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Tx Thyroid Disorders
Pharm-II
| Question | Answer |
|---|---|
| What stimultates the hypothalamus, inhibits? | circadian rhythms, cold, acute psychosis I: severe stress and ↑T4/T3 |
| What inhibits the ant pit | corticoids, somatostatin, dopamine and ↑ T4, T3 levels |
| What inhibits and stimulates the thyroid gland | iodine does both |
| Subjective signs of hypothyroidism | dry, cold, wt gain, constipation, weakness, lethargy, fatigue, depression |
| Physical signs of hypothyroidism | course skin and hair, cold skin, periorbital puffiness, brady, speech is slow and hoarse, muscle cramps, myalgia, stiffness, muscle weakness |
| Gold std thyroid test | TSH |
| What would lower TSH | dopamine, dopamine agonists, clucocorticoids, recovery from severe illness |
| What are Anti-TPO abx | present in autoimmune hypothyroidism, predicts more rapid progression to worsening hypothyroidism |
| Nl levels of TSHR-Sab | undectable: present in Graves’ dz |
| Sequelae of hypothyroidism | hypercholestermia, ↑ diastolic BP, dementia-like symptoms, fetal risks, myxedema coma |
| What are fetal risks of low thyroid | miscarriage, developmental impairment |
| What are signs of myxedeeema coma | CNS and resp depression, CV instability, f & e imbalances |
| Pharm therapy goals for hypothyroidism | replace missing thyroid hormones, relieve sxs, achieve stable euthyroid state, prevent neuro sxs |
| MC use for thyroid replacement | levothyroxine (synthetic T4) |
| AE’s of levothyroxine | excessive doses→HF, angina, MI allergic reactions, but rare, (MC w/ animal derived), ↓ bone density w/ excessive doses |
| DI w/ levothyroxine | ↓ effect of PHT, cholestyramine absorption, ↑ oral hypoglycemic requirements, ↓ absorption w/ chronic acid suppression therapy |
| ↑ effects of levothyroxine | increased effects of oral anticoags |
| ↑ tox effects of levothyroxine | TCAs may ↑ toxic potential of drugs |
| 3 Drugs that ↓ TH production | lithium, iodine-contating meds, amiodarone |
| Drugs that ↓ TH absoption | ferrous sulfate, calcium products (Sucralfate, Cholestyramine, colestipol, aluminum-containing antacids) |
| Drugs that ↑ metabolism of thyroxine | rifampin, phenobarbital, CMZ, warfarin, oral hypoglycemic |
| Drugs that ↑ thyroxine F | furosemids, mefenamic acid, salicilates |
| When during the day do we dose thyroxine | first thing in morning on empty stomach, wait 30 mins prior to eating |
| Why ↓ absorption of thyroxine | Ca++, iron, fiber |
| What does initial dose depend on | patient age, presence of associated d/os, severity and duration of hypothyroidism |
| Refer down below for thyroxine dosing | Yup |
| How do we monitor thyroxine | TSH, sometimes T4 |
| What is T4 useful for monitoring | useful in detecting non-adherance (not appropriate for routine monitoring) |
| How often do we F/U | check levels q 6-8 weeks until euthryoid state, then 6-12m thereafter |
| Pt signs for thyrotoxicosis | nervousness, emotional liability, easy fatigability, heat intolerance, proximal muscle weakness, wt loss w ↑appetite, anorexia in elderly, palpitations, irregular bowels and menses |
| Physical signs of hyperthyroidism | warm, smooth, moist skin, fine hair, oncholysis, lid lag, tachy, systolic ejection murmur, widened PP, gynecomastia, fine tremor, ↑ DTRs |
| Therapeutic outcomes for tx of hyperthyroidism | relieve sxs, reduct TH production to nl levels, prevent LT adverse sequelae |
| Two antithyroid agents | propylthiouracil & methimazole |
| How do antithyroid agents work | block oxidation of iodine in thyroid gland (↓ TH production of T3 and T4), |
| What DON”T antithyroid meds do | inactivate circulating T3 and T4 |
| Additional action of propylituracil (PTU) | inhibits peripheral conversion of T4 to T3 |
| Minor AE’s of above | pruritic maculopapular rash, arthralgias, fevers, benign transient leucopenia, |
| Major AEs | agranulocytosis, lupus-like syndrome (after 6,), GI intolerance, hepatotox |
| Black box warning w/ PTU | severe liver injury: usually reserve for pts who can’t tolerate other tx |
| 3 mainstays of tx | antithyroid drugs, radioactive iodine, surgery |
| Rapid, effective tx | surgery, especially in pts w/ lg goiters, but most complications |
| Probs w/ radioactive iodine or surgery | permanent hypothyroidism |
| Radioactive iodine | 131I |
| How do we individualize thyroid tx | type, severity, pt age and gender, existence of nonthyroidal conditions, responsive to previous therapy |
| What are symptomatic txs for hyperthyroidism | BB’s and iodides |
| MOA of iodides | block conversion of T4 to T3 and inhibit hormone release |
| Indications for iodides | need for rapid ↓ in TH, preop, or used in pregnancy |
| AE’s of iodides | sialadenitis, conjunctivitis, acneform rash, |
| Precautions for BB use | older pt’s or pre-exhisting HD, COPD, asthma |
| Indications for BBs | prompt control of sxs, HR, BP |
| 1st therapy for hyperthyroidism | BB’s, short term in pregnancy |
| Tx of choice for pregnant women | PTU |
| d/o radioactive iodine is used for | graves’ multinodular goiter, toxic nodules, relapses from antithyroid drugs |
| indications for thyroid surgery | pregnant, children w/ major AE’s to drugs, toxic nodules in pts <40, large goiters w/compression sxs, severe dz and can’t tolerate recurrence (cosmetics) |
| seriously complications w/ thyroid surgery | temporary or permentant hypoparathyroidism or laryngeal paralysis |
| what must the pts be prior to surgery | euthroid pre op w/ antithyroid drugs or iodides |
| why | to avoid thyrotoxic crisis |
| surgery preparations | PTU or methimazole until chemically euthyroid, Iodides 500mg/day x 10-14 days prior to surg, to dec thyroid, levothyroxine to maintain euthhyroid |
| S/S thyroid storm | high fever, tachy, tachypnea, dehydration, delirum, com and GI disturbances |
| what is precipatated for the thyroid storm | infx, trauma, surgery, radioactive iodine tx, sudden withdrawl from antithyroidism drugs |
| Tx of thyroid storm | BB, IV or oral iodide, Lg dose of PTU (3-4 divided doses), supportive care, IV hydrocortisone |
| Dx thyroid d/o | CP and labs |
| Tx hypothyroidism | levothyroxine |
| tx hyperthyroidism | antithyroid drugs, radioactive iodine ablation, surgery |
Created by:
becker15
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