Harvoni treatment for hep C?
- Combination therapy: Sofosbuvir (Sovaldi) and ledipasvir.
- Introduced in 2014 and seems to be very effective with few side effects.
- 95K which is still cheaper than a new liver.
Protease inhibitor used in Hep C patients
Polymerase inhibitor. Blocks protein that hep C needs to grow.
Medication for Growth hormone deficiency?
- Somatropin (genotropin) used to treat growth failure in children
- Injection only abdomin/ Thigh prefered sites. it's identical to HGH
- Used to treat dwarfism
- SE: Hyperglycemia, hypothyroidism, edema of hands and feet.
- Therapeutic class: Growth Hormone
- Preg Cat: C or D
- MOA: recombinant polypeptide hormone with primary structure identical to that of HGH
- Indications: Dwarfism, small stature, GH deficiency
- Contraindications: severe respiratory impairments
- Adverse: Edema-peripheral edema up to 42%, blood dyscrasia, arthralgia, headaches, rhinitis, flu like symptoms.
- Labs: They will check IGF-Insulin like growth factor, along with checking Thyroid function, diabetes
Monitor for this during HGH replacement
- Height and weight
- give in evening
- assess glucose and thyroid levels
- assess dietary intake
- May need injection each day or a few times a week.
Too much HGH, treated with radiation/ surgery remove pituitary tumor
Excess HGH in adults leading to excess bone growth. Treated with medications or removal of pituitary tumor
octreotide (Sandostatin) Growth hormone antagonist
- Therapeutic class: endocrine-metabolic agent
- Preg Cat: B or C
- Route: SC/IM
- MOA: Blocks release of HGH from the pituitary gland, but also block GI hormones such as gastrin, Cholecytokinin and vasoactive intestinal peptide.
- Indications: acromegaly, carcinoid
- Contraindications: hypersensitivity, obviously dwarfism
- Adverse: GI discomfort, Nausea/vomiting
- Interactions: phenothiazines for epilepsy
- Labs: GH levels
- Alerts: May cause hypoglycemia, EKG changes, may need B12 injections due to inhibition of GI hormones.
- Instructs kidneys to retain water
- Diabetes insipidus which causes retention of water due to too little ADH-damage to pituitary gland
- Symptoms: polydipsia, polyuria, fatigue, dehydration, constipation, and poor skin turgor.
desmopressin (DDAVP, Stimate) Synthetic analog of human ADH with a longer action
- Therapeutic class: Antidiuretic hormone replacement
- Pharm class: Vasopressin analog
- Preg Cat: B
- Route: intra nasally, orally, IV or SC
- MOA: Increases renal tubule permeability, increasing water resorption, also has vasoconstrictive effects. Will only work with DM Insipidus not Nephrogenic Insipidus.
- Indications: Diabetes Insipidous, nocturnal enuresis, also useful for hemophilia due to the increase in clotting factor VIII
- Contraindications: Renal failure. also used with caution in patients with CAD, HTN, Hyponatremia or DVTs.
- Adverse: Water toxicity, monitor for fluid overload.
- Interactions: Increased ADH with NSAIDs, carbamazepine, chlorpropamide. Decreased ADH with lithium, alcohol, heparin and epinephrine.
- Labs: Monitor electrolytes or imbalances.
Levothyroxine (Levothyroid) Synthetic T4 used for primary hypothyroidism
- Therapeutic class: Thyroid hormone
- Preg Cat: A
- MOA: Increases the metabolic rate, increases oxygen consumption, respiration and heart rate. Increases the rate of fat, protein and carbohydrate metabolism. Doses are highly individualized. Takes 1-3 weeks to achieve full effect. Start low-go slow Take on empty stomach 1/2 hour before meal. Low TSH usually means the dose needs to be increased.
- Indications: Hypothyroidism
- Contraindications: Severe cardiovascular conditions and used with caution in patients with adrenal insufficiency and HTN. DM may become worse and antidiabetic drugs may require adjustments.
- Adverse: report chest discomfort, irregular or fast HR, nervousness, insomnia. (S&S of excess TH)
- Interactions: Calcium or iron may interfere with absorption, highly protein bound, Concurrent use with warfrain may cause potentiation of coumadin. Also dilantin potentiation.
- Labs: (TSH, T3, T4 levels), Has narrow therapeutic index, Assess Glucose. Regular lab checks with this medication.
- Alerts: Caution with HR above 100
PTU: Propyl-thio-uracil for hyperthyroidism if medications are required.
- Therapeutic class: hyperthyroidism
- Pharm: anti-thyroid
- Preg Cat: D
- MOA: Suppress of conversion of T4 to T3, may takes months of therapy. Take medication same time each day.
- Indications: An overproducing thyroid
- Contraindications: hypothyroidism
- Adverse: Rash, swollen lymph nodes, sore throat, fever. Can cause aplastic anemia, agranulocytosis
- Interactions: Increases actions of anticoagulants
- Labs: PT time may increase, also may increase AST, ALT and ALP
- Alerts: HR >100 or < 60
Medications for Parathyroid issues?
Calcitriol (Rocaltrol): vitamin D analog helps with calcium deposition. increases serum calcium as well by promoting calcium absorption from intestinal tract increasing levels. Duration of action 3-5 days.
conserve water and sodium
Prepares body for fight or flight, effects metabolism of cells
Most corticoids have a combination of mineral and gluco corticoids. However, which is higher?
Glucocorticoids with a little mineralcorticoid.
Glucocorticoid do what to the body?
- Increase glucose by inhibiting insulin secretion and promoting gluconeogenesis
- Increase breakdown of proteins and aminoacids
- increase breakdown of lipids
- suppress inflammatory response
- Increased sensitivity of smooth vascular to norepinephrine and angiotensin II, thus modifying smooth muscle tone.
- Increased break down of boney matrix
- affect mood and maintain nerve excitability
- Promotes bronchodilation
- stablizes mast cells=inflammation
SE of Glucocorticoids?
- protein depletion
- behavior changes(suicide)
- increased risk of infection
- removal of fatty layer of skin-increased bruising
What age should GH not be given?
Hydrocortisone (Cortef, Hydrocortone, others)
- Therapeutic class: Adrenal Hormone
- Preg cat: C
- MOA: Identical to natural hormone cortisol. Drug of choice for adrenocortical insuficiency. 6 types of salts (base, acetate, cypionate, sodium phosphate, sodium succinate and valerate)
- Indications: Adrenal Hypofunction, also given for inflammation, allergic disorders, and many other conditions.
- Contraindications: hypersensitivity, known infections, unless being treated concurrently, osteoporosis, diabetes, liver disease, hypothyroidism.
- Adverse: Rare when given in low doses, however high doses can lead to cushings syndrome. similar to other high dose corticosteroids.
- Labs: May increase serum values for glucose, cholesterol, sodium, uric acid, or calcium. may increase serym value for potassium and T3/T4.
- Interactions: Barbiturates, phenytoin, rifampin may increase hepatic metabolism thus decreasing hydrocortisone levels. Estrogen potentiates hydrocortisone. Concurrent use with nsaids increases the risk of peptic ulcers. There are many interactions depending on dosage. Check drug to drug interactions before given if it's a high dose so you can be aware of possible adverse effects.
Drugs similar to hydrocortisone?
- Dexamethasone: 20-30 times more potent than hydrocortisone.
- Prednisone: 4 times more potent than hydrocortisone.
High or low dose of corticosteroids for hypo functioning adrenal gland ?
- Usual dose of Prednisone for addison’s disease is 7.5 mg/day.
- Dose of prednisone Chron’s disease is 40- 60 mg/day
Ketoconazole (Nizoral)-useful for someone with cushings disease-caused by systemic use of corticosteroids or adrenal/pituitary tumors
- an antifungal blocks the synthesis of corticosteroids, lowering serum levels.Can develop tolerance
- Teratogenic in animals
fludrocortisone (Florinef)-adrenal mineralocorticoid
- Acts on the distal renal tubule to promote sodium and water reabsorption, and increased urinary potassium excretion
- Has an additive effect with Thiazide and loop diuretics Monitor for hypokalemia and teach patients for S&S ( muscle weakness, numbness/fatigue, mental depression, anorexia )