lOMoARcPSD| 63525276
NR565 – Advanced Pharmacology Fundamentals
Final Exam Study Guide – Completed Notes (Based on Lehne’s Pharmacotherapeutics, Rosenthal
& Burchum)
Week 5 – Pharmacotherapy for Endocrine Disorders (Ch. 48–49)
Radioactive iodine (RAI) – adverse effects & key counseling
• Goal: ablate thyroid tissue → decrease thyroid hormone production; used for Graves
disease, toxic nodular goiter; also pre-op thyroidectomy prep in some settings.
• Common/expected: transient neck tenderness, mild sore throat, temporary worsening of
hyperthyroid symptoms shortly after therapy (from hormone release).
• Thyroiditis/thyroid storm risk: rare; consider beta-blocker + antithyroid pretreatment for
high-risk patients (severe thyrotoxicosis).
• Hypothyroidism: very common long-term outcome → patient should expect eventual
lifelong levothyroxine replacement and periodic TSH monitoring.
• Salivary gland effects: sialadenitis, xerostomia, taste changes; hydration and sour candy per
local protocols can help (if permitted).
• Eye disease: may worsen Graves orbitopathy; avoid/consider alternatives or use steroids in
selected patients with active/moderate-severe orbitopathy.
• Pregnancy/lactation: contraindicated in pregnancy; avoid conception for the recommended
interval after RAI; breastfeeding must be stopped prior to therapy.
• Radiation safety: follow isolation/distance instructions; avoid close contact with
children/pregnant people for the specified time; hygiene/handwashing; separate bathroom
if advised.
Methimazole – indication & MOA
• Indications: first-line antithyroid drug for Graves disease and other hyperthyroid states
(except in 1st trimester pregnancy or thyroid storm where PTU is preferred).
• MOA: inhibits thyroid peroxidase → blocks iodination of tyrosine residues and coupling
reactions → decreases synthesis of T3/T4 (does NOT block hormone release).
• Time course: symptom improvement takes weeks because preformed hormone stores must
be depleted.
• Key adverse effects: rash/pruritus, arthralgias, GI upset; rare but serious agranulocytosis
(fever/sore throat) and hepatotoxicity/cholestasis.
• Monitoring: baseline CBC and LFTs often obtained; instruct patient to stop drug and seek
care for fever, sore throat, jaundice, dark urine.
, lOMoARcPSD| 63525276
Levothyroxine – education, special populations, monitoring, interactions,
dosing & adjustments
Indications: hypothyroidism (primary/secondary), TSH suppression (selected thyroid
cancer/goiter).
Administration: take on an empty stomach with water, same time daily; separate from
calcium/iron, bile acid sequestrants, sucralfate, and some antacids by 4+ hours to avoid
absorption issues.
• Monitoring: check TSH (and free T4 when indicated) 6–8 weeks after initiation or dose
change; once stable, monitor every 6–12 months or sooner if symptoms/change in meds.
• Dose titration: adjust by small increments (e.g., 12.5–25 mcg) based on TSH and symptoms.
• Older adults/CAD: start low and go slow (risk of angina/arrhythmias).
• Pregnancy: dose requirements often increase early; check TSH frequently (about every 4
weeks early pregnancy) and adjust to trimester goals per local guidance.
• Drug interactions: decreased absorption (iron, calcium, sucralfate,
cholestyramine/colesevelam); increased metabolism (enzyme inducers); warfarin effect may
increase as euthyroidism restored; monitor INR.
• Over-replacement risks: atrial fibrillation, osteoporosis, tremor, insomnia; under-
replacement: persistent fatigue, weight gain, constipation, bradycardia.
Pioglitazone – contraindications & key risks (TZD)
• Contraindicated: symptomatic heart failure (especially NYHA III/IV); avoid in patients with
significant fluid retention.
• Key warnings: edema/weight gain, heart failure exacerbation, fractures (especially in
women), possible bladder cancer signal (avoid with active bladder cancer or unexplained
hematuria).
• MOA: PPAR-γ agonist → improves insulin sensitivity in adipose/muscle/liver; onset is
gradual (weeks).
• Monitoring: weight/edema, HF symptoms; liver enzymes if clinically indicated; A1c response
over ~3 months.
Gemfibrozil – major drug interactions
• Strong interaction with statins (esp. simvastatin) → increased myopathy/rhabdomyolysis
risk (due to altered metabolism/transport). Prefer fenofibrate if fibrate needed with statin.
• Increases warfarin effect → monitor INR closely and adjust dose.
• Can increase levels of some diabetes meds; monitor for hypoglycemia when combined with
insulin/secretagogues.
• Mechanism: fibrate (PPAR-α agonist) → lowers TG, modestly raises HDL; most useful for
severe hypertriglyceridemia.
NR565 – Advanced Pharmacology Fundamentals
Final Exam Study Guide – Completed Notes (Based on Lehne’s Pharmacotherapeutics, Rosenthal
& Burchum)
Week 5 – Pharmacotherapy for Endocrine Disorders (Ch. 48–49)
Radioactive iodine (RAI) – adverse effects & key counseling
• Goal: ablate thyroid tissue → decrease thyroid hormone production; used for Graves
disease, toxic nodular goiter; also pre-op thyroidectomy prep in some settings.
• Common/expected: transient neck tenderness, mild sore throat, temporary worsening of
hyperthyroid symptoms shortly after therapy (from hormone release).
• Thyroiditis/thyroid storm risk: rare; consider beta-blocker + antithyroid pretreatment for
high-risk patients (severe thyrotoxicosis).
• Hypothyroidism: very common long-term outcome → patient should expect eventual
lifelong levothyroxine replacement and periodic TSH monitoring.
• Salivary gland effects: sialadenitis, xerostomia, taste changes; hydration and sour candy per
local protocols can help (if permitted).
• Eye disease: may worsen Graves orbitopathy; avoid/consider alternatives or use steroids in
selected patients with active/moderate-severe orbitopathy.
• Pregnancy/lactation: contraindicated in pregnancy; avoid conception for the recommended
interval after RAI; breastfeeding must be stopped prior to therapy.
• Radiation safety: follow isolation/distance instructions; avoid close contact with
children/pregnant people for the specified time; hygiene/handwashing; separate bathroom
if advised.
Methimazole – indication & MOA
• Indications: first-line antithyroid drug for Graves disease and other hyperthyroid states
(except in 1st trimester pregnancy or thyroid storm where PTU is preferred).
• MOA: inhibits thyroid peroxidase → blocks iodination of tyrosine residues and coupling
reactions → decreases synthesis of T3/T4 (does NOT block hormone release).
• Time course: symptom improvement takes weeks because preformed hormone stores must
be depleted.
• Key adverse effects: rash/pruritus, arthralgias, GI upset; rare but serious agranulocytosis
(fever/sore throat) and hepatotoxicity/cholestasis.
• Monitoring: baseline CBC and LFTs often obtained; instruct patient to stop drug and seek
care for fever, sore throat, jaundice, dark urine.
, lOMoARcPSD| 63525276
Levothyroxine – education, special populations, monitoring, interactions,
dosing & adjustments
Indications: hypothyroidism (primary/secondary), TSH suppression (selected thyroid
cancer/goiter).
Administration: take on an empty stomach with water, same time daily; separate from
calcium/iron, bile acid sequestrants, sucralfate, and some antacids by 4+ hours to avoid
absorption issues.
• Monitoring: check TSH (and free T4 when indicated) 6–8 weeks after initiation or dose
change; once stable, monitor every 6–12 months or sooner if symptoms/change in meds.
• Dose titration: adjust by small increments (e.g., 12.5–25 mcg) based on TSH and symptoms.
• Older adults/CAD: start low and go slow (risk of angina/arrhythmias).
• Pregnancy: dose requirements often increase early; check TSH frequently (about every 4
weeks early pregnancy) and adjust to trimester goals per local guidance.
• Drug interactions: decreased absorption (iron, calcium, sucralfate,
cholestyramine/colesevelam); increased metabolism (enzyme inducers); warfarin effect may
increase as euthyroidism restored; monitor INR.
• Over-replacement risks: atrial fibrillation, osteoporosis, tremor, insomnia; under-
replacement: persistent fatigue, weight gain, constipation, bradycardia.
Pioglitazone – contraindications & key risks (TZD)
• Contraindicated: symptomatic heart failure (especially NYHA III/IV); avoid in patients with
significant fluid retention.
• Key warnings: edema/weight gain, heart failure exacerbation, fractures (especially in
women), possible bladder cancer signal (avoid with active bladder cancer or unexplained
hematuria).
• MOA: PPAR-γ agonist → improves insulin sensitivity in adipose/muscle/liver; onset is
gradual (weeks).
• Monitoring: weight/edema, HF symptoms; liver enzymes if clinically indicated; A1c response
over ~3 months.
Gemfibrozil – major drug interactions
• Strong interaction with statins (esp. simvastatin) → increased myopathy/rhabdomyolysis
risk (due to altered metabolism/transport). Prefer fenofibrate if fibrate needed with statin.
• Increases warfarin effect → monitor INR closely and adjust dose.
• Can increase levels of some diabetes meds; monitor for hypoglycemia when combined with
insulin/secretagogues.
• Mechanism: fibrate (PPAR-α agonist) → lowers TG, modestly raises HDL; most useful for
severe hypertriglyceridemia.
