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Pharmacology > Thyroid > Flashcards

Thyroid Flashcards

1
Q

what is the function of the thyroid hormone

A

growth, development, function, maintenance, metabolism, body temp, heart rate

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2
Q

what are 3 hyperthyroid diseases

A

Grave’s disease
Muti-nodular toxic goiter (plummers disease)
Thyrotoxicosis

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3
Q

what are 2 types of primary hypothyroism

A

hasimotos thyroiditis

Iatrogenic

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4
Q

what are secondary causes of hypothyrodism

A

pituitarty disease

hypothalamic disease

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5
Q

what drugs decrease secretion of TSH

A

dopamine
glucocorticoids
octreotide

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6
Q

what drugs decrease thyroid hormone secretion

A

lithium
Iodine and Iodine preparations
Radiocontrast dyes
amiodarone

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7
Q

hyperthyroid epidemiology

A

between 40-60

more common in women

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8
Q

what is the treatment for hyperthyroidism

A 
anti-thyroid meds
radio active iodine
thyroidectomy
symptomatic treatment
beta-blockers
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9
Q

what are anti-thyroid medications

A

methimazole-1st line

propylthiouracil (PTU)-thyroid storm 1st trimester

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10
Q

what is drug of choice for most patients with hyperthyroidism

A

methimazole

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11
Q

when is PTU best used for

A

pregnancy

thyroid storm

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12
Q

what are predictors of remission

A

small goiter
mild disease
low or neg thyroreceptor antibody titer

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13
Q

how do thioamides work

A

inhibit thyroid hormone synthesis

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14
Q

how does PTU work

A

inhibits peripheral T4-T3 conversion with in hours of dosin

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15
Q

which of the thioamides is compatible with breast feeding

A

methimazole

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16
Q

what are some serious side affects with thioamides

A

agranulocytosis

hepatotoxicity

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17
Q

how do iodides work

A

inhibit thyroid hormone release
decrease thyroid hormone synthesis
decrease gland vascularity

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18
Q

how are iodides used in thyroid disease

A

reduce vascularity prior to thyroid surgery
prepare pts with graves disease for surgery
decreased thyroiodine accumulation in thyrotixic crisis
prevent thyroid uptake of radioactiv iodine

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19
Q

what are some iodide products

A

saturated solution SSKI

Lugols

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20
Q

When to use iodide products in intitial dosing

A

50-500mg in water or juice
10-14 days prior to surgery
as adjunct to RAI

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21
Q

what are adverse effects of iodide drugs

A 
rash, GI upset 
paresthesia, immune rxn
salivary gland swelling
burning throat
metallic taste
sore teeth or gums
cold symptoms
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22
Q

when is lithium used in treatment

A

adjunct to thoamides

decreased radioactive iodine does to cure graves disease

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23
Q

what are adverse effects with Lithium

A

tremors, polyuria, renal failure, seizure, arrhythmia, bradycardia, suicide
DO NOT USE

24
Q

when are beta blockers used

A

symptomatic treatment of palpitations, tachycardia, tremor, heat intolerance
Thyrotoxicosis
preoperatively adjunct to potassium iodide, radioactive iodine or antithyroid drugs for graves disease
thyroid storm
thyroiditis

25
Q

when is radioactive iodine contraindicated

A

pregnancy
lactation
thyroid cancer
antithyroid meds

26
Q

when do you used radioactive iodine

A

surgical removal of body tissue for grave disease
women planning pregnancy greater than 4-6 months in future
patients with increased surgical risk prior to neck surgery

27
Q

what are the benefits of radioactive iodine

A

well tolerated

low risk of thyroid storm

28
Q

what are side effects of radioactive iodine

A

dysphagia

thyroid tenderness

29
Q

what causes thyroid storm

A

stress from surgery
anesthesia, thyroid manipulation in patients
abrupt d/c of antithyroid meds

30
Q

what are symptoms of thyroid storm

A 
high fever 103>
tachchardia
A-fib
CHF
Tachypnea
Dehydration
N/V 
coma
31
Q

what is the treatment for thyroid stome

A 
identify cause and treat cause
anti-thyroid meds (give before iodine)
inorganic iodine
supportive care
beta blockade
32
Q

when would you use esmolol in a patient

A

in heart failure or patients who can not take per oral meds

33
Q

what is the cause of subclinical hyperthyroidism

A

low TSH

amiodarone induced

34
Q

how do you treat subclinical hyperthyroidism

A

initiante TSH

35
Q

what causes hypothyroidism

A

anti-thyroid meds, PTU, methimazole

36
Q

what are some complications with subclinical hypothyroidism

A

TSH above normal levels
myxedema (associated with coronary artery disease)
myxedema coma
Treat w/ TSH>10mIU/L

37
Q

what are signs of hypothyroidism

A

dry skin, cold intolerance, weight gain, constipation, weakness, lethargy depression

38
Q

what are signs of hypothyroidism

A 
coarse skin and hair
cold or dry skin
periorbital puffiness
bradycardia
slow hoarse speech
39
Q

what are laboratory findings for hypothyroidism

A

increased cholesterol, LDH, AST, ALT,CPK

40
Q

what are thyroid supplement options

A

desiccated thyroid and thyroglobulin
levothyroxine
liothyronine
liotrix

41
Q

what is first line for hypothyroidism

A

synthetic L-thyroxine (synthroid, levoxyl)

42
Q

what are the pharmocokinetics like fore the l-thyroxine

A 
40-80% bioavailibility
better with fasting
decreases with fiber
99%protein bound
80% hepatic metabolism
43
Q

what decreases absorption of l-thyroxine

A

cholestyramine
calcium carb
sucralfate
soybean fiber food

44
Q

how should levothyroxine be given orally, IV, feeding tube

A

30min prior to breakfast 4 hours after last meal
use 70-50% or oral dose for IV
create water suspension wait at least 1 hr to restart feeding

45
Q

What are the disadvantages of Liothyronine T3

A

higher cardiac effects
more expensive
hard to monitor lab values

46
Q

what are the disadvantages of liotrix

A

high cost, lack of therapeutic rationale

47
Q

What is euthyroid essential for

A

normal neurocognitive development in fetus

48
Q

What should you do with women who are being treated for hypothyroidism?

A

increased rate of metabolsims for thyroid hormone/transplacental transport
so dose of levothyroxine should be increased by 30%

49
Q

what percent of pts attain remission after initial therapy

A

20-30%

50
Q

how long should treatment be continued for?

A

12-18 months then taper or d/c if euthyroid at that time

51
Q

when should a person stop anithyroid meds

A

when they have normal TSH, FT4, T3 1 year after

52
Q

when should a patient who is in remission follow up

A

retest every 1-3 months for 6-12 months after initial remission and d/c methimazole

53
Q

when should you start monitoring FT4 level

A

4 months after start of therapy

then every 4-8 weeks until normalized then every 2-3 months

54
Q

Which medication of the thiomaides do you need to do LFTS on

A

PTU with sign of liver damage, jaundice, joint pain, ab pain, light stool, dark urine

55
Q

what is the half life of RAI

A

5 days

Pharmacology (7 decks)

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