Therapeutics exam 1 (steroids,hormones,thyroid) Flashcards
What is the physiologic dose replacement for hydrocortisone?
20mg daily
Physiologic dose of Pred?
5-7.5mg daily
Physiologic dose of Dexamethasone?
0.75mg daily
Physiologic dose of Methylpred?
4mg daily
What is considered a pharmacologic dose of a steroid?
Any dose higher than the physiologic dose
Why is it important to dose steroids before 9am?
Mimic circadian rhythm, and pituitary is less sensitive to steroid during this time.
What steroid doses require a tapering regiman?
Doses greater than or equal to 7.5mg/day for long term (>3 wks) to help HP axis regain function
What is normal taper regiman?
Decrease dose by 5-10% every 1-4 wks, longer tx = longer taper
What 4 drugs are CYP450 3A4 inducers and should be avoided with steroid use?
Phenytoin, Rifampin, Barbituates, carbamazepine. Increase GC dose if using with these meds.
What two drug classes are CYP450 3A4 inhibitors and require a decrease in GC dose?
protease inhibitors and antifungals
What should be monitored regularly during GC therapy?
glucose conc, electrolytes(serum and urine), ophtho exams, stool tests for occult blood, growth and development.
For adrenal insufficiency what are the important education points?
take with meals/milk, double dose during stressful times, dispense and educate about injectable rescue GC’s, Med alert bracelet, maintain adeq. Na+ intake, MC is required if primary (adrenal) dz
what are the monitoring parameters for a patient with adrenal insufficiency?
well being of patient, resolution of hypotension, dizziness, dehydration, hyponatremia, hyperkalemia, adverse steroid rxns, maint of normal wght, BP, electrolytes with regression of normal clinical features.
How is testosterone synthesis regulated?
Hypothalamus releases GnRH to Antereior Pituitary. LH goes to Testis to Leydig cells to release Testosterone to develop sex organs. Ant. Pituitary also releases FSH to sertoli cells for spermatogenesis.
Where are activin and inhibin produced and what are their functions?
Both in sertoli cells to either stim or inhibit FSH release from the Pituitary Gland.
What is the importance of 5 alpha reductase in testosterone synthesis?
to remove the double bond from testosterone to convert it to the more active/potent androgen in males, 5 alpha Dihydrotestosterone.
What two medications are used as antiandrogen 5 alpha reductase inhibitors and what is their role?
Finasteride - used to treat BPH
Dutasteride - hirsituism in women and early male pattern baldness. Keeps more potent form from being produced.
What 3 antiandrogen medications are receptor inhibitors?
Cyproterone and cyproterone esters = hirsutism in women,and excessive sexual drive in men
Flutamide = blocks testosterone activity, used to treat prostatic carcinoma
Spironolactone = Aldosterone antagonist
What are the 4 types of Estrogens?
Natural Estrogens (17 beta Estradiol - most potent, estrone, estrio.
Synthetic estrogens - drugs with estrogenic activity
Phytoestrogens = estrogen mimetic compounds in plants (flavonoids)
Environmental estrogens - used in manufacture of plastic
What are the oral estrogen Monotherapy products?
Premarin, Estrace and Enjuvia
Topical monotherapy estrogens?
EstroGel, Divigel, elestrin
Vaginal Ring Estrogen only?
Estring, Femring
Vaginal Tab estrogen only?
Vagifem
Estrogen Emulsions?
Estrasorb
Transdermal Estrogen only products?
Estraderm, Menostar, Alora, Climara, Minivelle, Vivelle-dot
Topical Estrogen spray?
Evamist
Estrogen and Progestin continuous cyclic products?
oral Premphase or transdermal Combipatch
Combined continuous cycle therapies (6 periods/yr)
Oral Prempro, angeliq, Activella, Transdermal ClimaraPro, Combipatch (Not good for Perimenopause b/c unpredicatable bleeding can occur.)
Intermittant combined - Best for Perimenopausal
Prefest orally
Progestin for Endometrial Protection
Dydrogesterone, Medroxyprogesterone acetate (Provera), Micronized progesterone (Prometrium - cant have a pnut allergy), Norethisterone, norethindrone acetate, Norgesterel, Levonorgesterel
Estrogen and SERM (Selective Estrogen receptor modulator)
Duavee - oral estrogen plus bazedoxifene - non hormonal agent: agonist in bone and Antagonist in breast and uterus, decrease risk of endometrial cancer,
Used to treat both menopausal symptoms adnprevent bone loss in women with a uterus.
Contraindications to Estrogen Use:
Undiagnosed, abnormal vaginal bleeding, DVT or PE, active or hx of arterial thromboembolic dz, Breast cancer, hypercoaguable dz, pregnancy
Contraindications for progesterones
Hx of or current VTE, severe hepatic dysfunction, breast cancer, undiagnosed vaginal bleeding
What drugs are synthetic analogs of GnRH and what are they used for?
Leuprolide, buserelin, nafarelin, goserelin, triptorelin,
(relin = release hormones)
Useful for Morrhagia, endometriosis, PMDD
What are the clinical uses of GnRH?
infertility - must be given in a pulsatile fashion to mimic release of LH and FSH
Suppression - continuous treatment leads to suppression of gonadotropin release hormone for treatment of ovarian hyperstimulation by suppressing the endogenous LH surge, treats endometriosis by suppressing GnRH release decreasing stimulation of ovaries to produce estrogen and progesterone, TX of prostate cancer causing biologic castration
What did the Womens health initiative conclude?
Estrogen and Progestin: increased risk of MI, stroke, blood clots
Estrogen: increased risk of stroke, blood clots, reduced risk of fractures
FDA rec: do not take to prevent heart disease, for osteoporosis only consider for high risk patients unable to take non estrogen; use at lowest dose for shortest duration.
