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Pharmacy 255 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What do colloid cells do in thyroid?

A

store building blocks

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2
Q

What do the parafollicular cells do?

A

make calcitonin

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3
Q

What do follicular cells do?

A

transport materials

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4
Q

What stims T3 and T4 production?

A

TSH, low iodine, low T3 and T4 levels

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5
Q

Explain the process of making T3 and T4?

A

iodine binds to tyrosine and thyroglobulin, either mono or di,

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6
Q

WHat is different between T3 and T4?

A

T3 is more potent
T4 can be converted to T3 in peripheral

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7
Q

What is the ratio of T4 to T3?

A

13:1

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8
Q

What enzyme is needed to make MIT and DIT?

A

thyroid peroxidase

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9
Q

What does T3 and T4 do to the body?

A

stims heart, bone development, catabolic

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10
Q

Why is there innactive T3?

A

to act as a reservoir in case needed

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11
Q

What inhibits T3 and T4 production?

A

high levels of them
lithium, lots of iodine

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12
Q

Why does low iodine stim production?

A

use it up before it runs out

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13
Q

Which gender has more issues with thyroid?

A

women

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14
Q

What are the four causes of hyperthyroidism?

A

Toxic diffuse goiter
Toxic multinodular goiter
acute phase of thyroiditis
toxic adenoma

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15
Q

What is diffuse goiter? who gets it more?

A

young women, most common cause, immune destroy TSH receptor

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16
Q

What is nodular goiter? who gets it more?

A

old women, iodine deficiency causes nodules to grow then TSH receptors always on

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17
Q

How does thyroiditis cause hyperthyroidism?

A

inflammation/damage causes hormone to be released

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18
Q

How does toxic adenoma cause hyper?

A

benign tumour secretes

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19
Q

Which hyperthyroid cause can lead to hypothyroidism?

A

thyroiditis

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20
Q

SX of Hyperthyroid?

A

tremor, diarrhea, weight loss, weak, tachycardia, palpitiations

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21
Q

What sx would you EXCLUSIVELY see in diffuse goiter?

A

bulging eyes-exophtalmos
eye swelling
purple rash on SHIN

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22
Q

What sx would you EXCLUSIVELY see in nodular goiter?

A

nodes on it

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23
Q

True or false. From lab work you can distinguish between diffuse and nodular goiters?

A

False

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24
Q

If you have hyperthyroidism what would labs show?

A

LOW TSH and HIGH T3 and T4

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25
What drug can cause hyperthyroidism?
amiodarone can increase synthesis
26
What are the 2 drugs for hyperthyroid?
methimazole and PTU
27
How long do you take MMI and PTU for?
Not lifelong as most people relapse
28
How does MMI and PTU work?
MMI- stops thyroid peroxidase PTU- same BUT also stops peripheral conversion of T4 into T3
29
Which is more potent, MMI or PTU? Which has more s/e?
PTU PTU
30
What is dosing STRATEGY for MMI and PTU?
Start HIGH then lower maintenance dose MMI is based on how severe hyperthyroid is
31
What is onset for thioamides?
1-4 weeks
32
If patient is experiencing side effects from MMI and PTU what do we do?
will resolve in 4 weeks
33
What are s/e of thiamides?
gi upset, rash, athralgia, neutropenia, fever,hepatotox, vasculitis,
34
How does MMI and PTU cause hepatotoxicity?
MMI- cholestatic PTU- allergic hypatocellular damage
35
What indicates relapse is likely for hyperthyroid?
suppressed TSH and normal T3 and T4
36
How often should you tests levels for hyperthyroid?
4-6 weeks
37
What are common drug interactions with thioamides?
warfarin and digoxin
38
Which thioamide has better compliance, faster, cheaper?
ALL IS MMI
39
Which thioamide to use in pregnancy?
1st trimester= PTU the rest is MMI
40
How does BB help hyper thyroid? Which type of BB?
helps with sx Propanalol is best because short acting and easy to use PRN
41
How can iodine help with hyperthyroid? What conditions allow it to be used?
radioactive to destroy thyroid ONLY with mild and no bulging eyes, not pregnant/breastfeed
42
What must you give if giving a definitive treatment for hyperthyroid?
THIOAMIDES
43
If on radioactive iodine what must patient do?
NOT TO SPREAD FLUIDS= toxic for others dont be near children and pregnant
44
What is treatment for acute thyroiditis?
NO THIOAMIDES bblocker and self limiting
45
What is thyroid storm?
severe and happens if trauma or surgery to thyroid
46
What is the most common cause of hypothyroid?
autoimmune- hashimotos
47
What drugs can cause hypothyroid?
lithium-block iodine transport amiodarone-
48
What signs of hypothyroid do elderly get?
fatigue, confused, coma,
49
Signs of hypothyroid?
weight gian, fatigue, bradycardia, constipation
50
What do labs show for hypothyroid?
HIGH TSH and Low T3 and really low T4
51
Explain the use of dessicated thyroid?
short acting, lots more T3- more of a stimulate, NOT standardized
52
Explain the use of liothyroinine?
Only T3, short acting, more cardiac effects
53
When would you use liothyroinine?
adjunctive or if low T3
54
What is average starting dose of levothyroxine?
12.5mcg/day titrate every 4-6 weeks
55
What is average replacement dose of levothyroxine?
1.6mcg/kg/day
56
What is dose of levothyroxine for healthy young people?
100mcg
57
When is it necessary to titarte levothyroxine dose?
if over 50, CVD, severe, longstanding hypothyroid
58
How should you take levothyroxine?
30 min before meals or 1 hour after, morning is best
59
What are s/e of levothyroxine?
hyperthyroid sx cardiac risk
60
Drug interactions with levothyroxine?
PPI, iron, calcium space by 2-4 hours away MORE thyroid metabolism if Ciprofloxacin, phenytoin, CBM
61
What is goal for labs with hypothyroid?
low normal TSH- <2.5 normal T3 and T4
62
When is onset for levothyroxine?
2-3 weeks
63
Do you treat subclinical hypothyroid?
only if CVD, HF, MI,
64
What to do if levothyroxine fails?
DI?, adherence? pregnant, other conditions?
65
If adherence is a struggle for levothyroxine what can we do?
weekly doses

Pharmacy 255 (16 decks)

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