Side Effects/toxicities Flashcards
L-triiodothyronine (T3)
Liothyronine Sodium
More expensive, harder to monitor, greater risk of cardiotoxicity
L-thyroxin (T4)
Levothyroid Sodium
Cardiac symptoms, angina and
palpitations.
Use with care, particularly in elderly
Thioamides- PTU and MMI
Skin rash, joint pain,
agranulocytosis in 0.2 % patients
hepatotoxicity (worse in PTU than MMI)
Methimazole
MMI
Greater risk of birth defects than PTU
Anion Inhibitors
Aplastic anemia
Iodide
Uncommon and usually
reversible when d/c
Acniform rash, swollen salivary glands,
mucous membrane ulcerations
Radioactive Iodine
I131
Eventually causes
hypothyroidism in 80% of patients, but this
is likely part of natural progression of
disease
Insulin
Hypoglycemia (<70 mg/dL) - can be reversed by glucose or glucagon
can be serious or fatal if not properly regulated
Dementia later in life
Biguanides
GI effects- N/D/D
May have small weight loss
Sulfonylureas
Hypoglycemia,weight gain
Many drug interactions which can enhance hypoglycemic effect and compromise glucose lowering effect
Non-Sulfonylurea Secretagogues (Meglitinides)
Hypoglycemia (lower risk than SU), weight gain
Drug interactions
Caution in liver dz pts
Preg risk cannot be ruled out
Thiazolidenediones (TZDs)
Fluid retention, weight game
↓ bone density
Poss risk of heart failure and bladder ca
GLP-1 Receptor Agonists
N/V/D (will ↓ with continued use but risk for acute renal failure)
↑ Risk of hypoglycemia when combined with insulin
secretagogues
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
↑ Risk of hypoglycemia when combined with insulin
secretagogues
Cleavage not specific to incretins
Pancreatitis, hepatic failure (can be fatal)
Joint pain
α-Glucosidase Inhibitors
Abd pain, diarrhea, flatulence (alleviated with dose titration/continued use)
↑ risk of hypoglycemia (must treat with oral glucose because disaccharides will not be absorbed)
Renal SGLT-2 Inhibitors
Genital mycotic infections
Recurrent UTIs
LT safety unk (possible ↑ risk bone fx)
Ketoacidosis
Metabolized by UDP-GT → drug interactions
Estrogens
High dose unopposed estrogen associated with endometrial cancer
↑ risk thromboembolism (stroke, MI) in cig smokers > 35
Progestins
Menstrual bleeding, irregularity, unfavorable lipid changes, LT progestin therapy can cause delayed return to ovulatory fn, androgenic effects (acne, hirsuitism), HA, ↑ B, weight gain
↑ risk breast ca when used w/ estrogen for postmenopausal HRT (compared to estrogen alone)
Estrogen/Progestin Combo Pill
N/V, HA, breast enlargement/tenderness alterations in libido, breakthrough bleeding (at lower doses), melasma, hair loss, GB dz
NO ↑ in endometrial ca w/ combo
Drug int- P450 inducers ↓ HL and low dose can lead ot failure, abx may ↓ enterohepatic cycling, phenytoin (anti-epileptic) can ↓ serum levels
Ulipristal
Uterine bleeding, menstrual irregularity, N/V, HA, abd pain
P450 substrate → drug interactions
Mifepristone
RU486
Serious bleeding in 1-5% pts
IUDs
Uterine perforation (on insertion)
Expulsion
Cramping – after insertion, may persist for a few months
Pelvic Inflammatory Disease risk: first 30 days after insertion
Copper: heavy menses
LNG: irregular spotting
Tamoxifen
Menopausal symptoms (e.g. hot flashes)
4-6-fold ↑ incidence of endometrial cancer (~0.2% risk). Hence, not administered for more than 5-10 years
Toremifene
Menopausal symptoms, may ↑ incidence of endometrial cancers
