Week 10 Notes Flashcards
What is the preferred treatment for hypothyroidism?
Synthetic levothyroxine
Synthetic levothyroxine is preferred over natural pork-derived thyroid hormone.
How does synthetic levothyroxine function in the body?
Acts like the body’s thyroid hormone
It increases metabolic rate and oxygen consumption in tissues.
What are the physiological effects of thyroid hormone?
Increases temperature, heart rate, respiratory rate
Also enhances protein and fat metabolism.
What adverse effects can occur from excessive levothyroxine administration?
Hyperthyroidism symptoms, increased heart rate, cardiac dysrhythmia
Can also lead to gastrointestinal issues like vomiting or diarrhea.
What can excessive thyroid hormone lead to in the myocardium?
Chest pain, exacerbation of angina, acute coronary syndrome
Due to increased oxygen consumption and insufficient blood flow.
What are the potential consequences of too much thyroid hormone?
Excessive weight loss, abnormal menstruation, heat intolerance
Can also cause bone loss leading to osteoporosis or osteopenia.
What is the recommended approach for patients with cardiovascular disease when prescribing levothyroxine?
Start with a lower dose and titrate up
Especially important for older adults.
What should be monitored in patients with existing bone density issues when prescribing levothyroxine?
Keep TSH in the upper limits of normal
Prevents further bone loss.
How can thyroid hormone affect patients with diabetes insipidus or adrenal insufficiency?
Worsening symptoms, potential adrenal crisis
Requires careful clinical monitoring.
What unique considerations are there for hypothyroidism during pregnancy?
Pregnant patients may require higher doses of levothyroxine
Important to treat hypothyroidism in pregnancy.
What inappropriate uses of levothyroxine have been noted?
Weight loss, infertility, depression relief
Not appropriate without demonstrated hypothyroidism.
What are the antithyroid drugs used for hyperthyroidism?
Propylthiouracil (PTU) and methimazole
These prevent synthesis of thyroid hormone.
What is a significant adverse effect associated with antithyroid drugs?
Agranulocytosis
Can also cause aplastic anemia and hepatitis.
What should be done if agranulocytosis occurs in a patient taking antithyroid drugs?
Immediately discontinue the drug
Monitor for signs of infection.
What is the preferred antithyroid medication for children?
Methimazole
Important to monitor heart rate and symptoms of thyroid dysfunction.
What should patients taking antithyroid drugs avoid?
Iodine-containing foods
Reducing iodine intake is crucial during treatment.
What are the pancreatic enzyme replacements used for?
To aid digestion in patients with exocrine enzyme deficiency
Helps patients absorb nutrients effectively.
What is the best way to diagnose hypertension?
Correctly measuring blood pressure over time.
In emergency situations, when might you treat hypertension immediately?
If the patient has markedly elevated blood pressure and evidence of end organ damage.
Why is it important to measure blood pressure correctly?
To ensure accurate readings and proper diagnosis.
What should be considered when treating a patient with hypertension?
Individual patient circumstances and comorbid conditions.
How does age influence hypertension treatment?
Older adults may require less aggressive blood pressure reduction.
What is a potential risk of orthostatic hypertension?
It can cause syncope and falls, especially in older adults.
What lifestyle modifications are important for hypertension management?
- Maintaining a lean body weight
- Regular strength training and aerobic exercise
- Proper diet that lowers blood pressure
What dietary changes might benefit a patient with hypertension?
- Reducing sodium intake
- Avoiding simple carbohydrates
What are the drug classes used to treat hypertension?
- Angiotensin-converting enzyme inhibitors (ACE inhibitors)
- Angiotensin II receptor blockers (ARBs)
- Direct renin inhibitors
- Calcium channel blockers
- Peripheral vasodilators
What is the function of ACE inhibitors?
They prevent angiotensin I from being converted to angiotensin II.
What are common examples of ACE inhibitors?
- Enalapril
- Lisinopril
What adverse effect is associated with ACE inhibitors?
Dry cough due to increased bradykinin.
What advantages do ARBs have over ACE inhibitors?
Less likely to cause cough and angioedema.
What is the role of aliskiren in hypertension treatment?
It inhibits renin activity.
What are the absolute contraindications for ACE inhibitors and DRIs?
- Pregnancy
- Bilateral renal stenosis
- Angioedema
What should be monitored when using calcium channel blockers?
For hypotension and heart rate effects.
What are the two types of calcium channel blockers?
- Dihydropyridines
- Non-dihydropyridines
What is a common adverse effect of dihydropyridine calcium channel blockers?
Edema.
What is the primary action of peripheral vasodilators like hydralazine?
Directly relax arteriolar smooth muscle.
When should peripheral vasodilators be considered in therapy?
After two other drugs have failed to control hypertension.
What is a potential adverse effect of hydralazine?
Lupus-like syndrome.
Fill in the blank: ACE inhibitors work by blocking _______.
Angiotensin-converting enzyme (ACE).
True or False: ARBs can cause a dry cough.
False.
What is a significant risk when using antihypertensives in patients with renal dysfunction?
Increased risk of hyperkalemia.
What is a possible effect of increased intravascular volume due to medication?
Headache may occur
Increased intravascular volume can lead to various symptoms, including headaches.
What is tachyphylaxis?
A condition where a drug becomes less effective due to being eliminated from the body more efficiently and faster
Tachyphylaxis can occur with certain medications, leading to decreased therapeutic effects.
What syndrome has been reported as a side effect of hydralazine?
Lupus-like syndrome
This syndrome may present with a positive antinuclear antibody but does not involve renal dysfunction.
What happens to the lupus-like syndrome after discontinuing hydralazine?
It resolves over time
This is a positive aspect of hydralazine’s adverse effects.
What effects does minoxidil have on fine body hair?
Increases length, thickness, and pigmentation
Minoxidil is often used for hair growth stimulation.
