Endocrine - Thyroid Pharm

Front 1

Hyopthyroid

-D.O.C.
-pharmacokinetics

Back 1

Levothyroxine (T4)

-long half-life
-stable
-potent
-inexpensive
-free of antigenicity

Front 2

Levothyroxine dosing

-normal maintenance dose
-parameters and titrations

Back 2

-NMD: 100-150ug/d

-Young patients w/o history of long standing symptoms or patients > 45 with no cardiac symptoms
Start: 50ug/d
Titrate: up 25-50 ug as required

-Elderly patients of patients with a history of cardiace symptoms
Start: 12.5-25ug/d
Titrate: ip 12.5-25ug as tolderate

Front 3

Levothyroxine

-drug interactions (6)

Back 3

All decrease concentration of levothyroxine

1. Resin binders -Cholestyramine, Colestipol
2. Aluminum containing compounds - Al-hydroxide, Sucralfate
3. Enzyme inducers: Phenytoin, Phenobarb, Rifampin, Carbamazepine
4. Raoloxifene, Estrogen
5. Setraline
6. Omeprazole

Front 4

Levothyroxine - patient counseling

-when and how to take it

Back 4

Take at the same time of day, preferably in the AM, ALWAYS on an empty stomach

Do not take with Iron or Calcium containing products

Front 5

Hyperthyroid

-D.O.C. (2)
-MOA

Back 5

1. Propylthiouracil (PTU)
2. Methimazole (MMI)

MOA: inhibits thyroid peroxidase, inhibits coupling of iodotyrosines, inhibits peripheral conversion of T4 --> T3

Front 6

Propylthiouracil and Methimazole

-adverse effects (6)
-which effects are signs to stop the medication
-which effects contraindicate switching medications

Back 6

1. Maculopapular rash
2. GI intolerance
3. Arthralgias & Lupus-like syndrome
4. Benign Transient Leukopenia
5. Hepatotoxicity -don't switch agents
6. Agranulocytosis - STOP agent - don't switch agents

Front 7

Hyperthyroid

-D.O.C. for toxic nodules, thionamide failure, elderly, cardiac disease or poor surgical candidate
-pre-treatment/adjunctive therapy

Back 7

Radioactive Iodine

-pretreat with beta-blockers and thionamides in selected patients
-post-treat with thionamides, beta-blockers or iodides