NR 565
3 Principle Actions of Thyroid Hormones - ANSWER✅✅✅(1) stimulation of energy use
(2) stimulation of the heart (3) promotion of growth and development 4 steps to synthesis
of thyroid hormoness - ANSWER✅✅✅1. Uptake 2. Activation (Oxidation by peroxidase)
3. Iodination of Tyrosine 4. Coupling of Iodinated Tyrosine a-Glucosidase Inhibitors -
ANSWER✅✅✅ a-Glucosidase Inhibitors - ANSWER✅✅✅Acarbose inhibits
pancreatic alpha-amylase and intestinal alpha-glucoside hydrolase, delaying glucose
absorption hypersens. to drug/class/compon. diabetic ketoacidosis, cirrhosis,
inflammatory bowel dz, colonic ulcer, partial GI obstruction, GI obstruction risk,
malabsorption syndromes, Cr >2 Accelerate levothyroxine metabolism -
ANSWER✅✅✅Phenytoin (Dilantin) , Carbamazepine (Tegretol, Carbatrol) , Rifampin
(Rifadin) , Sertraline (Zoloft) , Phenobarbital Active Immunity - ANSWER✅✅✅When the
immune system produces antibodies in response to an antigen by the vaccine, or by the
infection itself. For example, if a person who has never had hepatitis B contracts hepatitis
B and recovers from it, that person becomes immune to hepatitis B because of the
immune system's antibody response to the hepatitis B virus. Adverse effects of
antihistamines - ANSWER✅✅✅Drowsiness is most common side effect Others: dry
mouth vision changes difficulty urinating constipation Anticholinergics -
ANSWER✅✅✅ipratropium, tiotropium block acetylcholine to prevent bronchial
constriction and narrowing of the airways, indirectly facilitates bronchodilation and
reduces secretions For COPD, emphysema, and to prevent bronchospasm Antihistamines
- ANSWER✅✅✅tx allergies, rhinitis, hay fever, hives, itching, running nose,
anaphylaxis, angioedema, drug fevers, and sneezing ex. diphenhydramine, fexofenadine,
and loratadine antihistamine medications compete with histamine for the receptor site.
The antihistamine binds to the cell instead and stops the inflammatory process. Can also
be used for motion sickness, parkinson's, and vertigo Antitussives -
ANSWER✅✅✅suppress the cough reflex, decrease mucous in the respiratory track
and reduce pain. Baseline data for levothyroxine - ANSWER✅✅✅Serum levels of TSH
and free T4 Baseline data for methimazole - ANSWER✅✅✅Obtain serum levels of
thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4).
, Check baseline CBC and LFTs prior to initiation. Beta Agonists -
ANSWER✅✅✅Therapeutic Goal: Short-acting inhaled β2 agonists are used as needed
(PRN) for prophylaxis of exercise-induced bronchospasm and to relieve ongoing asthma
attacks and chronic obstructive pulmonary disease exacerbations. Oral and inhaled long-
acting β2 agonists are used for maintenance therapy. Baseline Data: Forced expiratory
volume in 1 second (FEV1), frequency and severity of attacks. Attempt to identify trigger
factors. Use systemic β2 agonists with caution in patients with diabetes, hyperthyroidism,
organic heart disease, hypertension, or angina pectoris. Contraindications: Systemic (oral,
parenteral) β2 agonists are contraindicated for patients with tachydysrhythmias or
tachycardia associated with digitalis toxicity. Use systemic β2 agonists with caution in
patients with diabetes, hyperthyroidism, organic heart disease, hypertension, or angina
pectoris. Monitoring Requirements: FEV1, peak flow. Monitor home assessments of peak
expiratory flow (PEF) at each clinic encounter. Evaluation of Therapeutic Effect: Asthma
control should be assessed at each clinic encounter. Monitor PEF, symptom frequency
and symptom intensity, nighttime awakenings, effect on normal activity, and short-acting
β2 agonist use. It is also important to discuss medication adherence or deviation from the
management plan. Because patients may forget some of the finer points of inhaled
medication administration, this is a good time to have the patient demonstrate their
technique for using inhalers. Minimizing Adverse Effects: Inhaled short-acting β2 agonists:
When used at recommended doses, SABAs are generally devoid of significant adverse
effects. Inhaled long-acting β2 agonists: When used correctly, LABAs are safe; however,
when used alone for prophylaxis, they may increase the risk for severe asthma attacks and
asthma-related death. (This is no Biguanides - ANSWER✅✅✅ Biguanides -
ANSWER✅✅✅Metformin decreases hepatic glucose production and intestinal glucose
absorption; increases insulin sensitivity hypersens. to drug/class/compon. eGFR <30
metabolic acidosis diabetic ketoacidosis lactic acidosis hypoxemia dehydration sepsis
surgery hepatic dz caution if eGFR 30-60 caution in pts 65 yo and older caution in
premenopausal anovulatory pts caution if CHF caution if alcohol abuse caution if
hypoglycemia risk Biguanides (Metformin) - ANSWER✅✅✅Metformin Decreasees
glucogenesis and insulin resistance 1st line tx with lifestyle changes rarely causes
hypoglycemia cont: renal disease, acidosis from hepatic disease, alcoholics, or in hypoxia
monitor renal and hepatic function studies, increased risk of lactic acidosis hold
metformin 48 hours after contrast--> serum creatinine should be normal b4 resuming
Bismuth subsaliculate (Pepto Bismol) - ANSWER✅✅✅OTC med for upset stomach,
diarrhea, heartburn, and indigestion antibacterial and antisecretory properties (tx travelers
diarrhea 2 tabs or 2 fl oz b4 each meal and at bedtime (4xd for up to 3 weeks during periods
of high risk no kids/teens c recent chickenpox or flu-like illness (Reyes syndrome) or aspirin
3 Principle Actions of Thyroid Hormones - ANSWER✅✅✅(1) stimulation of energy use
(2) stimulation of the heart (3) promotion of growth and development 4 steps to synthesis
of thyroid hormoness - ANSWER✅✅✅1. Uptake 2. Activation (Oxidation by peroxidase)
3. Iodination of Tyrosine 4. Coupling of Iodinated Tyrosine a-Glucosidase Inhibitors -
ANSWER✅✅✅ a-Glucosidase Inhibitors - ANSWER✅✅✅Acarbose inhibits
pancreatic alpha-amylase and intestinal alpha-glucoside hydrolase, delaying glucose
absorption hypersens. to drug/class/compon. diabetic ketoacidosis, cirrhosis,
inflammatory bowel dz, colonic ulcer, partial GI obstruction, GI obstruction risk,
malabsorption syndromes, Cr >2 Accelerate levothyroxine metabolism -
ANSWER✅✅✅Phenytoin (Dilantin) , Carbamazepine (Tegretol, Carbatrol) , Rifampin
(Rifadin) , Sertraline (Zoloft) , Phenobarbital Active Immunity - ANSWER✅✅✅When the
immune system produces antibodies in response to an antigen by the vaccine, or by the
infection itself. For example, if a person who has never had hepatitis B contracts hepatitis
B and recovers from it, that person becomes immune to hepatitis B because of the
immune system's antibody response to the hepatitis B virus. Adverse effects of
antihistamines - ANSWER✅✅✅Drowsiness is most common side effect Others: dry
mouth vision changes difficulty urinating constipation Anticholinergics -
ANSWER✅✅✅ipratropium, tiotropium block acetylcholine to prevent bronchial
constriction and narrowing of the airways, indirectly facilitates bronchodilation and
reduces secretions For COPD, emphysema, and to prevent bronchospasm Antihistamines
- ANSWER✅✅✅tx allergies, rhinitis, hay fever, hives, itching, running nose,
anaphylaxis, angioedema, drug fevers, and sneezing ex. diphenhydramine, fexofenadine,
and loratadine antihistamine medications compete with histamine for the receptor site.
The antihistamine binds to the cell instead and stops the inflammatory process. Can also
be used for motion sickness, parkinson's, and vertigo Antitussives -
ANSWER✅✅✅suppress the cough reflex, decrease mucous in the respiratory track
and reduce pain. Baseline data for levothyroxine - ANSWER✅✅✅Serum levels of TSH
and free T4 Baseline data for methimazole - ANSWER✅✅✅Obtain serum levels of
thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4).
, Check baseline CBC and LFTs prior to initiation. Beta Agonists -
ANSWER✅✅✅Therapeutic Goal: Short-acting inhaled β2 agonists are used as needed
(PRN) for prophylaxis of exercise-induced bronchospasm and to relieve ongoing asthma
attacks and chronic obstructive pulmonary disease exacerbations. Oral and inhaled long-
acting β2 agonists are used for maintenance therapy. Baseline Data: Forced expiratory
volume in 1 second (FEV1), frequency and severity of attacks. Attempt to identify trigger
factors. Use systemic β2 agonists with caution in patients with diabetes, hyperthyroidism,
organic heart disease, hypertension, or angina pectoris. Contraindications: Systemic (oral,
parenteral) β2 agonists are contraindicated for patients with tachydysrhythmias or
tachycardia associated with digitalis toxicity. Use systemic β2 agonists with caution in
patients with diabetes, hyperthyroidism, organic heart disease, hypertension, or angina
pectoris. Monitoring Requirements: FEV1, peak flow. Monitor home assessments of peak
expiratory flow (PEF) at each clinic encounter. Evaluation of Therapeutic Effect: Asthma
control should be assessed at each clinic encounter. Monitor PEF, symptom frequency
and symptom intensity, nighttime awakenings, effect on normal activity, and short-acting
β2 agonist use. It is also important to discuss medication adherence or deviation from the
management plan. Because patients may forget some of the finer points of inhaled
medication administration, this is a good time to have the patient demonstrate their
technique for using inhalers. Minimizing Adverse Effects: Inhaled short-acting β2 agonists:
When used at recommended doses, SABAs are generally devoid of significant adverse
effects. Inhaled long-acting β2 agonists: When used correctly, LABAs are safe; however,
when used alone for prophylaxis, they may increase the risk for severe asthma attacks and
asthma-related death. (This is no Biguanides - ANSWER✅✅✅ Biguanides -
ANSWER✅✅✅Metformin decreases hepatic glucose production and intestinal glucose
absorption; increases insulin sensitivity hypersens. to drug/class/compon. eGFR <30
metabolic acidosis diabetic ketoacidosis lactic acidosis hypoxemia dehydration sepsis
surgery hepatic dz caution if eGFR 30-60 caution in pts 65 yo and older caution in
premenopausal anovulatory pts caution if CHF caution if alcohol abuse caution if
hypoglycemia risk Biguanides (Metformin) - ANSWER✅✅✅Metformin Decreasees
glucogenesis and insulin resistance 1st line tx with lifestyle changes rarely causes
hypoglycemia cont: renal disease, acidosis from hepatic disease, alcoholics, or in hypoxia
monitor renal and hepatic function studies, increased risk of lactic acidosis hold
metformin 48 hours after contrast--> serum creatinine should be normal b4 resuming
Bismuth subsaliculate (Pepto Bismol) - ANSWER✅✅✅OTC med for upset stomach,
diarrhea, heartburn, and indigestion antibacterial and antisecretory properties (tx travelers
diarrhea 2 tabs or 2 fl oz b4 each meal and at bedtime (4xd for up to 3 weeks during periods
of high risk no kids/teens c recent chickenpox or flu-like illness (Reyes syndrome) or aspirin
