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Pharm II > Thyroid dz Meds > Flashcards

Thyroid dz Meds Flashcards

1
Q

etiologies of primary hypothyroidism? etiology of iatrogenic hypothyroidism?

A

primary: autoimmune phenomena (Hashimoto’s dz), malnutrition, deficient iodine intake
iatrogenic: surgery or radioactive ablation

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2
Q

what does secondary hypothyroidism imply? tertiary?

A

secondary implies pituitary dysfunction

tertiary implies hypothalamic dysfunction

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3
Q

what can inflammation of the thyroid gland result in? thyroiditis course?

A

in initial excess thyroid release which is then followed by a period of insufficient thyroid hormone release
course of thyroiditis is usu limited and reversible except in Hashimoto’s

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4
Q

clinical findings of hypothyroidism?

A

fatigue, weakness, cold intolerance, constipation, thinning hair, bradycardia, poor concentration
if chronic can result in respiratory depression, hypothermia, coma (myxedema coma), death
infants w/unrecognized and untreated hypothyroidism develop cretinism

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5
Q

3 hypothyroid tx options?

A

levothyroxine (T4)/synthroid
thyroid USP (T4, T3)/Armour thyroid
Liothyronin (T3)/Cytomel

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6
Q

class of levothyroxine/synthroid? indications? MOA?

A

class: thyroid hormone replacement, synthetic T4, dosed in mcg
indications: hypothyroidism, also TSH suppression in select cases of thyroid nodules and thyroid CA
MOA: replaces normal levels of T4 and T3 (T4 converted to T3 in periphery)

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7
Q

how to give levothyroxine/synthroid? how long to tx? when to hold or reduce dose?

A

give PO/IV once a day
oral absorption ~70%
slow onset of action
1/2 life 1 wk
takes 6-8 wks to achieve steady state
tx usu lifelong - need to follow pts clinical response and serum TSH
hold or reduce dose if any complaints of angina
begin at low dose and advance dosage slowly in pts over 65 or in any pts w/hx of coronary artery dz

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8
Q

SEs of levothyroxine/synthroid? long term elevation of T4 can cause what?

A

SEs: toxicity directly related to thyroxine level and manifests as palpitations, tachycardia, intolerance to heat and anxiety
long term elevation of serum T4 may accelerate cardiac dz and osteoporosis

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9
Q

in pts w/Addison’s dz and hypothyroidism what needs to be replaced first?

A

need to give cortisol first! then thyroid otherwise can be fatal

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10
Q

60 mg of Thyroid USP produces about an equivalent effect of how much synthroid?

A

60 mg of Thyroid USP = about 100 mcg of Synthroid (synthetic T4)

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11
Q

class of thyroid USP/armour? indications? mOA? how to give? how to dose?

A

class: thyroid hormone (T4, T3, T2, T1) from desiccated animal thyroid gland
indications: hypothyroidism
MOA: replaces both T4 and T3
give PO, generally standardized to iodine content
initiate medication at low dose and increase dosage according to pt response, more cautious dosing in pts over 65 or if hx of cardiac dz

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12
Q

SEs of thyroid USP/Armour? what do you need to follow? hold or reduce if complaints of what? how to dose?

A

SEs: similar to thyroxine/synthroid
follow pts clinical response and serum TSH
hold or reduce dose if any complaints of angina
begin at low dose and advance dose slowly in pts over 65 or in those w/hx of CAD

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13
Q

class of liothyronine/cytomel? indications? can also be used for what? MOA?

A

class: thyroid hormone replacement (synthetic T3) dosed in mcg
indications: hypothyroidism that has demonstrated intolerance to T4 replacement therapy or no improvement on T4 replacement therapy, myxedema coma
also used for Wilson’s syndrome
MOA: replaces T3

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14
Q

how to give liothyronine/cytomel? SEs? higher peaks and troughs of T3 can increase what risk?

A

give PO/IV, 100% oral absorption, rapid onset of action, half life of several hours
SEs: similar to T4
higher peaks and troughs of T3 may increase risk of coronary artery disease and osteoporosis

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15
Q

equivalent dosings between thyroid USP, synthroid and cytomel?

A

60 mg thyroid USP ~ = 100 mcg of T4 (synthroid) ~ = 25 mcg of T3 (cytomel)

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16
Q

most common underlying cause of hyperthyroidism?

A

autoimmune - Grave’s - antibodies stimulate TSH receptor sites on the thyroid gland
can also be caused by thyroiditis

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17
Q

what is thyroiditis facticia?

A

excess administration of thyroid hormone, either inadvertent or intentional

18
Q

clinical findings of hyperthyroidism include? hyperthyroidism places pt at increased risk for what?

A

nervousness, tachycardia, wt loss, heat intolerance, sweating, diarrhea, generalized weakness
places the pt at increased risk for osteoporosis and cardiac dz
if dt Grave’s dz often accompanied by presence of goiter and exophthalmos

19
Q

what is pretibial myxedema? associated with what? dt what?

A

lesions of non-pitting edema that occur in association w/Grave’s dz
appear on anterior or lateral aspects of legs in ~0.5-5% of pts w/Grave’s dz
dt deposition of hyaluronic acid in dermis and subcutis in thyroid dz
proposed mechanism is that fibroblasts are stimulated to produce high amounts of glycosaminoglycan dt exposure to thyroid hormones

20
Q

tx of hyperthyroidism involves what? what can be used to block teh adrenergic ssxs of hyperthyroidism?

A

tx involves medications that interrupt thyroid hormone synthesis and/or release of thyroid hormone as well as interruption of peripheral conversion of T4 to T3
beta blockers are often used to block adrenergic ssxs of hyperthyroid state

21
Q

definitive tx of hyperthyroidism?

A

surgical removal of radioactive iodine and ablation of the thyroid gland
after this though pts are rendered hypothyroid and will need exogenous thyroid hormone for the rest of their lives

22
Q

hyperthyroid tx options?

A 
methimazole
propylthiouracil
propanolol
iodine
radioactive iodine
23
Q

class of methimazole/tapazole? indications? place in tx of hyperthyroidism? after tx is discontinued what can happen? tx failure or recurrence suggests what tx is needed?

A

class: thioamide
indications: hyperthyroidism dt Grave’s dz, toxic nodular or toxic multinodular dz and thyroid storm (when give IV)
can allow for better control of hyperthyroid state until more definitive tx is used
pts may occasionally achieve a euthyroid state after tx is discontinued
tx failure or reucrrent of hyperthyroid state suggests more definitive tx is necessary

24
Q

MOA of methimazole/tapazole? how to give? where does it concentrate? effects on thyroglobulin already stored in thyroid gland?

A

MOA: inhibits transformation of inorganic iodine to organic iodine, therefore blocking production of thyroxine, also inhibits coupling of iodotyrosine to form T3 and T4, very minimal effect of blocking the peripheral conversion of T4 to T3
give PO, IV (thyroid storm)
concentration occurs in thyroid
does not affect thyroglobulin already stored in thyroid gland

25
SEs of methimazole/tapazole? feared SE? do not give when?
SE: may cause hypothyroidism, rash, edema, arthralgias agranulocytosis is a feared SE, drug is usu not given beyond 6-12 mo period do not give during PG or lactation as it crosses the placenta and into mother's milk
26
class of propylthiouracil (PTU)? indications? allows for what in regards to control? potential effect after discontinuation?
class: thioamide indications: hyperthyroidism dt Grave's, toxic nodular or toxic multinodular dz and thyroid storm (when to give IV) may allow for better control of hyperthyroid state until more definitive tx is used pts may occasionally achieve euthyroid state after tx is discontinued
27
MOA of propylthiouracil (PTU)? notable effect?
MOA: inhibits transformation of inorganic iodine to organic iodine, blocking the production of thyroxine and inhibits the coupling of iodotyrosine to form T3 and T4 notable effect of blocking peripheral conversion of T4 to T3
28
how to give propylthiouracil (PTU)? commonly used how? effects on T4 and thyroglobulin already stored in thyroid gland?
give PO, IV, may take wks to achieve therapeutic state, thus not used as an oral agent for thyroid storm commonly used before definitive tx by surgery or radioactive iodine ablation affects the production of thyroid hormone but does not affect the T4and thyroglobulin already stored in thyroid gland
29
SEs of propylthiouracil? most feared SE? how long can you give? PG category?
SE: hypothyroidism, rash, edema, arthralgias most feared SE is agranulocytosis drug usu not given beyond 6-12 mo period PG category D, but considered safer than methimazole and used in PG when benefit outweighs potential risks
30
class of propanolol/inderal? indications? MOA? how to give? SEs?
class: non-selective beta blocker indications: blockade of adrenergic sxs of hyperthyroidism, emergent tx of thyroid storm MOA: beta 1 and beta 2 receptor blockade give PO/IV SEs: sedation, fatigue, impotency or depression
31
class of iodine/SSKI? indications? MOA? how to give? SES?
class: elemental iodine indications: hyperthyroidism, thyroid storm MOA: large doses of iodine inhibit the release of thyroxine from the thyroid gland give PO/IV, usu given in form of supersaturated potassium iodide SEs: rash, fever, beneficial effects usu don't last longer than 2-3 wks as thyroid appears to adapt
32
definitive tx for hyperthyroidism?
radioactive iodine ablation | can also be used in selected cases of thyroid gland cancer
33
SEs of radioactive iodine? what thyroid state does a pt need to be in before starting radioactive iodine tx?
b/c the thyroid gland absorbs almost all the iodine, there are generally minimal systemic effects can cause tenderness, swelling during initial tx (can use acetaminophen to relieve), N/V may occur, salivary glands may swell prior to tx pt needs to be in euthyroid state by anti-thyroid drugs and/or doses of supersaturated potassium iodide
34
radioactive iodine PG category? extremely high doses can result in what? following administration what will most need to be tx'ed with?
PG category X extremely high doses may result in bone marrow depression (transient usu) following administration will most likely need to be tx'ed with lifelong thyroid replacement
35
class of radioactive iodine? indications? MOA? how to give? how long before it works?
class: radioactive isotope indications: thyroid gland ablation in cases of Grave's dz, thyroid nodules, in some cases of thyroid cancer MOA: radioactive emission of beta particles results in destruction of thyroid tissue give orally, generally takes weeks for destruction of thyroid gland tissues to be complete
36
conversation you will need to have with men regarding radioactive iodine tx for hyperthyroidism?
can have decreased sperm counts and temporary infertility for a period of roughly 2 years may need to discuss sperm banking w/a male partner who is expecting several doses for thyroid CA
37
what actions do you need to limit 1 day after RAI? what actions do you need to limit 2-3 days after RAI? what actions do you need to limit 5-11 days after RAI?
for 1 day after RAI: do not return to work, limit time in public places, do not travel by airplane or public transportation for 2-3 days after RAI: do not travel on a prolonged car trip with others, maintain prudent distances from others (~3 ft), drink plenty of fluids, do not prepare foods for others, do not share utensils with others, flush the toilet 2-3 times after use for 5-11 days after RAI: sleep in a separate bed (~7 feet of separation), avoid prolonged close contact w/children and PG women
38
whom can we never give RAI to?
should never be given to PG woman, can irreversibly damage the fetal thyroid tissue or to a nursing mother as it can reach the infant through breast milk PG should be delayed at least 6-12 mos after RAI tx since tx exposes ovaries to radiation
39
what is a thyroid storm?
most severe potential manifestation of hyperthyroidism ssxs: high fever, irritability, delirium, vomiting, diarrhea, dehydration, hypotension, vascular collapse coma and death can occur
40
when can a thyroid storm occur?
can occur in hyperthyroid pts who become septic | pts undergoing surgery for hyperthyroidism
41
how to tx a thyroid storm?
first stabilize pt then generally includes beta blockade as well as IV PTU or IV methimazole and IV iodine to "stun" the thyroid gland's ability to utilize iodine to synthesize thyroid hormone possibly anti-pyretics for fever

Pharm II (18 decks)

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