PHARM II EXAM 2 ENDOCRINE HINTSCause growth retardation in PEDSHypothyroidismEmergency hypothyroid conditionMyxedema Coma

Drug of choice for HypothyroidLevothyroxine(start dose at 50mcg)Periorbital puffinessHypothyroidism

Causes of Myxedema ComaCold exposure, infection, analgesics, sedatives, respiratory, other severe illnessExcessive doses of Thyroid h. Heart Failure / AnginaMI / BMD

TX: IV thyroid hormone, steroid, mech ventilationDrugs that T4 clearance (CYP 450 inducers)Thyroid h. replacement1. Carbamezapine2. Rifampin3. Phenytoin CRP

Thionamide MEDSPropylthiouracil (PTU)Methimazole (Tapazole)Drug that blocks conversion of T4T3Amiodarone

Inhibits T4T3Preferred in pregnancyPTUScanty / irregular menses BMs / fine hairSXs of Hyperthyroidism

Major SE of ThionamidesAgranulocytosis(w/n 3 months of start)Inhibits peroxidase (Iodide Iodine)Thionamides

Iodism:(SE of Iodide, used to block thyroid h. release)1. Metallic taste2. Burning mouth3. Sore gingiva4. Gynecomastiaadjunctive therapy with surgery to acutely inhibit thyroid hormone releaseIodide

size & vascularity of gland

Contraindications of BBsDecompensated or severe CHF, cardiomyopathy, asthmaDevelop necrosis & fibrosis of interstitial tissueRadioactive Iodide(Sodium Iodide 131)

If thyroidectomy is planned, steps PTU or Methimazole given prior to surgeryBBs used adjunctively for Symptoms: Palpitations, anxiety, tremor, & heat intolerance

Hyperthyroid medical emergencyThyroid storm

TX: BBs (dont prevent), IV fluids, PTU, Iodides (after PTU)Leuprolide (Lupron)

Continuous dosing: Suppress growth of endometriosis / prostate CAGnRH Med to secrete FSH / LH

Pulsatile dosing: Cause ovulation in pts w/ central amenorrhea

IV (continuous drip) to prevent GI bleeding from esophageal varicesOctreotide (Sandostatin)Somatostatin analog

Reduce portal pressure in portal HTNGiven to postpartum bleeding (IV drip)Oxytocin (Pitocin)(may cause HTN)

Used for Central DIand TX of enuresisVasopressin (DDAVP)ADHNasal spray formulation for bed wettingVasopressin (DDAVP)

Smooth/ moist skin, unusually fine hairHyperthyroidismDry skin, course hair, slowed/hoarse speechHypothyroidism

Yellow = underlined portions of the lectureFine tremor (of protruded tongue, outstretched hands)Hyperthyroidism