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pharm 2 > thyroid disease > Flashcards

thyroid disease Flashcards

1
Q

What drug class is levothyroxine (synthroid)

A

Thyroid hormone replacement (T4)

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2
Q

What is the MOA of levothyroxine (synthroid)

A

Replaces normal levels of T4 and T3 (T4 is converted into T3 in the periphery)

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3
Q

What are the indications for levothyroxine (synthroid)

A

Hypothyroidism. Also TSH suppression in select cases of thyroid nodules and thyroid cancer

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4
Q

How long does it take to reach a levothyroxine steady state

A

6-8 weeks

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5
Q

How is levothyroxine dosed

A

always in mcg (micrograms)

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6
Q

What is the half life of leothyroxine

A

~ 1 week

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7
Q

What are risks of having long term elevated T4

A

May accelerate cardiac disease and osteoporosis

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8
Q

In a patient with Addison’s and hypothyroidism, what is the appropriate pharmaceutical treatment

A

First replace cortisol, then thyroid. Not replacing cortisol first can be fatal

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9
Q

How does Thyroid USP (armor) compare to levothyroxine

A

It is porcine derived, and contains T3 and T4, along with some iodine and T1 and T2

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10
Q

How much is 1 grain of thyroid USP (armour)

A

60mg, which = 100mcg of synthroid

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11
Q

When should follow-up TSH testing be done

A

4-6 weeks, unless there is sweating anxiety, palpitations, increased heart rate, angina, etc

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12
Q

What is Liothyronine (Cytomel)

A

T3 thyroid replacement hormone.

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13
Q

What are the indications for liothyronine (cytomel)

A

For those intolerant or unresponsive to T4 replacement; myxedema coma; Wilson’s syndrome

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14
Q

What is the dosage of cytomel

A

25mcg = 100mcg of synthroid = 60mg Armour

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15
Q

Why are beta blockers used in hyperthyroid

A

because they block the adrenergic ssx like sweating palms, anxiety, etc

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16
Q

How is super saturated potassium iodine (SSKI) used in treatment of hyperthyroid

A

Supraphysiologic doses can be used to stun the thyroid, with effects lasting 2-3 weeks. helpful in thyroid storm

17
Q

What drug class is Methimazole (Tapazole)

A

Thionamide

18
Q

What are the indications for methimazole (tapazole)

A

Hyperthyroidism (Grave’s dis.) Can control hyperthyroidism until more definitive therapy (surgery or 131I therapy) is used

19
Q

What is the MOA of methimazole (tapazole)

A

Inhibits transformation of inorganic iodine to organic iodine, therefore blocking the production of thyroxine. Also inhibits the coupling of iodotyrosine to form T3 and T4. Minimal effect of blocking the peripheral conversion of T4 to T3

20
Q

How does methimazole compare to Propylthiouracil (PTU)

A

Propylthiouracil has much greater peripheral effect, methimazole has much greater central effect

21
Q

What is the most feared side effect of methimazole and Propylthiouracil (PTU)

A

agranulocytosis

22
Q

What category are methimazole and Propylthiouracil (PTU)

A

Category D (use it only if you have to)

23
Q

How is radioactive iodine used

A

131 I is used for ablation of the thyroid in hyperthyroidism ( 123 I is used for radioactive uptake imaging)

24
Q

How is hyperthyroidism managed in pregnancy

A

Methimazole is to be begun at the second trimester, with PTU still being used in the first trimester because PTU has more cases of hepatitis

25
Q

What are the indications for Propylthiouracil

A

hyperthyroid from Graves or toxic goiter. Not for thyroid storm

26
Q

What are the effects of propanolol in hyperthyroidism

A

Blockade of adrenergic symptoms of hyperthyroidism (i.e. tachycardia, anxiety). Emergent treatment of thyroid storm.

27
Q

What category is radioactive iodine

A

category X

28
Q

What are the outcomes of radioactive thyroid ablation

A

increased risk of parathyroid adenoma, no increase of thyroid cancer, temporary nausea and tenderness. may need to be on thyroid medications for life

pharm 2 (18 decks)

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