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Pharm Kay Exam 2 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

etiologies of hypothyroidism

A

hashimoto
thyroidectomy
RAI therapy

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2
Q

what drug replaces T4

A

Levothyroxine

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3
Q

what drug replaces T3

A

Liothyronine

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4
Q

what was synthroid made from

A

ground thyroid glands of cows [ew]

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5
Q

are all levothyroxine drugs on the market bio equivalent?

A

yes

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6
Q

MOA of levothyroxine

A

active compound= T3–then converted FROM T4 by deiodination in liver & peripheral tissues

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7
Q

how much levothyroxine is absorbed in the small intestine

A

80%

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8
Q

1/2 life of levothyroxine

A

7d

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9
Q

how many wks before steady state w/ levothyroxine

A

4-6wks

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10
Q

where should levothyroxine be stored?

A

out of heat,light or humidity

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11
Q

how should levothyroxine be taken?

A

empty stomach before breakfast

or 4hrs after last meal

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12
Q

what is the most important factor with taking levothyroxine

A

consistancy in timing of dose

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13
Q

dose adjustment when switching PO–> IV

A

decrease by 50%

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14
Q

how long till SE of levothyroxine go away?

A

2-3wks

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15
Q

what should we look at if we have a pt on a levothyroxine dose >300

A

adherence
malabsorption
drug interactions

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16
Q

avg. dose for adult *full replacement

A

1.6mcg/kg/d

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17
Q

avg. dose for elderly *full replacement

A

0.5mcg/kg/d

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18
Q

what pt population needs to start levothyroxine on a lower dose?

A

cardiac pts

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19
Q

how should we dose obese pts on levothyroxine?

A

w/ their lean body wt dosage

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20
Q

what do we monitor for levothyroxine dose?

A

TSH

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21
Q

what is 3 situations would warrant TSH checking

A

new symptoms
drug interaction w/ T4
pregnancy

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22
Q

what pt’s have TSH’s that are misleading

A

central hypothyroidism d/t hypothalamic or pituitary dz

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23
Q

ADR of levoyhrxoine

A 
palpitation
tremor
anxiety
wt loss
tachycardiac
increase # poops
osteoporosis
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24
Q

what pts are @ risk for cardiac complications (arrythmia, AMI, ACS) on levothyroxine?

A

cardiac dz

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25
how does levothyroxine cause ACS or dysrhythmia in HF pts
it increase HR and contractility--which increases myocardial O2 demand
26
what drugs decrease effects of LT4?
``` amiodarone PTU Antacids Carbamazepine Phenytoin Rifampin ```
27
if on levothyroxine when should you take antacids, bile acid resins, fiber, Calcium/iron?
@ a different time b/c it affects absorption
28
what drugs inhibit T4-->T3 conversion
amiodarone | PTU
29
what drugs increase LT4 metabolism via cyps
carba pheny rifampin
30
name of pure T3
liothyronine
31
what has a shorter 1/2 life levo or liothyroine?
liothyronine
32
when would you prescribe Liotrix?
pts who cannot convert T4-->T3
33
what is Liotrix made of?
T3 and T4
34
what is the problem w/ thyroid USP?
levels of T3 and T4 vary ALOT
35
why do some patients like desiccated thyroid meds?
b/c they get a lift off the fast acting T3, all in their heads (sorry pts)
36
common causes of hyperthyroidism
graves multinodular goiter autonomous nodule thyroiditis
37
what are the 3 definitive tx options for hyperthyroidism (not all drugs)
thionamides RAI surgery
38
what is a adjunctive tx options for hyperthyroidism?
b-blockers | Steroids
39
what are the 2 thionamides we use?
propylthiouracil | Methimazole
40
MOA of thionamides
inhibit thyroid hormones synthesis by interfering w/ thyroid peroxidase--mediation iodination of tyrosine residues in thyroglobulin
41
what thionamide do we prefer?
methimazole
42
why do we like methimazole
Qday effective @ low dose major ADR= rare
43
when do we use PTU
life-threatening thyroid-storm | pregnancy
44
what happens if methimazole is taken during pregnancy
aplasia cutis | esophageal atresia
45
how does dosing look for thionamides?
start high--then lower once symptoms are controlled (start lowing 4-8wks in)
46
how long till partial clinical resolution of thyrotoxicosis?
2 wks
47
what pts reach remission @ 12-18monthS
small goiter low levels of anti-TSH ab mild/mod hyperthyroidsm
48
fraction of pts on monotherapy of thionamide that reach remission
1/3
49
what is the recurrent rate of hyperthyroidism
50%
50
ADR of thionamides
arthralgias Rash Gi intolerance agranulocytosis
51
what joint problem can develop from thionamide use
anti-thyroid arthritis syndrome
52
what rheum condition is PTU associated w/
ANCA + vasculitis w/ other symptoms
53
if a pt on thionamides presents w/ fever, sore throat, mouth ulcers what should you get? why?
CBC w/ diff | agranulocytosis!!!
54
what can PTU possibly cause in the liver
acute hepatic failure
55
what do we use for RAI of the thyroid
sodium Iodide I-131
56
how does Sodium Iodide I-131 work?
thyroid gland takes it up--then it release Beta particles to cause a slow inflammatory response that destroy the thyroid
57
what should you try prior to RAI
thionamides
58
main ADR of RAI
radiation thyroiditis--lower neck pain
59
use of B-blockers in hyperthyroid
decreases symptoms of increased adrenergic tone
60
once hyperthyoridism resolves what can we do w/ b-blockers
taper down
61
what steroid do we use in hyperthyroidism
dexamethasone
62
how does dexamethasone help w/ hyperthyroidism
PREVENTS peripheral conversion of T4-->T3
63
how does hypothyroidism affect a fetus
``` increase risk of: miscarriage pre-term birth LBW fetal brain development ```
64
what do we need to do to levothyroxine dose in pregnancy
increase (25-30%)
65
should you take pre-natals and levothyroxine @ the same time of day?
no
66
can we use desiccated thyroid or lio in pregnancy?
no--not enough T4 gets to fetal brain
67
when can a pregnant woman resume her levothyroxine dose?
after delivery
68
what can uncontrolled hyperthyroidism cause in a fetus?
``` increase risk of: miscarriage gest. HTN pre-term pre-eclamp HF thyroid-storm IUGR premature still born ```
69
thionamide used in 1 trimester pregnancy
PTU
70
thionamide used in 2/3 trimester and breast feeding
methimazole

Pharm Kay Exam 2 (3 decks)

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