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NAPLEX EXAM 2025

Key drugs that can cause hypothyroidism - ANSWER--"I TALC" Interferons

Tyrosine Kinase Inhibitors

Amiodarone Lithium Carbamazepine

Conditions: Hashimoto's disease

Levothyroxine IV:PO - ANSWER--0.75:1 (IV:PO)

Full replacement dose levothyroxine - ANSWER--1.6 mcg/kg/day (IBW) If known CAD: start with 12.5-25 mcg daily

Levothyroxine tablet colors - ANSWER--Orangutans Will Vomit On You Right

Before They Become Large Proud Giants

25 Orange

50 White (no dye)

75 Violet

88 Olive

100 Yellow

112 Rose

125 Brown

137 Turquoise

150 Blue

175 Lilac

200 Pink

300 Green

Drug induced causes of hyperthyroidism - ANSWER--Iodine

Amiodarone

Interferons

Radiographic contrast media

treatment for thyroid storm - ANSWER--Antithyroid (PTU preferred- give 1 hour before iodide)

Inorganic iodide therapy (SSKI or Lugol's) Beta Blocker (Propranolol)

Systemic steroid (dexamethasone)

Aggressive cooling (APAP, cooling blankets, supportive treatments)

Hyperthyroid in pregnancy - ANSWER--Hyperthyroidism during pregnancy should be treated with propylthiouracil (PTU) during the first trimester then methimazole during the second and third trimesters. Although methimazole is a teratogen, the teratogenic effects are less during the second and third trimesters, and PTU can cause liver failure, which is why it is substituted out.

Cushing's syndrome - ANSWER--Adrenal gland produces too much cortisol or exogenous steroids are taken in doses higher than normal amounts of endogenous cortisol

Addison's disease - ANSWER--a condition that occurs when the adrenal glands do not produce enough cortisol; Addisonian crisis (volume depletion and hypotension, which can be fatal)

Steroids: least to most potent - ANSWER--(Cute Hot Pharmacists and Physicians

Marry Together & Deliver Babies)

Cortisone (25 mg): short acting
Hydrocortisone (20 mg): short acting
Prednisone (5 mg): intermediate acting
Prednisolone (5 mg): intermediate acting
Methylprednisolone (4 mg): intermediate acting o Triamcinolone (4 mg): intermediate acting
Dexamethasone (0.75 mg): long acting, highest potency o Betamethasone (0.6 mg): long acting, highest potency

Immunosuppression from steroids - ANSWER--A patient is immunosuppressed when using >/= 2mg/kg/day or >/= 20mg/day of prednisone or prednisone equivalent for >2 weeks

Immunosuppressed patients cannot receive live vaccines and have a high risk of infection

steroid will need to be slowly tapered off: reduce 10-20% every few days (tapers can last 7-14 days, longer or shorter)

Traditional DMARDs (disease modifying anti-rheumatic drugs) - ANSWER-- MTX (Trexall): first line in RA

Hydroxychloroquine (Plaquenil) Sulfasalazine

Leflunomide (Arava)

Traditional DMARDs (disease modifying anti-rheumatic drugs): MTX - ANSWER--MTX (Trexall): first line in RA

irreversibly binds and inhibit dihydrofolate reductase, inhibiting folate
7.5 to 20 mg once weekly
hepatotoxicity (avoid alcohol), myelosuppression, mucosistis/stomatitis, teratogenic
monitor: CBC, LFTs, chest X-ray, hep B/C
folate replacement
renal elimination is decreased by aspirin/NSAIDs

Traditional DMARDs (disease modifying anti-rheumatic drugs):

hydroxychloroquine - ANSWER--Hydroxychloroquine (Plaquenil)

Irreversible retinopathy
take with food or milk
alternative to MTX in liver disease

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