NR565 Advanced Pharmacology Final Exam –
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Radioactive Iodine Adverse Effects · Contraindicated when pregnant or breastfeeding
· Brassy taste in mouth
· Burning sensation in mouth, soreness of gums &
teeth
· Iodine can cause corrosive injury to GI tract
Methimazole (Graves Disease Tx) - · Treatment for hyperthyroidism
INDICATIONS · Reduces excessive production of thyroid hormone
· First line treatment, preferred over PTU
· PTU (Preferred in thyroid storm)
· Not recommended in first trimester pregnancy,
breast feeding or those in thyroid storm
· Can be used as adjunct to radiation therapy
o Can cause agranulocytosis à monitor CBC
· Less likely to cause liver damage than PTU
Methimazole (Graves Disease Tx) - · Takes 3 to 12 weeks to have a meaningful effect on
MOA the thyroid hormone levels.
· As T3 & T4 drop, negative feedback to pituitary is
altered à TSH secretion is increased à monitoring of
thyroid level takes place to determine whether client
has reached a normal thyroid level
,Levothyroxine - EDUCATION · Synthetic hormone intended to supplement or
replace natural thyroid hormone thyroxine (T4) that
converts into (T3)
· Has a high protein binding capacity, resulting in a
long half-life, which allows for once-daily dosing.
· Can be used to regulate thyroid hormone levels in
clients who have Had thyroid surgery irradiation or
drug treatment for hyperthyroidism.
Levothyroxine - POPULATION o Category A. Safe for pregnancy and breastfeeding.
CONSIDERATIONS Dosing may need adjusted while pregnant.
o Dosing will need to be adjusted for age and weight
and adjusted as child grows.
o Consider family's ability to manage medication
regimen (children)
o Older adults:
§ Start with lower dose (d/t potential underlying
cardiac issues)
§ Monitor bone density
§ Consider patient and family's ability to safely
administer medication/regimen
§ Consider polypharmacy and drug interactions
Levothyroxine - DRUG o Decreased absorption with concurrent intake of
INTERACTIONS {calcium, mag, iron] supplements AND meds
[antacids & PPIs].
o Levothyroxine should be taken on an empty
stomach and 4 hours apart from this medications to
be sure the absorption is not affected
o Can interact with warfarin à increases anticoag
effect and bleeding risk
o Can cause increased dosing requirements for
[insulin and digoxin]
o Elevated hearts sensitivity to [catecholamines],
increasing possible arrhythmias
,Levothyroxine - DOSING & o Varies based on condition, severity and client's
ADJUSTMENTS response to therapy
o Follow dosing guidelines
o IV administration for myxedema coma
o Take on empty stomach (30/600 mins before food
o Levothyroxine has a narrow TI
Levothyroxine - MONITORING o Monitor TSH levels 6-8 weeks after starting med
o T4 can also be used to evaluate therapy in pts who
TSH level remains high
Propranolol indications for · Helps to decrease
endocrine disorders o Tachycardia
o Palpitations
o Tremors
o Anxiety
o Heat intolerance
· Blocks T4 to T3 conversion in high doses
· Alternate drug use: esmolol infusion
Hyperthyroidism treatment · Beta blockers recommended in patients with resting
considerations HR 90 bpm or coexistent cardiovascular disease
(CCB verapamil/diltiazem have been effective in rate
control in those patients who cannot tolerate BB)
· Sensitivity,
, Pioglitazone contraindications · Reduces glucose levels by decreasing insulin
resistance and production
· HF can be precipitated or exacerbated by fluid
retention
· Can cause unintentional pregnancies in
premenopausal woman.
· Prolonged high doses can cause bladder
cancer (manifested by blood in the urine, painful
urination, or increased urgency)
· Fractures: risk increases with long-term, high-
dose therapy. Clients should take vitamin D and
calcium and ensure adequate exercise and
medications for osteoporosis
· Liver Failure: monitor LFTs to ensure this side
effect is not occurring before and during therapy
(rare)
Questions With A+ Answers
Save Groups
Terms in this set (383)
Radioactive Iodine Adverse Effects · Contraindicated when pregnant or breastfeeding
· Brassy taste in mouth
· Burning sensation in mouth, soreness of gums &
teeth
· Iodine can cause corrosive injury to GI tract
Methimazole (Graves Disease Tx) - · Treatment for hyperthyroidism
INDICATIONS · Reduces excessive production of thyroid hormone
· First line treatment, preferred over PTU
· PTU (Preferred in thyroid storm)
· Not recommended in first trimester pregnancy,
breast feeding or those in thyroid storm
· Can be used as adjunct to radiation therapy
o Can cause agranulocytosis à monitor CBC
· Less likely to cause liver damage than PTU
Methimazole (Graves Disease Tx) - · Takes 3 to 12 weeks to have a meaningful effect on
MOA the thyroid hormone levels.
· As T3 & T4 drop, negative feedback to pituitary is
altered à TSH secretion is increased à monitoring of
thyroid level takes place to determine whether client
has reached a normal thyroid level
,Levothyroxine - EDUCATION · Synthetic hormone intended to supplement or
replace natural thyroid hormone thyroxine (T4) that
converts into (T3)
· Has a high protein binding capacity, resulting in a
long half-life, which allows for once-daily dosing.
· Can be used to regulate thyroid hormone levels in
clients who have Had thyroid surgery irradiation or
drug treatment for hyperthyroidism.
Levothyroxine - POPULATION o Category A. Safe for pregnancy and breastfeeding.
CONSIDERATIONS Dosing may need adjusted while pregnant.
o Dosing will need to be adjusted for age and weight
and adjusted as child grows.
o Consider family's ability to manage medication
regimen (children)
o Older adults:
§ Start with lower dose (d/t potential underlying
cardiac issues)
§ Monitor bone density
§ Consider patient and family's ability to safely
administer medication/regimen
§ Consider polypharmacy and drug interactions
Levothyroxine - DRUG o Decreased absorption with concurrent intake of
INTERACTIONS {calcium, mag, iron] supplements AND meds
[antacids & PPIs].
o Levothyroxine should be taken on an empty
stomach and 4 hours apart from this medications to
be sure the absorption is not affected
o Can interact with warfarin à increases anticoag
effect and bleeding risk
o Can cause increased dosing requirements for
[insulin and digoxin]
o Elevated hearts sensitivity to [catecholamines],
increasing possible arrhythmias
,Levothyroxine - DOSING & o Varies based on condition, severity and client's
ADJUSTMENTS response to therapy
o Follow dosing guidelines
o IV administration for myxedema coma
o Take on empty stomach (30/600 mins before food
o Levothyroxine has a narrow TI
Levothyroxine - MONITORING o Monitor TSH levels 6-8 weeks after starting med
o T4 can also be used to evaluate therapy in pts who
TSH level remains high
Propranolol indications for · Helps to decrease
endocrine disorders o Tachycardia
o Palpitations
o Tremors
o Anxiety
o Heat intolerance
· Blocks T4 to T3 conversion in high doses
· Alternate drug use: esmolol infusion
Hyperthyroidism treatment · Beta blockers recommended in patients with resting
considerations HR 90 bpm or coexistent cardiovascular disease
(CCB verapamil/diltiazem have been effective in rate
control in those patients who cannot tolerate BB)
· Sensitivity,
, Pioglitazone contraindications · Reduces glucose levels by decreasing insulin
resistance and production
· HF can be precipitated or exacerbated by fluid
retention
· Can cause unintentional pregnancies in
premenopausal woman.
· Prolonged high doses can cause bladder
cancer (manifested by blood in the urine, painful
urination, or increased urgency)
· Fractures: risk increases with long-term, high-
dose therapy. Clients should take vitamin D and
calcium and ensure adequate exercise and
medications for osteoporosis
· Liver Failure: monitor LFTs to ensure this side
effect is not occurring before and during therapy
(rare)
