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NMT200 midterm (wk1-6) > pharm wk 6 > Flashcards

pharm wk 6 Flashcards

1
Q

what to do in patient with thyroid nodules

A

Recognize which patients with thyroid nodules require fine needle biopsy for cytologic diagnosis versus observation

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2
Q

thyrotoxicosis vs hyperthyroid vs thyroid storm

A

Thyrotoxicosis is any condition of excessive thyroid hormone and its effects

Hyperthyroidism is specifically due to excess thyroid hormone production

Thyroid storm if a life-threatening medical emergency caused by severe thyrotoxicosis

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3
Q

causes of thyrotoxicosis

A

graves disease, toxic nodules, iodine excess, and TSH-producing pituitary adenomas, among others

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4
Q

non pharmalogical choices for hyperthyroid

A

Important to consider surgery as an option given the limitations of medication and the potential for the formation of goitre

Hypothyroidism is a common and likely adverse effect thyroid surgery

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5
Q

what is the form of radioactive iodine used

A

iodine 131

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6
Q

what is iodine 131 used in

A

Used to ablate thyroid tissue in patients with Graves disease and toxic nodules

The thyroid rapidly concentrates iodine, so an oral dose has minimal effect on the rest of the body

Beta wave emission destroys surrounding tissue within a range of 0.6 – 2 mm

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7
Q

adverse effects of using radioactive iodine (iodine 131 to kill tissue in graves and toxic nodules)

A

High risk of hypothyroidism

Possible worsening of Graves orbitopathy

Risk of radiation thyroiditis

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8
Q

what does methimazole do ? what does it effect? what does it not effect?

A

Decreases the production of thyroid hormone

Interferes with iodination of tyrosine as well as with coupling

Does not affect stored thyroid hormone or thyroid hormone in circulation

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9
Q

adverse effects of methimazole

A

Risk of skin rash, allergic reaction, and agranulocytosis

Can cause hepatotoxicity in rare instances

Contraindicated during the first trimester of pregnancy due to causing aplasia cutis

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10
Q

what can methimazole cause in pregnancy

A

aplasia cutis

Contraindicated during the first trimester of pregnancy due to causing aplasia cutis

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11
Q

what is an example of beta blockers

A

propanolol

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12
Q

what is the thyroid hormone given in hypothryoid

A

levothyroxine

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13
Q

what are the 2 antithyroid agents

A

methimazole and propylthiouracil

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14
Q

PROPYLTHIOURACIL is similar to what

A

methimazole

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15
Q

what do propylthiouracil do

A

Similar mechanism of action to methimazole

Has the additional action of inhibiting the conversion of T4 to T3 in the periphery

Affects production of thyroid hormone and existing thyroid hormone

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16
Q

adverse effects of propylthiouracil

A

Similar adverse effects to methimazole

Risk of skin rash, allergic reaction, and agranulocytosis

Can cause severe hepatotoxicity that may be fatal in rare instances

Does not cause aplasia cutis

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17
Q

METHIMAZOLE VS PROPYLTHIOURACIL

a. in most instances?
b. in breastfeeding and kids?
c. 1st trimester pregnancy?
d. thyroid storm treatment?

A

m
m
p
p

Methimazole is the preferred drug in most instances due to the lower risk of causing hepatotoxicity

Methimazole is the preferred drug while patients are breastfeeding and in children

Propylthiouracil is the preferred drug during the first trimester of pregnancy

Propylthiouracil can be used to treat thyroid storm as it affects thyroid conversion in the periphery

18
Q

what to use for thyroid storm

A

Propylthiouracil

19
Q

what to use in 1st trimester of pregnancy

A

Propylthiouracil

20
Q

what has a lower risk of hepatotexocithy ; METHIMAZOLE VS PROPYLTHIOURACIL

A

METHIMAZOLE

21
Q

what do beta blockers not effect

A

thyroid hormone production

22
Q

what do beta blockers effect

A

Used to ameliorate the symptoms of adrenergic excess caused by excess thyroid hormone (elevated heart rate, hypertension, etc.)

23
Q

propanolol (beta blocker) can decrease what

A

Propranolol can decrease the conversion of T4 to T3 in the periphery

24
Q

adverse effects of beta blockers/ propanolol

A

Bradycardia, dizziness, fatigue, headache, hypotension.

Avoid in patients with asthma or conditions associated with bradycardia; taper once thyrotoxicosis improves.

25
Q

who should not take propanolol/ beta blocker

A

patients with asthma or conditions associated with bradycardia; taper once thyrotoxicosis improves.

26
Q

what is common vs uncommon cause of hypothyroid

A

Rarely caused by iodine deficiency in North America

Most commonly caused by Hashimoto’s thyroiditis

27
Q

what is the standard treatment for hypothryoid

A

levothyroxine

28
Q

what is levothyroxine

A

Replacement therapy – essentially treatment using orally administered T4

29
Q

how long does it take to get to a steady state with levothyroxine

A

Takes 6 weeks to attain a new steady state after dosage adjustments

wait 6 weeks to adjust dose

30
Q

what is levothyroxine dosing based on

A

Generally based on lean body mass

Elderly patients may need less

For those at risk of angina start lower

31
Q

dosing of levothyroxine depends on

A

depending on endogenous thyroid function

In patients with an intact thyroid or with mild or subclinical disease much smaller initial dosages may be needed (25 – 50 mcg)

In patients with negligible thyroid function full replacement dosages may be needed

32
Q

interactions of levothyroxine

A

Absorption may be reduced by antacids and mineral supplementation

Proton pump inhibitors and estrogens may interfere with absorption

Variable effects with anticoagulant drugs

Separate administration by 6 hours

Levothyroxine is typically taken first thing in the morning before any other medications

33
Q

adverse effects of levothyroxine

A

Symptoms of hyperthyroidism if overtreated

Possible exacerbation of angina

Glycemic control may decline with initiation of levothyroxine, potentially necessitating dosage adjustment of antihyperglycemic agents

34
Q

what is desiccated thyroid

A

Tablets contain T4 and T3 in fixed amounts

thyroid hormone pill made from animal thyroid gland

35
Q

adverse effects of desiccated thyroid

A

Similar to levothyroxine

Risk of cardiovascular and neurological adverse effects increases with larger doses (due to T3)

  • palpitation, tachycardia, cardiac arrhythmias, angina pectoris - nervousness, tremors, headache, insomnia
  • sweating, heat intolerance, fever, weight loss
36
Q

what added risk does desiccated thyroid have compared to levothyroxine

A

CVD and neurological bc of the T3

37
Q

typical dose calculation for levothyroxine

A

1.6 x weight in kg

but also take into account BMI, TSH level, symptoms, age, etc

38
Q

A patient returns for follow-up 6 weeks after receiving their first prescription for levothyroxine and their TSH value remains unchanged. The patient reports taking it every morning with the iron supplement they were also prescribed. Which of the following is the best course of action?
A. Increase the dose of levothyroxine by 12.5 mcg
B. Reduce the dose of levothyroxine by 12.5 mcg
C. Switch the patient to an equivalent dose of desiccated thyroid
D. Change the time the patient takes their iron supplement

A

D. Change the time the patient takes their iron supplement

39
Q

what affects levothyroxine absorption

A

antacids and mineral supplements

take separately

40
Q

DOSING FOR THYROID MED CASES

A

NMT200 midterm (wk1-6) (22 decks)

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