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En/ReCx
Levothyroxine
Indications
Hypothyroidism
Myxedema Coma
Mechanism of Action
Isomer of Thyroid Hormone (T4)
T3 has Higher Potency
Side Effects
Hyperthyroid Symptoms
57 secs
Hypothyroidism Intervention
Medications
Levothyroxine (Synthroid)
Liothyronine (Cytomel)
Complication
Myxedema Coma
Nursing Considerations
Lifelong Replacement Hormone
Monitor Vital Signs
Fluids and Fiber
Low Calorie, Low Fat Diet
Medication Education
No Switching Brands
2 mins
Hyperthyroidism Interventions
Drug Therapy
Propylthiouracil (PTU)
Methimazole (Tapazole)
Iodine
Beta Blockers
Other Therapies
Radioiodine Ablation
Thyroidectomy
Complications
Thyrotoxicosis
Post-Surgery Hypocalcemia
2 mins
Propylthiouracil (PTU) and Methimazole (MMI)
Indications
Hyperthyroidism
Mechanism
Inhibits Thyroid Peroxidase
PTU Blocks Peripheral Conversion of T4 to T3
Side Effects
Agranulocytosis
Skin Rash
Hepatotoxicity (PTU)
Teratogen (MMI)
1 min
Thyroid Storm
Symptoms
Diarrhea
Liver Failure
Insulin Resistance
Tachycardia
Lid lag
Change in LOC (Altered Mental Status)
High fever
Treatment
Propranolol (Or Esmolol)
PTU (Thionamides) Initially
Iodine Solution (Lugol Iodine)
Glucocorticoids
Cooling Blanket
3 mins
Octreotide
Indications
Acute Variceal Bleeds
Pituitary Tumors
GH Secreting Tumors
Carcinoid Tumors
VIPoma
Mechanism
Somatostatin Analog
2 mins
Leuprolide
Mechanism
GnRH Agonist (Pulsatile Use)
GnRH Antagonist (Continuous Use)
Upregulates FSH And LH
Downregulates FSH And LH
Indications Pulsatile
Infertility
Indications Continuous
Prostate Cancer
Precocious Puberty
Uterine Fibroids
Endometriosis
Side Effects
Anti-androgenic Effects
2 mins
Insulin
Rapid Acting
Insulin Lispro (Humalog)
Insulin Aspart (Novolog)
Insulin Glulisine (Apidra)
Short Acting
Regular Insulin (Humulin R)
Intermediate Acting
Isophane NPH (Humulin N)
Long Acting
Detemir (Levemir)
Glargine (Lantus)
2 mins
Metformin
Indications
Diabetes Mellitus Type 2
Polycystic Ovary Syndrome (PCOS)
Mechanism of Action
Decreased Gluconeogenesis
Increased Insulin Sensitivity
Side Effects
Lactic Acidosis
GI Distress
Weight Loss
B12 Deficiency
Contraindication
GFR < 30 ml/min
2 mins
Chlorpropamide and Tolbutamide (Orinase) (1st Generation Sulfonylureas)
Mechanisms
1st Generation Sulfonylureas
Stimulate Release of Insulin
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Possible Cardiovascular Toxicity
Weight Gain
Considerations
Exacerbated Hypoglycemia with Beta-blockers
Avoid During Pregnancy and Breast Feeding
Avoid Alcohol
2 mins
Glyburide and Glipizide (2nd Generation Sulfonylureas)
Mechanisms
2nd Generation Sulfonylureas
Blocks Potassium Channels in Beta Cells
Stimulate Release of Insulin
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Considerations
More Potent
Beta Blockers Reduce Effects
Avoid Alcohol
Avoid Breastfeeding
2 mins
Pioglitazone (Thiazolidinediones)
-glitazones Suffix
Mechanism
Binds PPAR-Gamma
Decreases Insulin Resistance
Indications
Type 2 Diabetes
Side Effects
Weight Gain
Heart Failure
Myalgia
Hypoglycemia
Upper Respiratory Infection
Considerations
Increased Risk of Bladder Cancer
Increased Fracture Risk in Women
Monitor Liver Enzymes
2 mins
Acarbose (Precose) and Miglitol (Glyset) (Alpha Glucosidase Inhibitors)
Mechanisms
Alpha Glucosidase Inhibitors
Delays Absorption of Carbohydrates
Indications
Type 2 Diabetes
Side Effects
Flatulence
Diarrhea
Anemia
Cramps
Considerations
Monitor LFTs
Oral Glucose for Hypoglycemia
2 mins
Repaglinide and Nateglinide (Meglitinides)
Mechanisms
Meglitinides
Increased Insulin Release
Indications
Type 2 Diabetes
Side Effect
Hypoglycemia
Considerations
Eat Within 30 Minutes
Gemfibrozil Increases Risk of Hypoglycemia
Short Half-Life
2 mins
Sitagliptin (Januvia) and Saxagliptin (Onglyza) (DPP-4 Inhibitors)
-gliptin Suffix
Mechanisms
DPP-4 Inhibitor
Increases Insulin Release
Indications
Type 2 Diabetes
Side Effects
Pancreatitis
Upper Respiratory Infection and Inflammation
Stevens-Johnson Syndrome
Considerations
Used as Add-on Agents
2 mins
Pramlintide (Symlin)
Mechanism
Synthetic Amylin Analog
Indications
Diabetes Type 1 and 2
Supplement Mealtime Insulin
Side Effects
Nausea
Skin Reactions at Injection Site
Considerations
Hypoglycemia When Combined with Insulin
Delayed Absorption of Oral Drugs
2 mins
Exenatide (Byetta)
Mechanism
Incretin Mimetic
GLP-1 Synthetic Analog
Indications
Type 2 Diabetes
Side Effects
Hypoglycemia
Nausea and Vomiting
Diarrhea
Thyroid Cancer
Pancreatitis
Renal Failure
Considerations
(Give Exenatide) One Hour After Other Medications
Adjunct Therapy
3 mins
Prednisone (Glucocorticoids)
Mechanism
Glucocorticoid
Indications
Inflammatory Conditions
Organ Transplant Rejection
Side Effects
Cataracts and Glaucoma
Cushing's Syndrome
Osteoporosis
Immunosuppression
Hyperglycemia
Ulcers
Considerations
Adrenal Insufficiency
Taper Gradually
2 mins
Dinoprostone and Misoprostol
Mechanism
Prostaglandins
Indications
Promote Cervical Ripening
Prevent GI Ulcers
Medical Abortion
Side Effects
Fetal Distress
Hyperstimulation of Uterus
Considerations
Vaginal Insertion
Give Before Induction of Labor
2 mins
Carboprost (Hemabate)
Mechanism
Prostaglandin F2-alpha Analog
Smooth Muscle Contraction
Indications
Postpartum Hemorrhage
Abortion
Side Effects
GI Distress
Hypertension
Fever
Bronchoconstriction
Considerations
Identify Cause of Fever
2 mins
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