Pharm Week 11

tertiary hypothyroidism

hypothalamus does not secrete thyroid tropin releasing hormone (stimulates release of TSH)

Levothyroxine (Synthroid) is used for tx of ___________________. Synthetic of _____ and is the drug of choice for hypothyroidism To avoid adverse effects, doses are highly individualized. It has a _________________ therapeutic range, so when a pt is first diagnosed, the initial dose is 50 mcg. Then, increase dose every 2-3 weeks by 25 mcg/day with the maintenance dose being from _______-_________mcg/day. May take ____-_____weeks for the drug to show full therapeutic benefits. If pt with pre-existing ___________ disease starts on this drug, usually increase the dosage between 4-6 weeks (extend increase in dosage to avoid triggering dysrhythmias or anginal attacks). Adverse effects include hyperthyroidism (palpitations, dysrhythmias, anxiety, insomnia, weight loss, heat intolerance). In women, it can cause menstrual irregularities and long-term use is associated with ______________. Liver and bone marrow toxicity is the most srs adverse effect that can occur. Does have BBW = using thyroid hormone in tx of ___________ or weight loss is contraindicated. Contraindications include hypersensitivity, experiencing thyrotoxicosis (severe cardiac disorder history or MI), adrenal insufficiency (thyroid hormone may contribute to an adrenal crisis: correct admiral insufficiency prior to administration), diabetic (sx of diabetes may be worsened with this drug, and doses of antidiabetic drugs may be to be adjusted). Interactions include epinephrine and norepinephrine increase risk of ___________ insufficiency, increase effects of warfarin which increases risk of bleeding, soybean flour, cottonseed meal, walnuts, dietary fiber may bind to levothyroxine and decrease absorption of the drug, calcium/iron supplements given 4hrs after taking this drug to prevent interference with drug absorption. OD can cause srs thyrotoxicosis which may not present until several days after the OD. Tx is symptomatic and usually target the cardiac toxicity with either a _________ _____________ (propranolol). Administer at same time every day (preferably in morning to decrease ____________ effects), take with full glass of water on an empty stomach and preferably 30-60 minutes before breakfast. Keep follow-up exams to monitor effectiveness and educate them that they will need thyroid TSH monitoring.

Hypothyroidism, T4, narrow, 75-125, 2-3, cardiac, osteoporosis, obesity, cardiac, beta blocker, insomnia

______________________ cause hyperaldosteronism characterized by hypotension and hypokalemia. _____________ regulates plasma volume by promoting sodium absorption and potassium excretion by renal tubules. Plasma volume falls which then triggers kidneys to secrete renin which leads to production of angiotensin II, in which we have aldosterone secretion which leads to sodium retention and water retention.

Mineralocorticoids, aldosterone

Primary hypothyroidism

abnormality in thyroid itself

__________ pituitary contains glandular tissue that secretes ACTH, TSH, growth hormone, prolactin, FASH, LH

anterior

Octreotide (Sandostatin) works in _________ pituitary gland as a Gonad hormone inhibitor. Used in alleviating sx of carcinoid (cancer) tumors stemming from secretion of vaso-active intestinal polypeptide Includes severe diarrhea, flushing, and potentially life-threatening hypotension associated with the cancer crisis (carcinoid crisis). Also used in helping to tx ____________ varices. Contraindications include hypersensitivity, may impair ___________ function, renally impaired pts, diabetic pts (type 1 = causes severe ______glycemia; type 2 or do not have diabetes = causes ______glycemia). Interactions =include drugs that prolong QT interval (toxic effects can occur). Instruct to report any abdominal pain.

anterior, esophageal, gallbladder, hypo, hyper

Hyperthyroidism is hyper secretion of the hormone, Most common cause is _______________ disease where body develops antibodies against its own thyroid gland (also caused by thyroid adenomas, pituitary tumors, pregnancy, and grave's disease). ________________ disease cause of hyperthyroidism is more common in women aged 30-40 yrs. It can lead to a thyroid storm, they can occur when there is hypersecretion of the hormone accompanied with _________ of infection which is life threatening. Sx of thyroid storm = high __________, cardiovascular effects (tachycardia or angina/MI), CNS (agitated, restless, delirious). Sx can progress to __________ if not treated. Want to provide supportive care, manage fever, prevent shivering, maintain fluid and electrolyte balances, provide nutritional support, administer antithyroid drug, and provide with _____________ _______________ to help with HTN. Overall increase in metabolism. Over time, if left untreated, it can cause exophthalmos (bludging develops in ____________ bc tissue in eyeballs swells...extra fluid in eyes. Number of cells in the eyes increase which results in larger eyes which push forward from their orbits. Gives pt a ____________expression with higher ratio of white sclera exposed). Tx = administer thamizevit to decrease activity of the thyroid gland and potentially ___________ iodide which kills overactive thyroid cells or surgical interventions (may remove the gland or do oblation which is where they try to clean up the gland a little bit)

autoimmune, graves', stress, fever, coma, beta blocker, eyes, staring, radioactive

Thyroid: _____________cells secrete thyroid hormone (T4, T3) T3 is 3-5x more biologically active than T4. Essential _____________ is needed for synthesis of of T3/T4 (get enough via iodized salt in diet). Parafollicular cells secrete calcitonin (responsible for calcium homeostasis). Controls BMR. _____________ is the way the body uses energy, affects nearly every organ in the body w/o enough thyroid, many body functions slow down. Located near parathyroid which is responsible for maintaining adequate levels of calcium in the extracellular fluid Works by ______________ feedback loop. Thyroid disorders = hyper/hypo function, disease within the thyroid gland, or abnormal _________________ or hypothalamus will occur.

follicular, iodine, metabolism, negative, pituitary

Hypothyroidism causes include chronic autoimmune thyroiditis, ____________________ disease, can occur when the body's immune system attacks its own cells/organs causing inflammation and interfering with the body's ability to produce thyroid hormones. Can also be caused by surgical removal of the thyroid or high doses of ________________. Also congenital hypothyroidism (hyposecretion of thyroid hormone during youth which present with low metabolic rate/low growth/delayed sexual development and can also cause possible mental delays). Adults have _____________ (hyposecretion of thyroid hormone during adulthood). Can present with decreased metabolic rate, loss of mental/physical stamina, weight gain, loss of hair, and yellow/dullness color of the skin. A goiter/enlargement of the gland can develop due to overstimulation of thyroid hormone by elevated TSH levels due to little or no thyroid hormone in circulation. Values associated with hypothyroidism = ______________ TSH level, decreased T3/T4 levels. Early symptoms = thickened _______, constipation, hair loss, anorexia, generalized _____________, muscle cramps Severe symptoms = ____________ speech, bradycardia, weight gain, decreased sense of taste and smell, intolerance to cold environments. Tx with natural or synthetic thyroid hormone, more targeted at treating the _____ level

hashimoto's, amiodarone, myxedema, elevated, skin, weakness, slurred, T4

Adrenal Gland is located at top of _________. It consists of the renal cortex. Each region secretes specific hormones. Feedback process of hormone regulation. Adrenal __________= secretes catecholamines (epinephrine and norepinephrine) Adrenal ___________ = secretes 3 hormones (glucocorticoids, mineralocorticoids, and gonad corticoids)

kidneys, medulla, cortex

glucocorticoids are responsible for _________ the body from long-term stress, increase blood _____________, increase breakdown and use of proteins and lipids, suppress inflammatory and immune responses, increase sensitivity to vascular smooth muscle to norepinephrine and angiotensin II, increase risk of demineralization, promote bronchial _____________, and increase brain excitability)

mobilizing, glucose, inflammation

secondary hypothyroidism

occurs when pituitary gland is dysfunctional and does not secrete TSH

___________ pituitary contains nervous tissue. Responsible for releasing antidiuretic hormone (ADH) and oxytocin. Released in response to nerve impulses from the hypothalamus.

posterior

Gonad corticoids are mostly male sex hormones (androgens) and small amounts of estrogen. Contribute to onset of __________ . Sx include hypoglycemia, fatigue, orthostatic hypotension, increased skin _____________, gastrointestinal disturbances, low plasma cortisol and high plasma ACTH levels

puberty, pigmentation

Endocrine system contains glands that secrete hormones. Its main goal is physiological _________. Every cell and organ in the body is influenced by the ___________ system. Hormones are used as replacement therapy, also used as antineoplastic, and have natural therapeutic effects. Effects can be exaggerated response or suppression of body defenses. Some are hormone blockers that inhibit action of certain hormones

stability, endocrine

Hormones either work as a _________ or antagonize the effects of natural pituitary hormones

supplement

Desmopressin (DDAVP), the _______________ form of ADH, is the drug of choice for ____________ pituitary issues. It acts on the kidneys to ___________ reabsorption of water into the distal tubules and collecting ducts of the nephron. Concentrate the urine, reducing water excretion by up to 90%. Used in diabetes insipidus. Causes ____________ of smooth muscle in the vascular system, uterus, and GI tract. This drugs works to prevent/control sx from occurring and avoid dehydration associated with diabetes. Helps treat hemophilia A and type 1 von willebrand disease due to different blood clotting effects. Also management of nocturnal ____________ (bed wetting). When given this an hr before bedtime, it helps slow process down to prevent nighttime bedwetting. Adverse effects include water intoxication (drowsiness, headache, which can progress to convulsions or a coma), nausea, mild abdominal pain and cramping, facial __________, hypertension, pain, swelling at injection site) Intranasal form adverse effects include nasal congestion, rhinitis, and _______________ (nose bleeds). IV/nasal, when administered more than every _________hrs builds a tolerance to the drug. Contraindications include diabetes insipidus from chronic kidney disease or acute kidney disorder (worsen fluid retention/overload), use cautiously in coronary artery disease and hypotension. Risk of hyponatremia (thrombi) when taking drug. Indications include increased antidiuretic action with use of ___________s, decreased antidiuretic action with use of __________/alcohol/heparin/epinephrine. OD tx is to put person on water retention and loop __________ or thiazide. Look at kidney/liver function, and what their glucose levels are (esp diabetics). Educate pts to not take OTC drugs w/o checking with PCP first. Children who are prescribed ____________l hormones, educate parents to keep track/journal of child's growth patterns. Make sure you do not stop these drugs abruptly.

synthetic, posterior, increase, contractions, enuresis, flushing, epistaxis, 48, NSAID, lithium, diuretic, gonadal

T/F: anterior and posterior pituitary govern ALL bodily functions. Works via negative feedback loop.

true