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Pharm 584 > MCP Endocrine System > Flashcards

MCP Endocrine System Flashcards

1
Q

Overview of Thyroid Hormone

A
  • Produced by the thyroid gland
    • Two forms: tiiodothronine (T3) and thyroxine (T4)
    • T3 is more potent than T4
  • Has effects on nearly every system in the body
    • Regulates metabolism, growth, development, and more
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2
Q

Hypothyroidism: Definition, Causes

A
  • Deficient thyroid hormone production
  • Causes:
    • Hashimoto’s thyroiditis
    • Severe iodine deficiency
    • Congenital hypothryoidism
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3
Q

Hyperthyroidism: Definition, Causes

A
  • Excess thyroid hormone production
  • Causes:
    • Graves’ disease
    • Thyroid nodule
    • Postpartum throiditis
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4
Q

Hypothyroidism: Symptoms

A
  • Cold intolerance
  • Weakness
  • Fatigue
  • Weight gain
  • Hair loss
  • Constipation
  • Decreased libido
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5
Q

Hyperthyroidism: Symptoms

A
  • Heat intolerance
  • Sweating
  • Weight Loss
  • Increased heart rate
  • Irritability
  • Nervousness
  • Exopthalmos (bulging eyes)
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6
Q

Hypothyroidism: Treatment (General Term)

A
  • Thyroid hormone replacement therapy
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7
Q

Hyperthyroidism: Treatment (General Term)

A
  • Anti-Thyroid medications
  • Radioactive iodine treatment
    • Ultimately leads to hypothroidism
  • Surgical removal of thyroid gland
    • Ultimately leads to hypothroidism
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8
Q

Thyroid Hormone Replacement: Generic vs. Brand

A
  • Generic: levothyroxine
  • Brand: Synthroid, Levoxyl, Levothroid, Unithroid
  • Note: bioavailability may differ between different brands/products
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9
Q

Thyroid Hormone Replacement: MOA

A
  • Mimics the endogenous thyroid hormone thyroxine (T4)
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10
Q

Thyroid Hormone Replacement: Dosing

A
  • Titration is necessary
  • Dose varies depending on the patient
  • 25-200 mcg daily is common
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11
Q

Levothryoxine Counseling Point: Administration

A
  • Take 30-60 min before the first meal of the day
  • Take with a full glass of water
  • Separate from antacids, iron supplements, and multivitamins by 4 hours
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12
Q

Levothryoxine Counseling Point: Side Effects

A
  • Symptoms of hyperthyroidism:
    • Indicate that dosing is too high
    • ​Be able to tell the patient what these symptoms are
  • Decreased bone mineral density
    • With long-term therapy
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13
Q

Levothyroxine: Follow-Up and Monitoring

A
  • Patient will begin to see symptom improvement within about 2 weeks
    • May take 6-8 weeks to see normalized thyroid stimulating (TSH) levels
  • Follow up with prescriber 4-6 weeks after beginning therapy
  • Monitor TSH levels throughout course of therapy
    • Every 6-12 months
  • Do not abruptly discontinue this medication
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14
Q

Levothryoxine: Precautions, Contraindications, and Drug Interactions

A
  • Severe adverse effects include cardiac arrhythmias, and cardiac arrest
    • Use with caution in patients with cardiovascular disease
  • Contraindiciations
    • Recent acute myocardial infarction
    • Uncorrected adrenal insufficiency
  • Drug Interactions include:
    • Warfarin (anticoagulant)
      • Levothryozine may increase the anticoagulant effect of warfarin
    • Antacids, iron supplements and multivitamins
      • May decrease absorption of levothyroxine
      • Separate by 4 hours
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15
Q

What is Osteoporosis?

A
  • Osteoporosis is a disease characterized by low bone mass
    • The bones become weak and brittle, making them more suseptible to fracture
  • Referred to as a “silent disease”
    • Often diagnosed after a fracture occurs
  • Most commonly affects those over age 50 years
    • 80% og those affected are women
      ​
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16
Q

Osteoporosis Risk Factors

A
  • Older age
  • Female
  • Caucasian or Asian
  • Physical inactivity
  • Smoking
  • Excessive alcohol intake
  • Dietary factors such as inadequate calcium and vitamin D intake
  • Certain illneses and medications
  • Family history of osteoporosis
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17
Q

National Osteporosis Foundation

A
  • Screening through bone mineral density (BMD) exams recommended for:
    • All women 65+ yo
    • ALl men 70+ yo
    • Others of younger age who meet certain clinical criteria
18
Q

Osteoporosis Prevention Stragies

A
  • Adequate Calcium intake
    • Dietary intake of calcium
    • Males less than 70 and females less than 50: 1000mg daily
    • Older than that, 1200 mg daily
  • Adequate Vitamin D intake
    • All persons less than 50: 600-800 units daily
    • All persons older than 50: 800-100 units daily
  • Regular exercise
    • Emphasize weight-bearing exercises and strength training
  • Smoking cessation
  • Decreased alcohol intake
19
Q

Bisphosphonates

A
  • alendronate: Fosamax®
  • ibandronate: Boniva®
  • risedronate: Actonel®
20
Q

Bisphosphonates: MOA

A
  • Inhibit activity of osteoclasts
    • osteoclasts break down bone
  • Do not affect osteoblasts
    • osteoblasts build bone
  • Overall effect is to prevent further bone loss
21
Q

Bisphosphonates: Administration

A
  • Take immediately upon waking
  • Take with a full glass of plain water
  • Remain upright and do not lie down for at least 30-60 min
  • After taking, do not consume any food, beverages or other medications for at least 30-60 min
22
Q

Bisphosphonates: Calcium and Vitamin D Supplementation

A
  • Osteoporosis treatment with bisphosphonates should be supplemented wiht calcium and vitamin D
    • Help to preserve bone mineral density
    • Prevent hypocalcemia
23
Q

Bisphosphonates: Side Effects

A
  • ​Upper GI tract irritation
    • Dyspepsia, abdominal pain
    • Follow special administration instructions for prevention
    • Use with caution in patients with pre-exisiting GI irriation
  • Osteonecrosis of the jaw
    • Rare but serious side effect​
    • Risk factors include invasis dental procedure and poor oral hygiene
    • Patients with risk factors should revieve dental exam prior to initiating bisphosphonate therapy
    • Patient should contact prescriber if experiencing jaw pain or swelling
24
Q

Bisphosphonate: Follow-Up and Monitoring

A
  • Obtain a bone mineral density (BMD) scan at baseline and then at least every 2 years
    • central dual-energy x-ray absoptiometry (DXA) of the hip or spine
25
Q

Bisphosphonates: Contraindications

A
  • Abnormalities of esophagus
  • Inability to sit upright or stand for at least 30 min
  • Hypocalcemia
    • Must be resolved prior to initiating bisphosphonate therapy
26
Q

Bisphosphonates: Drug interactions

A
  • Antacids
    • Decrease absorption of bisphosphonates
  • Oral NSAID
    • Increase risk of GI irritation
27
Q

Cortcosteroids: Drugs

A
  • prednisone
  • dexamethasone (Decadron®)
  • methylprednisolone (Medrol®)
28
Q

Corticosteroids: Uses

A
  • Inflammatory disorders
    • Asthma
    • Severe allergic reations
    • Arthritis
    • Irritable bowl syndrome
  • Immunosuppressive therapy
29
Q

Corticosteroids: Dosing

A
  • Sometimes dispensed as taper packs
  • Usually short-term therapy
30
Q

Oral Corticosteroid: Administration

A
  • Take early in the day
    • To prevent hyperactivity
  • Take with food or milk
    • To prevent GI upset
  • Do not discontinue abruptly
    • Because of potential rebound
31
Q

Oral Corticosteroid: Short Term Side Effects

A
  • GI irritation
  • Hyperactivity
  • Insomnia
  • Mood changes
  • Hyperglycemia
  • Sodium/fluid retention
32
Q

Oral Corticodteroid: Long Term Side Effects

A
  • Immunosuppresion (dose related)
  • Hypertension
  • Bone loss
  • Cataract/glaucoma
  • Weight gain
  • Buffalo hump
  • Moon face (dose-related)
33
Q

Oral Corticosteroid: Contraindication

A
  • Systemic fungal infections
34
Q

Oral Corticosteroid: Drug interactions

A
  • Drug interaction are extensive and include:
    • NSAIDs
      • May cause increased GI irritation
    • Live vaccines
35
Q

Oral Corticosteroid: Moinitoring and Followup

A
  • Symptom improvement
  • With prolonged use in specific pateint population:
    • Blood pressure (patients with hypertension)
    • Blood glucose (patients with diabetes)
    • Bone mineral density (those with osteporosis risks)
    • Opthalmic exams (potential cataract/glaucoma)
    • Growth (in children)
36
Q

Topical Corticosteroids: Drugs

A
  • Hydrocortisone: low potency
  • Triamcinolone acetonide: medium potency
  • Betamethasone dipropionate: high potency
37
Q

Topical corticosteroid: Uses

A
  • Used to treat inflammation, swelling, or itching associated with various skin conditions including:
    • Dermatitis
    • Eczema
    • Rashes
    • Insect Bites
    • Other irritations
38
Q

Topical Corticosteroid: Administration

A
  • Wash hands before and after application
  • Clean and throughly dry the affected area of skin before application
  • Apply a thin layer to the affected area and gently rub into skin
  • Use on skin only
    • Keep out of mouth, nose and eyes
    • May use on open or broken skin
  • Avoid using high potency preaprations on areas of thin sensitive skin such as genitals, body folds, and eyes
39
Q

Topical Corticosteroid: Side Effects

A
  • More likely to occur with higher potency and are usually local:
    • Irriation
    • Thinning of the skin
    • stretch marks
    • skin disscoloration
    • bruising
    • Thin spidery blood vessels (telangiectasia)
  • Potential systemic side effects are rare but may occur with prolongs use
    • Mainly a concern in children who need frequent doses of high potency topical corticosteroids, which can affect growth
40
Q

Topical Corticosteroids: Contraindication and Drug Interaction

A
  • Contraindication
    • Systemic fungal infections
  • Drug interactions
    • not as big of a concern with topical corticosteroids as with oral corticosteroids

Pharm 584 (13 decks)

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