Review Flashcards
most important labs in thyroid
free t4 and TSH
hyperthyroidism labs
low TSH
high T4
hypothyroidism labs
low T4
high TSH
compounds that have iodine
Amiodarone, lithium
hyperthyroidism treatment
thioamides: methimazole and propylthiouracil
methimazole dosing
free t4 1-1.5 ULN 5-10 mg
1.5-2 ULN 10-20 mg
2+ ULN 30-40 mg
thioamides adverse effects
GI, rash, agranulocytosis (fever,flu, immune), hepatitis
what to use in hyperthyroid patients with HR over 90
beta blockers
(prefer metoprolol and atenolol)
hypothyroidism drugs
levothyroxine, liothyronine, armour thyroid
black box warning levothyroxine
weight loss
counseling for levothyroxine
60 mins before breakfast or 4 hours after dinner
empty stomach
uncomplicated adult levothyroxine dosing
1.6 mcg/kg/day
elderly thyroid dose
start 25-50 mcg / day
cvd thyroid dose
12.5-25 mcg/ day
pregnant pts thyroid dose
45% increase in dose
drug interactions
levothyroxine
antacids, bile acid, calcium, warfarin
GERD alarm sx
dysphasia
odynophagia
bleeding
weight loss
when to refer GERD
alarm sx or no PPI relief after 14 days
side effects of calcium
constipation
side effects magnesium
diarrhea
side effects aluminum
constipation
antacids counseling
w
take meds 2 hours before or 4-6 hours after antacids
H2RA mechanism
reversible inhibition of histamine receptors
H2RA pearls
beers
tachycardia
delirium
good for nocturnal
H2RA with side effects
cimetidine
PPis MOA
irreversible inhibition of proton pump
PPis with meals
30-60 mins before meal
pregnancy w gerd agents preferred
antacids or sucralfate
H2ra second line
which agent should be avoided in kids
bismuth subsalicylate
ulcer in duodenum
pain relieves with food
ulcer in stomach
worsens with food
h pylori tx principle
PPI and 2-3 antibiotics
bismuth quad
PPI BID
bismuth subsaliclate
metronidazole
tetracycline
10-14 days
alternative to bismuth quad
PPI BID
levofloxacin 500 mg
amoxicillin 1 g BId
prophylaxis NSAID induced ulcer drug
misoprostol
treatment only drug NSAID induced ulcer
sucralfate
NSAID induced ulcer treatment time
8 weeks if NSAID stopped
12 weeks if continued
post of n/v risk factors
female
non smoker
history motion sickness
history post op nv
loperamide dosing
4 mg initially then 2 mg after each loose stool
max 16 mg / day
constipation when to refer
2 weeks sx
black stool
abe pain
fever
bulk laxatives
psyllium
softens stools better than docusate
surfactant
docusate
not effective for active constipation
hyperosmotic
glycerin suppository and miralax
good for chronic constipation
stimulant laxatives
senna and bisacodyl
good for opioid induced constipation
hip and knee tx osteoarthritis
acetaminophen 4 g per day
hand tx osteoarthritis
oral NSAID
osteopenia t score
-1.1 to -2.4
osteoporosis t score
<2.5
bisphosphonates counseling
take on empty stomach
full glasss of water
do not lie down for at least 30 mins
do not chew
serms can be used for
back
raloxifine black box
risk vte or stroke
denosumab risk
rebound risk fracture after discontinuing
hypoclcemia
