Pharm 38 - Drug List

Question 1

○ Synthetic steroid with a structure identical to cortisol

○ Has glucocorticoid (major) and mineralocorticoid (minor) effects

Answer 1

Hydrocortisone

Question 2

Hydrocortisone use

Answer 2

§ Primary oral use: adrenal insufficiency

Question 3

Name other glucocorticoids

Answer 3

dexamethasone

prednisone

Question 4

Why is hydrocortisone preferred over other glucocorticoids

Answer 4

Harder to titrate exact doses (to have the lower doses) that are needed to mimic physiologic cortisol levels - thus prefer hydrocortisone

Question 5

Mineralocorticoid drug

Answer 5

Fludrocortisone

Question 6

Designed to increase blood pressure and provide electrolyte support common in adrenal insufficiency

Answer 6

Fludrocortisone

Question 7

§ USE: Prevents/treats:
□ Sodium loss
□ Vascular volume depletion
□ Hyperkalemia

Answer 7

Fludrocortisone

Question 8

Fludrocortisone ADE

Answer 8

Similar to what happens with too much aldosterone:

□ Hypertension 
□ Edema
□ Cardiac enlargement 
□ Hypokalemia
□ Hypernatremia

Question 9

Pharmacological thyroid hormones should be taken…

Answer 9

first thing in the morning at least 30-60 minutes before breakfast

4+ or more from GI medications that are cations

Question 10

Common ADE of thyroid supplementation

Answer 10

○ Occur far more with T3 than T4
§ Can also occur if T4 dose is too high
○ Tachycardia
○ Angina
○ Tremors

Question 11

MC used thyroid supplement

Answer 11

levothyroxine sodium (inactive T4)

Question 12

thyroid supplement that causes far worse ADE of tachycardia, angina, tremors

Answer 12

Liothyronine

Question 13

○ Original thyroid hormone product
§ A natural ground up porcine thyroid hormone
§ Combo of both T3 and T4

Answer 13

“Thyroid USP” or Dessicated Porcine Thyroid Extract

Question 14

Thyroid synthesis inhibitors (2)

Answer 14

1. Propylthiouracil (PTU)

2. Methimazole

Question 15

Propylthiouracil (PTU) dosing and duration to effect

Answer 15

§ Short 1/2 life with TID dosing

§ Full benefits may take up 6 to 12 months

Question 16

Propylthiouracil (PTU) use

Answer 16

Moderate to severe hyperthyroidism

Question 17

Propylthiouracil (PTU) ADE

Answer 17

§ Agranulocytosis
§ Not always able to establish a “euthyroid” state
□ May lead to hypothyroidism after 6 to 12 months of use
§ Concerns in pregnancy and lactation
§ Can cause severe liver damage
§ Readily cross placenta and is category D

Question 18

§ Agranulocytosis
§ Not always able to establish a “euthyroid” state
□ May lead to hypothyroidism after 6 to 12 months of use
§ Concerns in pregnancy and lactation
§ Can cause severe liver damage
§ Readily cross placenta and is category D

Answer 18

Propylthiouracil (PTU) ADE

Question 19

Methimazole dosing and time to effect

Answer 19

§ Once daily dosing

§ Takes 3 to 12 weeks for euthyroid state

Question 20

Methimazole use

Answer 20

§ Moderate to severe hyperthyroidism

§ Adjunct therapy to thyroid irradiation

Question 21

Methimazole ADE

Answer 21

§ MORE dangerous than PTU in first trimester of pregnancy and lactation
§ Agranulocytosis
§ Readily cross placenta and is category D

Question 22

§ MORE dangerous than PTU in first trimester of pregnancy and lactation
§ Agranulocytosis
§ Readily cross placenta and is category D

Answer 22

Methimazole ADE