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PHRM 825 - Exam 4 > LECTURE 38: therapeutics of thyroid disorders > Flashcards

LECTURE 38: therapeutics of thyroid disorders Flashcards

(54 cards)

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1
Q

What is the gold standard for measuring thyroid function?

A

TSH levels

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2
Q

What does low TSH levels indicate? Why?

A

hyperthyroidism, the thyroid is overperforming so body understimulates to try to compensate

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3
Q

What does high TSH levels indicate? Why?

A

hypothyroidism, the thyroid is underperforming so body overstimulates to try to compensate

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4
Q

The most accurate test for measuring thyroid function measures the levels of what?

A

Free T4

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5
Q

List the treatment options for HYPERthyroidism

A

Thioamides
RAI (radioactive iodine)
Surgery (thyroidectomy)

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6
Q

List Thioamides used for treatment of HYPERthyroidism

A

PTU
Methimazole

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7
Q

What is the dosing for PTU?

A

Q8-10h

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8
Q

What is the dosing for Methimazole?

A

daily

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9
Q

Does PTU block T4 -> T3 conversion?

A

yes

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10
Q

Does Methimazole block T4 -> T3 conversion?

A

no

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11
Q

When is PTU safe to use in pregnancy?

A

1st trimester

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12
Q

When is Methimazole safe to use in pregnancy?

A

2nd + 3rd trimester
(start after 16 weeks)

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13
Q

Is PTU safe to use during lactation?

A

NO

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14
Q

Is Methimazole safe to use during lactation?

A

YES

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15
Q

Does PTU have a black box warning?

A

YES, hepatic toxicity

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16
Q

Does Methimazole have a black box warning?

A

also hepatic toxicity
(according to google)

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17
Q

Which thioamide symptoms indicate that the patient should d/c thioamide used?

A

Rash with wheals, hives, SOB
Agranulocytosis
Hepatitis

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18
Q

What counseling should be given to a patient on thioamides experiencing GI upset (n/v)?

A

take w/ meals, divided doses

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19
Q

What type of rash indicates that the patient does not have to immediately d/c thioamides, and can just switch to another thioamide?

A

maculopapular, no systemic symptoms

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20
Q

List warning signs to look for with a patient on thioamides that may indicate agranulocytosis

A

cold sores
fever, chills, sore throat

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21
Q

What should be monitored for a patient on thioamides to test for efficacy?

A

√T-4, t-3, TSH initially Q4-6 weeks until euthyroid, then √Q3-6 months while on thioamides

TSH can be misleading – remains suppressed after T-4 & T-3 normalize

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22
Q

How often should testing should be done after a patient d/c a thioamide?

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A

√Q4-6 weeks for first 3-4 months, then test yearly after

23
Q

Describe RAI (radioactive iodine) treatment

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A

Slow destruction of thyroid gland with 131-I radioactive isotope

24
Q

List the contraindications for RAI treatment

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A

current pregnancy
current lactation
planning pregnancy <6 months

25
What counseling point should be given to a patient on RAI treatment?
AVOID PHYSICAL CONTACT & SECRETION > 5 DAYS
26
What disease indicates that caution should be used in selecting RAI as a treatment option for a patient?
Grave’s orbitopathy (new or worsening) - Not recommended for moderate-severe orbitopathy
27
When should surgery (thyroidectomy) be considered as an appropriate treatment option?
For: - large glands (obstructive symptoms) - multinodular goiter - cancer - medication failure - ophthalmopathy - pregnancy (2nd trimester)
28
List some potential risks of surgery (thyroidectomy)
vocal cord damage removal of parathyroid glands
29
How soon after having a thyroidectomy should the patient be evaluated?
2 months post-surgery
30
How should beta-blockers be used in the treatment of HYPERthyroidism?
as adjunct therapy - short-term use to alleviate symptoms Use in patients with HR > 90 bpm
31
List cardio-selective beta-blockers that can be used in the treatment of HYPERthyrodism
Atenolol 25-100 mg daily Metoprolol 25-50 mg BID Propranolol 10-40 mg PO Q6H or Q8H (slow onset- 7-10 days) **preferred to maintain HR 60-90 bpm**
32
List calcium-channel blockers that can be used in the treatment of HYPERthyrodism
Diltiazem Verapamil
33
What beta-blockers should be AVOIDED in the treatment of HYPERthyroidism?
agents with intrinsic sympathomimetic activity Acebutolol Carteolol Penbutolol Pindolol
34
List treatment options of HYPOthyroidism
thyroid supplements: Levothyroxine Liothyronine Desiccated thyroid
35
Which thyroid supplement is the first choice for the treatment of HYPOthyroidism
Levothyroxine (T-4)
36
List drugs that contain Levothyroxine (T-4) & can be used in the treatment of HYPOthyroidism
Tirosint (capsule) Tirosint-SOL (solution) Ermeza (solution) Thyquidity (solution) Euthyrox Synthroid Levoxyl, Unithroid
37
List drugs that contain Liothyronine (T-3) & can be used in the treatment of HYPOthyroidism
Cytomel
38
List drugs that contain desiccated thyroid & can be used in the treatment of HYPOthyroidism
Armour Thyroid AdthyzaTM Niva Thyroid NP Thyroid (gluten-free tablet)
39
What is the black box warning for Levothyroxine?
weight loss
40
Describe the potential weight loss effects in euthyroid patients taking levothyroxine within the range of daily hormonal requirements
Ineffective for weight reduction
41
Describe the potential effects in euthyroid patients taking high doses of levothyroxine
May produce serious or even life-threatening toxic effects particularly when used with some anorectic drugs (eg, sympathomimetic amines)
42
What are some patient counseling points for levothyroxine?
TAKE ON AN EMPTY STOMACH options: 60 minutes before breakfast bedtime ~ 4 hours after dinner
43
Should levothyroxine be taken by pregnant patients?
YES, it is ESSENTIAL to continue levothyroxine throughout pregnancy
44
What dosing adjustments should be made for pregnant patients taking levothyroxine?
Required higher dose Adjust by 25 mcg, √TSH Q trimester Resumes to pre-pregnancy dose immediately after delivery !! Re √TSH in 6-8 weeks
45
How should Liothyronine (T-3) be used to treat HYPOthyroidism?
Short-term replacement Diagnostic agent in T-3 suppression test
46
What are the disadvantages of Liothyronine (T-3)?
- Cardiac toxicities (rapid absorption of T-3 can cause hyperthyroid symptoms) - Short t1/2 (necessitates BID-QID dosing) - More expensive than T-4
47
Describe desiccated thyroid USP
Natural product derived from pork thyroid glands **risk – allergic reactions to animal protein**
48
List drugs that commonly interact with Levothyroxine (T-4), causing low T-4 absorption
Bile acid sequestrants Al(OH)3 antacids Ferrous sulfate Sucralfate Calcium supplements
49
List drugs that commonly interact with Levothyroxine (T-4), causing high serum TBG
estrogen
50
List drugs that commonly interact with Levothyroxine (T-4), causing high T-4
enzyme inducers: phenytoin (PHT) carbamazepine (CBZ) rifampin phenobarbital (PB)
51
List drugs that commonly interact with Levothyroxine (T-4), causing disease-drug interaction
warfarin
52
Describe "euthyroid state"
Normal TSH & FT-4
53
What is the goal of therapy for HYPOthyroidism treatment?
Attain & maintain euthyroid state
54
Describe how the efficacy is monitored for HYPOthyroidism treatment
- √TSH, FT4, and clinical symptoms Q6-8 weeks (6-8 weeks after any dose or product change) - Until TSH normalized, then √Q3-6 months for the 1st year, then yearly Reversal of signs/symptoms in 2-3 weeks (max 4-6 weeks) Anemia, hair, skin changes may take 6 months

PHRM 825 - Exam 4 (4 decks)

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