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NURS 301 > Drugs Affecting the Thyroid > Flashcards

Drugs Affecting the Thyroid Flashcards

1
Q

Hyper-function of endocrine glands indicate…

A

Tumors, excess stimulation → the patient is suspected to have a tumor until proven otherwise

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2
Q

Hypo-function of endocrine glands indicate…

A

Congenital defects/absence of gland or enzymes, destruction, age-related changes, receptor defects, lack of stimulation

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3
Q

Primary endocrine gland disorders

A

Dysfunction of gland or organ itself

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4
Q

Secondary endocrine gland disorders

A

Abnormal stimulation to gland

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5
Q

Thyroid gland

A

Vascular, two-lobed, surrounds trachea

Secretes T3, T4, and calcitonin in parafollicular cells

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6
Q

T3

A

Triiodothyronine (active form)

Contains 3 atoms of iodine

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7
Q

T4

A 
Thyroxine (inactive form)
Contains 4 atoms of iodine
More T4 is produced than T3
T4 is converted to T3
Body's source of T3
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8
Q

The thyroid gland is regulated by…

A

TRH and TSH

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9
Q

Three principle actions of thyroid hormones

A
  1. Stimulation of energy use
  2. Stimulation of growth
  3. Promotion of growth and development

Thyroid hormones have profound impact on metabolism, cardiac function, growth and development

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10
Q

Conditions of the thyroid

A
  • Hyperthyroidism
  • Hypothyroidism
  • Iodine deficiency
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11
Q

More than _____ of thyroid hormones are bound to protein.

A

99.5%

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12
Q

TSH lab test

A
  • Appears to offer better discrimination for only a slightly higher cost
  • TSH has become the standard of care as the single initial test of thyroid function
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13
Q

If serum TSH is within normal limits…

A

No further testing is required

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14
Q

If serum TSH is increased…

A

Free T4 level is then measured on the same initial sample to distinguish between overt and subclinical hypothyroidism

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15
Q

If serum TSH is suppressed…

A

Both serum T3 and T4 should be assessed off of the same initial sample to distinguish between overt thyrotoxicosis, T-3 toxicosis and subclinical thyrotoxicosis

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16
Q

The half-life of plasma TSH is…

A
  • Approximately one hour

- Deviates more rapidly from the steady state

17
Q

The half-life of plasma T4 is…

A

Approximately one week

18
Q

Medications that influence TSH secretion

A
  • T3 (triiodothyroacetic acid)
  • Glucocorticoids
  • Dopamine
  • Amiodarone
  • Amiodarone and Phenytoin (Dilantin) - tissue drug effects proportional to hormone concentration
19
Q

Thyroid hormone replacement agents

A
  • Levothyroxine (Synthroid, Levoxyl) = synthetic T4 (inactive form!)
  • Dessicated thyroid = bovine (cow or pig hormone) & porcine T4 + T3
  • Liothyronine (Cytomel, Triostat) = synthetic T3 (active form!)
  • Liotrix (Euthroid) = synthetic T4 + T3 in 4:1 fixed ratio
20
Q

Anti-thyroid agents

A
  • Propylthiouracil (PTU)

- Methimazole (Tapazole)

21
Q

Hypothyroidism

A
  • May occur at any age
  • Mild: Hypothyroidism
  • Severe: Myxedema
22
Q

Hypothyroidism in infancy is known as…

A

Cretinism

23
Q

Clinical presentation of hypothyroidism

A
  • Cold and dry skin
  • Face is pale, puffy, and expressionless
  • Hair is brittle and thin
  • Heart rate and temperature are lowered
  • Impaired mentation
  • Patient may complain of lethargy, fatigue, and cold intolerance
24
Q

Causes of hypothyroidism

A
  • Malfunction of the thyroid gland
  • Surgery
  • Decreased iodine in diet
  • Decreased secretion of TSH and TRH
25
Q

Treatment for hypothyroidism

A

Nearly always requires life-long replacement of thyroid hormones

26
Q

Graves’ disease

A
  • Most common cause of excessive thyroid hormone secretion
  • Most frequently occurs in women ages 20 to 40
  • The incidence in females is six times greater than in males
27
Q

Clinical presentation of Graves’ disease

A
  • Known as thyrotoxicosis
  • Heartbeat is rapid and strong
  • Dysrhythmias and angina may develop
  • CNS is stimulated
  • Skin is warm and moist
  • Appetite is increased
  • Weight loss
  • Exophthalmos
28
Q

Exophthalmos is caused by…

A

An immune-mediated infiltration of the EOMs and orbital fat by lymphocytes, macrophages, plasma cells, mast cells, and mucopolysaccharides

29
Q

Treatment for exophthalmos

A
  • High doses of oral glucocorticoids
  • Surgery
  • Return of normal thyroid hormone levels will not affect this
30
Q

Treatment of Graves’ disease

A
  • Decrease the production of thyroid hormones via surgery
  • Destruction of thyroid tissue with radioactive iodine
  • Anti-thyroid drugs (PTU or Methimazole)
31
Q

Plummer’s disease

A
  • Toxic nodular goiter (Plummer’s Disease)
  • Results of thyroid adenoma
  • Clinical manifestations are much like those of Graves’ disease, except exophthalmos is absent
  • Treatment:
    • Anti-thyroid medication
    • Surgery
    • Radiation
32
Q

Thyroid storm

A
  • Occurs in patients with severe thyroitoxicosis when they undergo major surgery or develop a severe intercurrent illness
  • Is not triggered by a rise in thyroid hormones
  • Cannot be identified with laboratory tests
  • Life-threatening and requires immediate treatment
33
Q

Manifestations of thyroid storm

A
  • Profound hyperthermia
  • Severe tachycardia
  • Restlessness
  • Agitation
  • Tremor
  • Unconsciousness
  • Coma
  • Hypotension
  • Heart failure
34
Q

Treatment for thyroid storm

A
  • Iodine solutions to suppress thyroid hormone release
  • Propylthiouracil to suppress thyroid hormone synthesis and peripheral conversion of T4 to T3
  • Beta-blockers
  • Glucocorticoids
  • IV fluids
35
Q

Levothyroxine

A
  • Synthroid, Levoxyl
  • Synthetic T4
  • Reverses effects of thyroid hormone deficiency (hormone is needed for body’s energy and metabolism)
36
Q

Pharmacotherapeutics of levothyroxine

A
  • Replacement therapy for hypothyroidism (all kinds)
  • Can also be used for treatment of goiter (goiter is enlarged thyroid gland caused by hormone imbalances, radiation treatment, surgery or cancer)
37
Q

Pharmacokinetics of levothyroxine

A
  • Given by mouth and well absorbed in empty stomach (taken with a FULL glass of water, but NO food for one hour)
  • IV form for coma
  • Converted to T3
  • Highly protein-bound (thyroid-binding globulin)
  • Half-life of 7 days; Plateau in 3-4 weeks
  • Dosed every day
  • Liothyronine (T3) more rapid onset and shorter duration, more expensive
38
Q

Contraindications of levothyroxine

A
  • Thyrotoxicosis
  • Acute MI
  • Adrenal Gland Disorder (not yet controlled by treatment)

NURS 301 (5 decks)

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