Thyroid
What are the two drugs produced by the thyroid? Which one is produced in larger quantities?
T3 (triiodothyronine) and T4 (thyroxine)
T4 is about 80-90% of the output
What is hypothyroidism?
Compare primary and secondary hypothyroidism
Reduced thyroid hormone production
Primary - gland itself
Secondary - other body system dysfunction
What is hypothyroidism called in infants?
Cretinism - low metabolic rate and mental retardation
Some hypothyroidism signs
- firm edema (myxedema)
- intolerance to cold
- weight gain
- slow HR (always fatigued)
- loss of hair
Goiter is an _____ of the thyroid gland caused by elevated levels of ______
enlargement
TSH
Goiter occurs in:
a) hypothyroidism
b) hyperthyroidism
c) both
c) both
because is occurs in situations where the thyroid gland is overstimulated
Treatment of hypothyroidism name one drug what is the half-life AEs Care
levothyroxine
- synthetic T4 hormone
- replacement therapy
half-life is 7 days!
since it takes 4-5 half lives of a drug to reach plateau, then it’ll take 4-5 weeks to reach full effect
AEs: think hyperthyroidism
- palpitations, tachycardia, tremors, anxiety, weight loss
Care: report chest pain, palpitations
- take 30 to 60 min before breakfast
Hyperthyroidism
what is it
name two types of the disease
Treatments
excessive thyroid hormone secretion
- Graves disease - autoimmune (antibody stimulation)
- Toxic nodular goiter
Treatments:
- radioactive iodine to destroy thyroid gland
- surgery to remove
- antithyroid drugs (e.g., methimazole) which prevent thyroid hormone synthesis
thyrotoxicosis symptoms
palpitations, increase HR
CNS stimulation (nervousness, rapid speech, insomnia)
High metabolic rate (heat intolerance, skin flushed and moist)
Muscle weakness and atrophy
Increased appetite but weight loss
Glucocorticoids - review name our endogenous one they \_\_\_\_\_\_\_ (promote or reduce?) glucose availability Pathophysiology: - over secretion leads to \_\_\_\_\_\_ - under secretion leads to \_\_\_\_\_\_\_
cortisol
promote glucose availability (gluconeogenesis in liver)
over = Cushing's syndrome under = Addison's disease
Glucocorticoids drugs name one routes of admin help control: Indications (conditions); Cautions AEs
Prednisone
routes: inhalation (asthma), nasally (rhinitis), topically (inflammation), systemic (IV, PO for hormone replacement therapy)
help control: inflammatory and immune responses
Indications: deficiency, COPD, asthma, organ transplant
Caution: infections, Diabetes (can cause hyperglycemia), HF, pregnancy
AEs: excess can mimic Cushing’s syndrome (moon face, thin skin, striae), steroid psychosis mood swings, peptic ulcers
Care implications of glucocorticoids
- Sudden discontinuation of glucocorticoids can precipitate an adrenal crisis (can be fatal, low BP and shock)
- take same time every day with food
- don’t use with NSAIDs
- rinse your mouth (inhalers)
- try not to get an infection
Anterior pituitary drugs
GH - two related drugs
replacement therapy: somatropin (is basically GH )
excess: octreotide (mimics somatostatin to reduce GH secretion)
Posterior pituitary drugs
what’s the condition called where you produce large volumes of urine?
Vasopressin vs desmopressin - which is preferred?
Diabetes insipidus
desmopressin is preferred (can be given PO, no vasoconstrictor activity)
What blood disorder does desmopressin help with?
Hemophilia A because it causes the release of clotting factor VIII (8)
