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Unit one & DM Med.s
| Term | Definition |
|---|---|
| Muscle Spasms and Spasticity Medication Cyclobenzaprine (Flexeril) Methocarbamol (Robaxin) metaxalone (Skelaxin) Baclofen (Lioresal) is used for | Used to release local spasms r/t muscle injury . |
| Side effect of Muscle Spasms and Spasticity Meds Cyclobenzaprine (Flexeril) Methocarbamol (Robaxin) metaxalone (Skelaxin) Baclofen (Lioresal) | CNS depression, Light headedness Physical dependence |
| Side effect of metaxalone (Skelaxin)? | Hepatic toxicity |
| Baclofen (Lioresal) acts | Within the spinal cord to suppress hyperactive reflexes r/t Multiple sclerosis and spinal cord injury |
| Patient teaching for Muscle Spasms and Spasticity Meds | avoid hazardous activities, no driving, no drinking |
| Osteoblast | create new bone |
| Osteoclast | absorbs old bone |
| Absorption of calcium | happens in the small intestine; increase absorption with PTH and Vit. D; corticosteroids decrease CA absorption |
| Parathyroid Hormone : PTH & Vita D | Promotes CA re-absorption from the bone, gloerulus, activites vit. D; Decrease in P. (Will take from bone to maintain blood no matter what) |
| Calcitonin | secreted by thyroid; inhibits resorption from the bone, increased secretion from kidney |
| Calcium Salts and Vita D Meds | Calcium Acetate(Phoslo), Tums, |
| Calcium Acetate(Phoslo), Tums Side effects | Gi upset, Renal Dysfunction (calculi), hypercalcemia |
| Biphosphonates | end in "ate" Alendronate(Fosamax Risedronate(Actonel) Ibandronate (Boniva) |
| Biphosphonates BIGGEST RISK: Alendronate(Fosamax Risedronate(Actonel) Ibandronate (Boniva) | Esophagitis (Erosion or esophageal lining) decrease activity of osteoclasts Do NOT take w/ Food (decreases absorption) |
| How to prevent Esophagitis | Take Med with full glass of water, stay upright for 30 min, no antacids for 30 min, No food, No OJ/coffee for 30 min, Call MD with Painful/diff. swallowing or increase in heartburn |
| HX of Kidney stones | Avoid Ca Salts |
| Osteoporosis Meds | Raloxifene (Evista) |
| Raloxifene (Evista) Side effects: | increased risk for DVT, PE,Stroke, contraindicated: w/ PT HX of DVT, P.E D/C 72hr Pre-surgery CAT X:fetal harm May cause Hot flashes & rash |
| Raloxifene (Evista) does what | Mimics estrogen in bone,protects against breast cancer, (used in menopausal woman w/ Osteoporosis |
| Osteoarthritis Meds | COX-1 Ibuprofen, Naproxen, capsaicin (Zostrix), diclofenac (Voltaren) COX-2 Celecoxib (Celebrex) |
| Adverse Effects of Osteoarthritis Meds | stomach upset (Take with food to prevent) avoid ETOH, watch renal function |
| COX-1 Medications | Ibuprofen, Naproxen, capsaicin (Zostrix), diclofenac (Voltaren) |
| COX-2 Medication | COX-2 Celecoxib (Celebrex) |
| Cox-1 does | protects stomach mucousa, supports renal function, stimulates platelet aggregation (NOT GOOD, leads to gastric erosion, increased risk of bleeding and renal impairment |
| COX-2 does | site of tissue injury; inflammation and pain, fever, contributes to colon CA, supports renal fx results in renal impairment, decreased inflammation, pain, and fever, protects against colong CA, increases risk of stroke and MI |
| Corticosteroids | Methylprednisone (solumedrol), prednisone |
| Corticosteroids Methylprednisone (solumedrol), prednisone are used to | decrease inflammation and/or suppress immune response Increases blood glucose, decreases protein synthesis which leads to decrease muscle mass, thinning skin; redistribution of fat results in pot belly, moon face and buffalo hump; suppresses bone formati |
| Corticosteroids Methylprednisone (solumedrol), prednisone adverse reactions | adrenal insufficiency, osteoporosis, infection, hyperglycermia |
| Corticosteroids Methylprednisone (solumedrol), prednisone considerations | Need to taper off, do not stop abruptly Should receive smallest dose that achieves therapeutic response |
| Medications for RA | NSAIDS ;Glucocorticoids DMARDS: Disease Modifying Antirheumatic drugs (non-biological) Methotrexate Sulfasalazine (Azulfidine) Hydroxychloroquine (Plaquenil) |
| NSAIDS for RA provide | rapid relief of symptoms but do not prevent joint damage, do not slow progression of disease |
| Glucocorticoids for RA | Provide rapid relief of symptoms, slow disease progression; long term use leads to toxicity and long term side effects; usually reserved for exacerbations and used short term |
| DMARDS Methotrexate Sulfasalazine (Azulfidine) Hydroxychloroquine (Plaquenil) for RA | reduce joint destruction and slows progression; start with DMARD early in course; may use NSAID until DMARD takes effect; takes WEEKS to months to see benefit |
| DMARDS are what meds | Methotrexate Sulfasalazine (Azulfidine) Hydroxychloroquine (Plaquenil) |
| DMARDS: Methotrexate | first line drug; therapeutic effects 3-6 weeks (quickest response), suppresses immune response by reducing activity of B and T lymphocytes; given weekly orally or by injection; |
| Methotrexate side effects | CATEGORY X hepatic fibrosis, bone marrow suppression, GI ulceration, and pneumonitis; monitor renal and hepatic labs; given weekly |
| Sulfasalazine Side effects | Can’t take if have sulfa allergy; GI disturbance (N/V/D), skin reactions are common (pruritis, rash, urticaria); more serious side effects of hepatitis and bone marrow suppression are rare but need to be monitored |
| Plaquenil | Usually combined with methotrexate; 3-6 months for therapeutic response; |
| Plaquenil side effects | Retinal damage which can result in irreversible blindness; need to have eye exams every 6 mos; D/C any vision changes |
| Dmards for Tumor Necrosis Factor Antagonists (TNF) | Etanercept (Enbrel) Infliximab (Remicade) Adalimumab (Humira) |
| Destruction of B-Lymphocytes | Rituximab (Rituxan) |
| Inhibition of T-Lymphocytes | Abatacept (Orencia) |
| Biologic DMARDS do what | utilize DNA technology |
| Biologic DMARDS have a | big risk for infection (bacterial sepsis, fungal infections, TB) Rarely side effects include heart failure, cancer, hematologic, liver injury; immunosuppressants; target specific components of inflammatory process; often combined with methotrexate |
| Etanercept (Enbrel) | Binds to TNF preventing it from binding to site on synovial membrane of joint; subQ weekly; site reactions (Itching, redness, swelling) risk for heart failure |
| Infliximab (Remicade) | Given IV infusion; loading doses at 0, 2, and 6 weeks then every 8 weeks; give slowly over several hours; may have infusion reaction (hypo, HA, and flu like sym.); do not use with heart failure patients; often given with methotrexate; very expensive |
| Adalimumab (Humira) | given subQ in the anterior thigh or abdomen every 2 weeks; injection site reactions |
| Rituximab (Rituxan) | Destruction of B-Lymphocytes given IV; premedicate with antihistamine, Tylenol; Risk for severe hypersensitivity reaction (hypotension, bronchospasm, hypoxia, pulmonary infiltrates, MI, death has occurred within 24 hours) |
| Abatacept (Orencia) | Inhibits T lymphocytes T-cell activation inhibitor; often used with other DMARD but cannot use with TNF antagonists Increased risk for infection; fairly well tolerated |
| Azathioprine (Imuran) | immune suppressant and anti-inflammatory actions. Serious toxicities include hepatitis & blood dyscrasias (leukopenia, thrombocytopenia, anemia); category X; small risk of malignancy |
| Gold containing compouds: Aurothioglucose (Solganal) Gold sodium thiomalate (Myochrysine) Auranofin (Ridaura) | mechanism of action is unknown; relieves pain and stiffness, may delay disease progression; many side effects: intense pruritus, rashes, kidney damage, hepatitis, hypotension |
| Naproxen, diclofenac (voltaren) | First choice of treatment is NSAIDS for GOUT due to decreasing inflammation; do not treat elevated uric acid levels(7); usually see positive response within 24 hours; |
| Colchicine | For Gout: anti-inflammatory ; short/ long term: toxic to proliferating cells; common side effect is GI upset, can cause rhabdomyolosis if taking long term especially if taking statins, watch for muscle injury or tenderness |
| Allopurinol | For Gout:reduce uric acid levels; also used with chemotherapy; Side effect: hypersensitivity reaction,interacts with warfarin- (need to decrease dose) |
| Probenicid | For Gout:acts on renal tubules to inhibit reabsorption of uric acid thereby increasing excretion; side effects: mild GI upset, renal injury due to urate deposits in kidneys; need to push fluids; aspirin interacts with probenecid |
| Short Duration, Rapid Acting Insulin | Insulin Lispro (Humalog) Insulin Aspart (NovoLog) Insluin glulisine (Apidra) |
| Short Duration, Rapid Acting Insulin given when? does what? | given with meals to control post prandial rise in blood sugar; usually given subQ, can be give IV in emergencies |
| Neutral protamine Hagedorn Insulin Suspension (NPH) Insulin Detemir (Levemir) | not used with meals; administer 1-2x a day; cloudy to clear |
| Insulin Glargine (Lantus) | given once daily, steady release over 24 hours; less risk for hypo or hyperglycemia |
| Metformin (Glucophage | decreases insulin in 1. inhibits glucose production in liver, 2. decreases glucose absorption in gut &sensitizes insulin in circulation; 3.does not increase insulin production, |
| Sulfonylureas 1st Generation: tolbutamide (Orinase), chlorpropamide (Diabinese) | increase insulin release from pancreas, only used for Type II diabetes; extent of release is glucose dependent |
| Sulfonylureas 2nd Generation: Glipizide (glucotrol), glyburide (Diabeta), glimepiride (Amaryl) | more potent, less drug-drug interactions |
| Metformin (Glucophage) Side effects | DO NOT use in renal failure, liver disease or shock states; Avoid with IV contrast, discontinue 24-48 hours before scan, may resume 48 hours after scan. S/E decrease appetite, nausea, diarrhea, |
| tolbutamide (Orinase), chlorpropamide (Diabinese) Side effects | hypoglycemia (more common in renal & liver failure patients); Avoid during pregnancy; avoid when breast feeding; avoid ETOH N/V, palpitations |
| repaglinide (Prandin), nateglinide (Starlix) | : increase insulin release from pancreas; same mechanism as sulfonylureas (if sulfonylureas don’t work, glinides won’t work); S/E: hypoglycemia Prandin: peak 1 hour, return to baseline in 4; give with food; avoid use of gemfibrozil (Lopid) with Prandin |
| rosiglitazone (Avandia), pioglitazone (Actos) | ): decrease blood sugar by decreasing insulin resistance (increase cell uptake of glucose); benefits take several weeks to develop; S/E: headache, URI, myalgia, sore throat, retention of fluid (2-3kg) results in edema and weight gain, be careful with hea |
| acarbose (Precose), miglitol (Glyset) | act in intestine to delay absorption of carbs; decrease rise in blood sugar after meals; local action, few systemic side effects; S/E: flatulence, cramps, abd distention, diarrhea; inhibits absorption of Fe (watch for anemia); hypoglycemia if used with i |
| Sitagliptin (Januvia), Vildagliptin (Galvus) | enhance actions of incretin hormones which stimulate release of insulin, decrease release of glycogen; S/E: URI, headache |
Created by:
Gunnar492
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