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Name: Levothroxine or thyroxine (Levoxyl) (Levee on river, huge thighs on dude)MOA: T4 is converted to T3 (the active form) inside cells by one of two distinct deiodinases, depending on the tissueT3 binds to specific receptor proteins (alpha & beta) in the nucleus, resulting in altered gene expression, and increased formation of RNA and proteinSystemic effects include increased oxygen consumption by most tissues of the body and increases the basal metabolic rate and the metabolism of carbohydrates, lipids and proteins (Sand is T4, put into bags for T3, metabolism arrow up, shovel says activate inside the cell, alpha & beta binding sand bags)Indications: HypothyroidismPituitary TSH Suppression (in the treatment or prevention of various types of euthyroid goiters) (Low TSH and Pituitary inhibiting TSH in river)ADME: Taken orally, T4 has a longer half life (7 days) compared to T3 (1 day) (1/2 = ? days on T4 and T3)Adverse Effects: Symptoms resembling hyperthyroidism: nervousness, anxiety, tremor, heat intolerance, weight loss with increased appetite, palpitation (AE = arrow up thyroid)Notes: Children require greater doses than adults (Child carrying way more T3)

By using a __________ system, patterns of unacceptable behavior are readily identified on a tracking sheet.

Name: Codeine (Coding computer)MOA: Codeine is a pro-drug that is converted to the active metabolite, morphine by CYP2D6Morphine agonizes the mu opioid receptor in the cough center in the brainstem, which reduces the release of excitatory peptides that trigger cough (Green plus, CYP2D6 = morphine, brain with green brain stem)Clinical: Antitussive and analgesic with abuse liability (Cough and Oww in conversation bubble, radio song I want it all and I want it now)ADME: Prodrug metabolized by CYP2D6 to active metabolite. Ultrarapid metabolizers à toxicity, poor metabolizers à lack of efficacy. Dose reduction required in renal failure (Sticker on radio with kidney = arrow down)AE: Constipation, sedation. Black box warning for addiction risk, respiratory depression in ultra-rapid metabolizers, interaction with CYPs, Neonatal opioid withdrawal risk, and concomitant use of CNS depressants (like benzodiazepines (eg, Valium)) (Constipated colon mouse cord, ZZzzs on screen, black box with addiction and resp-depress on top of computer)Contraindications: pediatric patients less than 12, acute/severe bronchial asthma in an unmonitored setting, GI obstruction, concurrent use of MAOIs (within the last 14 days)Notes: Overdose S/S: CNS depression and coma, severe chest and stomach pain, respiratory depression, panic, fear of death

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