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Pharmacology Exam 1 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

S/S of hypERthyroidism?

A
  • Tachycardia
  • Hypertension
  • Cardiac dysrhythmias
  • Heart failure
  • Low cholesterol
  • Anxiety or insomnia
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2
Q

S/S of hypOthyroidism?

A
  • Decrease in cardiac output
  • Decrease in BP
  • Decrease in HR
  • Cardiac enlargement
  • Heart Failure
  • Weight gain
  • Constipation
  • Poor appetite
  • Risk of atherosclerosis development and high cholesterol
  • Emotional dullness
  • Lethargy
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3
Q

What labs do we look at for thyroid issues?

A
  • TSH (can screen and diagnosis for hypo and hyper)
  • Serum T4
  • Serum T3
  • Thyroid antibodies
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4
Q

What does the lab TSH tell us?

A
  • Elevated = hypo

- Decreased= hyper

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5
Q

What does the serum T4 lab tell us?

A

Used to see how effective treatment is

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6
Q

What does the serum T3 lab tell us?

A

More commonly used to officially diagnose hyper

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7
Q

What do thyroid antibody labs tell us?

A

Just looking to see if there is any autoimmune type function

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8
Q

What drug therapy is used for hypOthyroidism?

A

Levothyroxine

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9
Q

What drug therapy is used for hypERthyroidism?

A
  • Methimazole (MTM)
  • Grave’s disease (cause of hyper): second line drug for this disease is Propylthiouracil (PTU)
  • Radioactive Iodine
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10
Q

What is the mechanism of action for Levothyroxine?

A
  • Synthetic preparation of thyroxine (T4)

- Taken to replace missing hormone (T4)

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11
Q

When do we give Levothyroxine?

A

Taken in morning on empty stomach 30-60 minutes before breakfast

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12
Q

What are adverse effects of Levothyroxine?

A

Possibility of hyperthyroidism

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13
Q

What are therapeutic effects of Levothyroxine?

A
  • Decrease in TSH
  • Increase in T3 and T4
  • Lessening symptoms of hypothyroidism
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14
Q

What patient teaching is needed with Levothyroxine?

A
  • Take first thing in morning on empty stomach
  • S/S of hypothyroidism should get better
  • If S/S of hypo don’t get better then need new labs and plan
  • Lifelong medication
  • Black box warning
  • Frequent monitoring of serum drug levels, TSH, T4 and T3 needed
  • Brand name= synthroid
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15
Q

What is the black box warning for Levothyroxine?

A

Person with normal thyroid can not take this, or serious side effects will occur

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16
Q

What does the drug PTU stand for?

A

Propylthiouracil

17
Q

What is the mechanism of action of PTU?

A
  • Suppresses synthesis of thyroid hormones

- Short half-life compared to MTM (about 90 min)

18
Q

When is PTU given?

A

2-3 daily doses (every 8 hours)

19
Q

What adverse effects are there with PTU?

A
  • Can cause drowsiness, N/V, and GI upset
  • Look for S/S of hyperthyroidism
  • Black box warning
20
Q

What is the black box warning for PTU?

A

-Causes severe liver injury that can result in acute liver failure or death

21
Q

What are therapeutic effects of PTU?

A
  • Tx of Grave’s disease (2nd line drug)
  • Adjunct to radiation therapy
  • Preparation for thyroid surgery
  • Tx of Thyrotoxic crisis (preferred)
  • Expect to see S/S of hyperthyroidism lessen
  • Expect decrease in T3 and T4 and an increase in TSH
22
Q

What patient teaching is needed with PTU?

A
  • Monitor for S/S of hypothyroidism

- Full benefits may take 6-12 months (needs to build up in system)

23
Q

What does MTM stand for?

A

Methimazole

24
Q

What is the mechanism of action for MTM?

A

Inhibits synthesis of thyroid hormones by blocking oxidation of Iodine

25
Q

When do we give MTM?

A

Usually one dose per day

26
Q

What are adverse effects of MTM?

A

Hypothyroidism

27
Q

What are therapeutic effects of MTM?

A
  • Sole therapy for Grave’s disease
  • Adjunct to radiation therapy or in preparation for thyroidectomy
  • Tx of Thyrotoxic crisis
  • Expect to see decrease in T3 and T4. and an increase in TSH
  • Lessening symptoms of hyperthyroidism
28
Q

What patient teaching is needed with MTM?

A

-Monitor for S/S of hypothyroidism

29
Q

What is the mechanism of action for Radioactive Iodine?

A
  • Destruction of thyroid tissue

- Takes 2-3 months for full affect

30
Q

When do we give Radioactive Iodine?

A
  • Determined by thyroid size and rate of thyroidal iodine uptake
  • Some disease has a range of treatment levels
31
Q

What are adverse effects of Radioactive Iodine?

A

Large doses like in cancer treatment may cause:

  • Radiation sickness
  • Leukemia may be produced
  • Bone marrow function may be depressed (leukopenia, thrombocytopenia, anemia)
32
Q

What are therapeutic effects of Radioactive Iodine?

A
  • Lessening symptoms of hyperthyroidism
  • Grave’s disease treatment
  • Used for some thyroid cancer
33
Q

What patient teaching is needed with Radioactive Iodine?

A
  • Radiation precautions (not used for pregnancy/lactation)

- S/S of hypothyroidism

34
Q

Explain the feedback loop:

A
  • Hypothalamus secretes TRH (thyroid releasing hormone)
  • TRH tells Anterior Pituitary to release TSH
  • TSH stimulates the thyroid to produce T3 and T4
  • T3 and T4 communicate to Anterior Pituitary what they need
35
Q

What are levels of TSH, T3, and T4 like in hypOthyroidism?

A

-Elevated TSH
-Decreased T3 and T4
(thyroid not working, anterior pituitary yelling at thyroid to produce TSH to make more T3 and T4)

36
Q

What levels of TSH, T3, and T4 like in hypERthyroidism?

A

-Decrease TSH
-Increased T3 and T4
(T3 and T4 communicate to Anterior Pituitary that they don’t need more TSH)

37
Q

What is the goal of the Thyroid Feedback loop?

A

To normalize TSH levels

Pharmacology Exam 1 (4 decks)

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