Thyroid Drugs

Question 1

Levothyroxine

Answer 1

Replacement
therapy in
hypothyroidism;
pituitary thyroid
stimulation
hormone
(TSH)
suppression in
treatment of
goiters and
management of
thyroid cancer,
thyrotoxicosis in
conjunction with
other therapy;
myxedema coma
ADVERSE: Tremors,
headache,
nervousness
palpitations,
tachycardia
skin
reactions, loss of
hair in children (in
1st months of tx)
N,V and Diarrhea
Take with full glass
of water to avoid
issues with difficulty
swallowing and
esophageal atresia
Administration:
Take in AM with full
glass water- 30-60
min before or 2
hours after food
Caution use in
lactation, hypo-
adrenal conditions
(Addison disease),
pts. with potential
cardiac problems or
pts. with anxiety
reactions.
↓ absorption if
taken with
cholestyramine (if
combo needed take
2hrs apart)
oral anticoagulants
↑ when combined
together
↓ effectiveness of
digitalis

Question 2

Propylthiouracil

Answer 2

Adjunct therapy
for
hyperthyroidism;
thyroid blocking
in a radiation
emergency
Adverse: Hepatotoxicity,
nausea, vomiting
Stevens-
Johnson, rash
aplastic
anemia, bleeding
stains teeth
Endocrine:
hypothyroidism,
goiter, swelling of
the salivary glands,
Administer: oral (3
times a day). Give
at the same time in
relation to meals
daily
(food may either ↑
or ↓ absorption)
Teaching:
Report signs of
infection, headache,
yellowing of eyes or
skin, bleeding or
bruising, symptoms
of hyper or
hypothyroidism)

Question 3

Strong Iodine
solution

Answer 3

Adjunct prep for
thyroidectomy;
treatment of
thyrotoxic crisis;
radiation
protectant
following
radiation
emergencies
Adverse: GI bleeding,
diarrhea
hypothyroidism
hyperkalemia
Misc: iodism*
Oral solution:
Mix in full glass of
water or juice,
administer after
meals to minimize
GI upset.
Drink through a
straw to avoid teeth
staining

Question 4

Alendronate

Answer 4

Treatment and
prevention of
osteoporosis in
postmenopausal
women
Glucocorticoid
induced
osteoporosis,
and osteoporosis
in men.
Paget’s Disease
Adverse: headache
Increased or
recurrent bone pain
Nausea,
diarrhea,
esophageal erosion
Hypermagnesemia if
combined with
magnesium-
containing antacids
Contraindicated
with Hypocalcemia
Use caution with
Renal insufficiency
and Upper GI
disease.
Avoid: antacids,
calcium products,
iron or
multivitamins d/t
decreased
absorption when
taken PO.
Administration:
Take in am with full
glass of water;
remain upright 30-
60 minutes after
taking

Question 5

Calcitriol

Answer 5

Management of
hypocalcemia
(chronic renal
dialysis)
Hypocalcemia
associated with
hypoparathyroidism
Stimulates new
bone formation
Adverse: weakness,
headache
nausea,
vomiting, dry
mouth,
constipation,
metallic taste
muscle pain, bone
pain,
Monitor:
Serum calcium
levels
signs of
Vit D intoxication
Keep dietary
calcium intake
consistent (avoid
sudden ↑)
Many drug/drug
interactions (DIG)