PoP II Exam 3 (Dr. Kuhl) Drug Charts- Steroids and Thyroid

Glucocorticoid Medications

Betamethasone, Dexamethasone (Decadron), Methyprednisolone (Medrol, Solumedrol), Triamcinolone, Prednisolone (Millipred, Orapred, Prelone), Prednisone, Hydrocortisone (Solu-cortef, Cortef), Cortisone

Cortisone Equivalent Dose

25

Hydrocortisone Equivalent Dose

20

Prednisone/Prednisolone Equivalent Dose

5

Methylprednisolone Equivalent Dose

4

Dexamethasone Equivalent Dose

0.75

Which glucocorticoids are pro-drugs and require hepatic activation?

Cortisone and prednisone

Glucocorticoid Indications

Acute exacerbation of COPD or asthma

Glucocorticoids with Short DOA

Cortisone and hydrocortisone

Glucocorticoids with Intermediate DOA

Prednisone, Prednisolone, Methylprednisolone, and Triamcinolone

Glucocorticoids with Long DOA

Dexamethasone and Betamethasone

Glucocorticoid Contraindications

Use with caution in fungal infection. Avoid with live attenuated vaccines.

Glucocorticoid Precautions

Glaucoma; activation of latent infection

Glucocorticoid Acute Adverse Effects

Increased appetite, weight gain, sodium/water retention, hypokalemia, CNS effects (euphoria, mood swings, irritability, confusion, psychosis, insomnia), indigestion, HTN, hyperglycemia, immunosuppression, impaired wound healing, acne, myopathy, and masks symptoms of infection

Glucocorticoid Chronic Adverse Effects

Cushing syndrome (moon face, abdominal fat, buffalo hump, somatic muscle wasting), dermal thinning, bruising, diabetes, glaucoma, cataracts, amenorrhea, growth retardation, acne, pancreatitis, GI bleed/esophagitis/ulcers, osteoporosis/fractures, immunosuppression, and hirsutism

Mineralocorticoid Medications

Fludrocortisone (Florinef)

Mineralocorticoid Indications

Addison’s disease to treat hyponatremia

Mineralocorticoid Precautions

Liver dysfunction

Mineralocorticoid Common Adverse Effects

Sodium/water retention, hypokalemia, hyperglycemia, and myopathy

Mineralocorticoid Serious Adverse Effects

Chronic heart failure and hypercortisolism

Basal rate of secretion of steroids

10 mg/d

Physiologic stress secretion rate

250 mg/d

Natural/Synthetic Thyroid Hormone Mechanism of Action

Levothyroxine (T4) is converted to active T3. THyroid hormone (T4 and T3) bind to nuclear supra family, causing DNA and protein transcription and translation, effect on growth and development, increase basal metabolic rate, reverse the biochemical abnormalities of hypothyroidism, restore normal thyroid hormone levels, provide relief from hypothyroidism symptoms.

Natural/Synthetic Thyroid Hormone Medications

T4- Levothyroxine (Unithroid, Levoxyl, Synthroid), T3- Liothyronine, Natural/desiccated thyroid hormone (Armour Thyroid)

Thyroid Hormone-Amiodarone Drug Interactions

Can cause hypo or hyperthyroidism. Inhibits synthesis and peripheral conversion of T4 to T3. Initially increases release due to iodine.

Thyroid Hormone-Warfarin Drug Interaction

Decrease dose in hyperthyroidism. Hyperthyroidism increases clearance of clotting factors causing an increase in INR. Hypothyroidism decreases clearance of clotting factors causing a decrease in INR.

Thyroid Hormone-Digoxin Drug Interaction

Decrease dose in hypothyroidism due to decreased drug clearance.

Thyroid Hormone-Antidiabetics Drug Interaction

Decreased effect in hypothyroidism. Increases peripheral insulin resistance in hypothyroidism.

Thyroid Hormone-CYP450 Inducer Drug Interaction

Increase metabolism of T4

Thyroid Hormone-Lithium Drug Interaction

Causes hypothyroidism

Thyroid Hormone-Sedative/Analgesic Drug Interaction

Decrease dose in hypothyroidism. More sensitive to CNS depressant effects in hypothyroidism.

T4 Adverse Effects

Symptoms like hyperthyroidism, menstrual irregularities, increased HR, restlessness, insomnia, heat intolerance, tremor, and weight loss

Thioamide/Thiourea Mechanism of Action

Inhibits iodine organification and inhibits thyroid peroxidase catalyzed reaction → blocks thyroid hormone synthesis. PTU also inhibits peripheral conversion of T4 to T3.

Thioamide/Thiourea Medications

Propylthiouracil (PTU) and methimazole (MMI)

Natural/Synthetic Thyroid Hormone Boxed Warning

Not for obesity and weight loss

Thioamide/Thiourea Boxed Warning

Hepatotoxicity (monitor first 6 months of treatment)

Thioamide/Thiourea Adverse Effects

Pruritic maculopapular rash, GI upset, agranulocytosis

Radioactive Iodine Mechanism of Action

Necrosis and destruction of the thyroid gland

Radioactive Iodine Contraindication

Pregnancy or nursing

Radioactive Iodine Adverse Effects

Hypothyroidism (months to years later) and increases thyroid hormone release initially

Potassium Iodide Mechanism of Action

Inhibits thyroglobulin (Tg) proteolysis which leads to a decrease in the size and vascularity of the thyroid gland

Potassium Iodide Boxed Warning

Instruct patients on use and emergency measures in radiation emergency

Potassium Iodide Adverse Effects

Hypersensitivity reaction, swollen salivary gland, mucus membrane ulceration, and “iodism” (metallic taste, burning mouth and throat, and GI upset)