Endocrine Deck 4 Flashcards
Thyroid Hormones ADR
Symptoms of hyperthyroidism
Cardiovascular (CV): angina, blood pressure increase, flushing, palpitations
Central nervous system: anxiety, headache, insomnia
Long-term thyroid replacement associated with decreased bone density in hip/spine in postmenopausal women
Thyroid hormone drug interactinos
Bile-acid sequestrants, iron salts, and antacids decrease absorption; estrogens may decrease response.
Drugs may decrease action of warfarin, digoxin, and beta blockers
hypothyroidism
Treatment is indicated
in patients with TSH levels greater than 10 μIU/mL or in patients with TSH levels between 5 and 10 μIU/mL in conjunction with goiter or positive antithyroid peroxidase antibodies (or both).
Thyroxine replacement is typically
lifelong
Consult with pediatric endocrinologist before
treating a pediatric patient with thyroid hormone
subclinical hypothyroidism
is controversial on whether or treat it or not
T4 Dosing
For patients with no known CV disease
Initial dose can be started at 50 mcg/day for 2 to 4 weeks and may be increased in increments of 25 mcg/day.
Average full replacement of T4
100 to 125 mcg/day
what are you monitoring regarding t4
lab work and patient response
T4 Dosing
For patients 50+ years with CV disease or with long-standing hypothyroidism
Initial dosage of T4 is 12.5 to 25 mcg/day.
T4 Dosing
For patients 50+ years with CV disease or with long-standing hypothyroidism – an increase of
An increase of 12.5 to 25 mcg increments at approximately 1-month intervals avoids rapid increases in cardiac workload and symptoms of ischemic heart disease.
T4 if exacerbations of angina
pectoris occurs, the previous dosage regimen should be administered and titrated up in smaller increments.
start low and increase slowly
t4 rational drug selection
T4 is drug of choice for thyroid replacement and suppression therapy.
In older adults with no cardiac disease, consider consulting with endocrinologist regarding using T3 and T4 or liotrix.
TSH level should be measured
in 6 to 8 weeks, and the T4 dose should be adjusted as necessary.
The target tsh level should be between
0.3 and 3.0 μIU/mL
Once a stable TSH level is achieved
annual examination is appropriate (or if they have symptoms)
T4 monitor for
for osteoporosis in high-risk populations.
Many drugs affect TSH levels.
If you are on a natural version of t4 like naturethroid or armourthroid you need monitor
T3 and T4 because the t3 is unpredictable
t4 patient education
Take medication each day in the morning, preferably before breakfast because absorption is increased on an empty stomach.
T4 ADR
ADRs: Learn how to measure heart rate.
Lifestyle management is important
one of the biggest treatments for subclinical hypothyroidism
diet and exercise.
Antithyroid Agents
Propylthiouracil (PTU), methimazole (Tapazole)
Antithryroid agent block
Both block synthesis of T4 and T3.
Neither drug treats the underlying pathology in hyperthyroidism.
Antithryroid relapse rate
exist but are less likely if treated for 18 to 24 months
Antithyroid
Absorption
rapidly absorbed after oral dosing, peaking within 1 hour; 85% to 95% bioavailability
PTU is
75% to 80% protein bound; methimazole is NOT protein bound
PTU and methimazole are both
metabolized in the liver; both have short half-life; excreted in urine: 35% of PTU, 80% of methimazole
Takehome for methimazole
it is an antithyroid agent that does not cure the disease. There is a very high relapse rate, but are less likely if treated for 18 to 24 months. Once patient stopts takeing this they will likey go back to their hyperthroid state.
Antithyroid Agents
Precautions and contraindications
Pregnancy major concern: readily cross the placenta
Recommend that patient not get pregnant while on these drugs.
High concentrations in breast milk
PTU not recommended in children
PTU is not
reommended in childern.
Antithryoid agents ADR and reactions
ADRs: agranulocytosis, drowsiness, headache, alopecia, skin rashes, renal/hepatic failure
Drug reaction: lithium, warfarin
Rational drug selection
Antithyroid Agents
Check guidelines, as use in pregnancy and children varies frequently.
Antithyroid Agents
Monitoring
Thyroid studies, complete blood count (CBC), liver/renal panels before starting drug
Recheck in 1 to 2 months after starting drug.
Antithyroid Agents VERY IPORTANT
to NOT miss doses; if dose is missed, patient should NOT make up dose.
Antithyroid Agents
Teach about
hypothyroid symptoms; prolonged subclinical hyperthyroidism is associated with bone loss, atrial fibrillation, and impaired left ventricular diastolic filling
Antithyroid Agents
Dietary sources of iodine
should be reduced because they interfere with action of drugs.
Antithyroid Agents WATCH USE OF
over-the-counter cold medicines.
if patient misses a dose of antithryoid
skip it and start back the following day
Pancreatic Enzym uses
cystic fibrosis and pancreatitis
Some bariatric procedures require supplements
Enzymes for digestion output less than 10% of normal then these enzymes are needed
Posthyperthyroid Treatment
Patients need to expect that they will become hypothyroid.
This may not occur for several months.
Patients must take thyroid supplements for life.
Pancreatic Enzymes Inactivated by pH values less than
Inactivated by pH values less than 4; do not crush or chew
Pancreatic enzyme are used for
digestion
Pancreatic enzyme Sprinkled
on food if powder form
Often enteric coated to withstand the low ph of the stomach
pancreatic enzyme main work occurs in the
in the duodenum and upper jejunum (digestion)
pancreatic enzyme Pharmacokinetics
Absorption
none, because it acts locally in gastrointestinal (GI) tract
pancreatic enzyme excretion
feces
pancreatic enzymes precations
antacids decrease effectiveness, decreases absorption of oral iron
Pancrelipase made from
pork
pancreatin made from
pork, beef, or vegetable sources
Pancreatic Enzymes do not
crush or chew
Pancreatic Enzymes avoid
leaving in mouth
Pancreatic Enzymes enteric coated
formulations should not be mixed with alkaline foods prior to ingestion
Pancreatic Enzymes if powered spills
wash off skin immediately
Pancreatic Enzymes with infants
watch for aspiration, inhalation
Pancreatic Enzymes lifestyle management
follow dietary guidelines
