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47 Cards in this Set
- Front
- Back
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Labs results for hypothyroidism
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> TSH
< T4 and T3 |
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Lab results for hyperthyroidism
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< TSH
> T4 and T3 |
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A pt has normal TSH levels with slightly < T4, what do you do?
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increase synthroid dose
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Causes of hyperthyroidism
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Graves disease
TSH like proteins(from IVIG) Tumors Goiter due to Iodine |
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Physical characteristics of Graves disease
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Goiter
Exophthalmos Pretibial edema |
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Clinical presentation of Graves
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Loss of weight
Nervousness Heat intolerance Moist skin Onycholysis |
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How do you treat hyperthyroidism?
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Methimazole
Propothiouracil Iodides RAI-radioactive iodine Sugery |
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What's the MOA of Thioamides?
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inhibit coupling of MIT and DIT
inhibits oxydation of iodine inhibits peripheral conversion of T4 and T3 (only PTU) |
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what's the dose of Methimazole?
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30mg/d initial for 7 days then 5mg maintenance
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what are the adverse drug reactions of methimazole?
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LFT changes
Leukopenia Agranulocytosis(stop drug) Rash GI |
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PTU is the DOC in which conditions
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Pregnancy
Nursing mothers Thryoid storm |
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what drug inhibits peripheral conversion of T4 to T3
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PTU
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What is the dose of PTU?
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75 mg QID initial then
100mg/day in divided doses |
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What are the S.E of PTU?
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LFT changes
Leukopenia Agranulocytosis Rash GI Hepatitis |
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A pt in the ER comes in with a thyroid storm, what do you order?
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PTU and Lugol's solution
Has better progression to euthyroid state |
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what are 2 Iodine treatments
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SSKI- 40mg of iodine/drop
Lugol's- 8mg iodine/drop |
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what are the S.E of iodides
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Metallic taste
Rash |
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what is the MOA of RAI?
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Destroys thyroid follicles
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How long does it take to see the effects of RAI?
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3-6 months
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what is the MOA of iodides?
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prevents hormone release and hormone synthesis
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what is the presentation of Acute thyrotoxicosis(thyroid storm)
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Fever
Tachy Tremor Confusion |
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How do you treat thyroid storm?
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BBs- control systemic and peripheral symptoms
PTU, Iodides- suppress hormones Corticosteroids- suppress inflommatory process |
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MCC of hypothyroid
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Hashimoto's - autoimmune
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what are the S.E of Synthroid?
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Sweating
Weight loss (which are symptoms of hyperthyroid if you think about it) |
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What drugs interact with thyroid replacement?
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Bile Acids
Oral Contraceptives Warfarin Lithium |
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How does Synthroid affect Warfarin?
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There may be an increase in synthesis of clotting factors so the INR may decrease; you may need to increase the dose of warfarin
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What does lithium do?
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inhibits release of thyroid hormone
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what does the adrenal cortex secrete?
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Aldosterone
Androgens Cortisol |
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Name some functions of cortisol
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response to stress
maintains BP breaks down sugar metabolism of proteins,carbs,fats slows inflammatory respone |
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name a mineralcorticoid produced in the cortex
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Aldosterone
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How do you Dx Cushing's syndrome?
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Dexamethasone suppression test(overnight- give 1mg at 11pm, obtain cortisol level at 8 am)
24 hr free cortisol test |
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How do you treat Cushings?
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If adenoma, carcinoma or pituitary dependent, do surgery
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what is the effect of spironalactone on aldosterone?
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Antagonist
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S/Sx of hyperaldosteronism
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HTN
< K- due to Na retention Fatigue Nocturia |
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Dose of spironalactone
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200-400mg/day
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Causes of secondary hyperaldosteronism
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Diuretics
Pregnancy Hemorrhage |
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which diurectic can cause hyperaldosteronism
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Thiazides
spironalactone Loops |
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A pt with HTN and hyperaldosteronism; what drug should you prescribe
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Ace Inhibitor to decrease aldosterone production
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what are the clinical presentations of Addison's disease?
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Hypotension
Hypoglycemic Wt loss Dehydration < NA > K |
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How do you treat Addison's?
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Lifetime Tx of corticosteroids
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How do you treat chronic adrenal insufficiency?
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Fludrocortisone: replaces aldosterone to control Na and K and keep BP normal
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What is the dosing for Fludrocortisone?
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0.10mg PO q24
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How do you treat acute adrenal insuffieciency?
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Hydrocortisone 100mg IV q6 for 24 hr then
50mg IM q6 hr Once oral meds are tolerated: 40mg po q AM and 20mg q PM 24 |
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which corticosteroids come in IV or oral formulations?
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Hydrocortisone (Cortef)
Methylprednisone Dezamethasone |
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what are the equivalent conversions of corticosteroids?
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Cortison 25mg
Hydrocortisone 20mg Prednison 5 mg Methylprednisone 4mg Dezamethazone 0.75mg |
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what are some uses of corticosteroids?
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Replacement therapy
Anti-inflammatory Immune suppression Asthma/allergies |
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what happens if you stop steroids too quickly?
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HPA axis suppression; so taper off slowly
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