Endo - Pharm (Part 2: Other [non-Diabetic] drugs)

Question 1

What other drug shares the same mechanism as propylthiouracil? What is this mechanism? What additional mechanism does propylthiouracil have?

Answer 1

Propylthiouracil, Methimazole; Block thyroid peroxidase, inhibiting the oxidation of iodide and the organification (coupling) of iodine => inhibition of thyroid hormone synthesis. Propylthiouracil also blocks 5’-deiodinase, which decreases peripheral conversion of T4 to T3.

Question 2

What is the clinical use of propylthiouracil and methimazole?

Answer 2

Hyperthyroidism; Think: “PTU blocks Peripheral conversion, used in Pregnancy”

Question 3

What are 4 toxicities of propylthiouracil and/or methimazole? Compare/Contrast them in terms of their use in pregnancy.

Answer 3

(1) Skin rash (2) Agranulocytosis (rare) (3) Aplastic anemia (4) Hepatotoxicity; PTU blocks Peripheral conversion, used in Pregnancy; Methimazole is a possible teratogen (can cause aplastic cutis).

Question 4

What is the mechanism of Levothyroxine? What other drug functions the same way?

Answer 4

Levothyroxine, Triiodothyronine; Thyroxine replacement

Question 5

What are 2 clinical uses for Levothyroxine and Triiodothyronine?

Answer 5

(1) Hypothyroidism (2) Myxedema

Question 6

What are 4 toxicities associated with Levothyroxine and Triidothyronine?

Answer 6

(1) Tachycardia (2) Heat intolerance (3) Tremors (4) Arrhythmias

Question 7

Name 4 hypothalamic/pituitary drugs.

Answer 7

(1) GH (2) Somatostatin (Octreotide) (3) Oxytocin (4) ADH (DDAVP)

Question 8

What are 2 clinical uses for GH?

Answer 8

(1) GH deficiency (2) Turner syndrome

Question 9

What is another name for the Somatostatin drug? What are 5 clinical uses for it?

Answer 9

Somatostatin (Octreotide); (1) Acromegaly (2) Carcinoid (3) Gastrinoma (4) Glucagonoma (5) Esophageal varices

Question 10

What are 4 clinical uses for Oxytocin?

Answer 10

Stimulates (1) labor, (2) uterine contractions, (3) milk let-down; (4) Controls uterine hemorrhage

Question 11

What is another name for the ADH drug? What is a clinical use for it?

Answer 11

ADH (DDAVP); Pituitary (central, not nephrogenic) DI

Question 12

What is the mechanism of Demeclocycline? To what drug family does it belong?

Answer 12

ADH antagonist (member of the tetracycline family)

Question 13

What is the clinical use for Demeclocycline?

Answer 13

SIADH

Question 14

What are 4 toxicities of Demeclocycline?

Answer 14

(1) Nephrogenic DI, (2) Photosensitivity, Abnormalities of (3) bone and (4) teeth

Question 15

What are 6 examples of Glucocorticoids?

Answer 15

(1) Hydrocortisone (2) Prednisone (3) Triamcinolone (4) Dexamethasone (5) Beclomethasone (6) Fludrocortisone (mineralcorticoid and glucocorticoid activity).

Question 16

What are 4 effects of glucocorticoids, and what is their mechanism?

Answer 16

(1) Metabolic, (2) Catabolic, (3) Anti-inflammatory, and (4) Immunosuppressive effects mediated by interactions with glucocorticoid response elements and inhibition of transcription factors such as NF-kappaB.

Question 17

What are 4 clinical uses for glucocorticoids?

Answer 17

(1) Addison disease (2) Inflammation (3) Immune suppression (4) Asthma

Question 18

What syndrome is a toxicity of glucocorticoids? What 10 symptoms characterize this syndrome?

Answer 18

Iatrogenic Cushing syndrome - (1) buffalo hump, (2) moon facies, (3) truncal obesity, (4) muscle wasting, (5) thin skin, (6) easy bruisability, (7) osteoporosis (treat with biphosphonates), (8) adrenocortical atrophy, (9) peptic ulcers, (10) diabetes (if chronic)

Question 19

How is osteoporosis due to glucocorticoids treated?

Answer 19

Osteoporosis (treat with biphosphonates)

Question 20

What toxicity occurs when glucocorticoids are stopped abruptly after chronic use?

Answer 20

Adrenal insufficiency when drug stopped abruptly after chronic use.