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)
o Cortisone (25 mg): short acting
o Hydrocortisone (20 mg): short acting
o Prednisone (5 mg): intermediate acting
o Prednisolone (5 mg): intermediate acting
,o Methylprednisolone (4 mg): intermediate acting
o Triamcinolone (4 mg): intermediate acting
o 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
Used for a variety of diseases including RA (typically add on therapy to MTX)
Needles are provided
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