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thyroid/
Mod 5 Pharm
| Question | Answer |
|---|---|
| What hormone imbalance is created by hypothyroidism? | elevated TSH, decreased T3, T4 |
| What hormone stimulates the thyroid to secrete T3, T4? | TSH by the pituitary TSH is stimulated by TRH from the hypothalamus |
| What is TRH | thyrotropin releasing hormone |
| What role does the thyroid play in calcium metabolism? | Thyroid secretes calcitonin which is responsible for calcium metabolism, and inhibition of osteoclastic bone resoorption |
| How is T3, T4 secretion regulated? | negative feedback loop |
| What is the recommended daily intake of iodine? | 150mcg 200 mcg if pregnant |
| How much iodine does the body use for hormone secretion? | 75mcg |
| What are sources of iodine? | water, food, medication |
| A pt exhibiting symptoms of lid lag and retraction, tremors, excessive sweating, anxiety, nervousness, and elevated heart rate exhibits what type of thyroid imbalance? | hyperthyroidism (thyrotoxicosis) |
| A pt exhibiting symptoms of lethergy, fatigue,decreased metabolism, increased appetite exhibits what type of thyroid imbalance? | hypothyroidism |
| If a patient is not a candidate or chooses not to have surgery, what medication option can be used to treat hyperthyroidism? | 1. radioactive iodine 2. anti-thyroid drug therapy (thioamides) |
| List two thioamides. | methimazole propylthiouracil |
| What is the brand name of methimazole? | Tapazole |
| What is the dosage of methimazole for mild hyperthyroidism? | 15mg/day in 3 divided doses |
| What is the dosage of methimazole for moderate hyperthyroidism? | 30-40 mg/day |
| What is the dosage of methimazole for severe hyperthyroidism? | 60mg/day |
| Would a patient with mild hyperthyroidism take 60mg/day of methimazole? | No, 60mg is the dosage for severe hyperthyroidism. The dosage for mild hyperthyroidism is 15mg/day divided in 3 doses |
| A patient taking Tapazole complains of rash, pruritis and urticaria. Is this an expeced reaction? | These are symptoms of an adverse reaction to methimazole (Tapazole.) hyperpigmentation is another adverse reaction to methimazole |
| What are less common reactions to Tapazole? | edema, nausea/vomiting, headache |
| What is the pregnancy class of hyperthroid medications? | D should be avoided |
| What precautions should patients take when storing hyperthyroid medication? | should not be stored in bathroom due to susceptible to heat/humidity |
| What is a SALAD of methimazole? | metolazone |
| What is PTU? | PTU is propylthiouracil, a medication used to treat hyperthyroidism |
| What is the dosage of PTU? | 300-400mg divided every 8 hrs. |
| What are possible adverse reactions to propylthiouracil? | edema, fever, drowsiness, skin irritations, headache |
| How is PTU compared to methimazole? | PTU less potent than Tapazole |
| What special instructions should be given to pts taking PTU? | Take at the same time every day; do not stop suddenly |
| How should PTU be discontinued? | withdrawn slowly once euthyroidism state is achieved |
| SALAD of propylthiouracil? | purinethol |
| What interactions should be monitored for if a patient is taking a medication for hyperthyroidism with coumadin? | monitor INR closely, PTU & Tapazole decrease anticoagulability of coumadin |
| What medication may need to have the dosages decreased while taking PTU or Tapazole? | digoxin beta blockers theophylline |
| What medication contains iodine and may decrease effectiveness of hyperthyroid medication? | amiodarone |
| What medication is used for treating hypothyroidism? | levothyroxine (Synthroid) |
| Is levothyroxine the treatment option if a medicaton causes hypothyroidism? | No, removal of medication be treatment option |
| What is the range of dosages for levothyroxine? | 25-200 mcg daily |
| What is the treatment plan for pt prescribed levothyroxine? | start at 50mcg, increase by 25 mcg every 2-3 wks as body adjusts |
| Is Synthroid safe for pregnant women? | Yes, pregnancy category A |
| Can a patient switch to a generic brand of Synthroid? | Not without physician knowledge |
| What medications can decrease the effectiveness of levothyroxine? | 1. cholestyramine, colestipol (bind and inactive synthroid) 2. antacids, iron, sucralfate, simethicone (chelation) 3. carbamazepine, phenytoin, rifabutin, rifampin (> clearance of Synthroid) |
| What interaction does levothyroxine have on antidiabetic medications? | may need to increase antidiabetic medications as euthyroidism is achieved |
| SALAD of levothyroxine? | lamotrigine, lanoxin |
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