Pharmacology of Thyroid Medications

PROPYLTHIOURACIL (PTU)

• Used for Graves' disease (pre-surgery)
• Monitor for hypothyroidism (too much can cause hypo)
• Liver function tests (ALT/AST) are needed
• Assess if TSH and T4 levels are good to determine effectiveness

METHIMAZOLE

• Used for hyperthyroidism (Graves' disease)
• Side effects include hepatotoxicity
• Agranulocytosis (infection symptoms, fever, palpitation)
• Monitor Complete Blood Count (CBC), Thyroid Stimulating Hormone (TSH), liver function tests (LFT)

LUGOL'S SOLUTION (NON-RADIOACTIVE)

• Used to shrink the thyroid before surgery
• Treatment for thyroid storm (high fever, agitation, restlessness)

RADIOACTIVE POTASSIUM IODINE (I-131)

• Used to suppress thyroid activity
• Avoid use

LEVOTHYROXINE

• Used for hypothyroidism
• Take in the morning
• Do not take for weight loss (contraindicated)
• Side effects of too much include increased heart rate and hot flashes

HYDROCORTISONE

• Used for Addison's disease, inflammation, asthma, allergies, and COPD
• Take as prescribed, not when symptoms present
• Side effects include hypertension

COSYNTROPIN

• Treats adrenocortical insufficiency
• Similar to ACTH, used to diagnose insufficiency
• Addison's disease is a common cause if stopping corticosteroid without tapering

OCTEOTIDE

• Used for acromegaly (too much growth hormone)

KETOCONAZOLE

• Antifungal used to decrease steroid levels

CUSHING'S DISEASE

• Causes elevated blood pressure
• Related to DM (diabetes mellitus) medications

A1C

• Measures glucose over 6-12 weeks

• 6.5% indicates diabetes mellitus (DM)

• DM patients want <7%

DESMOPRESSIN

• Hormone regulating water balance
• Used in treating diabetes insipidus
• Intramuscular (IM) route for glucagon use should not be administered except for severe hypoglycemia when no intravenous access is available

INSULINS BY ONSET

• Rapid-acting insulins (Aspart, Lispro)
• Short/Regular insulin
• Intermediate-acting insulin (NPH)
• Long-acting insulin (Glargine)

NPH (ISOPHANE) INSULIN

• Long-acting insulin; Lantus and Levemir are other long-acting insulins
• Cannot be mixed with other insulins

GLUCAGON

• Treats hypoglycemia
• Produced by the pancreas

METFORMIN

• First-line medication for type 2 diabetes
• Decreases glucose production in the liver
• Decreases B12 and folic acid absorption
• Side effects include GI upset, poor appetite, metallic taste
• Drug interactions with garlic and ginseng might cause hypoglycemia.

DAPAGLIFLOZIN (FARXIGA)

• Used for type 2 diabetes
• Not associated with hypoglycemia
• Contraindicated in chronic kidney disease (CKD)
• Could be used for weight loss

EPOTIN ALPHA

• Increases red blood cell production
• Used in treating anemia, cancer, sickle cell disease

TAMOXIFEN

• Breast cancer treatment.
• Blocks estrogen receptors
• Side effect: increased risk of uterine cancer.

METHOTREXATE

• Cancer treatment.
• Severe myelosuppression when combined with NSAID's
• Hepatotoxicity, ulcerative stomatitis, diarrhea, hemorrhagic enteritis, and pneumocystis pneumonia can be severe adverse effects.
• Pulmonary toxicity, Stevens-Johnson syndrome and malignant lymphomas are other potential symptoms

DOXORUBICIN

• Chemotherapy medication for various cancers
• Cardiotoxicity is a potential. Damage to the heart muscle can occur 4-5 months after treatment ends.

VINCRISTINE

• Chemotherapy medication
• Numbness and tingling affect extremities, may cause difficulty concentrating

THYROID STORM

• Severe hyperthyroidism
• High fever, tachycardia, agitation, restlessness

ADDISON'S DISEASE

• Autoimmune disease
• Low cortisol levels
• Requires high doses of hydrocortisone

HASIMOTO'S DISEASE

• Autoimmune disease that causes hypothyroidism

LEVOTHYROXINE (MICROGRAMS, NOT MG)

• Used for hypothyroidism
• Dosage is in micrograms (mcg) not milligrams (mg).

1:1 RATIO

• Low-grade fever, stress intolerance
• Associated with Addison's disease
• High doses of hydrocortisone are required

COLONY STIMULATING FACTORS

• Stimulates white blood cell production
• Used in cancer patients
• Can cause tingling in hands and feet

FILGASTRIM

• Increases neutrophil production
• Used in cancer patients

RADIOACTIVE IODINE (I-131)

• Used to suppress thyroid activity
• Given in the hospital, frequently requires NPO.

INSULIN: GLUCAGON

• Glucose homeostasis in the body (regulation)

HYPOGLYCEMIA

• Low blood sugar
• Symptoms: cool, clammy skin; fatigue; diaphoresis

BIGUANIDE

• Used for type 2 diabetes
• Metformin is included in this group

DESMOPRESSIN

• Synthetic vasopressin (antidiuretic hormone)
• Treats diabetes insipidus
• Can be used for nighttime wetting (nocturia); hemophilia

COSYNTROPIN

• Treats adrenal insufficiency

DAPAGLIFLOZIN (FARXIGA)

• Given for hypothyroidism; NPO.
• Must be taken for life

This quiz covers various medications used in managing thyroid conditions, including Propylthiouracil, Methimazole, and Levothyroxine. It highlights their uses, side effects, monitoring requirements, and specific patient considerations. Test your understanding of these critical treatments and their implications in patient care.