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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
Q

What drug can cause hyperthyroidism?

A

amiodarone can increase synthesis

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26
Q

What are the 2 drugs for hyperthyroid?

A

methimazole and PTU

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27
Q

How long do you take MMI and PTU for?

A

Not lifelong as most people relapse

28
Q

How does MMI and PTU work?

A

MMI- stops thyroid peroxidase
PTU- same BUT also stops peripheral conversion of T4 into T3

29
Q

Which is more potent, MMI or PTU? Which has more s/e?

A

PTU
PTU

30
Q

What is dosing STRATEGY for MMI and PTU?

A

Start HIGH then lower maintenance dose
MMI is based on how severe hyperthyroid is

31
Q

What is onset for thioamides?

A

1-4 weeks

32
Q

If patient is experiencing side effects from MMI and PTU what do we do?

A

will resolve in 4 weeks

33
Q

What are s/e of thiamides?

A

gi upset, rash, athralgia, neutropenia, fever,hepatotox, vasculitis,

34
Q

How does MMI and PTU cause hepatotoxicity?

A

MMI- cholestatic
PTU- allergic hypatocellular damage

35
Q

What indicates relapse is likely for hyperthyroid?

A

suppressed TSH and normal T3 and T4

36
Q

How often should you tests levels for hyperthyroid?

A

4-6 weeks

37
Q

What are common drug interactions with thioamides?

A

warfarin and digoxin

38
Q

Which thioamide has better compliance, faster, cheaper?

A

ALL IS MMI

39
Q

Which thioamide to use in pregnancy?

A

1st trimester= PTU
the rest is MMI

40
Q

How does BB help hyper thyroid? Which type of BB?

A

helps with sx
Propanalol is best because short acting and easy to use PRN

41
Q

How can iodine help with hyperthyroid? What conditions allow it to be used?

A

radioactive to destroy thyroid
ONLY with mild and no bulging eyes, not pregnant/breastfeed

42
Q

What must you give if giving a definitive treatment for hyperthyroid?

A

THIOAMIDES

43
Q

If on radioactive iodine what must patient do?

A

NOT TO SPREAD FLUIDS= toxic for others
dont be near children and pregnant

44
Q

What is treatment for acute thyroiditis?

A

NO THIOAMIDES
bblocker and self limiting

45
Q

What is thyroid storm?

A

severe and happens if trauma or surgery to thyroid

46
Q

What is the most common cause of hypothyroid?

A

autoimmune- hashimotos

47
Q

What drugs can cause hypothyroid?

A

lithium-block iodine transport
amiodarone-

48
Q

What signs of hypothyroid do elderly get?

A

fatigue, confused, coma,

49
Q

Signs of hypothyroid?

A

weight gian, fatigue, bradycardia, constipation

50
Q

What do labs show for hypothyroid?

A

HIGH TSH and Low T3 and really low T4

51
Q

Explain the use of dessicated thyroid?

A

short acting, lots more T3- more of a stimulate, NOT standardized

52
Q

Explain the use of liothyroinine?

A

Only T3, short acting, more cardiac effects

53
Q

When would you use liothyroinine?

A

adjunctive or if low T3

54
Q

What is average starting dose of levothyroxine?

A

12.5mcg/day titrate every 4-6 weeks

55
Q

What is average replacement dose of levothyroxine?

A

1.6mcg/kg/day

56
Q

What is dose of levothyroxine for healthy young people?

A

100mcg

57
Q

When is it necessary to titarte levothyroxine dose?

A

if over 50, CVD, severe, longstanding hypothyroid

58
Q

How should you take levothyroxine?

A

30 min before meals or 1 hour after, morning is best

59
Q

What are s/e of levothyroxine?

A

hyperthyroid sx
cardiac risk

60
Q

Drug interactions with levothyroxine?

A

PPI, iron, calcium
space by 2-4 hours away
MORE thyroid metabolism if Ciprofloxacin, phenytoin, CBM

61
Q

What is goal for labs with hypothyroid?

A

low normal TSH- <2.5
normal T3 and T4

62
Q

When is onset for levothyroxine?

A

2-3 weeks

63
Q

Do you treat subclinical hypothyroid?

A

only if CVD, HF, MI,

64
Q

What to do if levothyroxine fails?

A

DI?, adherence? pregnant, other conditions?

65
Q

If adherence is a struggle for levothyroxine what can we do?

A

weekly doses

Pharmacy 255 (16 decks)

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