endocrine pharm

Question 1

aminoglutethimide: moa

Answer 1

blocks synthesis of all adrenal steroids

Question 2

aminoglutethimide: I

Answer 2

temporary therapy to decrease cortisol production
reduce cortisol by 50%
does not affect underlying disease process
temporary, dont use longer than 3 mo, usually just waiting for sx or want to do radiation before sx

Question 3

aminoglutethimide: SE

Answer 3

drowsy, n, anorexia, rash

Question 4

ketoconazole: moa

Answer 4

antifungal drug that also inhibits glucocorticoid synthesis

Question 5

ketoconazole: I

Answer 5

I: adjunct therapy to sx or radiation for cushing S

Question 6

ketoconazole: SE

Answer 6

severe liver damage
dont take with OH or other drugs that harm liver
dont give pregnant (fetal thyroid damage)

Question 7

phenoxybenzamine HCl

Answer 7

alpha blocker - non competitive receptor antagonist (receptor blocking is not reversible)
I: pheochromocytoma

Question 8

phenoxybenzamine HCl: moa

Answer 8

long lasting irreversible blockage of alpha adrenergic receptors
lowers bp

Question 9

phenoxybenzamine HCl: SE

Answer 9

orthostatic hypoT, reflex tachy, nasal congestion, sexual SE in men

Question 10

demeclocycline

Answer 10

tetracycline broad spectrum abx
I: abx and chronic SIADH

Question 11

demeclocycline: SE

Answer 11

photosensitivity
teeth staining
nephrotoxic

Question 12

demeclocycline: moa

Answer 12

interferes with renal response to ADH, lowers response

Question 13

desmopressin

Answer 13

DDAVP
treatment for neurogenic DI
nasal spray, PO, IV, SQ

Question 14

desmopressin: moa

Answer 14

synthetic ADH replacement, antidiuretic effects

Question 15

desmopressin: SE

Answer 15

small doses = none
nasal spray = nasal irritation
large doses = hypoNa, water intox

Question 16

levothryroxine

Answer 16

replacement hormone therapy with
T4 synthetic thyroid hormone
drug 1/2 life = 7 days -> results ~1 mo, stay consistent with regimen
take for life

Question 17

levothryroxine: moa

Answer 17

converted to T3 in body

Question 18

levothryroxine: SE

Answer 18

rare, if dose too high or too low you can have hypoT or hyperT s
drug interactions (warfarin - increase risk of bleed) and food can reduce abs (empty stomach, 30 min before eating in morning)

Question 19

PTU

Answer 19

antithyroid hormone med
blocks thyroid hormone synthesis, suppress conversion of T4 -> T3
hepatotox: BB!
can be used in 1st T with caution, change to different med in 2nd and 3rd bc hepatotox

Question 20

Hydrocortisone
Prednisone (5-10 mg/day)
Dexamethasone (0.25 – 0.75 mg/day)

Answer 20

glucocorticoid
Some MCC action - hydro
Direct replacement of glucocorticoid
P: chronic disease states (COPD)
D: get idea of adrenal function

Question 21

glucocorticoids: SE

Answer 21

Low dose = minimal to none
Large dose = toxic
Acute: increase intraocular pressure (eye diseases like glaucoma), fluid retention, htn, mood swings, weight gain (fat deposits in abdomen, face, back of neck – centralized), hunger, high BS
Long term (months to years): clouded eye lens, high BS, increased risk of infection (wbc depression), thinning bones and fractures, suppressed adrenal hormone gland production (fatigue, loss of appetite, n, muscle weakness), thin skin, bruising, slow wound healing

Question 22

glucocorticoid: nc

Answer 22

Synthetic, identical to cortisol (can distinguish from endogenous, except dexamethasone)
Oral = 15-25 mg/day
Parenteral (50-100 mg IV q8hr
Don’t abruptly stop taking, steroid taper, deadly
Take at same time throughout day (esp with long term)
Wear medical alert bracelet with long term
Monitor weight and BS

Question 23

fludrocortisone

Answer 23

mineralcorticoid
direct replacement
low mineralcorticoids
not as many SE
Only mineralcorticoid replacement, may be needed with GCC replacement to combat salt wasting (inability to maintain Na and K levels high despite adequate renal function)