Flashcards in Pharm 38 Objectives Deck (72)
What are the 3 main steroid products of the adrenals.
What is the primary physiologic glucocorticoid?
What is the primary pharmacologic congener of glucocorticoid?
What is the primary physiologic mineralocorticoid?
What is the primary pharmacologic congener of mineralocorticoid?
What is the primary drug therapy option for Addison’ and its typical dosing regimen?
- Dose: 2/3 in am and 1/3 in afternoon
What medication is used as an adjunct drug therapy to support blood pressure, if needed?
Fludrocortisone (potent mineralocorticoid)
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
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
What is T3?
Active thyroid hormone
What is the Physiologic Abundance of T3?
- 20% secreted by thyroid gland
- Most produced from T4 in the liver
What is the Biologic activity of T3?
Activates gene transcription leading to increase syntheses of proteins necessary for growth development, and calorigenesis (heat production)
What is the onset of T3?
Within a few hours
What is the duration/half life of T3?
Approx. 1 day
What is T4?
- Inactive thyroid hormone
- Precursor for T3
What is the Physiologic Abundance of T4?
- 80% secreted by thyroid gland.
- Produced in thyroid gland and stored in thyroid follicles
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
What is the onset of T4?
What is the duration/half life of T4?
Approx. 7 days
What pharmacologic product contains T4? and "who is best pt" for this drug?
- Can be used on its own
- Preferred thyroid supplement for most pts
What pharmacologic product contains T3? and "who is best pt" for this drug?
- Used in pts who doesn't get adequate convert T4 to T3.
What are CI with Liothyronine (T3)?
- Should not be used on it own for thyroid supplement
- Do not use in pts with cardiac issues
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
What are the 2 Thyroid synthesis inhibitors used in Hyperthyroidism?
- Propylthiouracil (PTU)
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
What are the ASEs of Propylthiouracil (PTU)?
- Not always able to establish a euthyroid state: may lead to hypothyroidism
- Concerns w/ pregnancy and lactation
- Severe liver damage
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
Methimazole is an adjunct therapy to what?
What are the ASEs of Methimazole
- MORE dangerous than PTU during lactation and during the 1st trimester of pregnancy