HSC 343 Pharmacology Final Exam 2025

Regular insulin - -- short-duration, slow acting - onset: 30 min-1 hr - duration: 6-10 hours NPH insulin - -- intermediate acting - onset: 1-2 hrs - duration: 16-24 hours Insulin glargine - -- long-acting - onset: 1 hour - duration 24 hours Insulin lispro - -- rapid-acting - onset: 15 min-30 min - duration: 3-5 hours Insulin aspart - -- rapid acting - onset: 12-18 min - duration: 3-5 hours Anatomical absorbance (greatest to latest) - -- abdomen - arm - thigh - hip All insulins are CLEAR--- except for what insulin? - -NPH insulin (it is cloudy) What insulins may be given IV? - - - regular - aspart - lispro - glulisine When mixing insulin, which insulin would you draw up first? What are the steps after that? - -- when mixing insulins, draw up the SHORT-ACTING insulin into the syringe first, then NPH Why would you draw up the short-acting insulin first when mixing insulins? - -this stops contamination of the short-acting insulin w/ NPH HSC 343 HSC 343 HSC 343 S/S of insulin OD - -- hypoglycemia (dizziness) - weakness - sweating - HA - increased HR - anxiety - tremor - mental and visual disturbances How would you treat insulin OD? - -- eat something sweet or out the pt on a sugar drip (if in the hospital) Metformin - -- widely used - oral drug Type II DM - may be used w/ other drugs for diabetes - increases HDL, decreases BP, weight loss - SE: GI upset, acidosis - DO NOT use in pts w/ renal diseases or liver disease - d/c before using iodinated radiocontrast media, wait Acarbose - -- oral drug for Type II DM (glucosidase inhibitor) - inhibits the enzymes that break down oligosaccharides into monosaccharides - delays digestion and prolongs absorption of CHO, decreasing PPH - do not cause postprandial hypoglycemia - adrs: GI upset and flatulence - pts take these drugs w/ first bite of each meal Tolbutamide - -- older drugs that stimulates insulin release from the pancreas - onset: 30 in-1hr - duration: 6-12 hrs Sitagliptin - -- PO used to stimulate insulin release Canagliflozin - -- excretes glucose through the kidneys -- increases urine excretion of kidneys SE: yeast infections and genital gangrene Exanatide - -- injectable, that slows gastric emptying What is PPH? - -postprandial hyperglycemia - it is correlated w/ increased risk of cardiovascular disease Signs of hypoglycemia - -early signs - fatigue, HA, drowsiness, lassitude, tremulousness, nausea Late signs HSC 343 HSC 343 - weakness, sweating, tremors, nervousness, LOC/convulsion (use Glucagon for this) Signs of hyperglycemia - -- thirst. Polyuria, drowsiness, flushed skin, fruity odor to breath, LOC - instruct family to call physician, EMT - have insulin ready - observe pt closely after insulin is administered What is ketoacidosis? - -high blood glucose -- above 300, high ketones in blood and urine How is ketoacidosis treated? - -- IV fluids and electrolytes - IV insulin- but given slowly to reduce blood glucose levels slowly (initial bolus, then continuous infusion to maintain BG levels) - Bicarb for acidosis, K+ for hypokalemia What is HHNKS? - -hyperglycemic hyperosmolar Nonketonic syndrome What does thyroid do? - -- it synthesizes and releases 2 hormones (T3 and T4) What do T3 and T4 do? - -regulate many facets of cellular metabolism Why is thyroid hormone (TH) important? - -- they are the main controller of how we burn calories and are also permissive w/ respect to catecholamines S/S of hypothyroidism - -- fatigue, weakness, cold-intolerance, weight gain, anemia, cretinism S/S of hyperthyroidism - -- nervousness, weakness, heat-intolerance, sweating, weight loss, exophthalmos (Graves disease) Synthroid - -- PO or IV - mimics TH - most commonly prescribed drug in the US - DOC for hypothyroidism -- life long therapy PTU (propylthiouracil) - -- antithyroid - blocks iodine incorporated into ths and also blocks conversion of T3/4 in periphery - long term use in absence or surgery of l131 - safe in first trimester of pregnancy -- the switch to methimazole Methimazole - -- antithyroid L131 - -- destroys thyroid w/ a single (or double) dose - can NOT be used in pts who are pregnant HSC 343 HSC 343 - fast and cheap but produces hypothyroidism Propranolol - -- blocks the CV effects of TH -- decreases the sympathetic activation caused by TH - good during a thyroid storm and pregnancy Use of glucosteroids - -anti-inflammatory, immunosuppression, and replacement therapy in adrenal insufficiency How to dose steroid drugs - -- PO steroids given in the AM to mimic body's normal release or by taper pack Hydrocortisone - -- - used for status asthmaticus, anaphylactic shock (IV); - PO for Addison's disease - Topical form for itching/inflammation Solu-medrol - -- DOC (IV) for acute asthma - allergy inflammation Prednisone - -- given PO - DOC for maintenance therapy in asthma, and other autoimmune disorders Ses of glucosteroids - -- osteoporosis - ulcers - metabolic fat (hyperglycemia, hyperlipidemia, fat redistribution) - growth retardation -- children - adrenal suppression - decreased wound healing - immunosuppression (do not give immunizations) - HTN, glaucoma, increased CNS excitability, menstrual irregularities COX-1 inhibitors - -mediate pain, inflammation, clot formation, vasoconstriction/dilation, platelet aggregation, fever, integrity of gastric mucosal barrier, renal homeostasis, labor and patency of the ductus arteriosus COX-2 Inhibitors - -- more selective for inflammation - ex.: Celecoxib - main use is arthritis, bu it may affect renal function and has a greater risk of MI and stroke - fewer GI bleeds and no effect on clotting time Which antacids cause constipation? - -aluminum salts and Ca carbonate Which antacids cause diarrhea? - -Mg salts HSC 343 HSC 343 Opiate - -- drug for diarrhea - DO NOT USE W/ maois - i.e. Imodium Alosetron - -- for IBS-D and is currently for emergency/restricted use for IB-C Metamucil - -- fiber-based - for constipation - used for flatulence and impaction - takes 1-3 days Docusate - -- osmotic - surface acting to increase H2O into stool Golytely - -- lower GI prep - increases water into feces and is used to treat occasional constipation or used prior to lower GI procedures Drugs for nausea - -- used to prevent nausea and vomiting - some used in pregnancy, but not many are - other uses: pt who's had surgery, motion sickness, and in wasting syndromes Antihistamines (PO or IV) - -- Benedryl, Promethazine - DA antagonists- work to block the effect of DA at the trigger zone in the brain - some given PO (some IV, IM, and PR) - once DA is blocked, nausea and vomiting is subsided - ses: extrapyramidal ses (dystonias) Ondansetron - -- serotonin antagonists - mainly used for chemo and anesthesia-induced nausea Steroids - -- IV steroids may be used following surgery or along w/ chemo - typically, it is used short-term Compazine - -- antipsychotics - DA antagonists - same as Promethazine Emend - -- Aprepitant - substance P/Neurokinin antagonists - used for post-op and chemo-induced NV - given PO --- well tolerated but there are many drug interactions Resistance - -- ability of bacteria, virus, or parasites to "tolerate" an antibiotic and thrive in its presence - Can occur in many different ways HSC 343 HSC 343 Spectrum of activity - -- the microorganisms - narrow = few, selective microorganisms - broad = wide range of microorganisms Resistance - -- ability of bacteria, virus, or parasites to "tolerate" an antibiotic and thrive in its presence - can occur in many different ways Factors that promote resistance - -- poor pt compliance - monotherapy - indiscriminate antibiotic use Superinfections - -- often a problem w/ broad-spectrum drugs - there is an overgrowth of a second organism when drug therapy is treating the first organisms Empiric - -- based on observation - when the pt first comes into the hospital complaining, the dr. Will decided what microorganism it PROBABLY is but not 100% sure and will give that drug to the pt - usually it's broad spectrum drug Culture - -- based on lab results and can know definitely know the organism and its sensitivity Penicillin G - -- class 1 - effective only a/g gram [+] - hypersensitivity a problem 1-10% of the time - cannot be given PO (not acid stable) - used a lot in strep throat - can be given in conjunction w/ another drug - if given IM, it is one and done Amoxicillin - -- class 5 - sensitive to penicillinase - used in sinus infections and uris - used more in the community - given in a high dose- allows for more pt compliance Ampicillin - -- class 5 - sensitive to penicillinase - used in combination w/ other drugs in the hospital Amoxicillin + Clavulantate (Augmentin) - -resistant to penicillinase which makes it very expensive HSC 343 HSC 343 Piperacillin - -- Class 4 - Covers gram -+ pseudomonas (which are water born bugs) - Given PO. Vancomycin - -- DOC for anitbiotic associated pseudomembranous - given for any GI trauma who has a high probability of infection. Need to monitor trough levels to make sure the kidneys are clearing it out - RISK: can cause ototoxicity and nephrotoxicity Cephalosporins - -If patient is allergic to penicillin, then they're probably allergic to Cephalosporin too. Anything with "cef" usually means some sore of bronchitis, sinusitis or soft tissue infection. Cephalexin - -• Used for =MRSA • Side Effects=Ototoxicity,Anemia, Nephrotoxicity, cross sensitivity • Given PO • First generation; narrow spectrum (sensitive to B-lactamase). Cefepime - -• Fourth generation • Used for =MRSA • Side effects =Ototoxicity, Anemia, Nephrotoxicity, cross-sensitivity • Good for surgical prophylaxis Ceftriaxone, Cefixime, and Ceftaroline - -- Used for neurological infections - Third generation (broad Spectrum-B-lactamase resistant). - Side Effects=Neurotoxicity, Nephrotoxicity, Excretion - Given IM or IV. Cross-sensitivity w/ penicillins - -leads to bleeding because of decreased platelet function and clotting factors, including neurotoxicity. Gentamicin - -- All good for gm - aerobes = get into cell via 02- dependent pump. SE=Neurotoxicity, nephrotoxicity, ototoxicity. - Slow IV/IM Synergistic when combined with a B-lactam Erythromycin - -DOC for legionnaires Disease and good in PCN-allergic pt Azithromycin/ Clindamycin - -uris Tetracyclines - -- Used in penicillin allergy, used for acne, travelers diarrhea, rickettsia, chlamydia - SE= superinfection, tooth discoloration, photosensitivity, hepatotoxicity, nephrotoxicity - Dont take with antacids or dairy products Daptomycin - -- Given IV for MRSA and strep infections. - Inserts into bacteral membrane of gm organisms HSC 343 HSC 343 Sulfa drugs - -- Used for UTI and otitis media - SE= photosensitivity, hypersensitivity, hemolytic anemia, stevens- Johnsons syndrome. Crystalluria(drinks lots of h20), sulfa allergy Ciprofloxacin - -- Broad spectrum. Good distribution, Used for LRT, skin and UTI - SE=dizziness, seizures, tendron ruptures (long term use) Metronidazole - -- Bactericidal. Used against anaerobes & parasites - SE= Antabuse like reaction, GI upset, CNS disturbances - MOA- Binds DNA and inhibits its synthesis - can't drink because it binds to the alcohol and forms acid Combination therapy for TB - -- Treatment relies on drug combinations because resistance is so prevalent. - Treatment is challenging because mycobacteria are slow growers who may wall themselves off. - Also, they have a unique cell wall and we can't use bacteriostatic drugs in the immunocompromised host What is DOT? - -Directly Observed Therapy Amphotericin B - -- Drug of choice for fungal infections - SE= fever, chills, nausea, nephrotoxicity, headache, anemia - MOA- Binds to ergosterol in fungal cell membrane Nystatin - -- DOC for oral or intestinal Thrush - MOA-binds to ergosterol in fungal cell membrane Fluconazole/Miconazole - -- Used for immunosuppressed pts with serious fungal infections - MOA- inhibits fungal cytochrome p-450. Funguscant demethylate sterols for plasma membrane Acyclovir - -- used for hsv 1, hsv 2, and varicella zoster. - If given iv, give slowly because it burns, can cause nephrotoxicity Interferon Alpha - -- used for Hep. C PEP (Post-Exposure Prophylaxis) - -- Needle stick, syringed, Iv tubing needles - Decontaminate the wound, document, determine the source, determine th risk - Pep is most effective within 2 hrs Metronidazole (antiparasitic) - -- Used for trichomoniasis, amebiasis, and giardiasis - MOA-Activated intermediates bind DNA and inhibit replication HSC 343 HSC 343 Mebendazole - -- Drug of choice for pinworms, also roundworms - MOA- Disrupts microtubules Permithrin - -- Used for ectoparasit