HIM2966 Module 06 Post- Assessment Term
GRADED A
Muscarinic ANTAGONISTS for Urinary Retention - ANSWER: Activate muscarinic
receptors of the urinary tract
Adverse effects:
SLUDGE & the KILLER B's »Salivation, Lacrimation, Urination, Diaphoresis/Diarrhea,
GI cramping, and Emesis. This can progress to Bronchospasm, Bronchorrhea, Blurred
vision, Bradycardia or tachycardia, hypotension, confusion, and shock
Bethanechol (Urecholine), Direct-acting muscarinic AGONIST - ANSWER: Uses:
Urinary retention
Adynamic ileus --> causes increased intestinal motility
Gastric atony --> cause
Contraindicated in patients with:
Peptic ulcer disease, urinary tract obstruction, intestinal obstructions, hypotension,
asthma, coronary insufficiency, and hyperthyroidism
Administer:
1 hour before or 2 hours after meals
Glucose Regulating Hormones - ANSWER: Insulin:
Increases glucose transport into skeletal muscle and adipose tissue
How?
Increases glycogen synthesis
Decreases gluconeogenesis
Glucagon:
Promotes liver glycogen breakdown
Increases gluconeogenesis
Type 2 DM: Glucophage (Metformin) - ANSWER: Weight loss
Increased insulin sensitivity
(Has been known to be used with NEWLY, insulin naïve type 1's to sensitize the body
to the injectable insulins that are started)
Adverse reactions:
GI upset initially
Lactic acidosis in presence of renal failure
Check GFR - can be started in patients with GFR > 45; contraindicated with GFR <30
Do not use ETOH
Increases fertility - a bonus or a bad thing depending on the intent
Start with 500 mg daily and advance to max of 1,000 mg BID
Extended release (ER)
Less GI side effects
Type 2 DM: Sulfonylureas - 2nd Line Drug - ANSWER: Stimulates insulin release from
pancreatic B cells (Ex: glipizide, glyburide, Glimepiride)
Take 30 minutes before meal
,Pros:
Effective in reducing HgbA1c by 1.25 %
Cheap
Cons:
Moderate hypoglycemia risk
Some weight gain
Nausea/Vomiting
Type 2 DM: Meglitinides, (repaglinide; nateglinide) - ANSWER: Must have functioning
pancreas
Will not work in pts who do not respond to sulfonylureas
Give 30 minutes before meals; skip dose if meal is skipped, add dose if added meal;
do not exceed 4 doses per day
MONITOR:
Sweating, tachycardia, fatigue, XS hunger, tremors, hypoglycemia, nausea/diarrhea
Type 2 DM: Thiazolidinediones (TZDs) - ANSWER: Increase glucose uptake by skeletal
muscle and adipose cells and decrease gluconeogenesis in liver
Ex: pioglitazone (Actos)
Pros:
Effective in reducing HgbA1c
Lower risk of hypoglycemia than sulfonylureas
Cons:
Some weight gain
Risk of edema and heart failure
More expensive
Type 2 DM: Alpha-Glucosidase Inhibitors - ANSWER: Act in the intestine to delay
absorption of carbohydrates
Reduces rise of blood glucose after meals
Examples: acarbose; miglitol
GIVE WITH FIRST BITE OF FOOD; SKIP DOSE IF MEAL IS SKIPPED
Monitor: hypoglycemia; GI effects: distention, flatus, hyperactive BS, diarrhea,
hypoglycemia, LFTs, anemia
Must use DEXTROSE to treat hypoglycemia
Precautions: liver impairment (remember those LFTs); GI distress
DRUG INTERACTIONS:
Insulin, sulfonylureas, ginseng increase hypoglycemia
Metformin worsens GI effects
Estrogen, thiazides, steroids, phenothiazines
Type 2 DM: SGLT2 Inhibitors - ANSWER: Canagliflozin (Invokana®); Dapagliflozin
(Farxiga®); & Empagliflozin (Jardiance®); Ertugliflozin (Steglatro®)
Side Effects:
Yeast infections in females and uncircumcised males
UTIs
Increased urination
, Weight loss
Hypotension (if used in conjunction with diuretics)
Dehydration
Monitor for:
DKA
Hypoglycemia
Renal function - contraindicated with GFR < 30
Hypoglycemia (Conscious vs Unconscious pt) - ANSWER: Blood sugar < 70mg/dL
Treatment:
Conscious patient:
Glucose tablets or orange juice, non- diet soda, honey, sugar cube, etc.
Unconscious patient:
IV Glucose (preferred)
Raises glucose immediately
Glucagon (SQ, IM, IV)
Takes about 20 min to restore consciousness
Dose 0.5-1mg is usually effective
Hypothyroidism: Treatment
Levothyroxine (Synthroid®): - ANSWER: *1.6 mcg/kg/d*; increase by 25 mcg/d every
4-6 weeks until TSH in normal range
*60 years of age, decrease dosage (2/3 of that needed in younger adult)*
Takes 8-12 weeks for TSH levels to adjust to meds so follow up every 8-12 weeks
until stable, then yearly
What about "natural treatment" for hypothyroidism
Armour Thyroid -
A T3/T4 combo prescription the reason it is deemed natural is because the active
ingredient is derived from thyroid of pigs
Prescribed in grains not milligrams and you must measure both T3 and T4 levels
*Different brands are not interchangeable (generic ≠ brand name)*
Synthetic and "natural" are never interchangeable without specific conversion
factors
Find a brand and stick with it.
Synthroid® (synthetic levothyroxine) --> the best there is
Available in many dosages
Start low and go slow !!
Levothyroxin (Synthroid®) when pregnant - ANSWER: increase dose by 50%
HYPERthyroidism - ANSWER: More common in women (8:1 ratio)
Onset most commonly between 20 and 40 years of age
*Grave's Disease*: Most common presentation
Other causes of hyperthyroidism include toxic adenoma, sub-acute thyroiditis, TSH
secreting pituitary tumor, high dose amiodarone
GRADED A
Muscarinic ANTAGONISTS for Urinary Retention - ANSWER: Activate muscarinic
receptors of the urinary tract
Adverse effects:
SLUDGE & the KILLER B's »Salivation, Lacrimation, Urination, Diaphoresis/Diarrhea,
GI cramping, and Emesis. This can progress to Bronchospasm, Bronchorrhea, Blurred
vision, Bradycardia or tachycardia, hypotension, confusion, and shock
Bethanechol (Urecholine), Direct-acting muscarinic AGONIST - ANSWER: Uses:
Urinary retention
Adynamic ileus --> causes increased intestinal motility
Gastric atony --> cause
Contraindicated in patients with:
Peptic ulcer disease, urinary tract obstruction, intestinal obstructions, hypotension,
asthma, coronary insufficiency, and hyperthyroidism
Administer:
1 hour before or 2 hours after meals
Glucose Regulating Hormones - ANSWER: Insulin:
Increases glucose transport into skeletal muscle and adipose tissue
How?
Increases glycogen synthesis
Decreases gluconeogenesis
Glucagon:
Promotes liver glycogen breakdown
Increases gluconeogenesis
Type 2 DM: Glucophage (Metformin) - ANSWER: Weight loss
Increased insulin sensitivity
(Has been known to be used with NEWLY, insulin naïve type 1's to sensitize the body
to the injectable insulins that are started)
Adverse reactions:
GI upset initially
Lactic acidosis in presence of renal failure
Check GFR - can be started in patients with GFR > 45; contraindicated with GFR <30
Do not use ETOH
Increases fertility - a bonus or a bad thing depending on the intent
Start with 500 mg daily and advance to max of 1,000 mg BID
Extended release (ER)
Less GI side effects
Type 2 DM: Sulfonylureas - 2nd Line Drug - ANSWER: Stimulates insulin release from
pancreatic B cells (Ex: glipizide, glyburide, Glimepiride)
Take 30 minutes before meal
,Pros:
Effective in reducing HgbA1c by 1.25 %
Cheap
Cons:
Moderate hypoglycemia risk
Some weight gain
Nausea/Vomiting
Type 2 DM: Meglitinides, (repaglinide; nateglinide) - ANSWER: Must have functioning
pancreas
Will not work in pts who do not respond to sulfonylureas
Give 30 minutes before meals; skip dose if meal is skipped, add dose if added meal;
do not exceed 4 doses per day
MONITOR:
Sweating, tachycardia, fatigue, XS hunger, tremors, hypoglycemia, nausea/diarrhea
Type 2 DM: Thiazolidinediones (TZDs) - ANSWER: Increase glucose uptake by skeletal
muscle and adipose cells and decrease gluconeogenesis in liver
Ex: pioglitazone (Actos)
Pros:
Effective in reducing HgbA1c
Lower risk of hypoglycemia than sulfonylureas
Cons:
Some weight gain
Risk of edema and heart failure
More expensive
Type 2 DM: Alpha-Glucosidase Inhibitors - ANSWER: Act in the intestine to delay
absorption of carbohydrates
Reduces rise of blood glucose after meals
Examples: acarbose; miglitol
GIVE WITH FIRST BITE OF FOOD; SKIP DOSE IF MEAL IS SKIPPED
Monitor: hypoglycemia; GI effects: distention, flatus, hyperactive BS, diarrhea,
hypoglycemia, LFTs, anemia
Must use DEXTROSE to treat hypoglycemia
Precautions: liver impairment (remember those LFTs); GI distress
DRUG INTERACTIONS:
Insulin, sulfonylureas, ginseng increase hypoglycemia
Metformin worsens GI effects
Estrogen, thiazides, steroids, phenothiazines
Type 2 DM: SGLT2 Inhibitors - ANSWER: Canagliflozin (Invokana®); Dapagliflozin
(Farxiga®); & Empagliflozin (Jardiance®); Ertugliflozin (Steglatro®)
Side Effects:
Yeast infections in females and uncircumcised males
UTIs
Increased urination
, Weight loss
Hypotension (if used in conjunction with diuretics)
Dehydration
Monitor for:
DKA
Hypoglycemia
Renal function - contraindicated with GFR < 30
Hypoglycemia (Conscious vs Unconscious pt) - ANSWER: Blood sugar < 70mg/dL
Treatment:
Conscious patient:
Glucose tablets or orange juice, non- diet soda, honey, sugar cube, etc.
Unconscious patient:
IV Glucose (preferred)
Raises glucose immediately
Glucagon (SQ, IM, IV)
Takes about 20 min to restore consciousness
Dose 0.5-1mg is usually effective
Hypothyroidism: Treatment
Levothyroxine (Synthroid®): - ANSWER: *1.6 mcg/kg/d*; increase by 25 mcg/d every
4-6 weeks until TSH in normal range
*60 years of age, decrease dosage (2/3 of that needed in younger adult)*
Takes 8-12 weeks for TSH levels to adjust to meds so follow up every 8-12 weeks
until stable, then yearly
What about "natural treatment" for hypothyroidism
Armour Thyroid -
A T3/T4 combo prescription the reason it is deemed natural is because the active
ingredient is derived from thyroid of pigs
Prescribed in grains not milligrams and you must measure both T3 and T4 levels
*Different brands are not interchangeable (generic ≠ brand name)*
Synthetic and "natural" are never interchangeable without specific conversion
factors
Find a brand and stick with it.
Synthroid® (synthetic levothyroxine) --> the best there is
Available in many dosages
Start low and go slow !!
Levothyroxin (Synthroid®) when pregnant - ANSWER: increase dose by 50%
HYPERthyroidism - ANSWER: More common in women (8:1 ratio)
Onset most commonly between 20 and 40 years of age
*Grave's Disease*: Most common presentation
Other causes of hyperthyroidism include toxic adenoma, sub-acute thyroiditis, TSH
secreting pituitary tumor, high dose amiodarone
