- Because adult learners may not come out and ask why they must do the training, CTOs do NOT have to build relevance into their training.
- NAME: SGLT-2 inhibitors: canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance), and ertugliflozin (Steglatro)MOA: Inhibit the sodium glucose transporter-2 in the PCT of the kidney, preventing reabsorption of glucose and sodiumClinical: Clinically indicated for the treatment of hyperglycemia in T2DM, particularly in patients with heart failure and renal failure, also causes weight lossADME: Oral drugsAE: Yeast infections in women (~10%) and men (3-5%)UTIPolyuria (remember how glucose can be an osmotic diuretic?)NauseaHypotensionDyslipidemiaContraindications: Renal dialysis, hypersensitivityInteractions: May cause hypoglycemia when combined with insulin or insulin secretogoguesNotes: Monitor renal function and blood pressure in patients taking SGLT-2 inhibitors
- Name: Atropine (Pine tree) - This was previously used and adjusted•MOA: Blocks the action of acetylcholine, increasing firing of the SA node & conduction through the AV node (Tree trunk)•Indications:•Second degree AV block (Wenckebach) and Third degree heart block with AV nodal escape (2 and 3 degree ornaments)•Dose•0.5 mg IV q 3-5 minutes, not to exceed 3 mg (IV ornament)•Onset of action•Immediate, max effect 0.7-4 minutes•Half-life•2-3 hours
- Staying current with the trends of __________ across the country is an excellent way for CTO's to ensure that their agency policies and procedures and their training is appropriate to reduce liability.
- Name: Intranasal corticosteroids: fluticasone (Flonase), mometasone (Nasonex) (Giant nose, 'NAS' on nose)MOA: agonize the glucocorticoid receptor in nasal epithelium to reduce inflammation (G C in nares)Clinical: the recommended first-line treatment for moderate to severe persistent allergic rhinitis. The most effective treatment of allergic rhinitis available. (Mod to Severe, 1st)ADME: Begins working within hours, though maximal effect may take several days. Therapy is typically started at maximal dose until symptoms are controlled, then stepped down. Patients with severe symptoms will require daily chronic use.Though different formulations are similar in efficacy they vary in taste/odor and some may be more tolerable than others to patients (Hours to Days on bottom, Max with arrows down)AE: minimal due to topical application (Spray into nose, inhibit AE)
- Name: Liothyronine or Triiodothyronine (Cytomel)MOA: T3 binds to specific receptor proteins (alpha & beta) in the nucleus, resulting in altered gene expression, and increased formation of RNA and proteinSystemic effects include increased oxygen consumption by most tissues of the body and increases the basal metabolic rate and the metabolism of carbohydrates, lipids and proteinsIndications: Replacement therapy or supplement in patients with hypothyroidismShort term suppression of the pituitary thyroid-stimulating hormone (TSH) in the treatment or prevention of various types of euthyroid goiters, including Hashimoto's As diagnostic agents in suppression tests to differentiated suspected mild hyperthyroidism or thyroid gland autonomyADME: taken orally or parenterallyshort half life (24hrs) compared to T4 (7 days), requiring multiple daily dosesAdverse Effects: Symptoms resembling hyperthyroidism: nervousness, anxiety, tremor, heat intolerance, weight loss with increased appetite, palpitation, cardiotoxicityContraindications: heart disease (T3 can cause cardiotoxicity)Notes: costs more than T4 (Money on bag)has a shorter t1/2 (requiring multiple daily doses) compared to T4is more difficult to monitor using conventional lab tests
- Name: Magnesium Sulfate• (Tom Selleck, Magnum PI)MOA: •Unsure of mechanism of action, likely linked to Ca2+ current-slowing rate of S-A node impulse formation and prolonging conduction time• (Slow SA reflection in sunglasses)Indications:•Torsadesde pointes (polymorphic VT with pulse)•Onset of action•1 to 2 g (diluted in 50 to 100 mL D5W) over 15 minutes (range: 5 to 60 minutes). If no response or torsadesde pointes recurs, may repeat dose up to a total of 4 g in 1 hour;•Side effects•Flushing, hypotension, vasodilation, hypermagnesemia (Tom is flushing, squeezing artery over heart which is actually oppositte of hypotension and vasodilation but whatever)
- The CTO certification runs for __________ years and has requirements of continuing dispatch education (CDE) credits that must be earned in each year of the certification.
- Name: Ocreotide (Sandostatin) (Oreo)MOA: binds to GPCRs in the pituitary and inhibit them from secreting growth hormone. Also inhibits the release of TSH (GPCR binding to pituitary, inhibit GHG and to the side is TSH)Indications: Acromegaly, Carcinoid tumors, vipomas (Little guy lookup up at giant brain, tumor in pancreas and abdomen)Adverse Effects: abdominal pain, steatorrhea, vomiting, cholelithiasis /gall bladder sludge (red arrow up esophagus, gallbladder with red sludge, fat in poop, red around abdomen pain)
- Name: LAMA (long acting muscarinic agonist) Tiotropium, umeclidinium, glycopyrrolate "TUG" (the man is tugging on the lead), all end in -IUM (on the llama's "shirt?" idk what you call that) MOA: Antagonist of muscarinic receptors in the lungs. (stepping on mushrooms). ACh action at these receptors causes vasoconstriction. Thus, antagonism here allows bronchodilation. Use: Initial therapy for COPD. Improvement in FEV1, QOL and dyspnea, reduced number of exacerbations in COPD and asthma, decreased hospitalizations in COPD. Adverse Effects: Dry mouth (the desert), sinusitis (the pink in the head), pharyngitis (the red tie at the throat), URI (there are boogers coming out the llamas nose if you can see it)
- Name: Desmopressin (Nocdurna) (Nocturnal for night, durna is a type of bird)MOA: Synthetic analogue of antidiuretic hormone with greater potency towards the V2 receptor, which regulates renal aquaporin insertion, than the V1 receptor, which causes vasoconstriction (Information about bird has ADH with big arrow to V2 and kidneys and small arrow to V1 and hypertension)Indications: Treatment of diabetes insipidus, nocturia, hemophilia A and von Willibrand disease (billboard with Walter Brimley talking about diabetes insipidus, peeing at night, HemA and VWV about his head)Adverse Effects: Hyponatremia (black box warning), headache, dizziness (Black box with Na+ arrow down, red squiggly on and around forehead)
- __________ learning involves the cycle of having a problem assigned, identifying what you need to know, and learning and applying it to solve the problem.
- The __________ is responsible for enforcing federal laws that make it illegal to discriminate against a job applicant or an employee because of the person's race, color, religion, sex, national origin, age, disability, or genetic information.
- Name: Radioactive Iodine MOA: Delivers beta radiation to thyroid gland resulting in tissue destruction Indications: Graves, primary inoperable thyroid CA, permanent cure of thyrotoxicosis without surgery Adverse Effects:Contraindications:Interactions:Notes:
- Name: Levothroxine or thyroxine (Levoxyl) (Levee on river, huge thighs on dude)MOA: T4 is converted to T3 (the active form) inside cells by one of two distinct deiodinases, depending on the tissueT3 binds to specific receptor proteins (alpha & beta) in the nucleus, resulting in altered gene expression, and increased formation of RNA and proteinSystemic effects include increased oxygen consumption by most tissues of the body and increases the basal metabolic rate and the metabolism of carbohydrates, lipids and proteins (Sand is T4, put into bags for T3, metabolism arrow up, shovel says activate inside the cell, alpha & beta binding sand bags)Indications: HypothyroidismPituitary TSH Suppression (in the treatment or prevention of various types of euthyroid goiters) (Low TSH and Pituitary inhibiting TSH in river)ADME: Taken orally, T4 has a longer half life (7 days) compared to T3 (1 day) (1/2 = ? days on T4 and T3)Adverse Effects: Symptoms resembling hyperthyroidism: nervousness, anxiety, tremor, heat intolerance, weight loss with increased appetite, palpitation (AE = arrow up thyroid)Notes: Children require greater doses than adults (Child carrying way more T3)
- By using a __________ system, patterns of unacceptable behavior are readily identified on a tracking sheet.
- Name: Codeine (Coding computer)MOA: Codeine is a pro-drug that is converted to the active metabolite, morphine by CYP2D6Morphine agonizes the mu opioid receptor in the cough center in the brainstem, which reduces the release of excitatory peptides that trigger cough (Green plus, CYP2D6 = morphine, brain with green brain stem)Clinical: Antitussive and analgesic with abuse liability (Cough and Oww in conversation bubble, radio song I want it all and I want it now)ADME: Prodrug metabolized by CYP2D6 to active metabolite. Ultrarapid metabolizers à toxicity, poor metabolizers à lack of efficacy. Dose reduction required in renal failure (Sticker on radio with kidney = arrow down)AE: Constipation, sedation. Black box warning for addiction risk, respiratory depression in ultra-rapid metabolizers, interaction with CYPs, Neonatal opioid withdrawal risk, and concomitant use of CNS depressants (like benzodiazepines (eg, Valium)) (Constipated colon mouse cord, ZZzzs on screen, black box with addiction and resp-depress on top of computer)Contraindications: pediatric patients less than 12, acute/severe bronchial asthma in an unmonitored setting, GI obstruction, concurrent use of MAOIs (within the last 14 days)Notes: Overdose S/S: CNS depression and coma, severe chest and stomach pain, respiratory depression, panic, fear of death
- Name: Somatotropin (Humatrope) (Human)MOA: Recombinant human growth hormone that directly binds to receptors and stimulates the production of IGF-1 to promote bone and muscle growth (IGF-1 on top of chart, green arrow up on muscle and above hands)Indications: The treatment of pediatric or adult-onset growth hormone deficiency (Arrows up along box)Adverse Effects: Unmet expectations, antibody development to treatment, rash and pain at injection site, transient fever, prepubertal gynecomastia, arthralgia, edema, benign intracranial hypertension, insulin resistance, progression of scoliosis, and slipped capital femoral epiphysis (Red around band aid on leg, fire on forehead, red curved spine, femur joint out of socket, breasts enlarged)Contraindications: Hypersensitivity, acute critical illness (No acute critical illness on left side)
- When documenting positive and negative behavior and performance, encouraging trainees with specific steps they can do to improve their performance is referred to as __________.
- Name: 2nd generation H1 antagonists: Cetirizine (Zyrtec), fexofenadine (Allegra) (ZyrAll box name, H1 with block/antagonize)MOA: non-sedating antihistamines that antagonize H1 receptors without crossing the blood brain barrier (Stop-BBB card, Hand in face with red inhibit marks at head, Zzzz crossed out, don't sleep on this box)Clinical: Treatment of allergic rhinitis (Card with nose with rhinitis)ADME: Formulated to be charged at physiological pH, preventing entry into the CNS. Metabolized by CYPs, so cautious with drug interactions. All oral except olapatadine, which is an eye drop (Card with PH of philly, and CYP in crowd)AE: Well tolerated (New, no AE)