Pharm 38 - Drug List Flashcards
○ Synthetic steroid with a structure identical to cortisol
○ Has glucocorticoid (major) and mineralocorticoid (minor) effects
Hydrocortisone
Hydrocortisone use
§ Primary oral use: adrenal insufficiency
Name other glucocorticoids
dexamethasone
prednisone
Why is hydrocortisone preferred over other glucocorticoids
Harder to titrate exact doses (to have the lower doses) that are needed to mimic physiologic cortisol levels - thus prefer hydrocortisone
Mineralocorticoid drug
Fludrocortisone
Designed to increase blood pressure and provide electrolyte support common in adrenal insufficiency
Fludrocortisone
§ USE: Prevents/treats:
□ Sodium loss
□ Vascular volume depletion
□ Hyperkalemia
Fludrocortisone
Fludrocortisone ADE
Similar to what happens with too much aldosterone:
□ Hypertension □ Edema □ Cardiac enlargement □ Hypokalemia □ Hypernatremia
Pharmacological thyroid hormones should be taken…
first thing in the morning at least 30-60 minutes before breakfast
4+ or more from GI medications that are cations
Common ADE of thyroid supplementation
○ Occur far more with T3 than T4 § Can also occur if T4 dose is too high ○ Tachycardia ○ Angina ○ Tremors
MC used thyroid supplement
levothyroxine sodium (inactive T4)
thyroid supplement that causes far worse ADE of tachycardia, angina, tremors
Liothyronine
○ Original thyroid hormone product
§ A natural ground up porcine thyroid hormone
§ Combo of both T3 and T4
“Thyroid USP” or Dessicated Porcine Thyroid Extract
Thyroid synthesis inhibitors (2)
- Propylthiouracil (PTU)
2. Methimazole
Propylthiouracil (PTU) dosing and duration to effect
§ Short 1/2 life with TID dosing
§ Full benefits may take up 6 to 12 months
Propylthiouracil (PTU) use
Moderate to severe hyperthyroidism
Propylthiouracil (PTU) ADE
§ 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
§ 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
Propylthiouracil (PTU) ADE
Methimazole dosing and time to effect
§ Once daily dosing
§ Takes 3 to 12 weeks for euthyroid state
Methimazole use
§ Moderate to severe hyperthyroidism
§ Adjunct therapy to thyroid irradiation
Methimazole ADE
§ MORE dangerous than PTU in first trimester of pregnancy and lactation
§ Agranulocytosis
§ Readily cross placenta and is category D
§ MORE dangerous than PTU in first trimester of pregnancy and lactation
§ Agranulocytosis
§ Readily cross placenta and is category D
Methimazole ADE
