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- COX1
- "good" COX; provides gastric protection, maintenance of renal function, platelet aggregation; inhibition causes gastric ulceration, bleeding tendencies, and renal impairment
- chondroitin sulfate
- treats symptoms of osteoarthritis; inhibits action of enzymes that metabolize cartilage; improves joint pain and function better than placebo, reducing symptoms by 30%; can cause mild digestive disturbances and allergic reactions
- adrenal crisis
- caused by adrenal failure, pituitary failure, inadequate doses of corticoids, abrupt withdrawal of high dose corticoids; presents with hypotension, dehydration, weakness, lethargy, N&V, diarrhea, could lead to shock and DEATH; treated with rapid replacement of fluid, salt and glucocorticoids as well as glucose
- st. john's wort
- relieves mild depression; decreases reuptake of serotonin, norepinephrine, and dopamine; effective as conventional antidepressants for mild depression, does not help severe depression; can cause dry mouth, dizziness, confusion, constipation, photosensitivity, enzyme inducer; interacts with P450 to accelerate metabolism of some drugs, decreases levels of digoxin, risk of serotonergic syndrome
- 2nd generation NSAIDs
- celebrex; selectively inhibits COX2
- black cohosh
- treats symptoms of menopause, PMS, menstrual cramps; beneficial in relieving menopausal symptoms; suppresses the release of luteinizing hormone (LH), mimics the action of estrogen, relaxes uterine smooth muscle; should not use in 1st and 2nd trimester; can cause upset stomach, hypotension with antihypertensive agents, hypoglycemia with insulin/oral diabetic agents
- severe persistent asthma
- continual symptoms, limited physical activity, and frequent exacerbations; foundation of therapy is high dose inhaled glucocorticoid plus long acting beta2 agonist; oral glucocorticoid added if needed
- agonist-antagonist opioids
- acts as agonists at kappa and antagonists at mu
- inhaled and systemic glucocorticoids
- used for long-term prophylaxis of asthma, not for aborting ongoing attacks; administered on fixed schedule, not PRN; should be administered by inhalation unless asthma severe (inhaled: beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone; oral: predinsolone, prednisone)
- hormonal regulation of thyroid
- TRH from hypothalamus causes the pituitary to release TSH, which causes the thyroid to make and release T3 and T4, which then act on the pituitary to suppress further release of TSH
- thromboxane
- substance made by platelets that causes blood clotting and aggregation; aspirin suppresses enzyme making thrombooxane
- Echinacea
- stimulates immune function, suppresses inflammation, treats viral infections; has antiinflammatory, antiviral, and immunostimulant effects; effectiveness is questionable; contraindicated in immunocompromised pts; unpleasant taste, stomach upset, headache, and dizziness; can antagonize effects of immunosuppresant drugs
- post feverfew syndrome
- nervousness, fatigue, insomnia, joint paint or stiffness, tension headache
- glucocorticoids asthma
- most effective antiasthma drugs available; reduce symptoms by suppressing inflammation and promoting synthesis of bronchial beta2receptors and increasing their responsiveness to beta2 agonists
- salicylism
- aspirin toxicity - appears just above therapeutic levels; tinnitus, sweating, headaches, dizziness, hyperventilation; treated by stopping dose, waiting a few days, and starting again at lower dose
- Addison's disease
- caused by adrenal insufficiency; treated by replacement therapy with glucocorticoids (mineralcorticoid added if actions of hydrocortisone are inadequate)
- 1st generation NSAIDs
- aspirin, ibuprofen, naproxen; inhibit both COX1 and COX2;
- COX2
- "bad" COX; mediates inflammation, pain perception, mediates fever; inhibition decreases inflammation, pain and fever
- SAMe
- prevents cartilage breakdown; superior to naprosyn, study suggests may be helpful in migraine headaches; could cause GI distress
- feverfew
- prophylaxis and treatment of migraine, reduces fever, stimulates menstruation, reduces upset stomach and suppresses inflammation; data support reduction and frequency of migraine attacks; to be most effective should be taken routinely, less effective if taken pm; can cause GI distress; cross allergenicity with ragweed; can suppress platelet aggregation, increasing risk of bleeding - use caution in pts taking antiplatelets or anticoagulants
- glucocorticoids
- influence the metabolism of carbohydrates, proteins, and fats; affect skeletal muscle, the cardiovascular system, and the CNS; at times of stress are essential for survival
- glucocorticoids
- glucose metabolism hormones that increase the availability of glucose - stimulate gluconeogenesis, promote storage of glycogen; high doses can cause increased glucose in plasma which mimics diabetes; cause protein catabolism which at high doses manifests as thinning of skin and wasting of muscles; causes metabolism of fat, which manifests at high levels as fat redistribution, buffalo hump etc (cortisol)
- acute aspirin poisoning
- respiratory alkalosis & depression, acidosis in blood, hyperthermia, dehydration, diaphoresis, severe risk of respiratory failure; treated with external cooling, correcting respiratory depression, induce vomiting, IV fluids
- PUD antibiotics
- amoxicillin, clarithromycin, bismuth, tetracycline, metronidazole; at least 2 should be used
- beta2 agonists
- promote bronchodilation by activating beta2 receptors in the bronchial smooth muscle
- cretinism
- thyroid deficiency in infancy
- mild intermittent asthma
- symptoms less than 2x week; treated on a PRN basis: a short acting beta2 antagonist inhaled to abort the few acute episodes that occur
- inhalation
- increases therapeutic effects of asthma meds by delivering drugs directly to their site of action; reduces systemic effects by minimizing drug levels in blood; facilitates rapid relief of attacks
- ma huang
- ephedrine; increase energy, relieve bronchospasm, reduce appetite; activates alpha1, alpha2, beta1, beta2 resulting in vasoconstriction, increased HR, bronchodilation, appetite suppression, CNS stimulation; can relieve symptoms of allergies, cold and flu, cause bronchodilation, suppress appetite; ephedra is dangerous because of CV and CNS stimulation; potentiates CNS stimulants and beta agonists, can cause hypertensive crisis with MAOIs, counteracts the effects of antihypertensives
- cromolyn
- inhaled antiinflammatory drug used for prophylaxis of asthma; very safe; prevents release of mediators from mast cells
- saw palmetto
- relieves urinary symptoms associated with BPH; possibly inhibits enzyme that converts testosterone to dihydrotestosterone suppressing the growth of prostate epithelial cells; data supports that urination problems are relieved; can cause diarrhea and false negative PSA; pregnant women should not touch; potentiates finasteride
- asthma
- chronic inflammatory disease characterized by inflammation of the airways, bronchial hyperactivity, and bronchospasm; allergy is often underlying cause; treated with anti-inflammatory drugs and bronchodilators
- opioid overdose
- produces triad of signs: coma, respiratory depression, and pinpoint pupils
- mu receptor
- activation includes analgesia, respiratory depression, euphoria, and sedation
- proton pump inhibitors
- suppress acid secretion by inhibiting the enzyme that makes gastric acid; most effective inhibitors of acid secretion available
- IV opioids
- best to dilute solution and give slowly over 5 minutes because of causticity
- PUD
- a group of upper GI disorders characterized by varying degrees of erosion of the gut wall; 60-70% caused by H. Pylori
- hypothyroidism
- mild deficiency of thyroid hormone - low HR, weight gain, lethargy, fatigue, intolerance to cold, dry brittle hair, decreased mental clarity, low serum TSH
- Grave's Disease
- most common cause of excessive thyroid hormone secretion; can be treated by surgical removal of thyroid tissue, destruction of tissue with radioactive iodine, or treatment with antithyroid drugs - bulging eyes, insomnia, increased HR, weight loss
- garlic
- lowers triglycerides, lowers LDL, raises HDL, lowers BP, suppresses platelet aggregation; interferes with cholesterol synthesis in liver, increases the activity of nitric oxide, a vasodilator; unpleasant taste and bad breath; raises risk of bleeding in pts taking antiplatelets, potentiates hypoglycemia in diabetics
- ginger root
- suppresses N&V, improves appetite, calms stomach, reduces flatulence, treats inflammatory conditions; hypothesized that it blocks serotonin receptors; data support treatment of motion sickness, postop N&V; high doses can cause CNS depression and cardiac dysrythmias; stimulates uterus; increases risk of bleeding with antiplatelets and anticoagulants; chew leaves or make a tea
- synthesis and release of glucocorticoids
- regulated by negative feedback loop involving CRH from the hypothalamus, ACTH from the pituitary, and cortisol from the adrenal complex
- long acting beta2 agonists
- can increase risk of asthma-related death when used incorrectly; should only be used by pts taking 1st line medication (inhaled glucocorticoid) for long term control, and only then if that med is inadequate by itself (formoterol, salmeterol)
- 2ndary adrenal hormone insufficiency
- results from decreased secretion of ACTH
- levothyroxine
- synthetic T4, drug of choice for most patients that require thyroid hormone replacement
- pharmacologic glucocorticoid
- cause adrenal insufficiency, osteoporosis, increased vulnerability to infection, muscle wasting, thinning of the skin, fluid and electrolyte imbalance, glucose intolerance, possibly peptic ulcer disease
- adrenal hormone insufficiency
- weakness, emaciation, hypoglycemia, increased pigmentation, hypotension, hyponatremia, malaise, loss of appetite, reduced ability to respond to stress, hyperkalemia
- exercise-induced bronchospasm
- can be avoided by inhaling either cromolyn or a fast-acting inhaled beta2 agonist prior to strenuous activity
- herbal medicine
- the use of plant derived products to promote health and relieve symptoms of disease; most common form of alternative medicine
- glucosamine
- retards degradation of cartilage; relieves symptoms of osteoarthritis more than placebo; causes peripheral edema, tachycardia, drowsiness, skin rash
- ketoconazole
- used to suppress synthesis of adrenal steroids in Cushing's pts; employed only as adjunct to surgery or radiation
- oral beta2 agonists
- excessive dosing can cause tachycardia and angina by activating beta1 receptors on the heart - selectivity is lost at high doses (albuterol, terbutaline)
- goiter
- enlargement of the thyroid
- short acting beta2 agonist
- most effective drugs for relieving acute bronchospasm and preventing exercise induced bronchospasm; rarely cause systemic side effects (albuterol, biotolterol, levabuterol, pirbuterol)
- asthma monitoring
- symptoms and peak expiratory flow rate (PEFR)
- Cushing's syndrome
- caused by excess glucocorticoid levels; principle treatment surgical removal of the adrenals (if adrenal adrenoma or carcinoma is the cause) or part of the pituitary (if pituitary adenoma is cause)
- thyroid storm
- thryotoxic crisis; result of major infection/sepsis or surgery; caused by increased thyroid hormone; symptoms are tachycardia, agitation, coma, hypotension - could lead to death; treated with iodine, PTU, beta blocker for tachycardia, cooling, sedation, glucocorticoids to decrease swelling, and IV fluids
- tincture
- made by steeping the active portion of a plant in a mixture of water and alcohol
- T4
- most converted to T3 in the periphery
- glucocorticoid potassium loss
- can increase risk of toxicity from digoxin, exacerbate hypokalemia caused by thiazide and loop diuretics
- cimetadine
- suppresses secretion of gastric acid by blocking histamine (H2) receptors on parietal cells of the stomach
- mild persistent asthma
- symptoms more than 2x week but less than 1x day, exacerbations may affect activity; foundation of therapy is daily inhaled low dose glucocorticoid; short acting beta2 antagonist used PRN to suppress breakthrough attacks
- serum TSH
- most sensitive way to diagnose hypothyroidism
- physiologic doses of corticoids
- given for adrenocortisol dysfunctions in the body; adrenal hormone excess (Cushing's Syndrome); adrenal hormone deficiency (Addison's disease)
- ginkgo biloba
- improves memory, sharpens concentration, promotes clear thinking, counteracts erectile dysfunction induced by antidepressants; actions due to enhanced blood flow secondary to vasodilation; causes upset stomach, HA, dizziness, vertigo; suppresses coagulation; avoid in pts at risk of seizures
- myxedema
- severe thyroid deficiency
- thyroid gland
- produces two active hormones, triiodothyronine (T3) which is highly active, and tetraiodothyronine (T4) which appears inactive
- kava
- relieves anxiety, promotes sleep and relaxes muscles; data support muscle relaxant and antianxiety effects; can cause CNS depression, impair vision, muscle incoordination, scaly skin disorder with prolonged use, can cause hepatitis, cirrhosis, and liver failure; potentiates effects of CNS depressants - avoid with alcohol, opioids, barbituates
- adrenal androgens
- contribute to sexual characteristics (androstenedione
- reye's syndrome
- mortality rate of 20-30%; symptoms are encephalopathy and fatty liver; caused by use of aspirin by children w/chickenpox or flu
- ginseng
- stimulates immune system, ergogenic aid in healthy pts, relieves fatigue and stress, enhances mental performance and CV function, regulates glucose in type II DM; documented increase in Tcells and WBCs in cancer pts undergoing chemo; causes headache, insomnia, anxiety, skin rashes
- tertiary adrenal hormone insufficiency
- results from decreased secretion of CRH
- potassium
- normal range is 3.5-5; low levels can cause dysrythmias
- inhaler not working
- 1- not using at all 2-not using correctly 3-different cause of asthma
- addiction
- behavior pattern characterized by continued use of a psychoactive substance despite physical, psychologic, or social harm
- mineralcorticoids
- influence renal processing of sodium, potassium, and hydrogen (aldosterone)
- COX
- cyclooxygenase - converts arachidonic acid into prostaglandins and related compounds; promotes inflammation at site of injury, protects gastric mucosa in GI tract, stimulates platelet aggregation, renal vasodilation and renal perfusion, fever, pain perception- stimulates pain receptors and increases our perception of pain
- aldosterone
- acts on the kidney to promote retention of sodium and water and excretion of potassium and hydrogen; acts directly on the heart and blood vessels causing harm when levels are high
- pharmacologic uses of adrenal corticoids
- rheumatoid arthritis; systemic lupus; inflammatory bowel disease; miscellaneous inflammatory disorders
- hawthorn
- mgmt of hypertension, atherosclerosis, angina, and possibly early CHF; shown to dilate coronary vessels and compares favorably with conventional inotropic drugs; adverse effects only if high doses taken
- analgesics
- relieve pain without causing loss of consciousness
- moderate persistent asthma
- daily symptoms, exacerbations affect activity; long term care established with either medium dose inhaled glucocorticoid or low dose inhaled glucocorticoid plus long acting inhaled beta2 agonist
- adrenal cortex
- produces three classes of steroid hormones: glucocorticoids, mineralocorticoids, and androgens
- acute severe exacerbations of asthma
- foundation of treatment repetitive inhalation of a beta2 agonist; systemic glucocorticoid may also be needed
- thyroid hormones
- three principal actions: stimulation of energy use, stimulation of the heart, and promotion of growth and development
- opioid receptors
- three classes: mu, delta, kappa
- Hashimoto's thyroiditis
- major cause of hypothyroidism (chronic autoimmune thyroiditis)
- glucocorticoids and inflammation
- reduce inflammation by suppression of the synthesis of inflammatory mediators (prostaglandins, leukotrienes, histamine), suppress infiltration of phagocytes, suppress release of lysosomal enzymes, suppress proliferation of lymphocytes
- abuse
- drug use that is inconsistent with medical or social norms
- PUD defenses
- mucus, bicarbonate, blood flow to prevent cell injury, prostaglandins stimulate the secretion of mucus and bicarbonate
- uncontrolled asthma
- wake up at night more than 2x month; need bronchodilators more than 2x week; daytime or activity symptoms more than 2x week; pulmonary function less than 70%
- valerian
- promotes sleep; increases availability of GABA; does not prevent night wakening; causes daytime drowsiness, depression, long term could cause cardiac abnormalities
- goldenseal
- treats bacterial, fungal and protozoal infections, inflammation of gallbladder, skin and eye irritations, liver cirrhosis; suppresses inflammation, stimulates peristalsis, alters BP, stimulates secretion of bile; effective against diarrhea caused by e. coli, shigella, salmonella, klebsiella, and cholera; Candida and Chlamydia; cholecystitis; high doses cause N&V, diarrhea, stimulation of CNS; toxic doses cause death; stimulates uterus, may be excreted in breast milk
- opioid agonists
- relieve pain by mimicking the actions of endogenous opioid peptides, primarily at mu receptors and partly at kappa receptors