Pharm Final Final 4 -adrenal thyroid Flashcards
Glucocorticoids are produced where?
What do they affect?
Adrenal cortex - Most potent natural cortisol
- Inflammatory response
- Metabolism
- Growth
- Biorhythms
- Carbohydrate, protein and fat metabolism
- Muscle and blood cell activities
cortisones end in “sone”
What do GLUCOCORTICOIDS treat?
- Trauma
- Surgery
- Inflammation
- Emotional upset/Anxiety
- Allergies
- Autoimmune dz like RA
- Ulcerative colitis
- Prevention of organ rejection
LIST SOME GLUCOCORTIOIDS
Cortisones - prednisolone, prednisone, dexamethasone, betamethasone
Fludrocortisone - used to treat Addison’s disease (hypo adrenal)
GLUCOCORTICOIDS - TWO Black Box Warning Drugs
Nasocort and Fluticasone
Suicidal thoughts or behaviors
Stop IMMEDIATELY
GLUCOCORTICOIDS - Five Routes
PO, IV (Z-Track), IM, Topical, Aerosol
NOT SUBQ
GLUCOCORTICOIDS - Side Effects
- Increase blood sugar - increased serum glucose levels
- Abnormal fat deposits (face, trunk - moon face/buffalo hump)
- Muscle wasting
- Edema
- Inc. IOP
- Thinned skin wih purpura
- Peptic Ulcers
- Growth Retardation
- Osteoporosis
- Adrenal atrophy - with long term use
- Increased potency of ASA and NSAIDS which increase risk of GI bleeds
- Licorice increases side effects.
- Immunosuppressant - avoid crowds
- Hypokalemia if used with K-wasting diuretics
RISK OF CUSHINGS SYNDROME with too MUCH
Glucocorticoids - how to discontinue?
Tapered to allow adrenal cortex to produce cortisol and other corticosteroids.
If not, adrenal insufficiency.
What does the THYROID GLAND SECRETE?
T3 triiodothyronine - regulates metabolism
T4 Thyroxine - regulates metabolism
Calcitonin - regulates serum calcium
How does the Thyroid negative feedback mechanism work?
- Hypothalamus releases thryrotropin releasing hormone TRH which simulates the release of
- TSH from the Pituitary Gland which stimulates the release of
- T3 and T4 from the thyoid gland
- Excess T3 an T4 prevent release of TRH and then TSH.
- Lack of T3 and T4 increase the function of the HPT axis
What is PRIMARY HYPOTHYROIDISM?
Thyroid gland Disorder D/O most common
Decreased T4
Elevated TSH
Why?
- Inflammation - Hashimoto’s Disease
- R/A Iodine
- Surgical excision of Thyroid
What is Secondary Hypothroidism?
Lack of TSH - a pituitary disorder
What is tertiary HYPOTHRYOIDISM?
Lack of TRH - Thyrotropin Releasing Hormone
Hypothalamus Disorder
What is MYXEDEMA and what are the symptoms?
MYXEDEMA is severe HYPOTHYROIDISM.
- Lethargy
- Emotional disturbances
- Wt. gain
- Edema
- Dry skin
- Intolerance to cold
- Constipation
- Amenorrhea
- Delayed growth in children
S/S of HYPOTHROIDISM
- Tiredness/fatigue
- Sensitivity to cold
- Weight gain
- Constipation
- Depression
- Slow movements and thoughts
- Muscle aches and weakness
- Muscle cramps
- Dry and scaly skin
- Brittle hair and nails
- Loss of libido
- Pain, numbness, and tingling in hands and fingers
- Irregular or heavy periods
Drugs used to treat HYPOTHYROIDISM
Levothyroxine (Synthroid) - increases T4 KNOW THIS
Adverse Effect - tachycardia. Taken in am on empty stomach
Liothyronine -synthetic T3 by itself or supplement to Synthroid. Rapid onset, short half-life.
Desiccated Thyroid - porcine thyroid glands - natural
Liotrix - synthetic T3 and T4
