39 Questions
What is the treatment of choice for toxic adenomas, toxic multinodular goiter, and most varieties of thyrotoxicosis?
Radioactive iodine therapy
Why is radioactive iodine contraindicated during pregnancy?
It crosses the placenta
What should women of childbearing age be instructed to do following radioactive iodine treatment?
Not conceive for at least 6 months
What is the goal of radioactive iodine therapy (131I)?
To eliminate the hyperthyroid state with sufficient radiation in a single dose
What is the principal test used for monitoring patients early after radioactive iodine treatment?
Serum free T4 measurements
Which medication is recommended during the first trimester of pregnancy due to teratogenic effects of methimazole?
Propylthiouracil
What is the purpose of antithyroid medications such as methimazole and propylthiouracil?
Inhibit thyroid hormone synthesis and release
When is thyroid hormone replacement initiated after stopping antithyroid medications?
4 to 18 weeks
What is the initial effect of an ablative dose of radioactive iodine?
Acute release of thyroid hormone, leading to increased symptoms
What condition are patients undergoing radioactive iodine treatment monitored for signs of?
Thyroid storm
What can happen if antithyroid medications are discontinued before completing therapy?
Relapse within 6 months
When should baseline blood tests be performed before initiating antithyroid medication therapy?
Before initiating therapy
What is the main target of radioactive iodine in the body?
Thyroid gland
What happens if patients treated with radioactive iodine contaminate their surroundings?
May cause radioactive contamination to others
How is the therapeutic dose of antithyroid medications determined?
Based on clinical criteria and laboratory studies
When should patients take antithyroid medications to avoid decreased absorption?
In the morning on an empty stomach
What is the primary purpose of antithyroid drugs?
To treat an overactive thyroid gland by decreasing the production of thyroid hormone
What should patients do if they experience signs and symptoms of acute liver failure?
Seek immediate medical treatment
What are the patient teaching guidelines for propylthiouracil?
Regular thyroid and liver function tests, avoiding seafood or iodized salt, and taking the drug at regular intervals
What should patients do before taking over-the-counter drugs while on antithyroid medication?
Consult a healthcare provider
What risk is associated with methimazole use during the first trimester of pregnancy?
Fetal abnormalities
Which statement about iodine preparations used in the short-term treatment of hyperthyroidism is true?
They should not be followed by certain antithyroid drugs
What is a potential consequence of using sodium iodide 131I to treat hyperthyroidism and thyroid cancer?
Hypothyroidism requiring lifelong hormone replacement therapy
When may the therapeutic benefits of sodium iodide 131I become apparent?
3 months or longer after therapy
For which symptoms is propranolol recommended in patients with symptomatic hyperthyroidism?
Tachycardia, palpitations, excessive sweating, and nervousness
In which patient population is propranolol particularly useful?
Older adults with resting heart rates greater than 90 beats/min or a history of cardiovascular conditions
When should propranolol be tapered and discontinued in patients with hyperthyroidism?
Once patients become euthyroid and definitive treatment has controlled hyperthyroid symptoms
What is the plasma half-life of propylthiouracil?
1-2 hours
What is the preferred treatment for hyperthyroidism in older adults?
Radioactive iodine
What is the only contraindication to propylthiouracil?
Known hypersensitivity
What is the main concern highlighted by the FDA's BLACK BOX WARNING for propylthiouracil?
Risk of severe liver injury
What is the evidence-based link between propylthiouracil and a specific condition, necessitating close monitoring and aggressive wound care?
Vasculitis
With which of the following medications may propylthiouracil potentially interact?
Amiodarone
What is the primary purpose of administering propylthiouracil around the clock?
To maintain therapeutic drug levels
What is the most common adverse effect associated with propylthiouracil use?
Hypothyroidism
When is propylthiouracil used in the management of hyperthyroidism?
As first-line monotherapy
What is the preferred treatment for hyperthyroidism in older adults?
Radioactive iodine
What is the primary action of propylthiouracil in the treatment of hyperthyroidism?
Inhibit thyroid hormone production
What is the preferred treatment for hyperthyroidism in older adults?
Radioactive iodine
Study Notes
Antithyroid Drug Patient Teaching and Other Drugs
- Antithyroid drugs are used to treat an overactive thyroid gland by decreasing the production of thyroid hormone.
- Patients should receive instructions about signs and symptoms of acute liver failure and seek immediate medical treatment if these symptoms occur.
- Patient teaching guidelines for propylthiouracil include regular thyroid and liver function tests, avoiding seafood or iodized salt, and taking the drug at regular intervals.
- Patients should report adverse effects to the prescriber and consult a healthcare provider before taking over-the-counter drugs.
- Methimazole is similar to propylthiouracil and carries a risk of fetal abnormalities, requiring a pregnancy test before use during the first trimester.
- Strong iodine solution and saturated solution of potassium iodide are iodine preparations used in short-term treatment of hyperthyroidism, but should not be followed by certain antithyroid drugs.
- Sodium iodide 131I is a radioactive isotope used to treat hyperthyroidism and thyroid cancer, but can lead to hypothyroidism and requires lifelong hormone replacement therapy.
- The therapeutic benefits of sodium iodide 131I may not be apparent for 3 months or longer, and patients should avoid expectorating or coughing freely for 24 hours after therapy.
- Propranolol is a beta-adrenergic–blocking agent recommended for all patients with symptomatic hyperthyroidism to control symptoms such as tachycardia, palpitations, excessive sweating, and nervousness.
- Propranolol is particularly useful in older adults with resting heart rates greater than 90 beats/min or a history of cardiovascular conditions.
- Propranolol is used to control symptoms during the delayed response to other hyperthyroidism treatments, before thyroidectomy, and in treating thyrotoxic crisis.
- Once patients become euthyroid and definitive treatment has controlled hyperthyroid symptoms, propranolol should be tapered and discontinued.
Propylthiouracil: Pharmacokinetics, Action, and Use
- Propylthiouracil is a thioamide antithyroid drug used to treat hyperthyroidism
- It inhibits thyroid hormone production and peripheral conversion of T4 to T3
- Propylthiouracil is well absorbed orally, with a plasma half-life of 1-2 hours
- It is used alone for hyperthyroidism, preoperative thyroidectomy preparation, and in thyroid storm treatment
- Hyperthyroidism affects drug metabolism, requiring close monitoring and potential dose adjustments
- In older adults, radioactive iodine is preferred over propylthiouracil due to fewer adverse effects
- A BLACK BOX WARNING by the FDA highlights the risk of severe liver injury with propylthiouracil
- Adverse effects of propylthiouracil include hypothyroidism signs, hematologic, dermatologic, CNS, GI effects, and more
- The only contraindication to propylthiouracil is known hypersensitivity
- Evidence-based practice shows a link between propylthiouracil and vasculitis, requiring close monitoring and aggressive wound care
- Propylthiouracil may interact with anticoagulants, amiodarone, potassium iodide, sodium iodide, and lithium
- Nursing implications include administering the drug around the clock, assessing for therapeutic and adverse effects, and preventing interactions
Test your knowledge on antithyroid drugs and patient teaching with this quiz. Explore essential information on propylthiouracil, methimazole, iodine preparations, and propranolol. Brush up on pharmacokinetics, actions, uses, adverse effects, and nursing implications for propylthiouracil.
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