12-6-12Dosage Frequency: 4x

Pharmakodynamics- Mechanism of action

Drug actionSupplement- already have but wants to addReplacement- lacking, lost > replaceStimulate Response- Agonists- MimeticsInhibit Responses- Antagonist- -lytic- block receptorsIrritate- irritate certain areas for actionAlter Cellular Functions/Activities

Adverse Effect: related to desiredSide Effect: unrelated to the desired effect; wanted or unwanted

CNSStimulantDepressed

ToxicityGI> Nausea/VomitingCTZ: Chemo Therapeutic ZoneEZ: Emetic Zone

NSAIDSCOX1- protect Gi with mucusCOX2. inflamatory= after meals

Hepato- ALT/SGPT- AST/SGOT- Jaundice

Nephro- BUN: influenced by diet- Crea: more accurate- Check Urine Output- Rhabdomyholysis; caused by (-statins)

Bone Marrow- RBC: oxygen- WBC: prone infection- Platelet: prone injury

Dermatologic Allergy > RASH = discontinuePhotosensitivity

Neurotransmitters> Acetylcoline communicate between neves and muscle> Norepinephrine and Epinephrine- Catecholamines, released in the nerves of the sympathetic branch of the ANS> Dopamine- High Concentrated in certain areas of the brain, for the coordination of impulses both motor and intellectual> GABA- found in the brain, inhibits nerve activity, prevents over excitability of the brain> Serotonin- found in the limbic system, for arousal and sleep prevents depression and promotes motivation

Anxiolitics- prevents feeling of tension or fear> Sedatives- calms the patient and makes them unaware of the environment- depress the brain; less awareness to envt- light sleep> Hypnotics- can cause sleep- depress the CNS> Minor Tranquilizers- can produce a state of tranquility in an anxious client

Menzodiazepine- "-zepam", "-zolam"- Diazepam (Valim)- muscle relaxent, anti tetanus- Lorazepam (Ativan)> Adverse EffectCNS Depressant- CNS: drowsiness, depression, lethargy- GI: Dry mouth, constipaiton, NV, increase liver enzymes- CV: hypo or hypertension, arrythmias- Gu- hesitant or retention, decrease libido- Hematologic- blood dyscrasias and anemias- Local injection sites: phlebitis, thrombosis, irritation- abrupt cessation can lead to withdrawal symptoms

Barbiturates- Barbitals- sedate- depressant- antiseizure- Phenobarbital (luminal)> Adverse Effect- CNS depression- respi: seriou s hypoventilation, depression ,laryngospasmp hypersensitivity reaction

Nursing Care- Do not mix with other solution- Give IV drugs Slowly- provisions for safety- Standby life support facilities- Void before administration- Taper the dosage gradually- Monitor CBC, renal and hepatic functions- Antidote for Benzodiazepine: FLUMAZENIL (ANEXATE)

NARCOTICS- pain reliever: moderate to severe- acts specificly the Mu receptors=pain blocking- other receptors: Kappa, Beta, Sigma receptorsTypesAgonist: stimulate all receptorsPartial Agonist (A): stimulate only the Mu receptors and blocks othersAntagonists: antidote Lanoxon

Opiate (Narcotic) Agonist- Codeine: used as an antitusive- Fentanyl (Durogesic, Sublimaze)- Hydrocodone (Hycodan)- Meperidine (Demerol)- Methadone (Dolophine): used for pt with narcotic addiction: used to taper - Morphine SO4- Oxycodone (Oxycontin)* PReg. cat. B, do not crush or chew tablets* HOLD the dose if RR < 12/min* not allowed to pt with Stones = Cause spasm in the sphincter

Opiate Partial Agonist- Nalbuphine (Nabain)- Buprenorphine * causes less potential for addiction, tolerance, depression- have less abuse potentioalp have abou the same analgesic effect as morphineAntagonist- Drugs that bind strongly to opioid receptors- Nalmefene (Revex)Naltrexone (ReVia): Oral, alcohol and narcotic dependanceNaloxone (Narcan): antidote

ANESTESIA

FACTORS THAT DETERMINE THE SCHOICE OF below the nipple line = Local/regionalabove the nipple line = General anasthesia- physical and mental condition of patient- age and weight of patient- operation to be performed: duration

Stages of AnesthesiaStage 1: Induction/Stage of analgesia- starts from induciton period until pt loses consciousness- pt may appear drowsy or dizzy- keep the room quit- Safety

> Stage 2: Excitement/Delirium- last from the time the pt loses consciousness until he loses certain reflexes such as swallowing, gag and eyelid- May appear excited, may breathe irregularly- sensitive to external stimuli: hearing is some what exaggerate- maintain silence

> Stage 3: Surgical Anesthesia- from period the pt lost certain reflexes and respiratory paralysis occurs- pt with regular respiration, constricted pupils, jaws relax and auditory sensation is lost- give muscle relaxant so pt dosnt resist the mechanical ventilation

> Stage 4: Stage of Danger- Reached when too much anesthesia is geven- death may occur, not breating

Types of Anesthesia> General Anesthesia- association pathways are broken in the cerebral cortex to produce more or less lack of sensory and motor perception. pain is controlled by general insensibility, the pt is unconscious, he cannot hear, feel, or move his whole body- used in operation above the Thoracic level

> Regional Anesthesia- depresses superficial nerves and interferes with the conduction of pain impulses from certain area or region- pain is controlled without loss of consciousness; one region or an area of the body is anesthetized

General Anesthesia> inhalationGETA- General Endotracial Tube AnastasiaGAOT- General Anastasia Oral tubeGANT: NasalLaryngeal Mask- "Blind Intubation"Face maskCommon 'anestheticsNitros Oxide Sevoflurane (Sevorane)Desflurane (Suprane)Isoflurane (ForaneHalothane (Fluothane)

> Intravenous- drug the may produce hyposis, sedation, amnesia and or analgesia is administrered via IVCOmmon Anesthetics- Propofol (Diprivan): killed MJ- Thiopental Na (Pentothal): truth serum- Ketamine (Ketalar): given for infantsCommon Concern:- PONV- Post Op Nausea and Vomiting- Malignant Hyperthermia- cells become hyperactive > rigidity > spasms > harden > increase metabolism > increase Co2 > increase heat > brown-black blood bc Co2; antidote: DANTROLENE sodium

Regional Anesthesia> Epidural Anesthesia- used for long procedures below the thoracic level- used for post op management of pain- uses an epidural Catheter (Perifix)Common Anesthetic- Bupivacain (Sensorcaine Isobaric, Marcain)- Lidocain (for testing)Complications- Spinal Head ache- flat on bed;

> Subarachnoid Block- aka "Spinal Block"- commonly termed as spinal anesthesia- For short cases below the thoracic level- use spinal needle gauge, 22, 25, or 27Commonly- Bupivacaine Hyperbaric (Sensorcaine Heavy)- PDE (Tetracaine (Pontocaine), Dextrose, Ephedrine)Complications- Urinary retention: foley catheter

> Field/Nerve Block- anesthetizing surrounding tissues (ofield)p or group of nerves (nerves at a given pointCommon Anesthetics- Bupvacain Isobaric (Sensorcaine, Marcaine)- Lodacaine

> Local Infiltration- agent is injected into the tissue around incision site- Lidocaine

Topical- agent applied directly into a mucosa or surface- Lidocaine spray

Anti Seizure

Hydantoins- stabilize nerve membranes and limit the spread of excitability from the - inhibit the GABA; doest cause too much cns depression- maintinancyCommon Drugs- Phenytoin (Dilantan)Adverse affects- CNS depression- Liver toxicity- GINGIVAL HYPERPLASIA: Frequent oral care, soft bristle tooth brush, gum massage- Dermatologic reaction: Hirsutism, Coarsening of facial skin- cardiac arrhythmias and BP changes- Urinary Retention and change sin libido- Hyperglycemia in long term use- pinkish to brownish urine

Anti Parkinsonism Agents- Decrease dopamine > increase dopamine- Acetly Choline > Anti Colinergic

Anti Cholinergic- Benztropine (Cogentin)- Biperiden (Akineton)- Diphenhydramine (Benadyl)- Procyclidine (Kemadrin)- Trihexyphenidyl (Artane)Caution- narrow angle glaucoma, GI or GU obstruction- MG- Hepatic dysfunciton- CV disorder- hyphypertension- Hot environment> Adverse effect- CNS: disorientation, confusion, memoryloss, agitaiton, light headedness, weaknes- GI: drymount, NV, paralytic ileus-CV: tachycardia, palitations, hypotension- GU: urinary retention, hesitancy

Dopamenergics

Levodapo (Dopar, Sinemet)- Precursor of dopamine crosses the BBB, where it is converted- Dopadecarboxylase affect before passing the BBB- Vit B6 convert levodopa in the periphery: avoid vitamin B6- Given with Carbidopa Other Drugs

Carbidopa- sacrifice

> Interaction- MAOI: INCREASE EFFECTS- Vitamin B6 and Phenytoin: Eggs, chicken, carrots, fish, liver, kidneys, peas, wheat, germs, walnuts, Multivitamins

Autonomic System

Adrenergic Agonist- Sympathomimetics- stimulate the sympathetics nervous system SNS- Mimic the effects of the SNS neurotransmitters:Norepinephrine (Ne)Epinephrine (Epi)

Alpha and Beta Adrenergic Agonists- Epinephrine- Norepinephrine (Levophed): Shock- Dopamin (Intropin)- Dobutamine (Dobutrex)- Ephedrine: adrenergic agents for colds- Mephentermine (Wyamine SO4)

Nursing ConsiderationA1IV: properly placed; ischemia, necrosisuse of infusion pumpsAntidote: Alpha Blocker Phentolamine

A2

Peta Specific Adrenergic Agonists- used to manage and treat bronchial spasm, asthma, other obstructive pulmonary condition: (oTerbutaline- Tocolitic: to stop pre term labor (oRitodrine)- shock and cardiac arrest (IsoproterenolActions- increase HR. bronchodilaiton, incease blood flow to skeletal muscles, relaxation fthe uterus- treatment of shock cardiac arrest and certain arrhythmias= increases cardiac activity and conduction- prevents bronchospasm

Adrenergic Blocking Agent- lytics

Alpha and Bata Andrenergic Blocking Agents- primarly used to treat cardiac related condition- contraindicated with asthma, which could be exacerbated by the loss of bronchodilating effects: shock or CHF, decrease HRAmiodarone (Cordarone) Antiarrhythmic; Bretylium (Bretylate) AntiarrhythmicCarvidelol (Careg)Guanadrel (Hylorel)Guanethidine (oIsmelin)Labetalol (Normodyne)- pheochromocytoma and clonidine withdrawal

Alpha1 Selective Adrenergic BLockingAGent- "-zosin"- use to treat hypertension and benign prostatic hyperplasia (BPH)Doxazosin (ZCardura)PrazosinTerazosinTamsulosinAlfuzosin

Beta Adrenergic Blocking Agents>Types:B1 selectiveB non selective: not alowed for copd, asthma> common B1 non selectivePropranolol (Inderal)Penbutolol (Levator)Pindolol (Vistken)Sotalol (Betapace)TImolol (Timoptic); glaucomaCarteolol (Cartrol)Nadolol (Corgard)> COmon B1 selectiveMEtroprololEsmololBetaxololAcebutololBisoprostolAtenolol

Colenergic Agents

> Drug Effects: SLUDGESalivationLacrimationUrinary IncontinenceDiarrheaGastrointestinal CrampsEmesis

> TypesDirect acting Cholinergic- stimulate Cholinergic receptorsIndirect acting- acts on the Acetylcholinesterase- "Acetylcholinesterase Inhibitors"

Direct Acting Cholinergic Agonist- used to increase bladder tone and urinary excretions and as ophthalmic agents- used for : miosis, motility, gu- Bethanecho (Urecholine)- Carbachol (Miostat)- Pilocarpine (Pilocar): opthalmic solution

Myasthenia Gravis- Autoimmune disorder- lack of acetylcholine reaching the cholinergic receptor- antibodies attach ach recepters- Decending paralysis- Problem related to thymic hyperlasia

> Diagnosis: Edrophonium (Tensilon) Test acts on the acetylcoholinesterase1 Myasthenia crisis- paralyis is resolved in 20 min- related to inadequate dosing2. Cholinergic Crisis- no effect- excess of acetylcholine- antidote: atropine SO4

Acetylcholinesterase Inhibitor- inhibit action of the enzyme- Does not cross the BBBNAPENeostigmine (Prostigmine)Pyridostigmine (Mestinon); longer acting drug; 6 hoursAmbenonium (MytelaseEdrophonium (Tensilon)

Althzimers- Can cross the BBBTRiDoGTacrineRivartigmineDonepezilGalamtamine

Anticholinergic Agents

MydriasisCycloplegia- inability of the lens to accomidate

Anticholinergic AGentsdx procedures- Mydriasis- cycloplegia

Atropine: blocks PNS effects and variethy of situationDIcyclomine (Antispas): relax GI for IBSPropantheline (Probanthine) adjunct for treatment of ulcersScopalomine Motion sickness, ulcers, urinary problems and pupil dilation

Anti Hypertensive

Diuretics> Thiazide and THiazide Like: loop convoluted tubule: K wasting- Hydrochlorothiazide- Chlorothiazide> Loop DiureticsL loop of henle; K wastingBumetanideFurosemide> Carbonic Anhydrase inhibitors: NaHCO3 formationAcetazolamideMethazolamide> K- Sparing Diuretic: aldosterone antagonistAmilorideSpironalactone> Osmotic DiureticMannitol

ACE- for hyprtension- tx of CHF and LVD- normal for initial hypotensive affectAction- decrease peripheral vascular resisrtancw ithout:increased cardiac output, rate, contractility

Angiotensin II Receptor BLockers ARB- -sartainsTelmisartanIrbesartanLosartanEprosartan- Eprosartan- Candesartan- Valsartan- decrase HPN, patassium

CC Blocker- inhibit movement of Ca ions across the membrane of myocardial and arterial muscle- Ca=force of contraction- depressing myocardial contractileVND- Very Nice DrugsVerapanilNifedipine and other -pineDiltiazenComon drugsfelodipineNicardipineNifedipineAmlodipineDiltiazemVerapamil

Vasodilators- Hydralazine (apresoline) - maintains or increases renal blood flow- Nitroprusside (Nitropress) cyanide toxicity- Diazoxide (Hyperstat) also blocks insulin release- Minoxidil (Loniten) associated with reflex tachycardia and increased renin release

Congestive Heart Failure

LSHF RSHF

Cardiac GlycosidesDIgoxin (lanoxin, Lanoxicaps)p0.5-2 nano grams. Adverse afefectsCNS: Yellow halow areound objects, head ach, weaknessNsg Care- Monitor Apical Pulse of r 1 full minuteHOLD if less than 60 BPM for adult and 90 BPM infant- administer IV doses very slowly for a period of 6 minutes- Avoid IM injections- Arrange for taking the client weight everydayEmergency equimpent- K salts, lidocaine, phenytoin, atropine So4Antidote: Digoxin Immun Fab (DIgibind, Digifab)Health Techings- food rich in K but low in Na- overdose- Hypo Kalemia, Hypo Magnesemia, Hyper Calium = Toxicity- doont sus wiht highlyprotein bound drugs

Anti Anginal AgentsCoronary Artery DiseaseAtheromas- fatty tumors in the intima of th evesselsAtherosclerosis- narrowing of the arteries caused by build up of atheromas, swelling and acculation of platelets; leads to a loss of elasticity and responsiveness to stimuli

Nitrates- causedecreases venour returndecrease arterial pressuereduce cardiac workloaddecrease myocardial oxygen consumption- has no effect on atherosclerotic vesselsNitroglycerine (Nitro Bid)Isosorbide Dinitrate (Isordil)Isosorbide mononitrateAmyl nitrate> IntractionHeparin: decrease therapeutic effect of NTG- Sildenafil= enhance hypotensive effect- Antigcholinergic= decrease absorbtion

Anti Infective Agents- selectively on foreign organism- selective toxicity- agent found on mold

Mechanism of Action- interfere with bacterial wall synthesis- penicillins, cephalosporins, carbapenems, vancomycinPrevention of utilizing substances essential for growth and development- interfere with protein synthesis: macrolides, chloramphenicol, tetracyclies, aminoglycosidesInterfrew ith DNA Synthesis: fluoroquinolones, antimycobacterium- Alter cell membrane Permeability: antifungal and antiprotozoal

Penicillins- Bactericidal: - aka Betalactams- Effective against Gram Positive Bacteria- inhibits cell wall synthesisCommon DrugsPenicillinsPen G Pen V> Extended spectrum PenicillinAmoxicillin> Penicillinase Resistant Antibioticsbacteria develop Beta LactamaseDicloxacillinOxacillin

Penicillinase or Beta lactamase inhibitorsClavulanic AcidTazobactamSulbactam

> Adverse Reaction- Assess alergies for Penicillin- Gi upset: glossitis, stomatitis, sore moutn NV, Diarrhea- anaphylaxis- Thrombocytopenia and Leukopenia

Drug Interactions- increase Probenecid plasma concentration- decrease secretion of Methotrexate- Tetracycline and Chloramphenicol: decreases penicillin action- Decreaed effectiveness of hormonal contraceptives- aminoglycosides- don't give oral meds with fruit juices; reduction in drug absorbtion- Synergistic effect: Penicillin and Gentamycin: cause incompatability > will distroy eachother; give 2 hours apart

Amminoglycosides- Bacteridalp- ihibits proteins- Gram negative infections- Ear, opthalmic infectionsNosocomial infections, UTI, CNS and Eye infection- often used in combinaiton with other antibiotics for synargistic effect- absorbed poorly in the GI tractCommonon Drugs "-mycinGANTSKGentamycin (Servigenta, Garamycin)Amikacin (Amikin)NeomycinTobramycinStreptomycinKanamycin> Drug Interaction- anesthetics, muscle relaxants- diuretics- other antibiotics

>Adverse Effect- cause Ototoxicity and Nephrotoxicity- neurotoxicity- cariac effects- bone marrow depression- GI irritation

Cephalosporins "Cef-"- Broad spectrum- structurally and pharmacologically related to penicillins- semisynthetic derivatives from a fungus> Adverse ReactionPseudomembranous Colitis: Bloody diarrhea- CNS- Headach, dizziness- Hypoprothrombinemia- phlebitis> Drug InteractionsAminoglycosidesAlcohol: Disulfiram like reactions: Antabus: adverse reaction

1st GenerationCephalexin Gram +cefazolin2nd GenerationCefaclor Gram +, slight -3rd GenerationDefatoxim Gram -4th Generationcefepime Gram +&- , broad spectrum

FLuoroquinolones "Floxacin- Bactericidal and Bacteriostatic- Effective agains Gram - bacteria- uti, respi, derma, eye, ear, bone and joint infeciton, after anthrax, typhoid> Adverse EffectsPhotosensitivity: highlightheadache, dizzinesGi upsi> Common DrugsCLONGCiprofloxacinLevofloxacinofloxacinnorfloxin

Macrolides- bactericidal or bacteriostatic- effective agains many sensitive organisms and intestinal amoebiasis- usually enteric coated- given if allergic to Penicillin> common Drugs DACEDirithromycin (Dynabac)Azithromycin (Zithromax)Clarithromycin (Klaricid)Erythromycin (Ilosone, Erythrocin, Erycin)> adverse EffectGI upset

> interact- TheophyllinedigoxinCoumadin

Lincosamides- inhibits bacterial Protein Synthesis- Similar to Macrolides in therms of Coverage- Associated with severe toxicityDrugs:Clindamycin (Dalacin C)Lincomycin (Lincocin)- careful monitoring of gi activitySTOP once bloody diarrhea occurs

Vancomycin- used to treat methicillin resistant S. Aureus MRSA- with increase incidence of vancomycin resistant therefor should bde sued only when C&uS confirms need for it- Giving slowly: serious dilatory effect> Red Man/Red Neck Syndrome> adverse reaciton- Renal Failure ototoxicity and super infections- RED Man Syndrome: sudden and severe hypotension, fever, chills, paresthesia and erythema of the neck and back

Chloramphenicol- Prevents bacterial cell wall division- common treatment for Typhoid Fever> Adverse affects- Gray Syndrome: abdominal distention, cyanosis, vasomotor collapse, irregular respiration, and even death. Bone Marrow Depression: Aplastic anemia

Sulfonamides- Bacteriostatic- Effective agains Gram negative and gram positive bacgteria and many resistant strainsCan Cause Crystal urie: incoruage fluid intake> Common Drugsp- CotrimoxazoleSulfadiazine> interactions- Sulfonylureas: used for DM, can cause hypglycemia- Cyclosporine

Tetracycline- Natural and Semi synthetic- obtain for cultures of streptomyces- Bacgteriostatic- wide range- Acne Treatment- Given on empty somach- Absor-iton affected by food, calcium and iron> COmmon Drugs DOM=TDoxycylineOxytetracyclineMinocyclineTetracyclin> caution use on- pregnant women- children under 8 years- can cause perminent tooth stain enamel hyperplasia

Isoniazid Itis Vitamin B5Ethambutol EyesStreptomycin Nephrotoxicity

Anti Neoplastic Agents and Biologic Response Modulators

Neoplasm CharacteristicsAnaplasia: loss of organizations and structureAutonomy: loss of normal controls and reactions that inhibit growth and spreadingMetastasis: ability to enter the circulatory or lymphatic system and travel to other areasAngiogenesis: abnormal cell release enymes that generate blood vessels

2 General Types of Anti Cancer DrugsCell Cycle Non Specific- more effective for slow growingCell Cycle Specific

Alkylating Agents- Nitrogen Mustards- make convalant bonds > DNA replicaiton is inhibit- avoid direct contact can cause severe skin, eye and respiratory reactionCyclophsphamideCHlorambucilIfosfamideMechlorathamine> Comon Side EFFEctFABVFertility IssuesAlopeciaBone Marrow SuppresionVomit, Nausea> Cytoprotectiv Agentsamifostine- for cisplatinMasna- ifosfamide, cyclophosphamide prevent hemorrhage cytitis- Give Antiemetics

AntibetaboliteFolic Acid Analogues- Methotrexate (Folex, Rheumatrix)- Hepatotoxic, renal failure, GI Toxicity- Leucoverin (Folinic Acid) Used to minimize adverse reactions

Myrimidine Analoges- sensitive to light; can cause toxicity- colon cancerCytarabine (Ara C)p meningeal and myelocytic leukemiaFloxuridineFluorouracil (Adrucil) Gi cancers; phototoxicity

Purine Analogues- Mercaptopurine (oPurinethol): Leukemias choriocarcinomas: hyperuricemia, jaundiceThioguanine: GI Toxicity, miscarriage

Antineplastic Antibiotics- cell cycle specific drugsnon specificBleumycin: Pulmonary Function Test PFTDexrazoxane (Zinacard)- Highlight: Give in a new vein every

Mitotic Inhibitors- Venblastine: effective an M phaase; lymphomas, and sarcomas

Drugs acting on the Endocrine System- deals with hormones

Adreoncorticotropic HormonesGlucocorticoids- SSSSugar; important to intake sugar; hyperglycemiaSalt: sodium will attract water: increas circulating blood volume > BP > CHF > hyper Na > Hypo K, EdemaSex:

Inflammation > COX1(gi protection) > irritaliton

decrease Immune response> auto immune disease

COmmon DrugsDexamethasone: CNS infectionBetamethasone: lung maturity for pretermHydrocortisone: anti inflammatory effectMethylprednisolonePrednisone

Nsg Considerationafter meals > cause gi irritaitonNa levels monitored bc hyper Na: limit na in diet- do not discontinue drug abruptly

Thyroid and Parathyroid Agents

Thyroid Drugs- Replacement Therapy> Common DrugsLevothyroxine (Synthroid)p T4Liothyronine (Cytomel) T3LiotrixThyroid DesiccatedThyroglobulin

AntithyroidThioamides- blocks iodines ability to combine with thyrosine Propylthiouracil PTU :does not cross placenta- gi irritation is commonMethimazole (Tapazole)- corsses placenta- bone marrow suppression

Iodine Solutions- stable or high doses of iodine inhibits hormone synthesis in which excess iodine decreases the formation and release of thyroid hormone- Potassium Iodide (Thyro Block)- Solium Iodide> cautionallergy, pulmonary edema or PTB> Adverse Effects- hypothyroidism which can lead to development of goitersIodism: metallic taste and burning in the mouth, sore teeth and gumsDiarrhea, cold symptoms and stomach upset- staining to the teeth, skin rash

Antihypercalcemia AgentsBIsphosphates- slow the normal and abnormal bone resorption but do not inhibit normal bone formation and mineralization- Indication: Paget's disease and Post menopausal osteoporosisCommon DrugsAlendronate (Fosamax): can cause esophageal errosion, osteoporosis in men

Antidiabetic Agents

Replacement InsulinDM 1; not enought produceDM 2: insulin resistantTypes Rapid acting

Inusin

RapidLispro (oHumalog)ShortRegular (Humulin R, Novolin RSemilente Insulin aspartinIntermediateNPH (H N, NnLente (H L, NLLongPZIUltralente

Milienda TImeOnly IV: Humulin R D50W plus insulin

Lipodystrophy- tissue atrophy which may interfere with insulin absorption- Cold insulin, didnt rotate site- lead to unknown absorption of insulin

Oral Anti Diabetic AgentsSulfonylureas- bind to potassium channels on pancreatic beta cells to increase insulin secretion- may improve insulin binding to insulin receptors and increase the number of insulin receptors- increase the effect of ADH on renal Cels- Effective only in Patients who have Functioning Beta Cells- SImples: increase insulin productionFirst Generation: more complications; nephrotoxicAcetohexamideCholrpropamideTolazamideTOlbutamide2nd Generation- safer to use in cclients with renal disorders- do not interact with highly CHON bound drugs- Long During of Action- Glimepiride (Amaryl)Glipizide (Glucotrol)GLyburide (Micronase)

NonSulfonylureasAlpha Glucosidase Inhibitor- inhibits the enzyme that breaks down glucose for absorption- delay absorption of glucose- with mefalsAcarbose OPrecose)Miglitol (oGLyset

Biguanide- decrease the producion and increase uptake of glucose- after meals- effective in lowering blood glucose levels and does not cause hypoglycemiaMetformin(Glucophage)

Meglitinides- increase insulin release- taken just before mealsRepaglinideNateglinide

Thiazolidinediones- Decreases insulin resistance- use in combination with sulfonylureas or metforminPioglitazone (Actos)Rosiglitazone (oAvandia)