SumExam1 Flashcards
Levothyroxine is what kind of drug?
thyroid hormone replacement
How would you treat hypothyroidism?
with thyroid hormone
Levothyroxine*= watch for too much- hyperthyroidism
How would you treat hyperthyroidism?
block thyroid or inhibit TSH-
Thionamides*
- watch for too little hypothyroidism
How could you describe levothyroxine?
Synthetic pre of T4 identical to naturally occurring hormone
What is unique about the half life of levothyroxine and the therapeutic index
A very narrow therapeutic index and a half life of 7 days
How long would it take levothyroxine to get to a steady state?
Steady state=4-5 half lives
Half life=7 days
About a month for steady state
If there is a cardiac patient, why would you need to watch them for thyroid issues?
Because some of the signs and symptoms of hypo//hyper are heart related
What type of medications/ foods would you want to avoid while taking levo?
anything that would effect absorption in the stomach- calcium, magnesium, antacids and Warfarin
What is the importance of iodine in the thyroid?
Iodine goes into the cell and is oxidized- iodination of tyrosine happens and then makes MIT and DIT which join together and create T3 (DIT +MIT) and T4 (DIT+DIT)
What two prototype drugs are considered thionamides?
Methimazole 1st line
and propylthiouracil 2nd line
Which prototype drug is an iodine product?
potassium iodide SSKI
What two routes can Levo be given?
Oral and IV
What is a contraindication for Levo?
It can cause cardiac stimulation
What 3 things would you monitor for someone on Levothyroxine?
hyer/hypothyroidism
T4
TSH
What time of day should someone take levothyroxine?
in the morning, either 30 min before breakfast, or 60 mins after
What is the main function of thionamides?
To suppress the synthesis of thyroid hormones
If a woman was pregnant or breastfeeding, which thionamide would be better for her to take and why?
propylthiouracil (PTU)
Has lower transplacental passing and lower levels in breast milk
What is the half-life of the thionamides?
methimazole has a half-life of 6-13 hours
PTU has a half-life of 1-2 hours
In terms of ease and remembering to take it, which thionamide would be easier ? why?
Methimazole- because you only have to take it once a day for maintenance and 1-3 for initial
PTU is 3-4 initial and 2-3 maintenance
What are the adverse effects of methimazole that need to be watched?
agranulocytosis, neonatal hypothyroidism if given in pregnancy
What are the adverse effects of PTU?
Liver injury, argranulocytosis and rash
What are the two most common products for iodine therapy?
Lugol’s solution
saturated solution of iodide solution
what is the biggest complaint of iodine therapy?
tastes terrible- brassy taste, sore teeth
What are the risks factors for a higher WTH ratio?
Cardiovascular problems
hypertension
diabetes
increased mortality
What do orexigenic peptides do?
Stimulate food consumption
What do anorexigenic peptides do?
block stimulation signals
Where is leptin produced?
adipose cells
What is the only orexigenic peptide?
ghrelin
What are the three short term peptides?
Ghrelin
Peptide YY
Choleocystokinin
What are the two long term peptides?
Leptin and insulin
What does leptin do?
it directly affects appetite by inhibiting the orexigenic peptide (Ghrelin) and stimulates anorexigenic neurons.
it also decreases the neurons that are releasing ghrelin
What are the symptoms of hypertyroidism?
Trouble sleeping excitability and nervousness weight loss intolerance to heat increased sweating diarrhea muscle weakness hand tremors
What are the symptoms of hypothyroidism?
Weight gain low HR constipation hair loss mental sluggishness fatigue husky voice periorbital edema depression
what is it called when someone goes into severe hyperthyroidism? what are the symptoms that come along?
thyrotoxicosis Hyperthermia Severe tachycardia Malignant hypertension Cardiac dysrhythmias
What is it called when someone goes into severe hypothroidism? What are the symptoms that come along?
myxedema coma- full slow down of body Altered mental status/coma Low temp Bradycardia Hypotension
What would the primary and secondary lab values be for hyperthyroidism?
Primary
Increased tyroxine
decreased TSH
Secondary
Increased tyroxine
increased TSH
What would the primary and secondary lab values be for hypothyroidism?
Primary
Decreased tyroxine
Increased TSH
Secondary
Decreased tyroxine
Decreased TSH
What is a goiter?
Visible enlargement of thyroid glad due to hyerplasia
*can be from hypo or hyper
Hashimoto’s Thyroiditis is caused by what?
Primary HYPOthyroidism
Grave’s Disease is caused by what?
Primary HYPERthyroidism
What happens during Hashimoto’s Thyroiditis?
Lymphocytes infiltrate thyroid- impaired function = increase TSH to try to increase
Inflammation causes fibrosis of thyroid
What happens during Grave’s disease?
Antibodies bind to cells and stimulate TSH but TSH level is low
What is the part of the brain that gives reward?
What parts of the brain are most affected by drugs?
Limbic system
Brain stem & frontal cortex
How does the reward pathway work?
more dopamine & glutamate than normal- and once you come down it’s much harder to function= more use
What happens during the prodromal phase of Schizophrenia?
strange behavior, changes in social life-isolation, paranoid
*more negative symptoms
Positive vs Negative symptoms
What symptoms have a better outcome?
positive symptoms have better outcomes- these signs are more observable, they “add to” a person, abnormal movements, hallucinations, delusions, alterations in thoughts and speech
negative symptoms- more internal, depression, social ques, lack of motivation, ability to experience pleasure, more likely to commit suicide
What are some of the prenatal and perinatal vulnerability factors?
- early environmental factors
- older fathers
- prenatal infections
- prenatal nutritional deficits
- prenatal complications
What are the phases of Schizophrenia?
Phase 1/ acute
Phase 2/ stabilization
Phase 3/ Maintenance
What are delusions?
fixed false beliefs
-75% of schizophrenic patients have them
What is concrete thinking?
the ability to think in abstracts, complicated ways- those with schizophrenia struggle with this
What are extrapyramidal side effects? (EPS)
Neuroleptic malignant syndrome
Tradive dyskinesia- lip smaking
Psuedo parkinsonism- drooling, tremors, mask face
Dystonia- COntractions of face, neck and back
Akathisia- restlessness, rocking, tapping
Why is Neuroleptic malignant syndrome so important to monitor?
its a 911 emergency
“mad as a hatter, red as a beet”
What are the biggest signs and symptoms of neuroleptic malignant syndrome?
Severe muscle rigidity,
flexor extensor posturing, cogwheeling, fever (>103), hypertension, tachycardia, diaphoresis, stupor, coma
What does AIMS stand for?
Abnormal Involuntary Movement Sclae
What are the 3 most common First Generation Antipsychotics?
Haloperidol,
thioridazine
fulphenazin
What are the most common anticholinergic effects?
Dry mouth, constipation, blurred vision, sexual dysfunction, photosensitivity, toxicity
What are the most common Second Generation Antipsychotics?
Clozapine,
Risperidone, quetiapine, ziprasidone,
apriprizole
What is metabolic syndrome?
weight gain, prediabetes, dyslipidemia
What are some side effects of Second Generation Antipsychotics?
Agranulocytosis for clozapine
Sedation and orthostatic hypotension
prolongation of QT interval for some
How do Antipsychotics work?
blockage of dopamine
& seratonin (2nd Gen)
What are the four episodes within bipolar? What is a simple definition of each?
Manic- increased, expansive or irritable mood
Depressive- depressed mood or loss of interest
Mixed- meets both manic and depressive
Hypomanic- increased, expansive or irritable mood but not as extreme as manic
What do the words hypomania, dysthymia and uthmia mean?
Hypomania- between uthmia and manic
Dysthymia- between uthmia and depressive
Uthmia- middle line, even steady state
What is major depressive disorder?
When someone drops from uthmia to depressive once or recurrent times
What is Dysthymic disorder?
When someone drops from Uthmia into dysthymic for 2 or more years
What is double depression?
When someone has been in a dysthymic state for 2 or more years and then drops to major depressive for 6-24 months
In order to be diagnosed with bipolar 1, What must happen?
You must have at least 1 manic episode, (or mixed) which will normally be accompanied by a depressive episode
In order to be diagnosed with bipolar 2, what must happen?
You must have at least one depressive episode, which will probably be followed by a manic episode.
What neurotransmitters are involved with bipolar?
Dopamine, Seritonin, and norepinephrine
If both of the parents of a child had bipolar, what % chance would the child be at?
56-84%
80-90% hereditary
What are the top 3 highest co-morbid problems that many people with bipolar have?
Panic attacks
Alcohol abuse
Social phobia
What neurotransmitters are blocked more with first gen antipsychotics?
Dopamine
What neurotransmitters are blocked more with 2nd gen antipsychotics?
Both Serotonin and dopamine but more serotonin
The risk of EPS is higher with what gen? how about metabolic syndrome?
EPS-1st gen
Metabolic- 2nd gen
What are the treatments for EPS?
Low doses
Lower potency
Anticholinergic meds- Benztropine (IM or PO)
Diphenhydramine (IM or PO)
What three signs are normally early signs of EPS?
Dystonia
Parkinson like symptoms
Akathisia
What sign is normally a late sign of EPS?
Tardive dyskinesia
Lithium is best used for what type of bipolar? why?
Bipolar 1
it is a mood stabilizer and works by preventing mania
What are the side effects of lithium?
diarrhea, vomiting, Hand tremor, Sedation, Edema, Fatigue & thirst, arrhythmia, hypotension, diabetes insipidus with polyuria, polydipsia
