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36 Cards in this Set
- Front
- Back
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What is the DOC for T4 replacement/suppression tx? |
1. Levothyroxine |
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What are the synthetic thyroid hormones? |
1. Levothyroxine-- T4 2. Liothyronine-- T3 3. Liotrix-- T4 and T3 |
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What are the animal thyroid hormones? |
1. Desiccated thyroid T4 and T3 2. **Less predictable |
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When is levothyroxine best absorbed? |
1. Fasting state |
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What is the potency of liothyronine vs. levothyrxine? |
1. Liothyronine more potent 2. Shorter duration of action |
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What is the tx for hypothyroidism? |
1. Oral hormone replacement to normal range |
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What is the tx goal for cretinism? |
1. Prevent irreversible mental retardation in newborns due to hypothyroidism |
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How do you tx myxedema coma? |
1. T3 and/or T4 |
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What is TSH suppression tx for nodular thyroid disease? |
1. Maintain TSH level **below normal** to prevent nodule or tumor growth |
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What are the adverse effects of thyroid hormones? |
1. Hyperthyroidism 2. A-fib 3. Osteoporosis |
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How should you dose thyroid hormones in a patient with long-standing hypothyroidism? |
1. Start with low dosages to avoid excessive CV stimulation |
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What are the thioamide drugs? |
1. Methimazole 2. PTU |
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What is the MOA of thioamides? |
1. Prevent thyroid hormone synthesis 2. Inhibit iodination and coupling reactions |
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What is the potency of PTU v. methimazole? |
1. Methimazole more potent and has a longer half-life 2. Less hepatotoxicity |
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What is the MOA of PTU specifically? |
1. Inhibits peripheral conversion of T4 to T3 2. May be preferred for tx of severe thyrotoxicosis |
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What is the use of thioamides in pregnancy? |
1. Can cross the placenta 2. Use cautiously 3. PTU safer than methimazole during 1st trimester |
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What are the adverse effects of thioamides? |
1. GI upset, rash, fever, joint pain 2. Agranulocytosis, hepatitis, cholestatic jaundice |
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What are the ionic inhibitors? |
1. Thiocyanate 2. Perchlorate |
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What is the MOA of ionic inhibitors? |
1. Competitively block the iodide transport mechanism |
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What is the MOA of KI? |
1. High does inhibit thyroid hormone release (rapid) 2. Inhibit thyroid hormone synthesis 3. Decrease size and vascularity of thyroid gland prior to surgery 4. Inhibits uptake of radioactive iodine |
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What causes iodism? |
1. Overuse of KI leading to concentration in the salivary and other glands |
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What are the adverse effects of KI? |
1. Unpleasant taste, gastritis, headache, iodism, conjunctivitis 2. Angioedema and anaphylactoid rxns, cutaneous hemorrhages, TTP |
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What is the MOA of RAI? |
1. I131 taken up and concentrated in the thyroid gland where it causes dose-dependent destruction of parenchymal cells |
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What is the definitive tx for hyperthyroidism? |
1. RAI |
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What are the absolute contraindications for RAI? |
1. Pregnancy 2. Nursing |
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What is the clinical use of thioamides (specific disorders)? |
1. Graves disease 2. Thyrotoxicosis 3. Thyroid storm |
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What is the use of iodides in the tx of hyperthyroidism? |
1. Temporary, short-term tx |
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What is the use of BB in antithyroid tx? |
1. Suppress overstimulation of SNS |
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What is the interaction of propranolol with thyroid hormones? |
1. Weakly inhibits conversion of T4 to T3 |
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What BB is best to use in a thyroid storm? |
1. Esmolol |
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What is the use of CCB in antithyroid tx? |
1. Diltiazem can be used to control HTN and tachycardia when BB are contraindicated |
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What is the use of NSAIDs in antithyroid tx? |
1. Useful for local pain and fever during subacute thyroiditis |
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What is the effect of lithium on the thyroid? |
1. Actively concentrated in the thyroid 2. Can inhibit thyroid hormone synthesis 3. Leads to hypothyroidism |
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What is the effect of amiodarone on the thyroid? |
1. Resembles thyroid hormone and contains iodine 2. Can inhibit peripheral conversion of T4 to T3 3. Can cause hyper- or hypothyroidism |
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What is the effect of corticoteroids on the thyroid? |
1. Inhibit TSH secretion 2. Decrease binding of T4 to TBG 3. Inhibit conversion of T4 to T3 |
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What specific thyroid disorders can corticosteroids be used to tx? |
1. Thyroid storm 2. Patients being treated for Graves disease with RAI--- prevents worsening of ophtlamopathy |
