Summary HESI PHARMACOLOGY STUDY REVIEW

 Common S/E: lipodystrophy (why we rotate injection sites) and hypoglycemia (can also result when giving insulin in an infrequently used site)  Hyperglycemia  Dry flushed skin  Kussmaul’s respirations (blowing off CO2)  Anorexia, N/V (trying to get sugar out)  Abdominal pain  CNS depression  Fruity breath odor  Eventual coma  Hypoglycemia  Tachycardia and palpitations  Diaphoresis with pale, clammy skin  Tremors, hunger (need to get sugar in)  Headache and dizziness  Anxiety and irritability (poor judgment)  Confusion  Seizures and coma Endocrine Agents  ¬Antithyroid drugs for HYPERthyroidism  PTU (propyltiouracil), Trapazole  Agranulocytosis is a major concern (early signs= sore throat, fever) need to report immediately!  Take medication at same time each day with meals to maintain therapeutic level and ↓GI distress  Monitor for S/S of hypothyroidism (wt gain, bradycardia, depression, anorexia, cold intolerance)  Sodium Iodide (I 131)  Pts should avoid contact with children/pregnant women because they may be emitting radiation  May have temporary swelling and tenderness of the thyroid gland for a few days; this is normal  Monitor for S/S of hypothyroidism (wt gain, bradycardia, depression, anorexia, cold intolerance)  Thyroid Replacement for HYPOthyroidism  Synthroid, Cytomel, Triostat  Administer early in the day to prevent insomnia; withhold medication if apical pulse 100 bpm  Monitor for S/S of hyperthyroidism (anxiety, tachycardia, heat intolerance, abdominal cramping)  HYPERparathyroidism - the major concern here is hypercalcemia (released through bone decomposition)  Calcimar, Miracalcin (Calcitonin)  Phosphate supplements to remove calcium (inverse relationship with phosphate)  HYPOparathyroidism- treatment is aimed at replenishing calcium and vitamin D (to help with absorption)  Calcium Chloride and Calcium Gluconate  HYPERpituitarism  Parlodel, Dostinex, Sandostatin- decrease hormone levels in acromegaly  Hypopituitarism  Somatropin, Protropin  Used to treat growth hormone deficiences; stimulates overall growth and protein production  Common S/E: hyperglycemia (will need increased insulin dosages; useful in diagnostics)  Diabetes Insipidus- a lack of ADH which manifests as gross polyuria  Vasopressin (ADH)  Monitor for S/S of fluid overload (lethargy, drowsiness, pounding HA) and hyperkalemia  Oral Hyperglycemic Agents- used mostly for type II diabetics; the pancreas has to be producing some amount of insulin for them to work properly (HgA1C 7%)  Diabanese, Glucotrol, Diabeta  Longer duration of action and therefore can be given once/day  Common S/E: GI distress, hypoglycemia, hepatotoxicity and jaundice, rash (pruritus)  Prandin  Fast but short-lived release of insulin; take before each of 3 meals per day (poor compliance)  Metformin  Does not promote insulin release; therefore does not cause hypoglycemia  Black Box Warning: Lactic Acidosis (hyperventilation, myaligia, sluggishness)  Byetta, Symlin  Parenteral therapy for type II diabetes; watch closely for hypoglycemia Antimicrobial Agents  Require C&S testing and allergy screening before starting therapy  May require ↑doses of oral contraceptives or an alternative form of birth control  Emphasize that the full course of antibiotics should be taken, even if feeling better already  Penicillins  Amoxicillin, Penicillin G, Methicillin  Destroy bacteria by weakening the cell wall; given PO, IM, IV (may cause phlebitis)  Drug of Choice- Meningitis, Syphilis  Common S/E: nausea and diarrhea, renal impairment (monitor closely in DM pts)  Food may interfere with absorption  give between meals 1 hr before or 2 hrs after  Cephalosporins  cephalexin (Keflex), ceftriaxone (Rocephin), cefepime (Maxipime)  Destroy bacterial cell wall; if allergic to PCN more than likely allergic to these  Monitor closely if given with medications that promote bleeding; renal impairment pts (nephrotoxicity  tell them not to drink ETOH)  Tetracyclines  Tetracycline hydrochloride (Sumycin), doxycycline (Vibramycin)  Broad spectrum; inhibit protein synthesis (bacteriostatic); given topically and orally  Drug of Choice- Acne, Rickettsia (RMSF), Chlamydia, Lyme Disease, H. pylori  Common S/E: GI discomfort, photosensitivity, yellow/brown tooth discoloration  Oral contraception is ineffective when taking this medication! • Pt will need another form of birth control because this medication is not safe during pregnancy  Interferes with normal bone and tooth development (avoid in children under 8 y/o)  Take with meals and avoid doses at hs to reduce discomfort and promote sleep  Do not take with any milk products, calcium/iron supplements, laxatives (magnesium) or antacids because these interfere with drug absorption  Macrolides  Erythromycin, Clindaymycin, Azithromycin  Often used when penicillins, cephalosporins and tetracyclines are contraindicated  Hepatotoxicity is the biggest concern so monitor LFTs closely  Drug of Choice- Chylamidia, Mycoplasma Pneumonia, Bacterial Endocarditis (Rheumatic Fever)  Aminoglycosides  Gentamicin, Neomycin, Streptomycin  Drug of Choice- E. Coli, Pseudomonas Aeruginosa  Ototoxicity and Nephrotoxicity are major concerns- monitor peak and trough levels  Need baseline hearing tests and pre-treatment urine specimen  Fluoroquinolones  Ciprofloxacin (Cipro)- 4 generations; many are used for urinary and respiratory infections  Drug of choice- inhaled anthrax; often used if bacteria is resistant to other antibiotics  Achilles tendon rupture- not administered to children 18 y/o due to risk  Other Antibiotics