Pharm Flashcards
What drug do we use for hypothyroidism
Levothyroxine
What do you use to guide dose adjustments for levothyroxine and how often do you check it
Use TSH
4-8 wks
What is the weight-based dose for levothyroxine
1.6 mcg/kg/day
Use ibw if obese
What is the levothyroxine dose for older pts with no cvd
50 mcg/kg/day
What is the dose for levothyroxine in a patient with CVD
12.5-25 mcg/kg/day
What test do you use for central hypothyroidism to monitor levothyroxine
Free T4
What drug is preferred for graves disease
Methimazole
MOA of Methimazole
Blocks iodide incorporation onto TG
Block coupling of t3/t4
Inhibits peroxidase
ADRs of Methimazole
Poly arthritis
Fetal abnormalities
Cholestasis
What medication do you give for thyroid storm
Propylthiouracil PTU
Moa of PTU
Blocks iodide incorporation onto TG
Block coupling of t3/t4
Inhibits peroxidase
Inhibits peripheral t4 conversion
What medication is used in pregnancy
PTU
ADRs of PTU
Polyarhyritis
ANCA + vasculitis
Hepatitis
Agranulocytosis
MOA of iodide solution
Inhibits production of thyroid hormones, inhibits release of thyroid hormone, decreased vascularity of thyroid gland
When do you want to use an iodide solution
Perioperatively
Don’t start until one hr after antithyroid
What is the mechanism of action on the thyroid gland for beta blockers propranolol
It blocks peripheral conversion of t4
What is the mechanism of action on the thyroid gland for corticosteroids
Inhibits peripheral conversion of t4
Which hyperthyroidism medication has a black box warning
PTU
Liver damage and failure
What medication do you use for acromegaly
Octreotide
What is the mechanism of action for octreotide
Inhibits release of GH TSH GLUCAGON INSULIN GASTRIN
ADRs for octreotide
GI complaints
Cardiac effects
Treatment > 6 mo: biliary sludge and gallstones
Treatment >12 mo: vit b 12 def
What medications do you use for hyperprolactinemia
Bromocriptine
Cabergoline
Moa of bromicriptine/ cabergoline
D2 receptor agonist
What is the contraindication for dopamine agonist
Small adenomas during pregnancy
What are the adverse reactions for dopamine agonist
Nausea
Headache
Orthostatic hypotension
Fatigue
What do you use to treat addison’s dz?
hydrocortisone + fludrocortisone (15-30 mg/day)
acute- 100-400mg/day
salt intake
What do you use to treat cushings dz?
stop use of glucocorticoids
dexamethasone test
strategies to limit corticosteroids ADRs
i. Use other drugs for chronic immunosuppression/immunomodulation/anti-inflammation
ii. Limit duration of use
iii. Local; topical administration
iv. Chronic system use:
1. Minimally effective dose
2. Once in AM
3. Every-other-day therapy (use intermediate duration drugs, e.g. prednisone)
4. Use with other anti-inflammatory and/or immunosuppressant drugs “steroid-sparing”
c. Tapering Corticosteroid Dose
i. Disease activity drops…steroid need drops…can decrease dose, maintain effectiveness and decrease potential ADRs.
ii. If chronic adrenal axis suppression and adrenal atrophy: adrenal axis cannot release physiologic and stress amounts of corticosteroids…slowly decrease dose…deliver physiologic corticosteroid levels and allow adrenal axis to recover (still need stress dose)…final tapering stages involve testing axis for adequate stress response. (after long time Tx, see suppression of HPA axis.)
d. Exogenous source of glucocorticoids used in system, thus inhibiting CRH and ACTH release (negative feedback) – must taper them off b/c have suppressed this axis.
e. Recovering from suppression may take 6-9 months.
i. CRH secretion return to normal and w/in few weeks, ACTH levels begin to increase, rising above normal values until adrenal steroidogenesis recovers.
ii. In interim, need replacement therapy (just a little bit). W/o replacement therapy, pts may experience symptoms of glucocorticoid deficiency, e.g. anorexia, nausea, weight loss, arthralgia, lethargy, skin desquamation, postural dizziness, etc.
iii. Make plan: get off exogenous glucocorticoids and taper off; test to make sure ok before take them off fully.
f. After stopping Tx, cortisol plasma conc. doesn’t start up until after 6 months.
g. ACTH is a trophic hormone (=helps support dev’t of tissue), so takes time to nourish the tissue and get it to recover before able to stimulate Cortisol release again.
What is adrenal suppression/acquired secondary adrenal insufficiency
caused by sudden cessation of exogenous glucocorticoid use
glucocorticoids affected; mineralcorticoid ok
What is a main indication for glucocorticoid use outside of autoimmune?
respiratory distress syndrome
inject betamethasone to stimulate cortisol in baby
what is the rapid effect of corticosteroids
vasoconstriction reversing inflammatory hyperperfusion
Prednisone is:
potent anti-inflammatory and less Na retaining
corticosteroid ADRs
osteoporosis hyperlipidemia depression headaches glaucoma cataracts gastric ulcer DM impaired wound healing
how does glucocorticoid inhibit inflammation
stimulate annexin A1 (lipocortin)
thus inhibiting prostaglandins, phospholipase A2, cyclooxygenases
fludrocortisone is:
high anti inflamm and salt retaining
What is the standard glucocorticoid?
hydrocortisone
what are lispro, aspart, and glulisine insulins
rapid acting
what is the onset, peak, and duration of rapid acting insulin?
onset:
What is the peak, onset, and duration of short acting insulin?
onset: 30-60 min
peak: 2-4 hrs
duration: 5-8 hrs
what type of insulin is regular U-100
short acting
what type of insulin is NPH?
intermediate acting
what is the onset, peak, and duration of intermediate insulin?
onset: 1-3 hrs
peak: 6-12 hrs
duration: 14-24 hrs
what is the onset, peak, and duration for long acting insulin
onset: 1-2 hrs
peak: flat
duration: 24 hr
what type of insulin are detemir and glargine
long acting insulin
when do you decrease dosage requirements for insulin
wt loss
exercise
renal/hepatic failure
hypoglycemic episodes
what is the best insulin therapy?
long acting + rapid acting with meals
what do you use for correction doses of insulin?
insulin sensitivity factor
1:50 (insulin: glucose)
what do you use to determine mealtime doses?
carb counting
1:10
1 insulin to 10 g of carbs
what are the rescue medications for hypoglycemia?
oral glucose
glucagon, IM
for severe cases: D50
