PHARM 2 Flashcards
Iodine pathway?
iodine–>ox to I2 (iodide) inside > ox by perox to make thyroglobulins and incorporated into MIT/DIT > T3 (active) and T4, deiodinase conv T4 to active T3
amount of iodine needed per day?
150 mg
Hypothyroidism (eg Hashimoto’s) sx
puffiness around eyes, autoimm, may or may not have goiters, can be from iodine deficiency, decreased met, thick skin/enlarged joints (example had fatigue and thinning hair)
Levothyroxine Sodium (T4) MOA
Converts T4 to active T3 via diodinase, T3 binds to R’s and alters gene expr and incr prots and stuff, so incr O2 consumption and incr BMR and met
-This T4 is the drug of choice for chronic hypothy tx!
Levothyroxine Sodium T4 SxE and CxI
Nervousness, anxiety, heat intelorence, wt loss, arr (etc, things rel to T4 lvls)
CxI- given once daily bc long half life, met by P40 so interacts with phenytoin, rifampin, carbamezepine
Some p450 drugs that stuff can interact with?
phenytoin, rifampin (abx) and carbamezepine
Graves
hyperthyroidism (opp of hashimotos)
Drugs for treating Hyperthyroidism
Methamazole, carbamiazole (Thioamides)
PTU
Tx of thyroid storm
Propanolol
Potassium Iodide
Radioactive Iodine-131
and PTU!
Methamizole
MOA
tx for hyperthyroidism (thioamide)
-prevents TH synth by inhibiting thyroid perox rxns and blocking iodine organification (similar to PTU but PTU also blocks diodinase D1 that conv T4 to T3)
Methimazole sxe and cxi
AGRANULOCYTOSIS, maculopap rash, hep/chol jaundice
-cxi in preg/nursing, can cause fetal harm
PTU (propylthiouracil)
MOA
use
prevents TH synth by inhib perox rxns n blocking org
- ALSO blocks coupling of iodotyrosines, and inhibs diodination of T4 conv to T3
- use for thryoid storm IV (in large doses)
PTU sxe
RASH, agrnulocytosis, edema, hep/chol jaundice (same as methamazole)
Potassium iodide
MOA
inhibs thryoid hormone release from gland, within hours, and inhibits perox (to decr TH synth), but WEARS OFF in a few weeks
Radiactive Iodine-131
use/moa
inc into storage follicles, used for THRYOTXICOSIS (excess thyroid hormone which is multinodular) and toxic adenomas
radioactive iodine 131 sxe and cxi
SxE: DELAYED HYPOTHYROIDISM
CxI: preg
most tx for hyperthyroidism are cxi in?
pregnancy!
Tx for primary and secondary syphilis
Benzanthine penecillin G single dose (2.4 mill units)
alternative tx for 1 and 2 syphilis
doxy 2wk, or desensitize then give pcn
tertiary syphilis tx (early vs late latent)
early latent <1 yr give benzathine pcn G single dose, for late latent/unknown give 3 x (1x per week) of same
neurosyphilis tx
aqueous crystaline pcn G 2wk, then tx for late latent syphilis with benzathine pcn g (usual)
neurosyphilis alternate
procaine pcn IM daily + oral probenecid, then tx late latent
gonorrhea tx
IM CEFtriazone single dose + azithro oral single dose
pharyngeal gonorrhea tx
CEFTRIAXONE
alt tx for gonorrhea if no cef avail
tx with CEFIXIME oral single dose / azithro
chalmydia tx
azithro (oral, single dose, BEST) OR doxy (oral bid for 1wk)
alternatives for chlamydia tx
erythro, erythro ehtylsuccinate, levofloxacin, ofloxacin
types of IM depository preparations of pcn?
procaine pcn G (not used much anymore, 1x day)
benzathine pcn G (drug of choice, t1/2 longer, for days, and only need once a week) for chronic
main syphilis test?
RPR (rapid plasma reagin)
primary syphilis sx
chancre (ulcer) at site of infx (eg genetalia, mouth), usu nontender, MAY have lymphad
secondary syphilis sx
chancre remission, org spreads so rash on palms and soles, alopecia, lymphad, MAY have menin
tertiary syphilis sx
quarter of ppl with latent get this, involves CV and neuro issues (incl eye/visual issues)
latent syphilis
spirochete is dormant, RPR positive but no sx
alternative tx for teritary syphilis? (if non-neuro)
doxy
exception to using doxy as alternative of tertiary syphilis?
if pregnant (or poor compliance), in which case do densisitization
why would doxy be cxi in preg?
stained teeth, bone issues in fetus
what skin issues would hpv show?
genital ulcers/warts
gonorrhea sx?
burning and cloudy discharge (but no genital lesions)
structure and gram stain of gonorrhea?
gram neg diplococci (tiny pink speckles)
treat which two sti’s at same time?
gonorrhea and chlamydia
which med is no longer recommended for GC infx?
cipro bc incr resistance
which heart drug can cause hypothyroidism?
amiodarone!
PTU vs methamizole?
methamizole has longer duration of action and fewer side effects, PTU better if preg or thyroid storm
