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38 Cards in this Set
- Front
- Back
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Rx Methimazole |
10 mg 3 tabs QD
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Methimazole vs. Propylthiouracil |
methimazole has longer ½ life – QD dosing vs. propylthiouracil which is TID; Propylthiouracil inhibits peripheral deiodination (T4 to T3); better if pregnant; 3-8 weeks to work
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ADRs: propylthiouracil
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BLACK BOX: liver failure; Agranulocytosis
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Workup before prescribing methimazole?
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Get baseline CBC w/ diff; tell pt they need to report sore throat, fever
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risk for agranulocytosis
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Risk of “forties” – doses >40 mg/day methimazole; pts >40 y/o
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ADRs: methimazole
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agranulocytosis? N/V, skin pigmentation, joint pain, hepatitis, nephritis
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Rx Levothyroxine
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100 mcg QD
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Most sensitive/reliable test for hypothyroidism
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serum TSH (Evaluate at 35 y/o, then q5y)
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What is Liothyronine (Cytomel)
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can be used fro hypothyroid; only contains T3
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Levothyroxine = best b/c…
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Free of antigenicity, Long half-life, Allows for careful/exact titration, “Cost effective”
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Monitoring pt taking levothyroxine
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TSH q4-8wks till stable, then q 6-12 mo
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ADRs: levothyroxine
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unlikely; insomnia, tachycardia, nervousness
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drugs that Increase metabolism of levothyroxine
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Carbamazepine, phenytoin, rifampin, sertraline
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drug that Impairs T4 to T3 conversion
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Amiodarone
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Myxedema coma Tx
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corticosteroids, then levothyroxine
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Non-steroidal compounds w/ estrogenic properties
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Flavones, Isoflavones, Coumestan derivatives
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Lifestyle mod. for menopause
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Diet, exercise, healthy wt; no smoking, limit EtOH
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Tx “hot flashes”
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mild → lifestyle changes; mod/severe → hormone therapy (paroxetine)
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Estrogen oral
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Premarin 0.625 one tab QD (3 wks on, 1 wk off)
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Estrogen patch
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Estradiol transdermal patch (weekly) 00.25 mg/24 hrs
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Estrogen/medroxyprogesterone oral
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PremPro 0.625 mg/2.5 mg one tab QD
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Rx Medroxyprogesterone
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5 mg one tab QD x5-10d (starting Day 16 or 21 of cycle)
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Indication for medroxyprogesterone
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amenorrhea, menopause, ART (Or: maintenance of pregnancy, endometriosis)
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ADRs: medroxyprogesterone
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wt gain, abd pain, menstrual issues
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Estrogen/Progestin oral
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Loestrin 1/20 - 1 cycle (28 tabs) one tab QD
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ADRs: Loestrin
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nausea, wt gain, mood changes, mastalgia, thrombophlebitis
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Rx Anabolic-Androgenic Steroid
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Axiron soln – 30 mg/actuation 90 ml (apply 60 mg to axilla same time each morning)
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Anabolic-androgenic steroids only work IF
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Prior/continued strength training, high caloric/protein diet; Measured via single repetition max wt
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ADRs: AA steroid use (normal)
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wt gain, gynecomastia, cardiac (high LDL, low HDL, high BP, stroke/MI risk), liver issues (benign tumors), long PTT
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ADRs: AA steroid abuse
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endocrine (impotence, shrinkage, low T4), hematological (high Hgb, Hct), dermatological (acne, baldness)
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Rx Glucocorticoids
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Prednisone – 5 to 60 mg QD
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ADRs: prednisone
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osteoporosis, hyperglycemia, wt gain, glaucoma, depression/euphoria
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ADRs prednisone assoc. w/ Long term, large doses
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adrenal & immune suppression; osteoporosis, seizure risk, repressed growth velocity
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Caution using prednisone if:
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HF, diabetes, electrolyte disturbances, renal impairment
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ADRs: mineralocorticoids
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edema, HTN, delirium, peptic ulcers, hives, etc
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Rx mineralocorticoid
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Fludrocortisone (Florinef) - 0.1 mg QD
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Fludrocortizone labeled for
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Addison’s, Tx of salt-losing adrenogenital syndrome (In Addison’s: only 3x/week; pair w/ cortisone)
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Off-label fludrocortisone?
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idiopathic orthostatic HOTN w/ increased Na+ intake |
