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41 Cards in this Set
- Front
- Back
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How to take thyroid medicine |
TAKE SAME TIME SAME WAY EVERY DAY take at night chance of insomnia |
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What lab to monitor for thyroid |
TSH |
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Types of Thyroid hormones |
T4 - thyroxine - not active - last 7 days T3- trilodothyronine - active form last 1-2 days Reverse T3 - ICU patients not active ALL ABOUT ADDING IODINE |
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Hyperthyroid vs Hypothyroid |
Hyper - heat intolerance, expohthalmos, tachy, tons of energy, increase appetite, diarrhea Hypo - cold inter tolerance - slow, lazy, decreased appetite, |
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Hashimoto |
have to be triggered can have whole life and never get trigged older you are the less risk of having it triggered |
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Iodine
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antithyroid lowers levels 6mg/day |
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Synthroid |
pure synthetic thyroxine |
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Liothyronine |
Pure synthetic T3 |
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Liotrix |
both synthetic T4 to T3 in 4:1 ratio |
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Drugs that increase or decrease TSH |
increase - dopamine, glucocorticoids and octreotide Decrease Tsh - lithium, iodide, amiodarone, aminoglutehimide |
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Drugs that decrease T4 absorption |
colestipol, Antacids |
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Drugs increase serum TBG |
Estrogens, Tamoxifen, Methadone, and flurouracil |
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Drugs that inhibit t4-5 deiodinase |
PTU, Amiodarone, beta blockers, glucocorticoids |
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Pregnancy |
Monitor TSH each trimester |
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PTU |
used for hyperthyroidism peripheral conversion t4to t3 inhibit peroxidase |
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Thyroid dx typical duration of therapy |
6-24 months relapse high unless used with thyroid hormone replacements. |
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Toxicity from thyroid tx |
Agranulocytosis - joint pain, and stiffness may be used prior to surgery to decrease thyroid -- PTU |
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Lithium Amio |
Lithium - cause low thyroid Amio- large amount of iodine. hypothyroidism - Wolf Chailkoff effect |
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Corticosteroids |
inhibit deiodinase T4 to T3 T4 T3 reach new steady state. |
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Adrenal 3 layers |
Outermost lay - glomerulosa - aldosterone - salt middle zone - fasiculate = cortisol Inner Zone reticularis = androgens or sex |
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Steroid side effects |
hypocalcemia, peptic ulcers, central fat Adrenal suppression with cortisol doses greater than 20mg/day Local therapy preferred single big dose not many issues |
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Chronic adrenal insufficiency |
Addisions dx tx with cortisol |
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Excess cortisol |
cushings - excessive ACTH |
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Primary hyperaldosteronism |
Conns due to aldosterone secreting tumor tx with spironolactone |
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Corticosteroid complications |
nervousness, insomnia, increased IOP, subcapsuular cataract digestive - N/V (give with food/milk) Muscle skeletal - muscle wasting - negative Ca balance lead to osteoporosis Hypokalemia Hyperglycemia |
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Herpes Varicella zoster Antiherpesvirus and nucleotide analogus |
tx with acyclovir, valacyclovir , famciclovir, penciclovir MOA - nucleoside analogs prevent DNA replication in virus infected cells NEPHROTOXICITY worst with IV ACYCLOVIR - hydration helps prevent |
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CMV Antiherpesvirus nuceloside and nucelotide analogues |
problem is immunocompromised ganciclovir, valganciclovir Prevent viral relication of CMV - if CMV resistant to ganc and foscarnet - combo may be effective ADE's - myelosuppression, NVD, Nephrotoxicity Foscarnet - neurotoxicity - use last |
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- Neuraidase Inhibitors ANti influenza |
A and B - doesn't cure just decrease duration and intensity MOA prevent release of new irons and host cell - only prevent spread Start at 1st sign of infection. Oseltamivir and Zanamivir |
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Zanamivir don't use in who |
COPD - causes bronchospasm ** |
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Nuecloside Nucelotide reverse transcriptase inhibitors |
HIV - Tenofovir, emtricitabine, lamivudine, zidovudine, abacavir, stavudine, didanosine, zalcitabine, hep - ten,emb, lami, entecavir Hard compliance with HIV d/t SE |
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MOA in nuecloside nueclotide reverse transcriptase |
HIV inhibit viral reverse transcriptase HBV inhibit polymerease NEED TEST DOSE FIRST |
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SE reverse transcriptase inhibitors |
neutropenia, hepatomegaly, peripheral neuropathy, optic neuritis. ABACAVIR - fatal hypersensitivity with 1st dose - need test dose. |
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Toxicity of Reverse transcriptase inhibitors |
Didanosine, Stavudine, Zidovudine = most toxic Lamivudine = least toxic Emtricitabine - daily dosing Adefovir Renal Tenofovir - hepatic Zi and Di = NVD most |
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NNRTIS - non-nuceloside nucelotide reverse transcriptase inhibitors |
Efavirenz, nevirapine, delavirdine, etravirine COMPLIANCE IS A MOST - resistance develops easily. Efavirenz = dizziness, insomina, and hepatoxicity CYP450 contraindicated with other drugs that use this pathway |
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Nonnucleoside DNA polymerease inhibitors |
HSV or CMV inhibit viral dna polymerase directly FOSCARNET NEPHROTOXICITY , ANEMIA Decrease dose with renal impairment |
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Protease inhibitors |
HIV inhibit HIV protease Monitor LIPIDS , Hyperglycemia Saquinavir,ritonavir, amprenavir,fosamprenavir,indinavir,nelfinavir,lopinavir,atazanavir,tipranavir,darunavir |
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Protease inhibitors |
Contraindicated in severe hepatic dx, 3A4 metabolism Fosamprenavir - prodrug of amprenavir - increased oral bioavailability Kaletra = combo of lopinavir/ritonavir |
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inhibitors of viral uncoating |
influenza A, parkinsonim (amantadine BLOCK M2 Protein KEY STEP IN REPLICATION process Amantadine and Rimantadine watch for NMS, peripheral edema, CNS confusion, Hallucination. INCREASE BODY TEMP AND DEHYDRATION = PUT PT AT RISK |
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Inhibitors of viral attachment and entry |
Maraviroc - CCR5 - tropism test -- HEPATIC TOXICITY Enfuvirtide = gp41 - fusion with HIV host. -- Renal impairment, GB 6th nerve palsy, injection site run |
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Viral integration inhibitors |
Raltegravir Watch for rhabdo - monitor CK levels |
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RSV resp syncytial |
Ribavrin CR CL < 50 ml/min , pregnancy, severe hepatic dysfunction |
