Flashcards in 09 Diabetes Insipidus Harieg Deck (48)
What should be remembered about Desmopressin Intranasal?
Delivers doses of 0.1 mL (10mcg) or multiples of 0.1 mL. Requires refrigeration. Primed prior to the first use
When should you consider an alternative route when using Desmopressin Intranasal?
If changes in nasal mucosa (scarring, edema) leads to unreliable absorption
What are the advantages to using Desmopressin Oral?
Extremes of age. Mentally/physically handicapped. Chronic allergic rhinitis. Nasal packing following transsphenoidal surgery
What is the Desmopressin Oral potency compared to Intranasal spray?
0.1mg tablet is equivalent to 2.5-5mcg of the nasal spray
How should Oral Desmopressin be taken?
Absorption decreased by 40-50% when taken with meals (take when fasting). Restrict fluid intake from 1 hour before to 8 hours after taking tablets
When should you consider IV or intranasal route when taking Oral Desmopressin?
If inadequate therapeutic response at maximum recommended oral doses
When is Parenteral Desmopressin used?
If cannot be administered intranasally or orally
How is Parenteral Desmopressin given?
1mcg SQ Q12h. If inadequate absorption --> 2mcg of desmopressin acetate given IV over two minutes
What are the ADRs associated with Desmopressin?
BP increased/decreased (IV). Facial flushing/HA. Dizziness. Chills. Hyponatremia. Water intoxication. Abdominal pain, nausea
What should patients report when taking Desmopressin?
Increased weight/swelling of extremities. Unresolved HA. Chest pain/palpitation. Respiratory difficulty. CNS change. Rash
What is the MOA of Chlorpropamide (Diabinese)?
Potentiates effect of small amounts of AVP or direct activation of V2 receptor (Antidiuretic effect enhanced by cotreatment with a thiazide diuretic)
What are the ADRs associated with Chlorpropamide?
Hypoglycemia. Disulfram like reaction to ethanol
What needs to be remembered about treatment of Nephrogenic DI?
Does not respond to ADH
What do you need to correct in Nephrogenic DI?
Hypokalemia and hypercalcemia
What is the treatment plan for Nephrogenic DI?
Discontinue any drugs that may be causing it. Thiazide diuretics and modest salt restriction is usually used (HCTZ 25mg QD or BID)
What are the complications when treating Nephrogenic DI?
Hypernatremia. Severe dehydration. Cardiovascular collapse. Death
What are the symptoms of Hypernatremia?
Weakness. Lethargy. Restlessness. Irritability. Twitching. Seizures. Coma. Death