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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 diseaseMuti-nodular toxic goiter (plummers disease)Thyrotoxicosis

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3
Q

what are 2 types of primary hypothyroism

A

hasimotos thyroiditisIatrogenic

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4
Q

what are secondary causes of hypothyrodism

A

pituitarty diseasehypothalamic disease

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5
Q

what drugs decrease secretion of TSH

A

dopamineglucocorticoidsoctreotide

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6
Q

what drugs decrease thyroid hormone secretion

A

lithiumIodine and Iodine preparationsRadiocontrast dyesamiodarone

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7
Q

hyperthyroid epidemiology

A

between 40-60more common in women

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8
Q

what is the treatment for hyperthyroidism

A

anti-thyroid medsradio active iodinethyroidectomysymptomatic treatmentbeta-blockers

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9
Q

what are anti-thyroid medications

A

methimazole-1st linepropylthiouracil (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

pregnancythyroid storm

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12
Q

what are predictors of remission

A

small goitermild diseaselow 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

agranulocytosishepatotoxicity

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17
Q

how do iodides work

A

inhibit thyroid hormone releasedecrease thyroid hormone synthesisdecrease gland vascularity

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18
Q

how are iodides used in thyroid disease

A

reduce vascularity prior to thyroid surgeryprepare pts with graves disease for surgerydecreased thyroiodine accumulation in thyrotixic crisisprevent thyroid uptake of radioactiv iodine

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19
Q

what are some iodide products

A

saturated solution SSKILugols

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20
Q

When to use iodide products in intitial dosing

A

50-500mg in water or juice10-14 days prior to surgeryas adjunct to RAI

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21
Q

what are adverse effects of iodide drugs

A

rash, GI upset paresthesia, immune rxnsalivary gland swellingburning throatmetallic tastesore teeth or gumscold symptoms

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22
Q

when is lithium used in treatment

A

adjunct to thoamidesdecreased 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, suicideDO NOT USE

24
Q

when are beta blockers used

A

symptomatic treatment of palpitations, tachycardia, tremor, heat intoleranceThyrotoxicosispreoperatively adjunct to potassium iodide, radioactive iodine or antithyroid drugs for graves diseasethyroid stormthyroiditis

25
when is radioactive iodine contraindicated
pregnancylactationthyroid cancerantithyroid meds
26
when do you used radioactive iodine
surgical removal of body tissue for grave diseasewomen planning pregnancy greater than 4-6 months in futurepatients with increased surgical risk prior to neck surgery
27
what are the benefits of radioactive iodine
well toleratedlow risk of thyroid storm
28
what are side effects of radioactive iodine
dysphagiathyroid tenderness
29
what causes thyroid storm
stress from surgeryanesthesia, thyroid manipulation in patientsabrupt d/c of antithyroid meds
30
what are symptoms of thyroid storm
high fever 103>tachchardiaA-fibCHFTachypneaDehydrationN/V coma
31
what is the treatment for thyroid stome
identify cause and treat causeanti-thyroid meds (give before iodine)inorganic iodinesupportive carebeta blockade
32
when would you use esmolol in a patient
in heart failure or patients who can not take per oral meds
33
what is the cause of subclinical hyperthyroidism
low TSHamiodarone induced
34
how do you treat subclinical hyperthyroidism
initiante TSH
35
what causes hypothyroidism
anti-thyroid meds, PTU, methimazole
36
what are some complications with subclinical hypothyroidism
TSH above normal levelsmyxedema (associated with coronary artery disease)myxedema comaTreat w/ TSH>10mIU/L
37
what are signs of hypothyroidism
dry skin, cold intolerance, weight gain, constipation, weakness, lethargy depression
38
what are signs of hypothyroidism
coarse skin and haircold or dry skinperiorbital puffinessbradycardiaslow hoarse speech
39
what are laboratory findings for hypothyroidism
increased cholesterol, LDH, AST, ALT,CPK
40
what are thyroid supplement options
desiccated thyroid and thyroglobulinlevothyroxineliothyronineliotrix
41
what is first line for hypothyroidism
synthetic L-thyroxine (synthroid, levoxyl)
42
what are the pharmocokinetics like fore the l-thyroxine
40-80% bioavailibilitybetter with fastingdecreases with fiber99%protein bound80% hepatic metabolism
43
what decreases absorption of l-thyroxine
cholestyraminecalcium carbsucralfatesoybean fiber food
44
how should levothyroxine be given orally, IV, feeding tube
30min prior to breakfast 4 hours after last mealuse 70-50% or oral dose for IVcreate water suspension wait at least 1 hr to restart feeding
45
What are the disadvantages of Liothyronine T3
higher cardiac effectsmore expensivehard to monitor lab values
46
what are the disadvantages of liotrix
high cost, lack of therapeutic rationale
47
What is euthyroid essential for
normal neurocognitive development in fetus
48
What should you do with women who are being treated for hypothyroidism?
increased rate of metabolsims for thyroid hormone/transplacental transportso dose of levothyroxine should be increased by 30%
49
what percent of pts attain remission after initial therapy
20-30%
50
how long should treatment be continued for?
12-18 months then taper or d/c if euthyroid at that time
51
when should a person stop anithyroid meds
when they have normal TSH, FT4, T3 1 year after
52
when should a patient who is in remission follow up
retest every 1-3 months for 6-12 months after initial remission and d/c methimazole
53
when should you start monitoring FT4 level
4 months after start of therapythen every 4-8 weeks until normalized then every 2-3 months
54
Which medication of the thiomaides do you need to do LFTS on
PTU with sign of liver damage, jaundice, joint pain, ab pain, light stool, dark urine
55
what is the half life of RAI
5 days

Pharmacology (14 decks)

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