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Thyroid Agents
| Question | Answer |
|---|---|
| Question: What dietary element is absolutely essential for the thyroid gland to synthesize thyroid hormones? | Iodine. |
| Question: During thyroid hormone synthesis, thyroid cells remove iodine from the blood, concentrate it, and prepare it for attachment to which specific amino acid? | Tyrosine. |
| Question: A lack of Thyroid-Stimulating Hormone (TSH) that leads to hypothyroidism is typically caused by a disease in which gland? | The pituitary gland. |
| The hypothalamus. | |
| Question: Where exactly is the glandular tissue that synthesizes and produces Parathyroid Hormone (PTH) located? | It is made up of four very small groups of glandular tissue located on the back of the thyroid gland. |
| Low serum calcium levels. | |
| Question: What happens to the secretion of Parathyroid Hormone (PTH) when serum calcium levels in the body are high? | PTH release is blocked (suppressed). |
| Question: Besides calcium, what other specific electrolyte in the body affects the secretion of Parathyroid Hormone (PTH)? | Magnesium. |
| Question: Which hormone is secreted to work directly in balance with Parathyroid Hormone (PTH) to maintain serum calcium levels? | Calcitonin |
| What specific condition triggers the parathyroid glands to release Parathyroid Hormone (PTH) | Low serum calcium levels |
| What dietary element is absolutely essential for the thyroid gland to synthesize thyroid hormones?" | Iodine |
| What is the main therapeutic action of thyroid hormones? | They increase the metabolic rate of body tissues, increasing oxygen consumption, heart rate, and metabolism of fats, carbs, and proteins |
| What life-threatening condition are thyroid hormones specifically indicated to treat? | Myxedema coma |
| For the best absorption, how should a patient take their thyroid hormones? | On empty stomach |
| Do thyroid hormones cross the placenta? | No |
| What are the three strict contraindications for taking thyroid hormones? | Known allergy, acute thyrotoxicosis, and acute myocardial infarction (MI) |
| Thyroid hormones should be used with caution in patients with what specific hypoadrenal condition? | Addison's disease |
| What are the signs that a patient's dose of thyroid hormone is too high? | Symptoms of hyperthyroidism, such as tremors, headache, palpitations, and tachycardia |
| What four specific drugs/drug classes have important interactions with thyroid hormones? | Catecholamines, insulin, digoxin, and oral anticoagulants |
| How does Calcitriol (a vitamin D compound) work to raise calcium levels? | It regulates the absorption of calcium and phosphate from the small intestine, and increases mineral resorption in the bone |
| What are the main indications (reasons to prescribe) antihypocalcemic agents? calcitrol | Management of hypocalcemia in patients on chronic renal dialysis, and hypocalcemia associated with hypoparathyroidism |
| What are the four main cautions when giving antihypocalcemic agents? calcitrol | Pregnancy, lactation, history of renal stones, and a higher osteosarcoma risk |
| What are the unique GI and sensory adverse effects of Calcitriol? | Dry mouth, constipation, and a metallic taste |
| What specific over-the-counter medication interacts with antihypocalcemic agents? calcitrol | Magnesium-containing antacids |
| Besides antacids, what other drugs interact with antihypocalcemic agents? calcitrol | Cholestyramine, mineral oil, and digoxin |
| How do bisphosphonates work? | They slow or block bone resorption |
| How are bisphosphonates metabolized in the body? | They do not undergo metabolism; they are excreted relatively unchanged in the urine |
| What are the three main contraindications for bisphosphonates? | Hypocalcemia, pregnancy, and lactation |
| What severe GI adverse effect is associated with bisphosphonates? | Esophageal ulceration |
| Long-term use of bisphosphonates increases the risk of what two severe adverse effects? | Femoral shaft fractures and osteonecrosis of the jaw |
| What common over-the-counter medications interact with bisphosphonates? | Antacids, calcium products, iron, multiple vitamins, and aspirin |
| What emergency condition are calcitonins salmon indicated to treat? | Emergency treatment of hypercalcemia |
| What specific patient allergy is an absolute contraindication for calcitonins? | Known allergy to salmon or fish products |
| Calcitonins should be used with caution in patients with what specific type of anemia? | Pernicious anemia |
| What are the most common adverse effects of calcitonins? | Flushing of the face and hands, nausea, vomiting, and nasal irritation (if using the intranasal form) |
| What should the nurse tell a patient experiencing flushing and nasal irritation from calcitonins? | Many of the side effects lessen with time |
| What specific drug interacts with calcitonins? | Lithium |
| Which generic thyroid medication is specifically a synthetic salt of T4? | Levothyroxine |
| Which generic thyroid medication is a synthetic salt of T3? | Liothyronine |
| Which generic thyroid medication is prepared from dried animal thyroid glands and contains both T3 and T4? | Desiccated thyroid |
| What are the therapeutic actions of generic thyroid hormones? | They increase the metabolic rate of body tissues, increasing oxygen consumption, respiration, heart rate, growth and maturation, and the metabolism of fat, carbohydrates, and proteins |
| What are the indications for prescribing generic thyroid hormones? | Replacement therapy in hypothyroid states, treatment of myxedema coma, suppression of TSH to treat/prevent goiters, management of thyroid cancer, and to treat thyroid toxicity |
| What are the pharmacokinetics of thyroid hormones regarding absorption and the placenta? | They are well absorbed from the GI tract (best on an empty stomach), eliminated primarily by the kidneys (some in feces), and they do not cross the placenta |
| What are the three strict contraindications for thyroid hormones? | Known allergy, acute thyrotoxicosis, and acute MI |
| What are the most common adverse effects of generic thyroid hormones if the dose given is too high? | Symptoms of hyperthyroidism, skin reactions, loss of hair, and less predictable cardiac/CNS effects |
| What specific generic drugs have important drug-drug interactions with thyroid hormones? | Catecholamines, insulin, digoxin, and oral anticoagulants |
| Which generic antihypocalcemic agent is a synthetic vitamin D analog used to manage hypocalcemia? | Calcitriol |
| Which generic antihypocalcemic agent is a recombinant human PTH analog that specifically stimulates new bone formation? | Teriparatide |
| Which generic antihypocalcemic agent acts to increase bone mineral content to strengthen bone? | Abaloparatide |
| What are the therapeutic actions of generic vitamin D compounds like calcitriol? | They regulate the absorption of calcium and phosphate from the small intestine, mineral resorption in bone, and reabsorption of phosphate from the renal tubes |
| What are the main indications for antihypocalcemic agents? | Management of hypocalcemia in patients on chronic renal dialysis, and treatment of hypoparathyroidism |
| What are the unique adverse effects associated with the generic prototype calcitriol? | Metallic taste, dry mouth, constipation, weakness, headache, nausea, vomiting, and muscle/bone pain |
| What is the generic prototype drug for the bisphosphonate class? | Alendronate |
| What is the generic prototype drug for the calcitonin class? | Calcitonin Salmon |
| What is the therapeutic action of generic bisphosphonates like alendronate? | They act to slow or block bone resorption |
| What are the therapeutic actions of generic calcitonins? | They balance the effects of PTH, inhibit bone resorption, lower serum calcium levels, and increase kidney excretion of phosphate, calcium, and sodium |
| What are the main indications for both generic bisphosphonates and calcitonins? | Treatment of Paget’s disease and postmenopausal osteoporosis |
| What is unique about the pharmacokinetics of generic bisphosphonates regarding metabolism? | They do not undergo metabolism; they are well absorbed from the small intestine and excreted relatively unchanged in the urine |
| What are the pharmacokinetics of generic calcitonins regarding metabolism and the placenta? | They are metabolized in body tissues to inactive fragments and they cross the placenta |
| What are the most common adverse effects of generic bisphosphonates like alendronate? | Esophageal ulceration, abdominal pain, constipation, bone pain, and with long-term use, an increased risk of femoral shaft fractures and osteonecrosis of the jaw |
| What are the most common adverse effects of generic calcitonins? | Flushing of the face and hands, skin rash, nausea/vomiting, and nasal dryness/irritation |
| What over-the-counter products have drug-drug interactions with generic bisphosphonates? | Antacids, calcium products, iron, multiple vitamins, and aspirin |
| What specific generic medication has a drug-drug interaction with calcitonins? | Lithium |
| While thyroid hormones do not cross the placenta, do they enter human breast milk? | Yes, they enter human milk in small amounts |
| What severe rebound effect can occur if a patient's antihypocalcemic treatment is suddenly interrupted? | Severe hypocalcemia |
| Because bisphosphonates can cause esophageal ulceration, they should be used with caution in patients with what specific type of disease? | Upper GI disease |
| What is an adverse effect of calcitonins related specifically to the urinary system? | Urinary frequency |
| What localized adverse effect can happen if calcitonins are given via injection? | Local inflammatory reactions at the injection site |
| A highly specific adverse effect of Calcitriol | Metallic taste |
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