Endocrine/adrenal Drugs

Front 1

Propylthiouracil (PTU)

Back 1

used for Hyperthyroidism
60-80% protein binding: competes for sites.
Blocks thyroid hormone synthesis, also aids in suppressing t4 to t3 conversion.
DOES not destroy existing thyroid hormone stores. May take 3-12 weeks to reach euthryroid state.
PO. short half life, must be taken several times a day.
used for graves disease, adjuctive to radiation therapy, and the thyroid supression.
ADv FX: agnaulocytosis-sore throat/fever 1st signs.
hypothyroidism,nausea, headache, dizziness, paresthesia, rash, liver injury.

Front 2

Iodine 131

Back 2

destroys thyroid tissue in pts. with hyerthyroidism. concentrates in thyroid gland.
can start in days, full effects in 2-3 months.
some people need more than one dose.
ADV. FX: hypothyroidism could result: too much of a good thing.
Contraindicated in pregnancy and lactation.

Front 3

propanalol

Back 3

beta blocker used adjunctively to help control cardiac issues with hyperthyroidism.
SE reduces jitters and nervousness/tremors caused by the reduced calcium.

Front 4

For adrenaocortical insufficiency as in Addision's disease

Back 4

Hydrocortisone, prednisone (Dletasone), dexamethasone (Decadron), Fludrocortisone (florinef).

Front 5

For corticosteroid suppression for situations such as Cushing's disease where there is an abundance of cortisone naturally

Back 5

Ketoconazole (Nizoral)
This is an antifungal.

Front 6

Ketoconazole

Back 6

for Cushing's disease and adrenal cortex hyperfunction.
antifungal.
only works if over abundance is naturally occuring, not due to human dosing.
suppresses glucocorticoid steroid synthesis.
half life: 3 hours.
discontinue at first signof liver injury (Typically given at higher doses for fungal infextions andthis is when liver injury can occur.)
Nausea/Vomiting- give with food to reduce this. Rash, itcing, dizziness, fever, chills, constipation, diarrhea, photophbia and headache. rarely: anaphylaxix, severe epigastric pain, an daltered adrenal function.
PO. avoid use with antacids...
SE: N/V, liver issues.

Front 7

hydrocortisone
prednisone
dexamethasone (Decadron)

Back 7

synthetic form of cortisol:principal glucocorticoid.
does have some mineralcorticoid effects, but mainly glucocorticoid.
Besides use for Addisons, also used to treat allergic reactions to inflammation to cancer...
No real effects in doses for addision's because dose is so low.
may be given at bedtime to mimic natural cortisol release (occurs while sleeping).
these three are basically the same, just weaker and stronger.
The hydrocodone is weakest, and you will have highest dose.
next is prednisone, and dexamethasone is strongest, so you get least amount of drug.
wean off, do not stop quickly.

Front 8

Cushings syndrome/disease

Back 8

excess steroid process...
it is cushy--excessive.

the disease is naturally occuring.
the syndrome is created from pt. receiving TOO much steroid medicine while trying to manage another condition. People have the same responses though with too much steroid.

Front 9

Addison's disease

Back 9

not making enough steroids...
we need to ADD some steroids to help body meet its needs.

Front 10

Fludrocortisone

Back 10

mineralocorticoid used for treating deficiency of mineralcorticoid. may be used with hydrocortisone/glucocorticoids.
if dose is too high, salt and water are retained in excess while potassium is lost in excess.

Front 11

pharmacologic dose

Back 11

this dose is given above teh therapeutic or normal level in body.
Body was not producing enough to meet need, so more is given. This is above the physiologic dose.

Front 12

physiologic dose

Back 12

The dose given to get a person up to normal levels in body.... person was sublevel before, now will be normal.

Front 13

Steroid therapy for non-endocrine levels at pharmaceutical doses.

Back 13

considerations: the longer you give an exogenous steroid the longer you take them, the following list of problems will occur: (Cushing's syndrome)
Long term steroids is taking steroids is longer than 3 weeks.
-25% people get osteoporosis
-glucose intolerance occurs
-myopathy (wasting away of arms and legs)
-Truncal obesity, moon face, buffalo hump
-electrolyte disturbances (k+ loss, na+ retention)
peptic ulcer disease that increases with simultaneous NSAID use.
ever increasing doses will need to be given as well.

Front 14

steroid therapy patterns

Back 14

create pattern that mimics person's own personal inherent pattern as possible.
Duration: not over 3 weeks-or collateral damage will occur.
wean off...allows adrenal glands to wake up and start taking over production again.
schedule: give evey other day at higher dose.... or take each day so a normal plusatile pattern forms...at 9am... pulse happens between 8-10am
if you miss a dose, don't take another... err on side of not taking too much.

Front 15

3x3 rule

Back 15

when you are in stress, you need more steroids... call first, but then will probably take 3 times the dose for three days...but call to determine if stressor is really stressful enough to do this.

Front 16

mineralcorticoid deficiency

Back 16

s/s increases K+, decreased Na+
metabolic acidosis.
Treatment: Add dietary Na+ to diet (NCLEX question..one time you are encouraged to add salt to diet)
give: fludocortisone. SE: mostly r/t water retention. you can also end up with cushing syndrome.
other choices are prednisone or dexamethasone.

Front 17

mineralcorticoid excess- too much aldosterone

Back 17

s/s htn, dependant edema
increased Na+, decreased K+
metabolic ALKALOSIS.