Pharm-DM. chemo, opioids Flashcards
(129 cards)
1
Q
who are oral antidiabetic agents used for?
A
Stable Type 2 diabetics with NO KETONES who can’t control BG with diet alone
2
Q
never use oral antidiabetics in
A
pts who make no inuslin (Type 1) Pt must make their won insulin to use oral agents
3
Q
Sulfonylurea action
A
Bind to Beta cells of pancreas and stimulate insulin release
4
Q
second generation sulfonylureas are better than 1st generation because
A
more potent, less interactions, less side effects
5
Q
2nd gen sulfonylureas end in
A
-ide
6
Q
glimepiride
A
Amaryl; sulfonylurea
7
Q
glipizide
A
Glucotrol; sulfonylurea
8
Q
glyburide
A
Micronase, DiaBeta,
sulfonylurea
9
Q
major adverse effect of sulfonylureas
A
Hypoglycemia
10
Q
side effects of sulfonylureas besides HoG
A
itchy rash, increased sun sensitivity
heartburn, anorexia, n/v
11
Q
sulfonylureas should be taken
A
30 minutes before a meal
except Glucotrol XL and Amaryl-qday
12
Q
Glucotrol + metformin
A
Metaglip
13
Q
gluburide +metformin
A
Glucovance
14
Q
sulfonylurea + biguanide combo drugs (2)
A
Metaglip and Glucovance
15
Q
sulfonylurea + TZD combo drugs (2)
A
Avandaryl and Duetact
16
Q
Amaryl + Avandia
A
Avandaryl
17
Q
Amaryl + Actos
A
Duetact
18
Q
Meglitinides action
A
“jumper cables”
stimulate insulin release from pancreas, faster and shorter duration than sulfonylureas
esp good for controlling ppBG
19
Q
Major adverse effect of meglitinides
A
hypoglycemia
20
Q
Meglitinide use contraindicated in
A
pregnancy and breastfeeding
21
Q
Admininster meglitinide when?
A
within 15 minutes of meal; only give if meal is eaten
22
Q
metformin and Januvia
A
Januvamet
23
Q
metformin and Avandia
A
Avandamet
24
Q
Biguanide action
A
decreases hepatic glucose production (gluconeogenesis) and
increases cellular uptake of glucose
25
Adverse effects of biguanides are rare if
pt has good renal and hepatic function
26
Potentially fatal AE of biguanide use
Lactic Acidosis
| due to excess drug accumulation
27
Labs before and every 6 months with biguanide use
Liver and Kidney function tests
28
Stop biguanide use immediately if
dehydration, severe infection, surgery
contrast dye use (stop 48 hours prior)
excessive Etoh
hepatic or renal disease
29
s/s Lactic acidosis
fatigue, weakness dizzyness
dyspnea
GI discomfort
bradycardia, arrythmia
30
Most common side effect of biguanide use
GI symptoms: diarrhea, n/v, bloating, anorexia, metallic taste
SO: take with meals
31
HoG can result from biguanide use if
it is taken with a sulfonylurea, excessive alcohol
| elderly and/or malnourished pt
32
alpha-glucosidase inhibitors action
"Starch Blockers"
| slow CHO digestion and glucose absorption by blocking carbohydrase enzyme; prevents surges in BG
33
Side effects of alpha-glucosidase inhibitors
GI: diarrhea, gas, abd pain ("gas pills"
| HoG when used with sulfonylureas
34
acarbose
Precose
35
miglitol
Glyset
| starch blocker
36
when HoG is cause by starch blocker use, treat with
oral glucose or milk, NOT sucrose because its digestion will be slowed
37
Administer starch blockers
with first bite of meal.
38
metformin
Glucophage
39
TZDs action
Insulin sensitizers; decrease insulin resistance at the cellular level by increasing uptake of glucose by skeletal muscle and decreasing glucose production by the liver. Overall: increases effectiveness of circulating insulin, DOES NOT stimulate secretion of insulin
40
TZD taken off market in 2000
Rezulin
41
TZD generic names end in
-glitazone
42
rosiglitazone
Avandia
| TZD
43
pioglitazone
Actos
| TZD
44
indication for TZD use
Type 2 DM pt on insulin >30 units/day still with inadequate BG control
45
TZDs don't cause HoG but can damage
the liver. LFTs monthly at first, then q6mos
46
decreases action of oral contraceptives and can cause ovulation in premenopausal anovulatory pts
Actos
47
avoid in severe cardiac disease bc can worsen HF
TZDs
48
exenatide
Byetta; incretin mimetic
49
incretin hormones released by/action
```
GI tract; in response to food. They:
Stimulate insulin secretion
decrease pp glucagon production
slow gastric emptying
increase satiety to decrease intake
```
50
incretin mimetic action
improves glycemic control in Type 2 DM pt by decreasing fasting and pp BG by mimicking incretin hormone action
51
indication for incretin mimetic use
Type 2 DM pt adjunct to metformin or sulfonylureas when pt is still not getting enough BG control
52
Admin of incretin mimetic
SubQ injection within 1 hour of am and pm meals
53
side effects of Byetta
decreased appetite, intake, and weight
| nausea, especially with first use
54
DDP-4 inhibitor action
enhance incretin system
| (DDP-4 enzyme inactivates incretins)
55
DDP-4 inhibitors generic names end in
-gliptin
56
sitagliptin
Januvia
| DDP-4 inhibitor
57
saxagliptin
Onglyza
| DDP-4 inhibitor
58
indications for use of DDP-4 inhibitors
```
with metformin (Januvamet) or TZDs or solo
Adjunct to diet and exercise to increase glycemic control
```
59
Side effects of DDP-4 inhibitors
Headache
URIs, sore throat
diarrhea
60
Do not use these with sulfonylureas because of increase risk of HoG
DDP-4 inhibitors
61
Admin of DDP-4 inhibitors
PO qday
62
injecable med for Type 1 and Type 2 pts; used with insulin to help lower ppBG by slowing food movement through stomach
pramlintide (Symlin)
63
administer Symlin
dont mix with insulin, prepare two different syringes
64
side effects of Symlin
HoG, nausea
65
glucagon action
pancreatic hormone that raises BG by stimulating glycogen breakdown
66
glucagon use
treat HoG when oral treatment isn't possible
67
to admin glucagon
reconstitute, not stable in liquid form
| IM or SubQ injection, repeat 1x in 20 min
68
who must have glucagon on hand at all times?
Type 1 pt or meds that have risk of HoG
69
class of controlled pain mgmt meds; natural or synthetic chemicals based on morphine
opioids
70
narcotic
any drug capable of causing physical dependence
71
opioid action
stimulate opioid receptors in CNS causing a combo of analgesia, sedation, mood change and euphoria specific to the receptor involved
72
opioid receptor that causes analgesia, sedation, and euphoria and whose major side effect of stimulation is respiratory depression
M (mu)
73
opioid receptor whose stimulation causes mainly analgesia and drowsiness and whose main side effect is decreased GI motility
K (kappa)
74
opioid receptor stimulated by endogenous endorphins
delta
75
specific effects of each opioid are determined by
it's particular affinity for the different opioid receptors
76
indications for opioid use (5)
Pain relief: mod-severe
Cough suppression (medullary center inhibition)
Cardiac-decreased workload due to claming effect and peripheral vasodilation
Antidiarrheal-bind intestinal opioid receptors
Anxiety decreased
77
agonist action
binds receptor to activate and produce a response
78
partial agonist (agonist-antagonist) action
mixed effects result in a weaker response than agonist; used when max effects would be dangerous
79
antagonist action
Blocks receptor response
80
opioid antidote
naloxone (Narcan)
naltrexone (Trexan)
given if RR <8 usually, precipitates withdrawal in dependent patients
81
why are oral morphine doses higher than IV/IM?
First Pass Effect in Liver
82
Analgesic standard for potency to which all opioids are compared
morphine
83
methadone use and action
used for detox and maintenence of heroin or other opioid addicts; decreases intensity of withdrawal symptoms
84
advantage of buprenorphine (Suboxone, Subtrex) over methadone
can give prescription to go home instead of regular visit to clinic
85
antihistamines are used as adjuvant meds with opioids because
sedation, potentiate analgesia
86
antidepressants are used as adjuvant meds with opioids because
decrease pain perception and induce sleep
87
anxiolytics are used as adjuvant meds with opioids because
decrease anxiety, induce sleep, promote amnesia
88
antipsychotics are used as adjuvant meds with opioids because
decrease pain perception, induce sleep, counter delerium
89
anticonvulsants are used as adjuvant meds with opioids because
stabilize neuronal membranes and potentiate analgesia
Often used for chronic pain
Ex-Neurontin
90
opioid contraindications
```
acute respiratory distress
decreased liver or kidney function
Head injury (increased risk of respiratory depression)
```
91
opioid side effects
```
*Respiratory Depression
n/v
drowsiness
dry mouth
miosis (pupil constriction)
orthostatic HoTN
diaphoresis
pruritis (some histamine release, not true anaphylaxis)
urinary retention (esp. morphine)
constipation
```
92
adverse reactions of opioids
```
seizures
tinnitus (often concurrent with Tylenol)
jaundice
facial Edema
confusion
tachycardia
severe respiratory depression (give Narcan)
```
93
dependence
response to ongoing exposure that can produce withdrawal syndrome
94
early s/s opioid withdrawal
anxiety
tearing and runny nose
clammy skin and goosebumps
95
late s/s opioid withdrawal
irritability
n/v and diarrhea
involuntary leg movement
96
very late s/s opioid withdrawal (can last months)
agitation, insomnia, fatigue
97
tolerance
adaptation; need increased dose for same effect
98
addiction
drug seeking for euphoriia, not pain mgmt
99
when to admin opioids before a painful activity
PO: 30 min before
| IV/IM: 3-5 min before
100
anaplasia
absence of normal cellular differentiation
101
myelosuppression
suppression of bone marrow function, which can result in dangerously low levels of rbs, wbcs, and plts
102
normal plt count
150-400
103
normal Hgb
males: 14-18
females: 12-16
104
normal Hct
males 42-52%
| females 37-47%
105
normal wbc count
4200-12500 (4.2-12.5)
106
nadir
lowest wbc count after count had been depressed by chemo; time to nadir can be reduced and duration can be increased in subsequent rounds of chemo
107
carcinomas are malignant neoplasms of
epithelial tissue (skin, GI lining, bronchial lining, other linings)
108
sarcomas are malignant neoplasms of
connective tissue (bone, fibrous, fatty, muscle, vascular, neuro). often present as painless swellings
109
leukemia
cancers that arise from bone marrow; marrow cells replaced by leukemic blasts resulting in abnormal numbers and forms of immature wbs.
110
goal of chemo
find best combination of meds for that particular cancer cell type to achieve the highest cell kill ratio possible.
111
induction therapy
first dose of chemo
| pt reponse often dictates course of treatment
112
standard insulin units/mL
100 units/mL
113
never dilute or mix
Lantus
114
insulin coverage is always with
rapid-acting or short-acting
115
draw venous blood sample to confirm BG if it is
500
116
the only insulin given IV is
short-acting (regular)
117
insulin syringe specs
1/2-5/8 inch
| 25-30 G
118
when mixing insulins draw up
regular first, then NPH (RN)
119
systematic rotation of injection sites is necessary
to prevent scar tissue formation and ensure adequate absorption
120
insulin injection sites separated by ? and use not more than?
1 inch
| every 3 weeks
121
medications that can increase hypoglycemic effects of insulin
alcohol; MAOIs; salicylates
122
two types of lipodystrophy
lipoatrophy--loss of subq fat; seen as dimpling
lipohypertrophy---development of fatty masses at injection site
Both caused by prolonged use of the same site, not rotating properly
123
complication sometimes seen after diabetic control is suddenly established in a client who has prolonged uncontrolled DM
Insulin Edema--generalized retention of fluid
124
most common cause of insulin resistance
obesity
125
true insulin resistance is a daily insulin requirement of
200+ units
126
treatment for insulin resistance
purer preparation
| prednisone treatment
127
an opened bottle of insulin is good for
28 days at rt
128
insulin pumps use only
rapid-acting insulin
129
get accucheck within ? minutes of meals
30 minutes
