Endo & Obgyn - Drugs

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Levothyroxine

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L-T4; Used in hypothyroidism

Available in oral and injectable form

Preparation of choice for thyroid replacement. It has a half-life of 7 days, which permits once-daily administration.

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Liothyronine

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T3;Used in hypothyroidism

Oral and injectable forms

Has a half life of 24 hours, which may necessitate multiple daily doses.

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Liothrix

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T4:T3 in a 4:1 ration; Used in hypothyroidism

Oral only

Since T4 is converted to T3, the use of this expensive drug cannot be justified.

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Methimazole

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Thionamide that is used to treat hyperthyroidism.

10 times more active than PTU. Requires only a single daily dose. Inhibits the thyroid peroxidase catalyzed reactions to block iodine organification. In addition, it also blocks coupling of the iodotyrosines. Iodine uptake is not blocked. Onset is slow.

Side effects include maculopapular rash and GI side effects. Rare adverse effects include vasculitis, arthralgia, a lupus-like reaction, cholestatic jaundice, hepatitis, and lymphadenopathy. The most dangerous side effect is agranulocytosis (neutrophil count < 500/mcL) but its rare.

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Propylthiouracil

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Thionamide; used to treat hyperthyroidism

MMI is 10x more active. Drug must be given every 8 hours. Inhibits the thyroid peroxidase catalyzed reactions to block iodine organification. In addition, it also blocks coupling of the iodotyrosines. Iodine uptake is not blocked. Onset is slow. PTU is preferible to MMI for pregnant women.

Side effects include maculopapular rash and GI side effects. Rare adverse effects include vasculitis, arthralgia, a lupus-like reaction, cholestatic jaundice, hepatitis, and lymphadenopathy. The most dangerous side effect is agranulocytosis (neutrophil count < 500/mcL) but its rare.

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Iodide

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Used to treat hyperthyroidism.

The major action is to inhibit the release of thyroid hormones, possibly through inhibition of thyroglobulin proteolysis. Rapid improvement in thyrotoxic symptoms occurs within 2-7 days, so it is good for THYROID STORM. Good for surgery prep as well, since they decrease the vascularity, size, and fragility of a hyperplastic gland.

Available as potassium iodide solution

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Ipodate

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Iodinated contrast media that is used to treat hyperthyroidism.

Inhibits the conversion of T4 to T3. The release of pharmacological quantities of iodine from these agents has the additional benefit of inhibiting the release of thyroid hormones. Act rapidly and are good for THYROID STORM. Relatively nontoxic.

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Iopanoic acid

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Iodinated contrast media that is used to treat hyperthyroidism.

Inhibits the conversion of T4 to T3. The release of pharmacological quantities of iodine from these agents has the additional benefit of inhibiting the release of thyroid hormones. Act rapidly and are good for THYROID STORM. Relatively nontoxic.

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I-131

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Radioactive iodine used for the treatment of thyrotoxicosis.

Administered orally. Destruction of the thyroid parenchyma is evidenced within weeks. Many patients may end up hypothyroid after radioactive iodine treatment.

Contraindicated in pregnant and breast feeding women.

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Propanolol

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Beta blocker used to treat the symptoms of thyrotoxicosis.

Alleviates symptoms of sympathetic stimulation.

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Tenormin

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Beta blocker used to treat the symptoms of thyrotoxicosis.

Alleviates symptoms of sympathetic stimulation.

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Sermorelin

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IV or SC with 12 min half-life.

Stimulates the synthesis and release of growth hormone from the anterior pituitary. It is used diagnostically for pituitary dwarfism and children of short stature.

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Hexarelin

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Given intranasally.

Stimulates the synthesis and release of growth hormone from the anterior pituitary. It is used diagnostically for pituitary dwarfism and children of short stature.

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Somatrem

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Promotes the growth of long bones, is anabolic to muscle, is lipolytic and increases plasma levels of glucose. Effects on growth linked to increased production of IGF-1.

Used for long term treatment of children with idiopathic short stature, to reverse catabolic states, and improve GI function in short bowel syndrome patients.

Adverse effects are diabetes, hypothyroidism, carpal tunnel syndrome, and swelling. Contraindicated for patients with Prader-Willi syndrome.

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Mecasermin

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A complex of recombinant human IGF-1 and recombinant human insulin-like growth factor-binding protein 3. For children with growth failure and severe IGF-1 deficiency who do not respond to GH.

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Octreotide

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IM slow release formula available for monthly injections.

Decreases the release of GH from the anterior pituitary and inhibits the release of gastrin, pepsin, glucagons, and gastric acid in the gut.

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Bromocriptine

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Oral dopamine agonist that decreases the release of prolactin. Used to treat hyperprolactinemia and inhibit post-partum lactation.

Do not use for pregnant women and patients with a history of schizophrenia.

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Desmopressin

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Vasopressin analogue

Longer acting then vasopressin; administered 2x a day intranasally.

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Demeclocycline

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Oral

Used for syndrome of inappropriate ADH secretion. Antagonizes the action of ADH on renal tubules.

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Conivaptan

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Used for euvolemic hyponatremia. It is a CYP3A4 inhibitor.

Contraindications include hypovolemic hyponatremia and use with CYP3A4 inhibitors.

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Methylergonovine

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Oral

Replaced oxytocin in being administered to reduce post-partum uterine hemorrhage.

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Gemeprost

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PGE1

Administered by injection, intra-amniotically, or intra-vaginally. Low dose is used to induce and reinforce labor. High dose is used to control post-partum bleeding; also used to induce 1st and 2nd trimester abortions.

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Dinoprostone

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PGE2

Administered by injection, intra-amniotically, or intra-vaginally. Low dose is used to induce and reinforce labor. High dose is used to control post-partum bleeding; also used to induce 1st and 2nd trimester abortions.

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Carboprost

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PGF2alpha

Administered by injection, intra-amniotically, or intra-vaginally. Low dose is used to induce and reinforce labor. High dose is used to control post-partum bleeding; also used to induce 1st and 2nd trimester abortions.

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Ritodrine

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Selective beta2 agonist

Causes relaxation of the pregnant uterus; may be used to prevent or delay premature parturition.

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Terbutaline

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Selective beta2 agonist

Causes relaxation of the pregnant uterus; may be used to prevent or delay premature parturition.