Therapeutics exam 1 (steroids,hormones,thyroid)

Question 1

What is the physiologic dose replacement for hydrocortisone?

Answer 1

20mg daily

Question 2

Physiologic dose of Pred?

Answer 2

5-7.5mg daily

Question 3

Physiologic dose of Dexamethasone?

Answer 3

0.75mg daily

Question 4

Physiologic dose of Methylpred?

Answer 4

4mg daily

Question 5

What is considered a pharmacologic dose of a steroid?

Answer 5

Any dose higher than the physiologic dose

Question 6

Why is it important to dose steroids before 9am?

Answer 6

Mimic circadian rhythm, and pituitary is less sensitive to steroid during this time.

Question 7

What steroid doses require a tapering regiman?

Answer 7

Doses greater than or equal to 7.5mg/day for long term (>3 wks) to help HP axis regain function

Question 8

What is normal taper regiman?

Answer 8

Decrease dose by 5-10% every 1-4 wks, longer tx = longer taper

Question 9

What 4 drugs are CYP450 3A4 inducers and should be avoided with steroid use?

Answer 9

Phenytoin, Rifampin, Barbituates, carbamazepine. Increase GC dose if using with these meds.

Question 10

What two drug classes are CYP450 3A4 inhibitors and require a decrease in GC dose?

Answer 10

protease inhibitors and antifungals

Question 11

What should be monitored regularly during GC therapy?

Answer 11

glucose conc, electrolytes(serum and urine), ophtho exams, stool tests for occult blood, growth and development.

Question 12

For adrenal insufficiency what are the important education points?

Answer 12

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

Question 13

what are the monitoring parameters for a patient with adrenal insufficiency?

Answer 13

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.

Question 14

How is testosterone synthesis regulated?

Answer 14

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.

Question 15

Where are activin and inhibin produced and what are their functions?

Answer 15

Both in sertoli cells to either stim or inhibit FSH release from the Pituitary Gland.

Question 16

What is the importance of 5 alpha reductase in testosterone synthesis?

Answer 16

to remove the double bond from testosterone to convert it to the more active/potent androgen in males, 5 alpha Dihydrotestosterone.

Question 17

What two medications are used as antiandrogen 5 alpha reductase inhibitors and what is their role?

Answer 17

Finasteride - used to treat BPH

Dutasteride - hirsituism in women and early male pattern baldness. Keeps more potent form from being produced.

Question 18

What 3 antiandrogen medications are receptor inhibitors?

Answer 18

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

Question 19

What are the 4 types of Estrogens?

Answer 19

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

Question 20

What are the oral estrogen Monotherapy products?

Answer 20

Premarin, Estrace and Enjuvia

Question 21

Topical monotherapy estrogens?

Answer 21

EstroGel, Divigel, elestrin

Question 22

Vaginal Ring Estrogen only?

Answer 22

Estring, Femring

Question 23

Vaginal Tab estrogen only?

Answer 23

Vagifem

Question 24

Estrogen Emulsions?

Answer 24

Estrasorb

Question 25

Transdermal Estrogen only products?

Answer 25

Estraderm, Menostar, Alora, Climara, Minivelle, Vivelle-dot

Question 26

Topical Estrogen spray?

Answer 26

Evamist

Question 27

Estrogen and Progestin continuous cyclic products?

Answer 27

oral Premphase or transdermal Combipatch

Question 28

Combined continuous cycle therapies (6 periods/yr)

Answer 28

Oral Prempro, angeliq, Activella, Transdermal ClimaraPro, Combipatch (Not good for Perimenopause b/c unpredicatable bleeding can occur.)

Question 29

Intermittant combined - Best for Perimenopausal

Answer 29

Prefest orally

Question 30

Progestin for Endometrial Protection

Answer 30

Dydrogesterone, Medroxyprogesterone acetate (Provera), Micronized progesterone (Prometrium - cant have a pnut allergy), Norethisterone, norethindrone acetate, Norgesterel, Levonorgesterel

Question 31

Estrogen and SERM (Selective Estrogen receptor modulator)

Answer 31

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.

Question 32

Contraindications to Estrogen Use:

Answer 32

Undiagnosed, abnormal vaginal bleeding, DVT or PE, active or hx of arterial thromboembolic dz, Breast cancer, hypercoaguable dz, pregnancy

Question 33

Contraindications for progesterones

Answer 33

Hx of or current VTE, severe hepatic dysfunction, breast cancer, undiagnosed vaginal bleeding

Question 34

What drugs are synthetic analogs of GnRH and what are they used for?

Answer 34

Leuprolide, buserelin, nafarelin, goserelin, triptorelin,
(relin = release hormones)
Useful for Morrhagia, endometriosis, PMDD

Question 35

What are the clinical uses of GnRH?

Answer 35

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

Question 36

What did the Womens health initiative conclude?

Answer 36

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.