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E52 Endocrinology Common Medications Toronto Notes 2019
Thyroid Medications
Drug Class
Mechanism of Action
Generic Drug Name
Canada Name
US Name (if different)
Dosing
Indications
Contraindications
Side Effects
Antithyroid Agent (thionamides)
Decreases thyroid hormone production by inhibiting iodine and peroxidase from interacting with thyroglobulin to form T4 andT3
propylthiouracil (PTU)
Propyl-Thyracil®
Start 100 mg PO tid, then adjust accordingly Thyroid storm: start 150-300 PO qid, then adjust accordingly
Hyperthyroidism, thyroid storm
Hypersensitivity
PTU recommended in 1st trimester, MMI during 2nd and 3rd trimester
Lactation: safe with PTU <300 mg/day and MMI <20-30 mg/d
N/V
Rash
Drug-induced hepatitis Agranulocytosis Hepatitis with PTU Cholestasis with MMI
Thyroid Hormone
Synthetic form of thyroxine (T4)
levothyroxine l-thyroxine
Synthroid® Eltroxin®
Levoxyl®
0.05-2.0 mg/d, usually 1.6x weight (kg) is dose in micrograms
In elderly patients start at 0.025 mg/d
Hypothyroidism Post thyroidectomy
Recent MI, thyrotoxicosis
Ifwrongdosing:symptomsof hypothyroidismor hyperthyroidism
Skin rash from dye in pill
Antithyroid Agent Radiopharmaceutical
Radioactive isotope of iodine that is incorporated into the thyroid gland irradiating the area and destroying local glandular tissue
sodium iodide I-131
Iodotope®
Dose corrected for 24 h radioactive iodine uptake Hyperthyroidism 4-12 mCi Thyroid Ca 50-150 mCi
Hyperthyroidism Thyroid malignancy
Hypersensitivity
Concurrent antithyroid medication Pregnancy, lactation
N/V
Bone marrow suppression Sialadenitis
Thyroiditis
PTU also interferes with conversion of T4 to T3
Metabolic Bone Disease Medications
Drug Class
Mechanism of Action
Generic Drug Name
Canada Name
US Name (if different)
Dosing
Indications
Contraindications
Side Effects
Bisphosphonates
Inhibits osteoclast-mediated bone resorption
alendronate
Fosamax®
Osteoporosis:
5-10 mg OD
70 mg once weekly Paget's:
40 mg OD for 6 mo
Prevention of postmenopausal osteoporosis Treatment of osteoporosis Glucocorticoid-induced osteoporosis Paget’s disease
Esophageal stricture or achalasia (oral)
Unable to stand or sit upright for >30 min (oral) Hypersensitivity
Hypocalcemia
Renal insufficiency (CrCl <35)
History or atypical femoral fracture or osteonecrosis of the jaw
GI
MSK pain
Headache Osteonecrosis of the jaw Atypical femoral fracture
risedronate
Actonel®
Osteoporosis:
5 mg OD
35 mg once weekly 150 mg once monthly Paget's:
30 mg OD for 2 mo
Treatment and prevention of postmenopausal osteoporosis Treatment and prevention of glucocorticoid-induced osteoporosis Paget’s disease
pamidronate
Aredia®
Hypercalcemia of malignancy 60-90 mg IV over 2-24 h
Wait at least 7 d before considering retreatment
Hypercalcemia of malignancy
Paget’s disease
Osteolytic bone metastases of breast cancer Osteolytic lesions of multiple myeloma
zoledronate
Zometa® Aclasta®
5 mg IV once yearly IV
Treatment of osteoporosis
Hypercalcemia of malignancy
Treatment and prevention of skeletal complications related to cancer
methimazole (MMI)
Tapazole®
Start 5-20 mg PO OD, then adjust accordingly
Up to 60 mg OD may be required