Endocrine drugs

Question 1

1) What is the P drug which tends to be used for hypothyroidism.
2) Which beta blocker is the P drug which us used for hyperthyroidism.
3) Name the 2 thionamide P drugs which are used to treat hyperthyroidism.
4) Name 2 other P drugs which can be used to treat hyperthyroidism.

Answer 1

1) Levothyroxine
2) Propranolol
3) Carbimazole and propylthiouracil.
4) Radioiodine (Iodine 131) and aqueous iodine oral solution.

Question 2

Give the 2 main clinical indications for the use of thyroid hormones such as Levothyroxine.

Answer 2

1) Primary hypothyroidism.

2) Hypothyroidism secondary to hypopituitarism.

Question 3

1) What hormone does the thyroid produce?
2) What happens to this thyroid hormone?
3) What do the thyroid hormones do?
4) How is hypothyroidism treated?

Answer 3

1) T4.
2) T4 is converted to the more active T3 in target tissues.
3) Regulate metabolism and growth.
4) Long term replacement of thyroid hormones, most usually Levothyroxine (T4).

Question 4

What is the difference between levothyroxine and liothyronine.

Answer 4

1) Levothyroxine is synthetic T4, Liothyronine is synthetic T3.
2) Liothyronin has a shorter half life and quicker onset and offset of action.

Question 5

1) What situations is the use of Liothyronine preferred over Levothyroxine?
2) What are the adverse effects of Levothyroxine usually due to?

Answer 5

1) Liothyronine is reserved for emergency treatment of severe or acute hypothyroidism.
2) Excessive doses.

Question 6

Describe the predictable side effects which can occur with excess thyroid hormone treatment.

Answer 6

1) GI adverse effects (D+V, weight loss)
2) Cardiac (palpitations, arrhythmias, angina)
3) Neurological (tremor, restlessness, insomnia).

Question 7

1) Why can thyroid hormones precipitate cardiac ischaemia in people with coronary artery disease?
2) Because of this, how should thyroid replacement be started in patients with coronary artery disease?
3) In hypopituitarism, why must corticosteroid therapy be initiated before thyroid hormone replacement?

Answer 7

1) Because they increase heart rate and metabolism.
2) Replacement should be started cautiously at a low dose with careful monitoring.
3) In order to avoid precipitating an Addisonian crisis.

Question 8

1) Why does administration of Levothyroxine and need to be separated with antacids, calcium or iron salts by 4 hours?
2) When might an increase in Levothyroxine dose be required?
3) What can be a result of Levothyroxine-induced changes in metabolism in patients with DM?
4) What does Levothyroxine to to Warfarin?

Answer 8

1) Because GI absorption of Levothyroxine is reduced by antacids, calcium or iron salts.
2) In patients taking CYP540 inducers (Phenytoin, Carbamazepine).
3) They can increase insulin or oral hypoglycaemic requirements.
4) Enhances the effect of Warfarin.

Question 9

1) How is levothyroxine available for administration?
2) Describe the recommended starting dose of Levothyroxine.
3) How should the dose of Levothyroxine be adjusted?

Answer 9

1) Orally.
2) 50-100mcg OD recommended, except in elderly and those with cardiac disease who should start on 25mcg OD.
3) Adjust dose monthly in 25-50mcg increments according to monitoring, to a usual maintenance dose of 50-200mcg OD.

Question 10

Give 5 main uses of glucocorticoids.

Answer 10

1) Replacement therapy
2) Endocrine testing
3) Treatment of inflammatory disorders - acute and chronic
4) Neoplastic disease
5) Organ transplantation

Question 11

Name the 3 glucocorticoid P drugs.

Answer 11

Hydrocortisone, Prednisolone and Dexamethasone.

Question 12

Give the main pharmacological use of mineralocorticoids.

Answer 12

Replacement therapy - primary (Addisonian) adrenal failure.

Question 13

What is the P drug which is a mineralocorticoid?

Answer 13

Fludrocortisone.

Question 14

What is Tetracosactide used for?

Answer 14

Testing adrenocortical function.

Question 15

Give 2 main uses of synthetic growth hormone.

Answer 15

1) Growth hormone deficiency in children and adults

2) Turner’s syndrome and Prader-Willi syndrome in children

Question 16

Name the P drug which is a synthetic growth hormone.

Answer 16

Somatropin.

Question 17

Give 3 main uses of Dopamine (D2) agonists.

Answer 17

1) Galactorrhoea
2) Hyperprolactinaemia
3) Prolactin secreting pituitary adenomas

Question 18

Name the P drug which is a Dopamine (D2) agonist.

Answer 18

Cabergoline.

Question 19

What can testosterone and its esters be used for?

Answer 19

Male hypogonadism.

Question 20

Name the 2 testosterone P drugs.

Answer 20

1) Sustanon 250® (testosterone esters - IM depot)

2) Testogel® (testosterone - transdermal)

Question 21

Give the 4 main clinical uses of Bisphosphonates.

Answer 21

1) Postmenopausal osteoporosis
2) Prevention of corticosteroid-induced osteoporosis
3) Hypercalcaemia
4) Paget’s disease of bone

Question 22

Name 3 P drugs which are Bisphosphonates.

Answer 22

1) Alendronic acid
2) Risedronate
3) Zoledronic acid

Question 23

Give 3 clinical uses for Calcium salts.

Answer 23

1) Mild hypocalcaemia [oral supplement]
2) Moderate to severe acute hypocalcaemia [parenteral - IV]
3) Hyperkalaemia for cardioprotection [parenteral - IV]

Question 24

Name 3 P drugs which are calcium salts and state how each is administered.

Answer 24

1) Calcichew® (Oral supplement)
2) Calcium gluconate (Parenteral - IV)
3) Calcium chloride (Parenteral - IV)

Question 25

Give 4 clinical uses for vitamin D compounds.

Answer 25

1) Vitamin D deficiency
2) Hypocalcaemia
3) Hypoparathyroidism
4) Renal bone disease [secondary hyperparathyroidism of chronic renal disease]

Question 26

Name the 3 P drugs which are vitamin D compounds.

Answer 26

1) Alfacalcidol (1α- Hydroxycholecalciferol)
2) Calcitriol (1,25- Dihydroxycholecalciferol)
3) Ergocalciferol (Vitamin D2)

Question 27

Give 3 clinical indications for the use of Vasopressin analogues.

Answer 27

1) Cranial diabetes insipidus [desmopressin]
2) Oesophageal bleeding [terlipressin]
3) Bleeding reduction in mild to moderate haemophilia [desmopressin]

Question 28

Name the 2 P drugs which are vasopressin analogues.

Answer 28

Desmopressin and Terlipressin.

Question 29

When are vasopressin V2 receptor antagonists used?

Answer 29

Hyponatraemia secondary to SIADH.

Question 30

Name the P drug which is a vasopressin V2 receptor antagonist.

Answer 30

Tolvaptan.