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37 Cards in this Set
- Front
- Back
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General sx of hyperthyroidism
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Tachycardia, diarrhea, sensitive to heat, weight loss
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General symptoms of hypothyroidism
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Bradycardia, constipation, sensitivity to cold, weight gain, edema, falling eye brows
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Types of hypothyroidism
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Hashimoto's (high anti-TPO lvl)
Iatrogenic, congenital, resistance to thyroid |
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Types of hyper thyroid
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Graves, multi nodular goiter
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Normal TSH levels
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O.3-5 ui/L or something
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CVD CAD and levothyroxine
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Start with 12.5 ug/d and taper up every month by 25
Exacerbation of angina |
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TSH monitoring
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2-6 months after dose change
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Hyperthyroid pregnancy drug of choice
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PTU - also stops peripheral conversion of t4 to t3, mmi does not
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PTU side effect
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More agranulocytosis, than MMI
Monitor: cbc lft |
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MMI side effect
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Nephrotoxicity
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Thyroid storm
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PTU, propranolol, KI (lugol's), rehydration
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Heparin induced thrombocytopenia sx
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Immune response to heparin
May progress to clot formation in artery or vein |
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Oral co's have what effect on thyroid?
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Increase T4 levels, takes 4 weeks to return to normal after d/c
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Levo absorption decreased by?
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Fe, Ca, cholestyramine (resin), colestipol, sucralfate, lots of protein?
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Hyperthyroid increases?
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INR
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DVT - 2ndary prophylaxis duration
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10 days - post op prphylaxis
3mo - first time dvt with risk factor 6-12 mo - first idiopathic event, activated protein c resistance Protein c or s deficiency 12 mo or more - recurrent disease, Cancer, thrombophilic conditions |
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Warfarin overlap with heparin?
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5-7 days until INR >2 for 2 days
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VTE risk factors
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Surgery, trauma, immobility, cancer, age, previous episode, pregnancy, contraceptives (w/ estrogen), IBD, nocturnal hemoglobinuria, obesity, smoking, varicose veins, hyperhomocysteinemia
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IFH dosing
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Tx: IV go by aPTT
Sc - loading dose of 5000-10000 U IV then 15000-25000 U sc q12h Monitor 4-6h later for APTT 2 - 2.5 x control |
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decr. INR
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ABx - griseofulvin, dicloxacillin, nafcillin, ribavirin, rifampin, ritonavir
CV - cholestyramine CNS - carbamazepine, phenytoin Smoking |
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Incr INR
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Decr. Clot factor - cefamandole, cefotetan, cefimetazole, cefoperazone, vit E
Impaired k prod. - broad abx Inhibitors - itra, keto, alcohol, amiodarone, azithro, miconazole, citalopram, paroxetine, cipro, clotrimazole, erythro, sildenafil, grapefruit, isoniazid, sulfamethoxazole Acarbose, thyroid hormones |
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Statin (HMG-Coa inh) Side Effects
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Common: Upper GI, headache, rash, muscle pain
Rhabdomyolysis rare |
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Statin (HMG-Coa) Monitoring
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LFT's and CK if at high risk
0,3,6,12 months CK check if muscle pain present |
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Drugs that increase statin tox
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amiodarone, clarithromycin, erythro,
gemifobrozil, grapefruit, conazoles, nefazodone, verapamil |
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Fibrates DI
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Incr. effect/tox : statin, pretty much all oral antidiabetics, warfarin
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High Risk patients factors that require LDL <2 Total <4
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CVD, CAD, PAD, diabetes, chronic renal disease
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Statin CI
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Pregnancy, alcohol, liver dx
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Fibrates CI
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Hepatic, renal dx, smokers and gemfibrozil more CVD
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Hypoglycemia Sx
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sweating, tremors, tachycardia, hunger!, palpitations, anxiety
Severe: seizures, coma, fatigue, LOC |
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Diabetes Risk Factors
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Vascular diease, HTN, schizophrenia, polycystic ovary syndrome
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Metformin DI/CI
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alcohol
CrCl < 60 - especially in HF or liver disease |
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SUs - SE
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hypoglycemia, weight gain, sulfa skin rash
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SUs CI/DI
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pregnancy, CrCl <50 ml/min
Alcohol |
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Meglitinides CI/DI
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Pregnancy
CYP3A4 inhibitors (GFJ, azole, PI) may decr. COCs |
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TZD (glitazones) SE
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weight gain, fluid retention,
macular degeneration |
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TZD (glitazones) DI/CI
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HF
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Orlistat SE/ CI
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diarrhea, GI upset, bloating
impairs absorption of vit ADEK only take if BMI >30 or if comorbid >27 |
