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Flashcards in Pharm 38 Objectives Deck (72)
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1

What are the 3 main steroid products of the adrenals.

- Glucocorticoid
- Mineralocorticoid
- Androgens

2

What is the primary physiologic glucocorticoid?

Cortisol

3

What is the primary pharmacologic congener of glucocorticoid?

Hydrocortisone

4

What is the primary physiologic mineralocorticoid?

Aldosterone

5

What is the primary pharmacologic congener of mineralocorticoid?

Fludrocortisone

6

What is the primary drug therapy option for Addison’ and its typical dosing regimen?

- Hydrocortisone
- Dose: 2/3 in am and 1/3 in afternoon

7

What medication is used as an adjunct drug therapy to support blood pressure, if needed?

Fludrocortisone (potent mineralocorticoid)

8

When is the most appropriate time(s) of day to dose the glucocorticoid (and mineralocorticoid if necessary)?

Give most of the dose in the AM and smaller doses throughout the day
- 2/3 in AM and 1/3 in afternoon

9

When should you dose adjustment glucocorticoid (and mineralocorticoid if necessary)?

- Dosage is increase in times of stress ---> double the dose
- If surgery dose may need to be greatly increased for 48-72 hrs

10

What is T3?

Active thyroid hormone

11

What is the Physiologic Abundance of T3?

- 20% secreted by thyroid gland
- Most produced from T4 in the liver

12

What is the Biologic activity of T3?

Activates gene transcription leading to increase syntheses of proteins necessary for growth development, and calorigenesis (heat production)

13

What is the onset of T3?

Within a few hours

14

What is the duration/half life of T3?

Approx. 1 day

15

What is T4?

- Inactive thyroid hormone
- Precursor for T3

16

What is the Physiologic Abundance of T4?

- 80% secreted by thyroid gland.
- Produced in thyroid gland and stored in thyroid follicles

17

What is the Biologic activity of T4?

Some of T4 is converted to T3 in liver and muscles and this conversion is the final step of thyroid activity
- T4 can also be converted into reverse T3 (rT3) which is the inactive and stored form of the hormone---> this is seen in pts taking too much T4

18

What is the onset of T4?

3-5 days

19

What is the duration/half life of T4?

Approx. 7 days

20

What pharmacologic product contains T4? and "who is best pt" for this drug?

Levothyroxine (T4)
- Can be used on its own
- Preferred thyroid supplement for most pts

21

What pharmacologic product contains T3? and "who is best pt" for this drug?

Liothyronine (T3)
- Used in pts who doesn't get adequate convert T4 to T3.

22

What are CI with Liothyronine (T3)?

- Should not be used on it own for thyroid supplement
- Do not use in pts with cardiac issues

23

What pharmacologic product contains T4 and T3? and what can it cause?

“Thyroid USP” or Desiccated Porcine Thyroid Extract (T4 and T3)
- Animal based: ground up pig thyroid "natural product"
- Can cause over stimulation of the heart and thyroid

24

What are the 2 Thyroid synthesis inhibitors used in Hyperthyroidism?

- Propylthiouracil (PTU)
- Methimazole

25

What is the duration/half life and how long does it take to reach Euthyroid state with Propylthiouracil (PTU)?

- Short half-life, required TID
- 6-12 mos for euthyroid state

26

What are the ASEs of Propylthiouracil (PTU)?

- Agranulocytosis
- Not always able to establish a euthyroid state: may lead to hypothyroidism
- Concerns w/ pregnancy and lactation
- Severe liver damage

27

What is the duration/half life and how long does it take to reach Euthyroid state with Methimazole?

- Longer half live, once-daily dosing
- May take 3-12 wks for euthyroid state

28

Methimazole is an adjunct therapy to what?

Thyroid irradiation

29

What are the ASEs of Methimazole

- Agranulocytosis
- MORE dangerous than PTU during lactation and during the 1st trimester of pregnancy

30

What is the role of Beta Blockers for pts with hyperthyroidism?

- Use for occasional or short time only for symptomatic tx not tx hyperthyroidism
- Longer term use can cause problems during pregnancy