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Thyroid Disorders > notes > Flashcards

notes Flashcards

1
Q

drugs that can cause hypothyroidism

A 
amiodarone
carbamazepine
eslicarbazepine
oxcarbazepine
interferons
lithium
phenytoin
TKIs especially sunitinib
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2
Q

What is the most common cause of hypothyroidism?

A

Hashimoto’s disease - an autoimmune disease

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3
Q

If left untreated, what life threatening emergency can occur it hypothyroidism?

A

myxedema coma

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4
Q

diagnosis of hypothyroidism?

A

low free T2

high TSH

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5
Q

monitoring parameter in hypothyroidism

A

TSH q4-6 weeks until levels are normal then q4-6 months rarely use T4

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6
Q

Too high doses of thyroid replacement hormone can lead to what in elderly pts?

A

atrial fibrillation and fractures

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7
Q

how to treat hypothyroidism in pregnancy

A

levothyroxine is safe in pregnancy and aggressive treatment is warranted (30-50% increase in dose)

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8
Q

What is the drug of choice in hypothyroidism?

A

levothyroxine (T4) - use same formulation

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9
Q

What are other supplemental medications used in hypothyroidism?

A 
liothyronine (T3, Cytomel, Triostat)
dessicated thyroid (T3 & T4, Armour Thyroid)
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10
Q

How should levothyroxine be taken?

A

60 minutes before breakfast or 3 hours after dinner at bedtime. Should be taken consistently.

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11
Q

What is the dose of levothyroxine in pts w/ CAD?

A

12.5 to 25 mcg/day

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12
Q

warnings levothyroxine

A

decrease dose in CAD and decreased BMD

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13
Q

levothyroxine brand

A

Synthroid, Levoxyl, Tirosint, Unithroid

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14
Q

SE levothyroxine

A

if euthyroid, no symptoms. Hyperthyroid symptoms if too high of dose

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15
Q

drugs that decrease levothyroxine absorption

A 
space out by 4 hours:
aluminum antacids
calcium
iron
magnesium
cholestyramine
sucralfate
sevelamer
vitamins containing ADEK, iron, folate
orlistat

space out by 3 hours:
Kayexelate

space out by 2 hours:
lanthanum

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16
Q

drugs that decrease thyroid hormone levels

A

estrogen
SSRIs
hepatic inducers

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17
Q

drugs that decrease conversion of T4 to T3

A

amiodarone
propylthiouracil
steroids

18
Q

thyroid hormones are highly protein bound. drugs that can cause protein binding displacement

A

NSAID
salicylates >2g/day
phenytoin
heparin

19
Q

levothyroxine and warfarin

A

can increase PT/INR

20
Q

levothyroxine and digoxin

A

decrease digoxin levels

21
Q

levothyroxine and theophylline

A

decrease theophylline levels

22
Q

levothyroxine and antidiabetic agents

A

decrease antidiabetic agent levels

23
Q

levothyroxine tablet colors

A

Orangutans Will Vomit On You Right Before They Become Large, Proud Giants

24
Q

what is IV:PO levothyroxine ratio

A

0.75:1

25
Q

Liotrix brand

whats in it?

A

Thyrolar

contains levothyroxine and liothyronine in a 1:4 ratio

26
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

27
Q

which drugs can cause hyperthyroidism?

A

iodine
amiodarone
interferon

(amiodarone and interferon can also cause hypothyroidism)

28
Q

What agent is typically used first for symptom control in hyperthyroidism?

A

beta blockers to control palpitations, tachycardia, tremors

29
Q

initially when treating hyperthyroidism with drugs, how long does it take for symptom control?

A

1-3 months on a high dose and then dose reduce to prevent hypothyroidism

30
Q

What are thionamides?

A

they are used in hyperthyroidism to prevent oxidation of iodine. propylthiouracil also prevents conversion of T4 to T3 in the periphery.

31
Q

pregnancy and thionamides

A

1st trimester: PTU

2 and 3 trimester: switch to methimazole

32
Q

brand methimazole

A

Tapazole

33
Q

BW PTU

A

acute hepatic failure, severe liver injury

34
Q

SE methimazole, PTU

A 
GI upset (take w/ food to decrease)
hepatitis, agranulocytosis
35
Q

which thionamide is preferred in thyroid storm?

A

PTU

36
Q

Iodides used in hyperthyroidism

A

Lugol’s solution - potassium iodide and iodine

SSKI, Thyroshield - saturated solution potassium iodide

37
Q

why is potassium iodide recommended right after thyroid radiation?

A

It blocks the accumulation of radioactive iodine therefore preventing thyroid cancer

38
Q

Drug treatment in Thyroid storm

A 
PTU 500-1000mg LD followed by 250mg q4h
inorganic iodide w/ Lugol's or SSKI
beta blocker
systemic steroids
aggressive cooling with acetaminophen and cooling blankets
supportive therapy
39
Q

what is the starting dose of levothyroxine?

A
  1. 6 mcg/kg/day

12. 5 to 25 in CAD

40
Q

PTU and warfarin

A

can decrease INR

Thyroid Disorders (1 decks)

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