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Pharmacology ATI Study Guide

THYROID REPLACEMENT
Examples Levothyroxine sodium (Synthroid, Levothroid, Levoxyl, Unithroid) Liothyronine sodium (Cytomel) Thyroid (Armour Thyroid) Liotrix (Thyrolar) Hypothyroidism:  Depression  Weight Gain  Bradycardia  Anorexia  Cold intolerance  Dry Skin  Menorrhagia Myxedema Coma (IV emergency tx) Signs of Hyperthyroidism:  Anxiety  Tachycardia  Palpitations  Altered appetite  Abd cramping  Heat intolerance  Fever  Diaphoresis  Weight loss  Menstrual irregularities  4 hrs apart from vitamins, antacids, iron, & Carafate  Monitor & report signs of cardiac excitability (angina, chest pain, palpitations, dysrhythmias)  Monitor T4 and TSH  Take on empty stomach  Lifelong replacement, don’t d/c abruptly  Check w/ provider before switching brands  Preg Category A  Caution in preg & lactation  CI in Thyrotoxicosis  Caution: CV problems (HTN, angina, ischemic heart disease)  CI following an MI due to cardiac stimulant effects  Not used in tx for obesity

Indications

Side Effects

Administration

Contraindications

INSULIN   Only regular insulin may be given IV Side effects: o Lipohypertrophy (rotate sites & leave 1 inch between injection sites) o Hypoglycemia  If abrupt onset – SNS sx (tachycardia. & ETOH ↑ hypoglycemic effects o Thiazide & glucocorticoids ↑ glucose levels Generic (Trade)  Lispro insulin (Humalog)  Insulin glulisine (Apridra)  Regular insulin (Humulin R or Novolin R)  NPH insulin (Humulin N)  Insulin detemir (Levemir)  Insulin glargine (Lantus) Onset <15 mins. glucose tabs)  If unconscious. tremors. administer IV glucose or glucagon Interactions o Sulfonylureas. 2 oz grape juice. Micronase) Expected Pharmacological Action  Results in insulin release from the pancreas . Peak 0.5 – 1 hr 2 – 3 hr 5 – 7 hr Intermediateacting 1 – 2 hr 4 – 12 hr 18 – 24 hr Long-acting 1 hr None 10. diaphoresis. shakiness)  Gradual – PNS sx (HA. 8 oz milk. meglitinides. beta blockers. weakness)  Administer 15 g carb (4 oz OJ.5 – 1 hr Duration 3 – 4 hr  Classification Rapid-acting Short-acting 0.4 – 24 hr ORAL HYPOGLYCEMICS Medications Sulfonylureas:  1st Generation: o Tolbutamide (Orinase) o Chlorpropamide (Diabinese) nd  2 Generation: o Glipizide (Glucotrol) o Glyburide (DiaBeta. palpitations.

diarrhea. somnolence) Med/Food Intxns: o ETOH ↑ risk of lactic acidosis SE: o Fluid retention o ↑ LDL o Hepatotoxicity Med/Food Intxns: o Gemfibrozil: ↑ risk of hypoglycemia o Insulin: ↑ risk of hypoglycemia SE: o Abd distention & cramping.o Glimepiride (Amaryl) Meglitinides:  Repaglinide (Prandin)  Nateglinide (Starlix)   SE: hypoglycemia Food/Med intxns: o Gemfibrozil (Lopid) ↑ risk of hypoglycemia SE: o GI effects (anorexia. hyperactive bowel sounds.) o Vit B12 & folic acid deficiency o Lactic acidosis (hyperventilation. N&V. sluggishness. excessive gas o Anemia o Hepatoxicity Med/Food Intxns: o Sulfonylureas & insulin: ↑ risk of hypoglycemia o Metformin: added GI effects & ↑ risk of hypoglycemia  Biguanides:  Metformin HCl (Glucophage)   Thiazolidinediones (Glitazones):  Rosiglitazone (Avandia)  Pioglitazone (Actos)   Alpha glucosidase inhibitors  . myalgia.