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Virtual Meeting questions. Use guidelines IE primary then secondary medications

Virtual Meeting questions. Use guidelines IE primary then secondary medications Study guide, picmonic, and osmosis Gerd tx: proton pump inhibitor prazole then tidiness. Long term use. Use for no more than 8 weeks risk for fx and osteoporosis b12 deficiency decrease calcium absorption Cdiff infections take with first meal of the day. H2 blockers and antacids prn 30 minutes before a meal. Magnesium causes diarrhea. Calcium carb diarrhea Peptic Ulcers: 2 types duodenal and gastric. 2 main causes NSAIDS and H. Pylori. Give PPI. Duodenal pain relieved by eating 1-3 hours after a meal. Gastric pain increases when eating usually caused by stress. 1st line therapy Omycins and a PPI and Flagyl. GERD biggest risk factor is Varices of the esophagus/CA. Charophyte take before meals used for duodenal ulcers no more than 8 weeks. Antiemetics: Zofran, Metoclopramide, ranitidine, and Phenergan… remember Zofran causes QT elongation and check for Hepatic Impairments. Phenergan causes respiratory depression. Allergic Rhinitis: 1st line tx is corticosteroids nasal sprays should use no more than 3 days otherwise they will rebound. 2nd line is antihistamines and avoid triggers be careful with Benadryl in older adults because is increased risk for falls. Asthma: 1st line is intermittent, mal persistent, moderate, severe. Need to know medication symptoms and frequency. Start with Albuterol as a rescue, then sones, then terols, then refer to pulmonology. Is inflammation. Must have long acting laba long n short. Decongestants for URI. Expectorants, leukotrienes, anti-tussives, cough suppressants. COPD: Sabas, short acting, then long acting, them tx with lamas, inhaled corticosteroid is the inverse of asthma. Is blockage. DX: FEV ratio Diabetes: Prediabetes A1C 6.4-6.6 diabetic 1st line is metformin diarrhea. Less than 7 on an A1c is goal. Dx requires 2 values A1c, fasting, and random. B12 deficiency and renal function gfr less than 30 don’t prescribe. GLP 1 black box warning Thyroid cancers and pancreatitis. Thyroid: hypothyroid 1st line medication is levothyroxine .25mg for elderly. Biggest side effect palpitations. 4-6 weeks after initiation recheck thyroid levels. In pregnancy 1st line tx in first trimester get labs prescribe beta blocker ie propranolol. Erectile dysfunction: PDE inhibitor such as Viagra or sildenafil. Check for cardiac dysfunction full cardiac profile, ekg, labs, testosterone, bp. Ultrasound. Alpha Blockers zosyn’s quick symptom relief. Teach on hypotension and take the medication at night. Alpha reductase inhibitors shrink the prostate. proscar and finasteride used for 6 months to tx enlarged prostate and has teratogenic effects so pregnant women should not touch this med. Herbal med for this saw palmetto for enlarged prostate. Urinary incontinence: Renal impairment check GFR lab and BUN creatinine. CKD caused by DM and Hypertension. Knowing there is 5 stages depending in GFR no symptoms until stage 3. GFR less than 60 kidney function is poor. Greater than 90 looks good, stage two 60-39, stage 1-3 control bp. Less than 15 is ESRD Osteoporosis: risk factor, steroid use, smoking, hormone use, postmenopausal. Do weight bearing exercise. Prescribe calcium 1200and vitamin d 800-1000. Bisphosphonate ie dronate is first line tx which reduces risk fx. Take with water 30 minutes before food or drinks. T-score for dx less than negative 2.5 osteo, negative 1-2.5 osteopenia. Keep greater than 1.0 give biphosphates as first line tx. For pain give Tylenol as first line tx max dose is 3grams be careful regarding liver disease. Nsaids are second line blocks coccyx enzyme and inhibits prostaglandins but causes increased sodium retention and decreases platelet causes increased acid production, ulcer development, kidney injury, risk for bleeding. Rheumatoid arthritis: autoimmune, any age, fast onset, and is bilateral. Pt c/o stiffness after awakening especially the hands, greater than an hour and then systemic onset. They typically are deficient in folic acid as well. Tx 1st line methotrexate, steroids, slow progression of disease and preserve joints. CBC, LFT, and Renal function. Refer to rheumatology for official DX. Difference between osteo and rheumatoid clinical sign. RA swan neck fingers, osteo nodules… Heberden nodes tx with Tylenol. Gout: acute attack is a build up of uric acid. 1st line is indomethacin and steroid pack for crisis. Colchicine for crisis as well, lots of GI side effects, also consider renal impairment. Maintenance med is allopurinol check cbc, lft, and renal function panel due to risk for kidney injury AND BONE MARROW SUPRRESION avoid things high in purines ie seafood. Depression: 1st line tx is SSRI also tx ocd, ptsd. Do not prescribe to elderly because of the longer half-life or have taken and MAOI. Paxil and trazadone cause sedation and weight gain. Lexapro works quickly and good for anxiety. Zoloft is elderly friendly. Start at lowest dose and titrate up slowly. Risk for suicide is number 1. 4-6 weeks we will know if medication is effective. SNRI’s block serotonin and norepinephrine Cymbalta and Effexor careful they are bad for HTN. Cymbalta good for neuropathy. Effexor has large impact on HTN. Biggest teaching point taper off these meds do not stop abruptly, risk for serotonin syndrome, and do a med profile check. Avoid taking triptans ie st johns wort. Tricyclic antidepressants increase weight gain and monitor cardiac profile ekg, anticholinergic effect, easy to OD. MAOI’s remove serotonin, norepi, and dopa this is a 3rd line tx. Herbal supplements can increase serotonin syndrome. Bipolar: Lithium is first line medication check levels greater than 2 is toxic. Not for use in pregnancy. Risk for weight gain. Then for acute situations benzodiazepines PTSD: SSRI is first line tx HA: Migraine, tension, cluster, and stroke. Cluster are one sided and tx with oxygen and HTN med. HTN HA give meds for bp and adjust medications and assess risk for stroke. Sumatriptan is for migraine. Aura migraine we tx Fiorocet, and triptans as soon as HA begins. with tricyclic antidepressants ie Elavil amitriptyline used as prophylaxis. Topamax Seizure: valproic acid is 1st tx for prevention. Not for pt liver issues, pg women. Keppra/ Dilantin/ good for general and complex seizures. Tegretol. Topamax Parkinson’s disease: occurs in the elderly. Dopamine is insufficient. Tremors, bradykinesia, and rigidity. Tx is levodopa carbidopa side effect HTN. After 5 years the medicine becomes less effective. Dopamine agonists- Ropinirole Vertigo-meclizine in elderly patients is causes sedation and mild anticholinergic effects. Contraception: combination can not be prescribed to pt c hx blood clots or 35 years or older or smoke, migraines with aura, liver disease, current ca, or uncontrolled HTN or a breastfeeding mom because it decreases milk production. Teach pt so use back up contraception for at least 7 days. Take at the same time every day. Sunday start is the first Sunday after period and use backup method. Miss 1 dose take it when remember, miss two take one dose and not double up, after missing 3 doses discard the pack and start a new one and use back up contraception for all scenarios. NuvaRing stays in place x3 weeks low steady hormone amount. If it falls out reinsert. Progesterone only medication is the mini pill good for breastfeeding moms, Depo-Provera works x1 year and increases weight gain. Another form of contraception is IUD watch for rupture of displacement and .01% risk of conception risk amenorrhea and break through bleeding and requires PAP and STD screen need to be replaced. Make sure they can perform string checks. Emergency contraception is plan B within 24 hours within 72 hours largest side effects, cramps, bleeding. Educate pt that this is not an abortive medication. Ovarian cysts, cycle control, acne, endometriosis, dysmenorrhea, and decreases risk for ovarian cancer. Increased risk for clots, breast tenderness, nausea, and break through bleeding (typically 2-3 cycles only). PCOS: Metformin is often prescribed. Indogrin check adrenal and cortisol levels. Vaccines: live start at 1 year old Post-menopausal tx with black cohosh and soy Common foods that interact with meds IE cyp450 pathway. Grapefruit, ginger Random questions she asked assuming from test: Determine need for vaccines: age… Birth Hep B (3 total doses) 2nd dose at 1-2 months, 3rd at 6 months. Dtap: ages less than 7 first at 2,4,6, and 12 months. over 7 is TDAP Before school starts must have… know milestones 2,4,6,1 year. Vaccines not given before age 1 (not given to mom don’t give to baby) MMR- Varicella HiB Polio You have a pregnant female do not expose her to pertussis (whooping cough) because it can cause miscarriage. A 51 year old male cannot be given a tetanus or pneumovax Gastritis c/o if viral give fluids first. Then antiemetic and antidiarrheal (loperamide) and bowel rest. Bacterial give abx determine what we are tx salmonella or E. coli give fluroquinolones or Bactrim. Camp pylo fluroquinolones or erythromycin. Giardia Flagyl. If C. Diff develops give flagyl and vancomycin po. If unresolved refer, teach handwashing, and keep in iso. Enzymes Cyp 2c19 prominent in Asians unable to metabolize pain medications like other individuals. uploads/Geographie/ study-guide-class.pdf