Reverse thyroid

Question 1

synthetic T4, converted to T3
-used to treat hypothyroidism

Answer 1

levothyroxine (Synthroid) MOA

Question 2

-oral or IV (mcg not mg)
-food interfered with absorption
-highly protein bound
-several strengths available (NTI)
-safe in pregnancy

Answer 2

levothyroxine (Synthroid) Pharmacokinetics

Question 3

• Rare if TSH in therapeutic range
• Overdose is thyrotoxic crisis
  (hyperthermia, tachycardia,
  restlessness, tremor, weight loss)

Answer 3

levothyroxine (Synthroid) adverse effects

Question 4

*Take early AM on empty stomach
* Generic/Brand consistency
* Regular lab monitoring
* Report thyrotoxic symptoms

Answer 4

levothyroxine (Synthroid) pt education

Question 5

• thionamides
• inhibit thyroid hormone synthesis
• PTU also suppresses conversion of T4
  to T3 in the body
• Short or long-term use
• treats hyperthyroidism

Answer 5

methimazole & propylthiouracil (PTU) MOA

Question 6

• PO
• Slow onset of effects
• Methimazole has longer T1/2
• PTU preferred in pregnancy
• frequent lab monitoring required

Answer 6

methimazole & propylthiouracil (PTU) pharmacokinetics/nursing consideration

Question 7

• Teratogenic (methimazole)
• Too much can cause
  hypothyroidism

Answer 7

methimazole & propylthiouracil (PTU) adverse effects

Question 8

Prototypes: Hydrocortisone or Prednisone
Administration: Oral, IV, IM, rectal, topical
Absorption: well-absorbed orally
Distribution: Widely distributed
Metabolism: in liver
Excretion: in urine

Answer 8

Glucocorticoids for adrenal disorders

Question 9

Minimal adverse effects
* Glucose for the brain
* Protein metabolism
* Fat metabolism
* Keeps BP in check
* Maintains blood cells

Answer 9

Glucocorticoids physiologic levels

adrenal disorders

Question 10

Higher risk of adverseeffects
Treating other conditions:
* Allergic reactions
* Lung conditions
* Inflammation
* Dermatologic conditions

Answer 10

Glucocorticoids pharmacologic levels

adrenal disorders

Question 11

• Not enough hormone
• Chronic adrenocorticoid insufficiency
• Requires lifelong supplementation with glucocorticoid
• Needs extra steroid dose during times of physical stress (fever, illness, surgery, trauma)

Answer 11

Addisons Disease and Glucocorticoids

Question 12

Prominent at higher & longer systemic / pharmacologic doses
* hyperglycemia
* muscle atrophy, skin thinning
* fat redistribution
* fluid retention & hypertension
* adrenal suppression
* osteoporosis
* growth retardation (in children)
* susceptibility to infection
* psychologic problems (agitation, euphoria)
* Peptic ulcers

Answer 12

Glucocorticoid adverse effects

adrenal disorders

Question 13

• Hyperglycemia – focus efforts on diet & exercise
• Adrenal suppression – taper after long periods
• Osteoporosis – wt-bearing exercise, calcium & vita D
• Susceptibility to infection – screen & prevent
• psychologic problems (agitation, euphoria) – educate
• Peptic ulcers & hypertension – Avoid NSAIDS

Answer 13

glucocorticoid nursing consideration

adrenal disorders