Pharm2 3 Thyroid pt1

Question 1

The thyroid glands function is to regulate

Answer 1

the bodies metabolism

Question 2

3 hormones produced by thyroid gland

Answer 2

Thyroxine (T4)
Triodothyronine (T3)
Calcitonin

Question 3

The pituitary gland is under control by the ___ which secretes __

Answer 3

hypothalamus

TSH Releasing Hormone (TRH)

Question 4

If history and physical shows signs of thyroid disease, test what?

Answer 4

TSH

Question 5

What is thyroid hormone’s target tissue?

Answer 5

There is no particular target tissue for thyroid hormone

Every cell in body is affected by the thyroid hormones

Question 6

Excessive thyroid hormones (T3,T4) can manifest themselves as (6 example symptoms)

Answer 6

hypertensive, sweating, febrile, tachycardic, exophthalmos, hair loss,

Question 7

Thyroid storm is life threatening, with what main 3 sx?

Answer 7

htnsive, tachy, altered mental status

Question 8

What is the most common thyroid disorder in the United States?

Answer 8

Autoimmune thyroiditis

Question 9

What is autoimmune thyroiditis?

Answer 9

the body interprets the thyroid glands and its hormone products T3, T4 and TSH as threats, therefore producing special antibodies that target the thyroid’s cells, thereby destroying it
It presents with hypothyroidism or hyperthyroidism and the presence or absence of goiters. With goiter = Hashimotos.

Question 10

Trade name for Levothyroxine:
used in \_\_thyroidism
Absorbed where?
Take how many times a day, why?
Who would need increased dose?

Answer 10

Synthroid,
used in Hypothyroidism.
Absorbed in GI tract
A long half life allows for once a day administration
Women on oral estrogen need increased dose of therapy

Question 11

Synthroid is always written with what 3 letters on it?

Answer 11

DAW = dispense as written. This drug is always written as DAW. Pharmacies always try to give a trade product, instead of the generic. This one is almost always the trade name.

Question 12

the biggest diff btwn commercial products and generic is:

Answer 12

trade can vary 5% up or down, but generic can vary by a greater percentage.

Question 13

*BQ: What is the median dose for patients on Synthroid in the United States?

Answer 13

about 125 micrograms (0.125 mg)

Question 14

If I write it for 100 micrograms and it’s branded, its range is what?
What if it’s generic?

Answer 14

Branded: 95-105 (the next two closes doses are 88 or 117, so it does not reach either one - safe)
Generic: 85-125 (this can branch into 88, 117, 125 doses - much less safe)

Question 15

6 dosing level regiments (in micrograms) of Levothyroxine/Synthroid

Answer 15

75, 88, 100, 117, 125, 150 (max is 300 mcg)

Question 16

What’s neat about Synthroid from the FDA’s point of view?

Answer 16

Synthroid’s been around for many years (late 1950’s). In 1962 the food, drug, cosmetics act was passed in the USA leading to the FDA. This drug predates the FDA, and therefore didn’t have clinical trials. FDA made them do it, but they threatened to stop manufacturing the drug, so the FDA backed off. So it’s never had clinical trials done. But it has been around so long we understand it very well.

Question 17

Levothyroxine Sodium / Synthroid
Route of admin
How to administer safely
What’s the max dose?

Answer 17

PO (daily)
Titrate up about once a month by checking TSH, and altering accordingly
Max dose: 300 mcg

Question 18

Levothyroxine/Synthroid - what is its big warning label?

3 side effects from class.

Answer 18

Do not use for obesity and weight loss

This can induce palpitations, tachycardia, put someone into A fib if they have a propensity

Question 19

Liothyronine Sodium
When is it used? (5)
and Why?

Answer 19

Used in INITIAL THERAPY of myxedema, myxedema coma, short-term suppression of TSH in patients undergoing thyroid cancer surgery, and rare 5’-deiodinase deficiency (rare endocrine disorders)
B/c it has a short 1/2 life

Question 20

Why would you not use Liothyronine for maintenance of thyroid hormone replacement therapy (like Synthroid/Levthyroxine)?

Answer 20

B/c it has a shorter 1/2 life than those.

Question 21

What is Used in initial therapy of myxedema, myxedema coma, short-term suppression of TSH in patients undergoing thyroid cancer surgery, and rare 5’-deiodinase deficiency (rare endocrine disorders)?

Answer 21

Liothyronine

Question 22

Liothyronine Sodium
Route of admin
Where is it absorbed?
What do you monitor?
Elderly?

Answer 22

PO
Rapidly absorbed through GI tract
Need to monitor T3 and TSH levels
Elderly need lower dose due to decreased renal function

Question 23

What is Liotrix used for?

What’s important to know about this drug?

Answer 23

Used for thyroid hormone replacement

No data supportive that Liotrix is better then other thyroid drugs. So it’s not really used, eh?

Question 24

No data supportive that __ is better then other thyroid drugs. So it’s not really used, eh?

Answer 24

Liotrix