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Pharm exam 5 chapters > ch 49 highlights > Flashcards

ch 49 highlights Flashcards

1
Q

in adults mild thyroid hormone deficiency is called

A

hypothyroidism

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2
Q

Severe thyroid deficiency is called

A

myxedema

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3
Q

When hypothyroidism occurs in infants its called

A

congenital hypothyroidism

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4
Q

if someone is pale, puffy, expressionless face with cold and dry skin. The hair is brittle and hair loss occurs. Heart rate and temp are lowered. Pt complains of lethargy, fatigue and intolerance to cold. Mentation may be impaired. What disease process do these symptoms most correlate to?

A

Hypothyroidism

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5
Q

maternal hypothyroidism can result in

A

permanent neurophysiological deficits in the child

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6
Q

At what trimester does the fetus have a thyroid gland that is fully functional and able to supply his/her own hormones

A

2 nd trimester

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7
Q

a pt with hypothyroid becomes pregnant

A

dosage requirements usually increase often by as much as 50% . The need for increased dosage begins at 4-8 weeks gestation and levels off at approximately week 16 then remains steady

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8
Q

In children with congenital hypothyroidism therapy should continue for

A

3 years then d/c for 4 weeks. Blood work to see if the TSH rises.

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9
Q

the more TSH the more

A

hypothyroid the pt is

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10
Q

the less TSH the less

A

hypothyroid the pt is

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11
Q

which form of hyperthyroidism has exophthalmos

A

Graves

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12
Q

Which form of hyperthyroidism does not have exopthalmos

A

Plummer Disease

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13
Q

Graves disease is most common in what gender

A

women

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14
Q

nervousness, insomnia, rapid speech, weakened muscles, increased body temp, intolerance to heat and skin that is warm and moist, increased appetite, weight loss

A

thyrotoxicosis

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15
Q

Treatment for Graves disease

A

1) Surgical removal of thyroid tissue
2) destruction of thyroid tissue with radioactive iodine
3) suppression of thyroid hormone synthesis with an anti-thyroid drug (methimazole or propyolthiouracil)

radiation is preferred treatment for adults
antithyroid drugs is preferred for younger ptatients

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16
Q

improvement of exophthalmos

A

will not improve with lowered thyroid levels

if severe, it can be treated with surgery and radiation

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17
Q 
symptoms
profound hyperthermia (105 or higher)
severe tachycardia
restlessness
agitation
tremor
unconsciousness
coma
hypotension
heart failure 
may ensue
A

thyrotoxic crisis (thyroid storm)

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18
Q

what is given for thyroid storm

A

high doses of potassium iodine solution to suppress the hormone synthesis

B blocker is given to reduce heart rate
additional measures include sedation
cooling 
glucocorticoids
IV fluids
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19
Q

first line for hypothyroid

A

Levothyroxine (Synthroid) - used in all types and for all causes of hypothyroid

20
Q

what time of day should synthroid be taken?

A

30 min before breakfast on an empty stomach

21
Q

overdose on synthroid

A 
causes thyrotoxicosis - 
tachycardia
angina
tremor
nervousness
insomnia
hyperthermia
heat intolerance
sweating

chronic overdose - accelerated bone loss
increased risk of a-fib (esp older adults)
loss of bone increases r/o fractures

22
Q

drugs that reduce levothyroxine (synthroid) absorbtion

A 
H2 receptor blockers (cimetidine (tagamet))
PPI (Prevacid)
Sulcralfate (Carafate)
Cholestyramine (Questran)
Colestipol (Colestid)
Aluminum containing antacids (maalox, mylanta)
Calcium supplements (Tums, Os-cal)
Iron supplements (ferrous sulfate)
mag salts
Orlistat (Xenical)

separate administration of synthroid and these drugs by 4 hours

23
Q

drugs that accelerate levothyroxine metabolism

A 
phenytoin (Dilantin)
Carbamazepine (Tegretol, Carbatrol)
Rifampin (Rifadin)
Sertraline (zoloft)
phenobarbitol
24
Q

if a pt on warfarin begins levothyroxine

A

synthroid accelerates the degradation of vit k-dependent clotting factors. Effects of Warfarin are enhanced and dosage of warfarin may need to be reduced

25
Q

drug interaction for Synthroid

A

Catecholamines (dopamine, norepinephrine, epinephrine) - Thyroid hormones increase cardiac responsiveness to catecholamines, which increases the risk for catecholamine-induced dysrhythmias

26
Q

Synthroid can increase requirements for

A

insulin and digoxin. Doses may need to be increased

27
Q

are Synthroid products interchangeable?

A

no, if you have to change manufacturers, levels will need to be monitored closer

28
Q

what is given for myxedema coma

A

IV synthroid

29
Q

when should you recheck labs after initiating Synthroid therapy

A

Check 4-6 weeks, then 6 mos -1 year after stabilzed

30
Q

what drug class
methimazole
propylthiouracil (PTU)

A

Anti-thyroid drugs: Thionamides

31
Q

What thionamide is appreved for pregnant or breastfeeding and for patients who are in thyrotoxic crisis

A

PTU - place pt on PTU for first trimester then switch them back to methimazole

32
Q

what drug is first line for this class for hypothyroid

A

Methimazole (Tapazole)

33
Q

what is the most dangerous toxicity for Methimazole

A

Agranulocytosis

34
Q

what is the first symptoms of agranulocytosis

A

This develops in the first 2 months of therapy

Sore throat and fever may be the earliest indication

35
Q

Treatment for Agranulocytosis

A

D/c methimazole
usually reverses on its own
Filgrastim (Neupogen) may accelerate recovery

36
Q

Radioactive Iodine advantages for treating hyperthyroidism

A

low cost
patients spared risk of thyroid surgery
death from treatment is extremely rare
no tissue other than thyroid is injured

37
Q

drawbacks to Iodine therapy for treating hyperthyroidism

A

effect of treatment is delayed (takes several months to become maximal)
Associated with delayed hypothyroidism from excessive dosing and occurs in up to 90% of pts within the first year after Iodine exposure

38
Q

Iodine therapy for hyperthyroidism is indicated for

A

Adults

slight risk of cancer when given to young patients

39
Q

what iodine is given to hyperthyroid individuals to suppress thyroid function in preparation for thyroidectomy

A

Nonradioactive Iodine : Lugol solution aka strong iodine solution

40
Q

Hyperthyroid while prepping for surgery

A

give methimazole to reduce plasma levels

strong iodine solution (Lugol) along with PTU for the last 10 days before surgery

41
Q

Lugol Solution (Strong iodine solution) is also used for

A

thyrotoxic crisis

42
Q

hypothyroidism in children is called

A

Cretinism

43
Q

What is needed for the diagnosis of hyperthyroidism/hypothyroidism

A

TSH

44
Q

Methimazole is safe in pregnancy when

A

2nd and 3 rd trimester

45
Q

signs of synthroid tox

A

insomnia, tremors, tachycardia

46
Q

what med do you give for thyroid storm

A

PTU

47
Q

Iodine is indicated for

A

greater than 30 years old and not responding to other therapies

Pharm exam 5 chapters (15 decks)

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