2. Drugs used in Thyroid disorders
Hawler medical university
Collage of pharmacy/ fourth year /pharmacy practice
Sham A. Talat Shareef
(B.Sc . Msc . clinical pharmacy)
Head of Department Of Clinical Pharmacy in DOH

7. Carbimazole

8. Carbimazole INDICATIONS: Hyperthyroidism
Classification :antithyroid drugs
CONTRA-INDICATIONS: Severe blood disorders
SIDE-EFFECTS▶ Common or very common
Arthralgia .
fever .
headache .
jaundice .
malaise .
mild gastro-intestinal disturbances .
nausea .
pruritus .
rash .
taste disturbance.

9. PATIENT AND CARER ADVICE
Warn patient or carers to tell doctor immediately if sore throat, mouth ulcers, bruising, fever, malaise, or non-specific illness develops. Medication dosage form :tablets

10. Important safety information
NEUTROPENIA AND AGRANULOCYTOSIS
Doctors are reminded of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly.
Patient should be asked to report symptoms and signs suggestive of infection, especially sore throat.
A white blood cell count should be performed if there is any clinical evidence of infection.
Carbimazole should be stopped promptly if there is clinical or laboratory evidence of neutropenia.

11. Propylthiouracil trade name

12. Propylthiouracil INDICATIONS : Hyperthyroidism
SIDE-EFFECTS:▶ Common or very common
Arthralgia .
fever .
headache .
jaundice .
leucopenia .
malaise .
mild gastro-intestinal
disturbances .
nausea .
pruritus .
rash .
taste disturbance

13. SIDE-EFFECTS, FURTHER INFORMATION
Hepatotoxicity Severe hepatic reactions have been reported, including fatal cases and cases requiring liver transplant discontinue if significant liver-enzyme abnormalities develop.

14. PATIENT AND CARER ADVICE PATIENTS
should be told how to recognise signs of liver disorder and advised to seek prompt medical attention if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice, dark urine, or pruritus develop. MEDICINAL FORMS: Tablet

15. Iodide with iodine

16. Iodide with iodine CLASSIFICATION: ESSENTIAL TRACE ELEMENTS
SIDE-EFFECTS :
Bronchitis .
conjunctivitis .
depression (on prolonged treatment) .
Goitre in infants of mothers taking iodides .
headache .
hypersensitivity reactions .
impotence (on prolonged treatment) .
insomnia (on prolonged treatment) .
lacrimation .
laryngitis .
pain in salivary glands .
rashes.

17. Iodide with iodine
DIRECTIONS FOR ADMINISTRATION For oral solution: dilute well with milk or water.
MEDICINAL FORMS:
Oral solution IODIDE WITH IODINE (Non-proprietary) Iodine 50 mg per 1 ml, Potassium iodide 100 mg per 1 m

18. PROPRANOLOL TRADE NAME

19. Propranolol hydrochloride
Classification: non selective beta blocker
INDICATIONS :
Thyrotoxicosis
Thyrotoxic crisis
Hypertension
Prophylaxis of variceal bleeding in portal hypertension
Phaeochromocytoma (only with an alpha-blocker) in preparation for surgery

20. INDICATIONS
Phaeochromocytoma (only with an alpha blocker) in patients unsuitable for surgery
Angina
Hypertrophic cardiomyopathy
Anxiety tachycardia
Anxiety with symptoms such as palpitation, sweating and tremor.

21. INDICATIONS Prophylaxis after myocardial infarction Essential tremor
Migraine prophylaxis
Arrhythmias

22. PRESCRIBING AND DISPENSING INFORMATION
Modified release preparations can be used for once daily administration.
MEDICINAL FORMS:
Tablet.
Modified released capsule .
Oral solution.

23. Levothyroxine trade names

24. Levothyroxine sodium INDICATIONS : Hypothyroidism
Hypothyroidism in patients with cardiac disease
Severe Hypothyroidism
Hyperthyroidism (blocking-replacement regimen) in combination with carbimazole
CONTRA-INDICATIONS :Thyrotoxicosis

25. SIDE-EFFECTS Anginal pain (usually at excessive dosage) .
arrhythmias (usually at excessive dosage) .
diarrhoea(usually at excessive dosage) .
excitability (usually at excessive dosage) .
fever .
flushing .
headache .
heat intolerance .

26. SIDE EFFECTS hypersensitivity reactions .
insomnia (usually at excessive dosage) .
muscle cramp .
muscular weakness .
oedema .
palpitation (usually at excessive dosage) .
pruritus .

27. SIDE EFFECTS rash . restlessness (usually at excessive dosage) .
sweating .
tachycardia (usually at excessive dosage) .
transient hair loss in children .
tremor (usually at excessive dosage) .
vomiting (usually at excessive dosage).
weight-loss

28. SIDE-EFFECTS, FURTHER INFORMATION
Initial dosage in patients with cardiovascular disorders If metabolism increases too rapidly (causing diarrhoea, nervousness, rapid pulse, insomnia, tremors and sometimes anginal pain where there is latent myocardial ischaemia), reduce dose or withhold for 1–2 days and start again at a lower dose

29. Administration patient education
Levothyroxine is more effective when taken in empty stomach or half an hour before morning meal. It is important to take levothyroxine at the same time each day. 

30. MEDICINAL FORMS:
Tablet
Oral solution

33. Alendronate trade name

34. Alendronic acid or Alendronate (fosmax)
INDICATIONS :
Treatment of postmenopausal osteoporosis
Treatment of osteoporosis in men
Prevention and treatment of corticosteroid-induced osteoporosis in postmenopausal women not receiving hormone replacement therapy
Pagets disease of bone

35. PATIENT AND CARER ADVICE
Atypical femoral fractures Patients should be advised to report any thigh, hip, or groin pain during treatment with a bisphosphonate. Osteonecrosis of the jaw During bisphosphonate treatment patients should maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms.

37. Alendronate CONTRA-INDICATIONS: Abnormalities of oesophagus .
hypocalcaemia .
other factors which delay emptying (e.g.
stricture or achalasia)

38. Alendronate SIDE-EFFECTS ▶ Common or very common
Abdominal distension .
abdominal pain .
alopecia .
asthenia .
constipation .
diarrhoea .
dizziness .

39. Side effects dyspepsia . flatulence . headache . joint swelling .
musculoskeletal pain .
esophageal reactions .
peripheral oedema .
pruritus .
regurgitation .
vertigo

41. Alendronate
MEDICINAL FORMS
Tablet (Fosamax)
Oral solution

42. Risedronat trade name

43. Risedronat sodium ( Actonel)
INDICATIONS :
Paget’s disease of bone
Treatment of postmenopausal osteoporosis to reduce risk of vertebral or hip fractures
Prevention of osteoporosis (including corticosteroid induced osteoporosis) in postmenopausal women
Treatment of osteoporosis in men at high risk of fractures
MEDICINAL FORMS: tablets

44. Risedronat sodium ( Actonel)
CONTRA-INDICATIONS: Hypocalcaemia SIDE-EFFECTS: ▶ Common or very common Abdominal pain . constipation . diarrhoea . dyspepsia . headache . musculoskeletal pain . Nausea.

45. DIRECTIONS FOR ADMINISTRATION
Swallow tablets whole with full glass of water; on rising, take on an empty stomach at least 30 minutes before first food or drink of the day or, if taking at any other time of the day, avoid food and drink for at least 2 hours before or after risedronate (particularly avoid calcium-containing products e.g. milk; also avoid iron and mineral supplements and antacids); stand or sit upright for at least 30 minutes; do not take tablets at bedtime or before rising.

46. PATIENT AND CARER ADVICE
Patients or carers should be given advice on how to administer risedronate sodium tablets. Oesophageal reactions Patients should be advised to stop taking the tablets and seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, pain on swallowing, retrosternal pain, or heartburn