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Nonliner (Dose Dependent Pharmacokinetics) > Thyroid Disorders Zobeck > Flashcards

Thyroid Disorders Zobeck Flashcards

1
Q

What is the purpose of the Thyroid hormone?

A

To regulate metabolism in every cell

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2
Q

Which thyroid hormone is more potent?

A

T3

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3
Q

Which thyroid hormone has a shorter half life?

A

T3

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4
Q

Which thyroid hormone is more protein bounded?

A

T4

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5
Q

What blocks NIS?

A

SCN, ClO4, low anions

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6
Q

What blocks TPO?

A

PTU, MMI, Carbimazole

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7
Q

If there is an excess of T4 and T3 in your body, how will that affect TSH and TRH?

A

negative feedback. Less TSH and TRH.

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8
Q

What are the proteins that TH bind to?

A

TBG, Albumin, Transthyretin

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9
Q

Is bound TH or unbound active?

A

UNbound is active because it is free TH

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10
Q

An increase in TBG …

A

decrease the free T4

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11
Q

What increases TBG

A
  1. Pregnancy
  2. New born state
  3. HIV infection
  4. Hepatitis
  5. Birth control
  6. Tamoxifen
  7. Perphenazine
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12
Q

What decreases TBG

A
  1. Steroids
  2. Glucocorticoids
  3. Salicylates
  4. Chronic liver disease
  5. systemic illness
  6. Nephrosis
  7. Phenytoin,
  8. carbamazepine
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13
Q

What is used to measure hormone levels?

A

Free T4

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14
Q

What are the symptoms of Hypothyroidism?

A
  1. Decrease BP, HR, CO
  2. Cold intolerance
  3. Constipation
  4. Lethargy, tired, depressed , mental fogginess
  5. dry skin, scaly, brittle nails, dry hair
  6. weight gain, hyperglycemia, hyperlipidemia, hypertriglyceridemia
  7. Goiter, myxedema
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15
Q

What are the symptoms of Hyperthyroidism?

A
  1. increase HR, BP, A. Fib, Myocardial hypertrophy
  2. Heat intolerance, flushing and sweating
  3. Anxiety, insomnia, tremor
  4. Warm/moist skin, hair loss
  5. Weight loss
  6. Osteoporosis
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16
Q

What is the most sensitive lab test for thyroid function?

A

TSH

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17
Q

What tests do you use to diagnose initial diagnosis

A
  1. TSH

2. FT4

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18
Q

What test do you use to test for abnormalities

A

FT3

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19
Q

What lab test is not useful

A

TT4

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20
Q

What are the FT4, TSH, T3 values for primary Hypothyroidism?

A
  1. FT4, low
  2. TSH, high
  3. T3 N/A
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21
Q

What are the FT4, TSH, T3 values for central Hypothyroidism?

A
  1. FT4, low
  2. TSH, low
  3. T3 N/A
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22
Q

What are the FT4, TSH, T3 values for Thyroid-mediated Hyperthyroidism?

A
  1. FT4, High
  2. TSH, low
  3. T3 High
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23
Q

What are the FT4, TSH, T3 values for TSH-mediated Hyperthyroidism?

A
  1. FT4, High
  2. TSH, High
  3. T3 High
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24
Q

What does Radioactive iodine uptake scan measure?

A
  1. Iodine utilization

2. Differentiates hyperthyroidism etiology

25
Q

What does Radioactive iodine uptake NOT measure?

A

hormone synthesis

26
Q

What does TSab test for?

A

Autoimmune disease

Test for thyroid stimulating antibodies. which can act like TSH to make hormones

27
Q

What is Grave’s Disease?

A
  1. High FT4
  2. Low TSH
  3. Tsab +
  4. goiter
    Autoimmune disease. Antibodies make a lot of TH.
    Hyperthyroidism
28
Q

What is the first and second line defense for Grave’s Disease?

A
  1. Thioamides
  2. Thyroidectomy
  3. I radiation
29
Q

What is a Toxic Thyroid Adenoma?

A

benign tumor that secretes T3 or T4

30
Q

What are the treatments for hyperthyroidism?

A 
1. Beta blocker
Propranolol 10-40 mg q6h 
2. Calcium channel blockers 
-diltiazem, verapamil
3. MMI, PTU
4. Iodine
31
Q

How should you adjust the dose of PTU, MMI once euthyroid?

A

Reduce by 30-75%.

32
Q

What is the dose of Methimazole?

A
  1. Initial dose: 15-60 mg/ TID

2. Maintenance dose: 5-15 mg TID

33
Q

What hyperthyroid drug is preferred?

A

MMI because they taste better, have a longer half life and is 10 times more potent than PTU

34
Q

What hyperthyroid drug is preferred for pregnancy?

A

PTU

35
Q

What is the dose of PTU?

A
  1. Intial: 100-200mg TID q4-6

2. Maintenance: 50-100mg TID

36
Q

What are the side effects of PTU and methimazole?

A
  1. Liver damage
  2. Leukopenia
  3. Rash
37
Q

What are the Iodine treatments available?

A
  1. SSKI

2. Lugol’s solution

38
Q

Which one of the Iodine solution is more concentrated?

A

SSKI

50mg/drop TID

39
Q

What are the side effects of Radioactive I and total thyroidectomy?

A

Hypothyroidism

40
Q

If a pregnant women has hyperthyroidism, how often should you monitor her FT4?

A

Every four weeks

41
Q

What medication for hyperthyroidism is preferred for a mother that is nursing?

A

MMI

42
Q

What is Thyroid Storm?

A

Hyperthyroidism

43
Q

What are the treatment for Thyroid Storm?

A
  1. MMI 60-80 mg
  2. PTU 500-100mg, 250mg q4
  3. propranolol 60-80mg q 4h
  4. SSKI
  5. Steroid IV
    - hydrocortisone 300mg IV x1, then 100mg IV Q8hrs
44
Q

What do the laboratory results for hypothyroidism show?

A
  1. Low TT4
  2. Low FT4
  3. High TSH
  4. High Cholesterol
  5. Antibodies if Hoshimoto
45
Q

What are the treatment for hypothyroidism?

A
  1. Levothyroxine (T4)
  2. Initial: 50-125 mcg/day
    then 12.5 to 25mcg/day
46
Q

When do you want to use Liothyronine sodium (Cytomel) over levothyroxine?

A
  1. can’t absorb levothyroxine
  2. Can’t convert T4 to T3
  3. quicker onset of action
47
Q

What is Liotrix?

A

4:1, Levothyroxine:liothyronine

48
Q

What is Armour Thyroid

A 
For hypothyriodism 
Natural 
unstable 
allergic potential
varaible potency
49
Q

what happens if you over dose on liothyronine?

A

You cannot go back to T4

50
Q

What’s the difference between Liothyronine and levothyrioxine

A

Quicker onset on action and shorter duration

51
Q

What should you dose an elderly patient if they are using levothyroxine?

A

12.5-25 mcg/day

52
Q

Why do you want to monitor elderly patients who are taking Levothryoxine?

A

They have a slower CL of T4 so they are at risk for toxicity.

53
Q

How often should you check TSH after a new treatment therapy?

A

6-8 weeks

54
Q

What are should CP for Levothyroxine?

A
  1. Monitor TSH
  2. Monitor closely in elderly
  3. Separate with food, medications and other drinks
55
Q

What dose of Levothryoxine should elderly be put on?

A

25 mcg/day. Can be increased 12.5 to 25 mcg q 6-8 weeks

56
Q

What dose of Levothyroxine should patients with pre-existing coronary artery disease be put on?

A

12.5 mcg/day can increase dose 12.5mcg q 6-8 weeks

57
Q

In pregnancy, while taking Levothyroxine, how much should your dose be increased by?

A

50% because the fetus needs T4 to develop

58
Q

What are the concealing points for pregnancy and levothyroxine

A
  1. Monitor every 4 weeks FSH, FT4
59
Q

what is Myxedema Coma?

A

Coma due to long standing hypothyroidism. Have to give T4 in IV because your body is shut down

Nonliner (Dose Dependent Pharmacokinetics) (4 decks)

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