Endocrine Pharm (Exam 3) Flashcards
aminoglutethimide: MOA
Blocks the synthesis of all adrenal steroids
aminoglutethimide: Indications
Temporary therapy to decrease cortisol production
Usually they are waiting on radiations
CUSHINGS
aminoglutethimide: Adverse reactions
Drowsiness
Nausea
Anorexia
Rash
aminoglutethimide: NSG considerations
Reduces cortisol levels by 50%
Do not use long term
Ketoconazole: MOA
Antifungal drug that also inhibits glucocorticoid synthesis
ONLY cortisol
Ketoconazole: Indications
Adjunct therapy to surgery or radiation for Cushing’s syndrome
Ketoconazole: Adverse reactions
Liver damage
Very hepatotoxic
Ketoconazole: NSG consideration
Do not take with ETOH or other drugs that harm liver
Damage fetal thyroid
phenoxybenzamine: MOA
Long lasting, irreversible blockage of alpha-adrenergic receptor
phenoxybenzamine: Indications
Pheochromocytoma
phenoxybenzamine: Adverse Reactions
Related to low blood pressure
Orthostatic Hypotension
Reflex Tachycardia
Nasal Congestion
Sexual Side Effects in men
Phenoxybenzamine: NSG considerations
Lowers blood pressure and is non reversible
demeclocycline: MOA
Interferes with renal response to ADH
demeclocycline: Indications
SIADH
demeclocycline: Adverse Reactions
Photosensitivity
Teeth Staining
Nephrotoxic
DDAVP desmopressin: MOA
Synthetic ADH replacement
DDAVP desmopressin: Indications
Neurogenic DI
DDAVP desmopressin: Adverse Reactions
Small dose: None
Nasal Spray: Irritation
Large Dose: Hyponatremia and water intoxication
levothyroxine: Class
T4 synthetic thyroid hormone
levothyroxine: MOA
Converted to T3 in the body
levothyroxine: Indications
Hypothyrodisim
Levothyroxine: Adverse Reactions
Hyperthyroidism if dosing to high
levothyroxine: NSG considerations
Drug life = 7 days (takes month to see results)
Food and Drug decrease absorption
Warfarin can increase bleeding
Have to take this medication for life
propylthiouracil: MOA
Blocks thyroid hormone synthesis, suppresses conversion of T4 to T3
propylthiouracil: Indications
Hyperthyroidism
propylthiouracil: NSG considrations
BBW: Hepatotoxicity
Drug Therapy for Cushing’s
Depends on the cause: Primary or Secondary = Surgery or Radiations
Exogenous Steroids = Taper
The drugs are just temporary to suppress
Glucocorticoids: What are they? What are they for?
Hydrocortisone
Prednisone
Dexamethasone
For Addison’s
Glucocorticoids: Adverse Affects
Short term:
Increase IOP
Fluid Retention
Mood swing
Weight Gain
Long term:
Cataracts
High blood sugar
Depressed Immune sys
Thinning of skin and bones
Glucocorticoids: Nsg Considerations
STEROID TAPER (Addison Crisis)
Take at same time each day
Increase when stress or sick
Wear medical alert bracelet
Have back up doses
TOXIC IN LARGE DOSES
Mineralocorticoid: ALL
Fludrocortisone
Salt wasting (inability to maintain Na and K levels despite good renal functions)
Addison Disease: Pharmacotherapy
LIfelong corticosteroid replacement
All patients required glucocorticoid
(Hydrocortisone ) (Prednisone) (Dexamethasone)
Dex or pred = mineral corticoid
(Fludrocortisone)
Why is hydrocortisone the drug of choice for addison’s disease
Glucocorticoid and Mineralocorticoid effect
Important Issues of Addison Pharmacotherapy
Dosing should mimic natural release of hormones (bed time)
Never stop steroids abruptly (always taper) (Addison Crisis)
Steroids will need to be increased during stress
Always maintain emergency supply
Wear a medic alert bracelet
Prefered Treatment Pheochromocytoma
Surgery is how we want to treat
Give alpha 1 blockers until the surgery happens (give pre-opp and after) (permanent)
phenoxybenzamine
SIADH: Pharmacotherapy
Pharm is not the first line of treatment
Treat the underlying cause
Can give loop diuretics only if sodium is above 125
Neurogenic DI: Pharmacotherapy
ADH replacement (Desmopressin)
Nephrogenic DI: Pharmacotherapy
Thiazide diuretics
Paradoxical effect. Reduces polyuria?!?!
Treatment of Hyperthyroidism
propylthiouracil
Radioactive iodine treatment (more common) (taken up by gland and suppresses activation)
Surgery (then need levothyroxine for life)
Hypoparathyroidism: Treatment
Replace PTH
Normalize Ca and Vitamin D
If parathyroid is removed then treatment is life long
Hyperparathyroidism: Treatment
Diuretics (Decrease calcium)
Calcitonin (regulate ca and phos levels)
Bisphosphonates (reduces bone breakdown)
Vitamin D (helps calcium be absorbed)
Surgical intervention
Cushing Disease Preferred Treatment
Primary or Secondary = Surgery and radiations
Exogenous = Steroid taper
