Term
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Definition
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Term
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Definition
1. Iodide
2. Iodine
3. Tyrosine
4. Thyroid Hormone
Here’s a Fun Fact: U.S. added iodine to salt in 1920’s to eliminate goiter |
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Term
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Definition
thyroid drugs
MOA - levothyroxine- synthetic preparation of thyroxine (T4)
Pharm - food can decrease absorption, take on empty; stomach; highly protein bound; levothyroxine- prolonged half-life (7 days); Narrow Therapeutic Index
Indications - All forms of hypothyroidism; Cadaver organ recovery; see vasopressors,inotropics, corticosteroids, insulin, levothyroxine
AE - Overdose- thyrotoxicosis
Acute S/S- tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance and sweating
Chronic S/S- accelerated bone loss, atrial fibrillation
Drug/Drug - Watch out for drugs that can affect pH, and take it on an empty stomach. |
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Term
| liothryonine/dessicated thryroid |
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Definition
Thyroid drugs
MOA - liothyronine- synthetic preparation of triiodothyronine (T3)
thyroid- desiccated animal thyroid gland (4:1 ratio)
Pharm - highly protein bound; liothyronine- short half life (1 day); Narrow Therapeutic Index
Indications - All forms hypothyroidism
AE - Overdose- thyrotoxicosis
Acute S/S- tachycardia, angina, tremor, nervousness, insomnia, hyperthermia, heat intolerance and sweating
Chronic S/S- accelerated bone loss, atrial fibrillation
Monitoring levothryonine - TSH, free serum T3 |
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Term
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Definition
| The American Thyroid Association/American Association of Clinical Endocrinologists do not recommend the use of desiccated thyroid for thyroid replacement therapy for hypothyroidism (ATA/AACE [Garber 2012]). |
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Term
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Definition
First line - levothyroxine
Speedy results - ?
potent - ? |
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Term
| Methimazole/propylthiouracil |
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Definition
anti-thyroid drugs (thionamides)
MOA - block synthesis of thyroid hormones; methimazole- prevents coupling of iodinated tyrosines, and conversion of iodide into iodine; PTU- same MOA as methimazole PLUS prevents T4 to T3 conversion in periphery
Indications - hyperthyroidism; short term for subtotal thyroidectomy; for therapy with radioactive iodine; thyroid storm
AE - Both drugs can cross the placenta, and are found in breast milk (ATA recommends low doses are safe for breastfeeding)
PTU- BOXED WARNING; poorly crosses the placenta, recommended for 1st trimester; methimazole is an option for 2nd & 3rd trimester, (fetal abnormalities in 1st trimester)
PTU- BOXED WARNING- hepatoxicity
monitor for s/s, routine LFT monitor doesn't seem to help
has resulted in multiple liver transplants and death
Both: Agranuolocytosis- rare, usually develops in first 2 months of therapy: fever, sorethroat; all other adverse effects rare: HA, N/V, arthralgia, dizziness |
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Term
| Glucocorticoids physiology |
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Definition
PHYSIOLOGIC -Cortisol,"Catabolic",
Glucose (supply for the brain)
stimulate gluconeogenesis
reduce peripheral glucose utilization
inhibit glucose uptake by muscle and adipose
lipolysis and fat redistribution
moon face and buffalo hump |
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Term
| Glucocorticoids pharmacologic |
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Definition
Suppress synthesis of the "inflammatory soup" & immune system
Suppress infiltration of phagocytes
Inhibit release of lysosomal enzymes
Inhibits proliferation of lymphocytes |
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Term
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Definition
Cardio: vasoconstriction, keep BP regulated, increase RBC, increase leukocytes, decrease lymphocytes, eosinophils, basophils, monocytes
Effects During Stress: large secretions of glucocorticoids with epinephrine. Maintains BP and BG
Aldosterone like: work on kidneys, sodium & water retention, lose potassium |
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Term
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Definition
| prednisone/hydrocortisone |
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Term
| Glucocorticoids used to treat |
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Definition
low dose: physiologic effects, treat adrenal insufficiency
high dose: pharmacologic effects, treat inflammation |
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Term
| Glucocorticoids indications |
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Definition
Adrenocortical deficiency
Cerebral edema
Collagen diseases
Dermatologic diseases
GI diseases
Exacerbations of chronic respiratory illnesses, such as asthma and COPD
Organ transplant (decrease immune response)
Palliative management of leukemias and lymphomas
Spinal cord injury
Antiemetic
NEONATES- Lung development
Many other indications |
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Term
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Definition
mineralocorticoids
MOA - Mimics Aldosterone-
sodium and water retention, lose potassium and hydrogen, think of RAAS |
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Term
| Mineralcorticoids/glucocorticoids AE |
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Definition
At high doses: see potent effects on all body systems
Cardiovascular
Heart failure, cardiac edema, hypertension—all caused by electrolyte imbalances (hypokalemia, hypernatremia)
CNS
Convulsions, headache, vertigo, mood swings, nervousness, insomnia, “steroid psychosis,” others
Endocrine
Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others
GI
Peptic ulcers with possible perforation, pancreatitis, abdominal distention, others
Integumentary
Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria
Musculoskeletal
Muscle weakness, loss of muscle mass (muscle wasting), osteoporosis
Ocular
Increased intraocular pressure, glaucoma, others
Other
Weight gain |
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Term
| Mineralcorticoid/glucocorticoid AE pnemonic |
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Definition
C – Cataracts
U – Ulcers
S –Skin thinning
H – Hypertension, Hirsutism
I – Immunosuppression, Infections
N – Necrosis of femoral heads
G – Glucose elevation
O – Osteoporosis, Obesity
I – Impaired wound healing
D – Depression/mood changes |
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Term
| What do I typically look for in m-corticoid/g-corticoid treatment? |
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Definition
Monitor for elevated BG levels
Can cause increased WBC count “shift”
Fluid Retention, electrolyte imbalance
Sleep issues "insomnia"
If taking oral, take with food, can cause GI upset/irritation
Take in morning to prevent adrenal suppression
Long Term Use: Osteoporosis, weight gain
Children- inhibits growth |
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Term
| corticosteroids drug/drug |
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Definition
NSAIDS- can increase GI issues, peptic ulcer disease
hyperglycemia
hypokalemia
vaccines! |
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Term
| Long-term adrenal drug comments |
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Definition
Long term use can cause adrenal suppression, TAPER OFF!!
-Can take anywhere from 5 days to a year
-Why we see tapers, everyone has their own "standard" can see some long term tapers or short tapers
-Commercialized Taper ="Medrol Dose Pack" |
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