Endocrine disorders Flashcards
Drugs that cause hypothyroidism: ITALC
interferon
TKi’s
Amiodarone
Lithium
Carbamazepine
T4
-thyroxine
-short half-life
T3
-triiodothyronine
-potent
hypothyroidism
deficiency in T4 and incr TSH
-commonly caused by Hashimoto’s
-Sx/S: cold intolerance, dry skin, fatigue, muscle cramps, voice changes, constipation, weight gain, goiter, myalgias, weakness, depression, bradycardia, coarse hair/loss of hair, menorrhagia, memory and mental impairment
hypothyroidism treatment
-levothyroxine (T4 -Synthroid, Levoxyl, Unithrold) > full replacement dose is 1.6 mcg/kg/day; different dose for those with known CAD
-Thyroid, dessicated USP (T3, T4 -Armour Thyroid)
-Liothyronine (T3) (Cytomel)
-levothyroxine > take with water, at least 60 min before breakfast or at bedtime (3 hours after last meal)
-levothyroxine IV: 0.75:1
Orangutans Will Vomit On You Right Before They Become Large Proud Giants
25 mcg = orange
50 mcg = white
75 mcg = violet
88 mcg = olive
100 mcg = yellow
112 mcg = rose
125 mcg = brown
137 mcg = turquoise
150 mcg = blue
175 mcg = lilac
200 mcg = pink
300 mcg = green
drugs that decrease the effect of thyroid replacement: decrease levothyroxine absorption
-antacids and polyvalent cations that contain iron, Ca, Al, or magnesium multivitamins
-cholestyramine, sevelamer, sucraflate
hyperthyroidism
-FT4 is high and TSH is low
-Sx/S: heat intolerance or increased sweating, weight loss, agitation, nervousness, irritability, anxiety, palpitations, tachycardia, fatigue, and muscle weakness, diarrhea, insomnia, tremor, thinning hair, goiter, light or absent periods
-common causes: graves disease, iodine, amiodarone, and interferons
hyperthyroidism treatment
-BB for symptom control
-surgery
-Propylthiouracil (PTU) or methimazole
PTU and Methimazole
-takes 1-3 months for symptom control once symptoms are controlled reduce dose to prevent hypothyroidism
-PTU box warning: severe liver injury and acute liver injury, preferred in 1st trimester
-methimazole is the DOC
-PTU is preferred in thyroid storm
-methimazole can be used in 2nd and 3rd trimester
S/Sx of thyroid storm
fever, tachycardia, tachypnea, dehydration, profuse sweating, agitation, delirium, psychosis, coma
tx of thyroid storm
PTU + inorganic iodide therapy + BB + systemic steroid
cortisol
replaced by giving any of the steroids
aldosterone
replaced by giving fludrocortisone - has mineralcorticoid activity and is used for addisons disease and orthostatic hypotension
glucocorticoids
cause adrenal glands to stop producing cortisol due to suppression of HPA
cushings syndrome
-making too much cortisol or high dose steroids that are higher than the normal amount of endogenous cortisol
-moonface, buffalo hump, acne, pink/purple stretch marks, poor wound healing, poor bone health, diabetes, muscle wasting
Steroids least potent to most potent: Cute Hot Pharmacists and Physicians Marry Together and Deliver Babies
cortisone > hydrocortisone > prednisone > prednisolone > methyprednisolone > triamcinolone > dexamethasone > betamethasone
short-acting steroid
cortisone and hydrocortisone (Solu-cortef)
intermediate-acting steroid
prednisone (Deltasone), prednisolone (millipred, orapred), methylprednisolone (medrol, solu-medrol), triamcinolone (kenalog)
long-acting steroid
dexamethasone (dexpak, decadron) and betamethasone
steroid side effects
-adrenal suppression
-increased appetite, weight gain, emotional instability
prednisone
prodrug of prednisolone
steroid immunosuppression
-using >2 mg/kg/day or > 20 mg/day of prednisone or prednisone equivalent for > 2 weeks
-immunosuppressed patients cannot receive live vaccines
-they must be tapered off steroids - typically 10-20%
RA
-bilateral, symmetrical disease
-joint swelling, pain, stiffness, bone deformity
-stiffness and pain worse after rest (OA does not cause prolonged stiffness)
-ACAP and RF
RA tx
-patients w/symptomatic RA should be started on DMARD
-MTX is the preferred initial tx for most patients
-low-dose steroids can be added in patients with moderate-high disease activity when starting DMARD as a bridging option
DMARD: methotrexate (Trexall)
-inhibits dihydrofolate reductase, inhibiting folate
-oral tablet, injection, oral solution
-once weekly dosing (no daily dosing for MTX)
-hepatotoxicity, myelosuppression, mucositis/stomatitis, pregnancy
-folate can be given to dcr hematological, GI, and hepatic side effects
DMARD: hydroxychloriquine (plaquenill)
-immune modulator
-irreversible retinopathy
Other DMARDs
-sulfasalazine (immune modulator); caution in sulfa allergy
-leflunomide (inhibits pyrimidine synthesis); do not use in pregnancy, hepatotoxicity
Janus Kinase Inhibitors (non-biologic DMARD)
Tofacitinib, Baricitinib, Upadacitinib
-boxed warning: infections, malignancy, thrombosis
-do not use with biologic DMARDs
Anti-Tumor necrosis factors
-Enteracept (Enbrel); +/- MTX; weekly
-Adalimumab (Humira); +/- MTX; every other week
-Infliximab (Remicade); + MTX; requires filter and can be used in only
-Certolizumab pegol (Cimzia); +/- MTX
-Golimumab (Simponi); + MTX; SC/IV
*serious infections, malignancies
*can cause demyelinating disease, hep B reactivation, HF, hepatotoxicity, lupus-like-syndrome
*do not use with other biologic DMARDs or live vaccines
Other biologic DMARDs (non-TNF inhibitors)
Rituximab (Rituxan)
+ MTX
-depletes CD20 B cells
-premedicate with a steroid, acetaminophen and an antihistamine
-infusion related reactions, HBV reactivation
-do not use with other biologic DMARDs or live vaccines
systemic lupus erythematosus (SLE)
-fatigue, depression, anorexia, weight loss, muscle pain, malar rash (butterfly rash), joint pain and stiffness
-arthritis and cutaneous symptoms most common
-renal, hematologic, and neurologic manifestations contribute to morbidity and mortality
- positive ANAs, anti-ssDNA, anti-dsDNA, anti-Sm, apa, low complements, and elevated acute phase reactants
drugs that can cause DILE: My Pretty Malar Marking Probably Has A TransIent Quality
Methimazole, Propythiouracil, Methyldopa, Minocycline, Procainamide, Hydralazine, Anti-TNF agents, Terbinafine, Isoniazid, Quinidine
SLE Tx
-Hydroxychloroquine
-Cyclophosphamide
-Azathioprine
-Mycophenolate mofetil
-cyclosporine
Belimumab (Benlysta)
-IgG1 -lamda mAb
-serious infections
-do not give with other biologic DMARD or live vaccines
MS
-chronic progressive autoimmine disease - where immune cells attacks the myelin sheath
-early symptoms: fatigue, numbness, and blurred vision
-deterioration of cognitive function, muscle spasms, pain, incontinence
Relapsing MS Tx
-interferon beta formulations (Betaseron, AVonex, Rebif, Extavia, Plegridy)
-glatiramer acetate (Copaxone)
-Fingolimod (Gilenya) and Teriflunomide (Aubagio); oral
-mitoxantrone (second-third line)
Glatiramer acetate (Copaxone)
-immune modulator
-SC injection
-flushing, diaphoresis, dyspnea
Siponimod
-S1P receptor modulator
-CYP2C93/3 genotype testing required
Ozanimod
-S1P receptor modulator
-severe untreated sleep apnea, use of MAOi
Natalizumab (Tysabri)
-mAb that binds to a subunit of integrins expressed on the surface of leukocytes
-Risk of PML - only available through REMs
Raynuds
nifedipine
drug-induced raynuds
- dcr blood flow to fingers causes incr cyanosis and pain
-beta blockers, bleomycin, cisplatin, sympathomimetics: amphetamines, pseudoephedrine and illicit drugs; drugs that worsen raynuds
drugs that worsen myasthenia gravis
AMG, quinolones, magnesium salts, select antiarrhythmics, BB, CCB, select antipsychotics, muscle relaxants, local anesthetics
-treatment: pyridostigmine (cholinergic)
