Endocrine Pharm

Question 1

what are the 3 main purposes of endocrine pharmacology

Answer 1

1. Replace a deficiency (diabetes mellitus)
2. Prevent hormone excess - or effects of (hyperadrenocorticism)
3. Diagnosis (ACTH stimulation test)

Question 2

what is the treatment of choice for hypothyroidism

Answer 2

Synthetic T4

Question 3

what are the common endogenous steroid hormones

Answer 3

• estrogen
  
  • progesterone
  • cortizol
  • aldostrone

Question 4

what are the common peptide hormones

Answer 4

oxytocin
insulin
ATCH

Question 5

what is a big difference between testing for steroid hormones vs peptide hormones?

Answer 5

steroid hormones are very stable, whereas peptide ones are not, and require special handling

Question 6

what are your 4 options for treating hypothyroidism

Answer 6

1. synthetic levothyroxine (T4)
2. dessicated thyroid (not recommended)
3. dessicated thyroglobulin (not recommended)
4. synthetic liothyronine (T3) (only used in rare exceptions)

Question 7

why is it important to talk to the pharmacist when prescribing synthetic T4

Answer 7

the bioavailability is very low in dogs compared to people

• 0.075 - 0.125 mg/kg in people
• 0.2 mg/10 kg per day in dogs

Question 8

why is using dessicated thyroid difficult to use, and not recommended?

Answer 8

it comes from cattle or pig thyroid, makes it not very predictable and very hard to control a patient on.

Question 9

what is liothyronine

Answer 9

synthetic T3

Question 10

what is levothyroxine

Answer 10

synthetic T4

Question 11

what is the problems with using liothyronine as a treatment modality for hypothyroid ism

Answer 11

liothyronine (T3) is the active form of T4 which is generally converted within tissues as it is needed.
When you give the active version you are not allowing the tissues to use it as needed and often will over medicate

Question 12

is rT3 active?

Answer 12

NO

this is produced when you are sick, so that it is not active and slows down metabolism

Question 13

is the compounded form of methimazole have good bioavailability?

Answer 13

yes, this is one of a few drugs that compounded medications will work.

however, the long term stability is not very good, so you should only look at prescribing a month at a time

Question 14

what are some adverse drug reactions with using methimazole, and how might you avoid some of them?

Answer 14

GI
   - split dose (BID to TID)
   - transdermal
Dermatologic
   - severe facial pruritis
   - presents in the 1st few weeks if it will happen
Hepatic
   - reversible
   - monitor liver enzymes
Hematologic
   - anemia (generally reversible)
   - monitor CBC

Question 15

what are some problems with using transdermal methimazole?

Answer 15

longer absorption time

• can lead to inadequate ammounts being absorbed from many things (other cats, rubbing owners or objects, ect)
• if you need immediate results might not be the treatment modality to start with (consider pills to start then transition to transdermal)

Question 16

T or F

methimazole is known for significant drug interactions

Answer 16

FALSE

Question 17

what important considerations should be considered when you have a patient being treated with methimazole, that is now going to be treated with I-131?

Answer 17

methimazole can interfere with the I-131 treatment so you would need to discontinue treatment ~5-7 days prior.
would be a good idea to call where ever they will receive this treatment and get their recommendations.

Question 18

T or F

restricted iodine diet is not effective in cats with naturally occurring hyperthyroidism

Answer 18

FALSE
restricted iodine diet is effective in 80-90% of cats with naturally occurring hyperthyroidism

the only problem is that they have to be on a VERY strict diet

• no treats unless correct ones
• no hunting (iodine found in rodents as well)
• can’t sneak other cats food

Question 19

what are the options for treating hyperthyroidism

Answer 19

• T4 treatment
• Iodine restriction
  
  • i.e. diet
• I-131
• surgery
  
  • consider consequences of removing parathyroid as well

however, if you are not managing it well you can cause kidney issues. Typically a mild hyperthyroid state is better for keeping kidney Dz at bay

if this happens you can supplement with synthetic T4 to help.