Pharm2 3 Thyroid pt2

Question 1

Adverse Effects of all hypothyroid Medications (8)

Answer 1

Cardiac palpitation and arrhythmias, tachycardia (especially w/ thyroid storm), weight loss, tremor, headache, insomnia, and heat intolerance

Question 2

Do what differently is the patient has a history of hypothyroidism or ischemic heart disease?

Answer 2

be slower in titrating them upwards

These patients should be started on a low dose and then are slowly titrated of hormone replacement over several months

Question 3

What must you do In patients who have both hypothyroidism and adrenal insufficiency?

Answer 3

Must adjust their corticosteroid replacement before any thyroid hormones are given.

Question 4

Just List 4 Drug interactions of Hypothyroid hormone meds.

Answer 4

Sympathomimetics (pseudophedrine)
Warfarin/anticoags
DM agents (Insulin and PO agents)
Digioxin/Digitoxin

Question 5

What’s the interaction of hypoThyroid hormone + Sympathomimetics:

Answer 5

Coronary insufficiency is increased in patients with coronary artery disease who are taking sympathomimetic agents (sudafed) and thyroid hormones

Question 6

What’s the interaction of Thyroid hormone + Warfarin/anticoagulants?
What will you do about it?

Answer 6

anticoagulants effects are enhanced because thyroid hormones increase the catabolism of vitamin k-dependent clotting factors
Dose of anticoagulant may have to be reduced

Question 7

What may you do if you give Thyroid hormone along with Diabetes agents?

Answer 7

Diabetes mellitus patients may need an increase in insulin or oral hypoglycemic agents due to start of thyroid hormones

Question 8

What may you need to do if you give Thyroid hormone + Digitoxin, Digoxin?

Answer 8

Digitalized patients who use cardiac glycosides (Digitoxin, Digoxin) may need a larger dose

Question 9

What 2 drugs can cause hypothyroidism?

Answer 9

Amiodarone & lithium

Question 10

Most widely used beta blocker in hyperthyroidism?
Improves many of the manifestations of Thyrotoxicosis (thyroid storm) (Hyperthyroidism)
Toxic solitary thyroid nodules
Toxic mulitnobular goiter
Subacute (De Quervain’s) thyroidits
Hashimoto’s thyroiditis

Answer 10

Propanolol

Question 11

5 therapeutic effects of Propanolol:

Answer 11

Reduces tachycardia, palpitations, tremor, sweating, heat intolerance, and anxiety

Question 12

Propanolol.

Contraindications (4). What would you use instead in these patients?

Answer 12

CI: asthma, COPD, heart block, CHF.
in these pts use Metoprolol instead.
While this is cardioselective and you wouldn’t want to use it if a pt had bradycardia, hyperthyroid patients will have TACHYcardia. You can test their response to betablockers with esmolol.

Question 13

If a patient has thyroid storm, what drugs will take care of it? What is each drug’s role?

Answer 13

Propanolol inhibits the symptoms
Thionamides are what actually stops it.
Iodinated contrast agents for the most severe thyroid storm cases?

Question 14

2 examples of Thionamides

Answer 14

Propylthiouracil (PTU), Methimazole

Question 15

Thionamides
What do they do?
What is PTU’s mech of action?

Answer 15

Decrease thyroid hormone production
Inhibit thyroid hormone synthesis and over time secretion
Propylthiouracil is used to ease sever thyrotoxicosis rapidly because it (inhibits D1) which deiodinates T4 to T3

Question 16

How do you deal with a pregnant patient with hyperthyroidism?

Answer 16

PTU, minimal dose to avoid inducing infantile hypothyroidism and thyroid enlargement.

Question 17

What are the half lives of the main 2 Thionamides?

Answer 17

PTU: 1.5 hours
Methimazole: 6 hours

Question 18

Thionamides

single dose lasts how long?

Answer 18

24 hours

Question 19

Most serious side effect of Thionamides (2)

it’s usually seen after how long?

Answer 19

granulocytopenia and agranulocytosis

usually seen w/in 3 months

Question 20

Iodinated Contrast Agents (not being used as contrast agents)
Who are they for?
Mech of Action?

Answer 20

These are for the sickest of your thyroid storm patients. Used w/ large doses of antithyroid drugs
(Inhibit D1 and D2), resulting in a rapid fall in plasma T3 in seriously thyrotoxic patients

Question 21

Big adverse effect of Iodinated Contrast Agent?

Answer 21

Acute Renal Failure

Question 22

Radioactive Iodine:
What does it do?
Pregnancy info
What if they are taking Methimazole or PTU?

Answer 22

Used to destroy overactive thyroid tissue (thyroid ablation) for hyperthyroidism.
Not used in pregnant women

Grave’s disease patients who are on Methimazole or Propylthiouracil may fail treatment
In such cases Methimazole and Proylthiouracil is DISCONTINUE FOR 6 days before treatment

Question 23

What is the 2nd most common cause of hypothyroidism in the US?

Answer 23

Use of radioactive iodine. It takes a hyperthyroid patient and makes ‘em hypothyroid, where they get thyroid hormone meds from then on.

Question 24

What can Radioactive iodine do to the hyperthyroidism sx (one specifically)

How does smoking affect this? (2)

Answer 24

may worsen Grave’s opthalmopathy in 15%, never improves it (unlike Methimazole).
But if you give Prednisone after, it improves it in 67%.
Smokers are encouraged to quit before radioactive iodine therapy because smoking increases a flare up in ophthalmopathy
Smoking also decreases the effectiveness of prednisone treatment

Question 25

Lithium Carbonate.
What is its normal use?
When would you use it in a thyroid patient?

Answer 25

This is normally used for bipolar disease.
Used to control thyrotoxicosis in patients. There is no advantage to control thyrotoxicosis UNLESS they are allergic to the other drugs, so this is a 3rd or 4th line drug.

Question 26

Big risk factor for Lithium.

5 CI for Lithium in a thyroid patient.

Answer 26

Narrow therapeutic range

CI: cardiovascular and renal disease, debilitation or dehydrations, sodium depletion, or brain damage

Question 27

Name 3 drugs used in Hypothyroidism

Answer 27

Levothyroxine Sodium
Liothyronine Sodium
Liotrix

Question 28

Name 4 drugs (2 are classes of drugs) used in Hyperthyroidism

Answer 28

Propranolol
Thionamides
Iodinated Contrast Agents
Radioactive Iodine