Thyroid Pharm Mjm

Front 1

what is thyroid hormone needed for?

Back 1

norm growth and development
metabolic stability
stimulates the heart and energy use
plays a role in every organ system in the body

Front 2

where is t4 converted to t4?

Back 2

thyroid gland, kidneys, muscle, liver

Front 3

thyroid hormones are transported by ?

Back 3

TBG, TBPA, albumin

Front 4

Primary hypothyroidism?

Back 4

hashimotos or iatrogenic

Front 5

Secondary hypothyroidism?

Back 5

dysfunction in the pituitary cland or the hypothalamus

Front 6

drugs that cause hypothyroidsim?

Back 6

lithium, amiodarone, alpha interferon

Front 7

subclinical hypothyroidism?

Back 7

normal t4 with and increased tsh

Front 8

physical findings in hypothyroidism?

Back 8

bradycardia, goiter, cool dry skin, atrphy of thyroid, edema, constipation, hoarseness, depression

Front 9

Tx for hypothyroidism?

Back 9

levothyroxine (7 day H/L), liothyronine (may improve cog in elderly, high incidence of cardiac event), liotrix (mimics natural secetion)
cut dose by half if switching to IV from oral

Front 10

levothyroxine dosing
dose changes?

Back 10

(1.7 mcg/kg/day) 100-125 mcg/day avg, 1 mcg/kg/day for elderly
> 50yo, kids, cardiac dz, chronic = titrate start at 25-50
made in 12.5 -25 mcg increments

Front 11

when do you check labs?

Back 11

every 6-8 weeks

Front 12

time line for turnaround?

Back 12

temp, alertness, speech improve > 72 hrs
diuresis, weight loss > 2/3 days
metabolic activity improves > 1 wk
TSH norm > 2-6 wks

Front 13

what drugs bind to levothyroxine?

Back 13

cholestyramine, mag, aluminum, kayexalate, iron prep, sucralfate

Front 14

adverse effects of levothyroxine?

Back 14

thyrotoxiosis, HF, angina, MI, atrial arrythmias, increased bone loss

Front 15

why shouldn't you give morphine to pt with hypothyridism?

Back 15

further depresses their resp drive

Front 16

prenancy and hypothyroidism?

Back 16

monitor because baby doesn't have the ability to produce thyroid hormones. Placenta also deiodinases levothyroxine so increased doses are needed. space prenatal vit by 4 hrs before or after levo

Front 17

types of hyperthyroidism?

Back 17

graves, toxic multi nodular goiter, factitious, tumors, drug producing (amiodarone, iodides)

Front 18

most common signs in hyperthyroidism?

Back 18

cardiac and weight abnormalities (may be know signs at all)

Front 19

how do you dx hyperthyroidism?

Back 19

radioactive iodine uptake, FT4, TSH

Front 20

Tx options?

Back 20

thioamides, RAI, surgery

Front 21

Thioamides?

Back 21

primary tx for kids and pregnant women. pretx before surgery and I131, no hypothyroidism

Front 22

definitive therapy for adult hyperthyroidism?

Back 22

radioactive iodine

Front 23

2 types of thioamides?

Back 23

methimazole, PTU

Front 24

how long does it take thiomides to return hormone levels to normal?

Back 24

4-8 weeks

Front 25

what should you use for symptomatic management of hyperthyroidism?

Back 25

BB Propranolol also inhibits peripheral conversion), CCB, iodides

Front 26

PTU vs methimazole?

Back 26

PTU: short half life, DOC in thyroid storm/preg/brst feeding, protein bound(placenta), inhibit peripheral conversion
Meth: longer half life, 10x more potent, does not effect existing stores

Front 27

how long should tx continue?

Back 27

12-18 months
monitor monthly until stable than 3-4 x yr

Front 28

How do you monitor a pt on thioamides?

Back 28

BP, pulse, weight, thyroid exam, eye exam, free t3/t4

Front 29

Adverse effects of thioamides?

Back 29

rash (histamines), leukopenia, arthralgia (d/c)
major: agranulocytosis (prodrome), hepatotoxicity, vasculitis (ARF, arthritis, skin ulcers, rash, hemoptysis)

Front 30

If pt has COPD/asthma and hyperthyroidism, what adjunctive therapy should you use?

Back 30

non dihydro CCB

Front 31

useful in short-term management of thyrotoxicosis?

Back 31

BB
propranolol, atenalol, metoprolol

Front 32

MOA of iodide?

Back 32

blocks thyroid hormone synthesis and release, decreases vascularity in thyroid

Front 33

Indications for iodides?

Back 33

after RAI therapy, pre-tx for surgery, attaining euthyroid state in severe dz in pt with cardiac comp, nuclear accident, thyroid storm

Front 34

what is wolff charchoff effect?

Back 34

autoregulatory mech that stops the organifiaction of iodides

Front 35

RAI tx?

Back 35

start with thioamides for 4 days than give RAI therapy and the thioamides for 4 days after

Front 36

adverse effects of RAI?

Back 36

hypothyroidism, mouth ulcers, thyroid tenderness

Front 37

thyroid storm?

Back 37

typically occurs with hyperthyroidism. thyroidtoxicosis form infx, trauma, surgery

Front 38

s/s of thyroid storm?

Back 38

hypermetabolism, fever, altered mental status, sweating, tachy, chf, arryhmia

Front 39

Tx for thyrid storm?

Back 39

PTU, iodide, steroids, supportive therpy

Front 40

benefit of corticosteroids?

Back 40

decreases inflammation, blocks t4>t3 conversion, can help with thyroid storm and ophthamyopathy

Front 41

How does amiodarone cause hyper and hypothyroidism?

Back 41

hypo: is releases iodine with each dose causing the auto reg system to stop conversion of t4-t3
hyper: inhibits the stoppage auto reg system and more T4-T3 is converted

Front 42

what other drug can induce hypothyroidism?

Back 42

lithium

Front 43

lugols solution?

Back 43

K iodine that fills the thyroid and prevent uptake of harmful radiation in nuclear attack. take several hours before radiation (goes down by 50% after 4hrs of exposure)