NR565 PHARMACOLOGY FINAL.

NR565 PHARMACOLOGY FINAL

Signspoandposymptomspoofpohypothyroidismpo-poans--
Facepoispopale,popuffy,poandpoexpressionless.
Skinpoispocoldpoandpodry.po
hairpoispobrittle,poandpohairpolosspooccurs.po
Heartporatepoandpotemperaturepoarepolowered.poThepopatientpolethargy,pofatigue,poandpoin
tolerancepotopocold.po
Mentationpomaypobepoimpaired.

Signspoandposymptomspoofpohyperthyroidismpo-poans--
HeartpoRatepoispoRapid;poPossiblepoarrhythmia/angina
Nervousness,poinsomnia,porapidpothoughtpoflow,poandporapidpospeech
Skeletalpomusclespomaypoweakenpoandpoatrophy
Metabolicporatepoisporaised,poresultingpoinpoincreasedpoheatpoproduction,poincreasedpobod
ypotemperature,pointolerancepotopoheat,poandposkinpothatpoispowarmpoandpomoist
Weightpolosspooccurspoifpocaloricpointakepofailspotopomatchpothepoincreasepoinpometabolicp
orate


Severepohypothyroidismpo-poans--Myxedema

HypothyroidpoTreatmentpo-poans--
Levothyroxinepoispothepodrugpoofpochoicepoforpomostpopatientspowhoporequirepothyroidpoho
rmoneporeplacement.

Levothyroxinepo(Synthroid)poTherapeuticpoGoalpo-poans--
Resolutionpoofposignspoandposymptomspoofpohypothyroidismpoandporestorationpoofponorm
alpolaboratorypovaluespoforposerumpothyroid-
stimulatingpohormonepo(TSH)poandpofreepothyroxinepo(T4).

Majorpoformspoofpohyperthyroidismpo-poans--
Gravespodiseasepoandpotoxicponodularpogoiterpo(alsopoknownpoaspoPlummerpodisease).

GravespoDiseasepo-poans--
Mostpocommonpocausepoofpoexcessivepothyroidpohormoneposecretion

Whatpoadjunctivepotherapypoispogoodpotopoprescribepotopocontrolposymptomspoofpohyperth
yroidismpootherpothanpothyroidpospecificpomedications?po-poans--β-
Blockerspoandpononradioactivepoiodinepomaypobepousedpoaspoadjunctivepotherapy.po

,β-Blockersposuppresspotachycardiapobypoblockingpoβ-receptorspoonpothepoheart.po
Nonradioactivepoiodinepoinhibitsposynthesispoandporeleasepoofpothyroidpohormones.

MonitoringponeedspoandpointervalspoforpoLevothyroxinepo-poans--CheckpoTSHpo6-
8poweekspoafterpoinitiatingpotherapypoandpoafterpoanypodosagepochange.po
CheckpoTSHpoatpoleastpooncepoapoyearpoafterposerumpoTSHpoispostabilized.

HyperthyroidpoTreatmentpo-poans--thionamidepodrugs—
methimazolepoandpopropylthiouracilpo(PTU)—
suppressposynthesispoofpothyroidpohormones.

MethimazolepoTherapeuticpoGoalpo-poans--
(1)poreductionpoofpothyroidpohormonepoproductionpoinpoGraves'podisease,po(2)pocontrolpoof
pohyperthyroidismpountilpothepoeffectspoofporadiationpoonpothepothyroidpobecomepomanifest
,po(3)posuppressionpoofpothyroidpohormonepoproductionpobeforeposubtotalpothyroidectomy,
po(4)potreatmentpoofpothyrotoxicpocrisis.


MonitoringponeedspoandpointervalspoforpoMethimazolepo-poans--
CheckpoCBCpowithpodifferentialpoifposignspoorposymptomspoofpoinfection.poCheckpoLFTspoif
posignspoorposymptomspoofpoliverpodysfunction.


HighpoRiskpoPatientspoforpoMethimazolepo-poans--
Shouldpobepoavoidedpoinpothepofirstpotrimesterpoofpopregnancy.

MethimazolepoToxicitypo-poans--Agranulocytosispoispothepomostpodangerouspotoxicity.

PTUpoHighpoRiskpoWarningpo-poans--
Carriespoaporiskpoforpoliverpotoxicity.poAlthoughporare,pothepoFDAporecommendspoagainstpo
usingpoaspoapofirst-linepotreatmentpoduepotopopotentialpoforpohepaticpotoxicity.

Effectspoofpomaternalpohypothyroidismpoonpooffspringpoandpoappropriatepopatientpoteachi
ngporelatedpotoponeedpoforpotreatment.po-poans--
Canpocausepodelaypoinpomentalpodevelopmentpoandpoderangementpoofpogrowth.poInpothep
oabsencepoofpothyroidpohormones,pothepochildpodevelopspoapolargepoandpoprotrudingpoton
gue,popotbelly,poandpodwarfishpostature.poDevelopmentpoofpotheponervousposystem,pobon
es,poteeth,poandpomusclespoispoimpaired.

CongenitalpoHypothyroidismpoTreatmentpo-poans--
requiresporeplacementpotherapypowithpothyroidpohormones.poIfpotreatmentpoispoinitiatedpo
withinpoapofewpodayspoofpobirth,pophysicalpoandpomentalpodevelopmentpowillpobeponormal.

replacementpotherapyposhouldpocontinuepoforpo3poyears,poafterpowhichpoitposhouldpobepost
oppedpoforpo4poweekspotopodeterminepowhetherpothyroidpodeficiencypoispopermanentpoorpo
transient.

, PatientpoTeachingpoforpoMethimazolepo-poans--
Tellpoyourpohealthcarepoproviderspothatpoyoupoarepotakingpothispodrug.po
Checkpobloodpoworkpoaspodirected.
Takingpothispodrugpomaypocausepoharmpotopothepounbornpobabypoifpoyoupoarepopregnant,p
oespeciallypoinpothepofirstpotrimester.
Ifpoyoupoarepopregnantpoorpobecomepopregnantpowhilepotakingpothispodrug,pocallpoyourpohe
althcarepoproviderporightpoaway.
Tellpoyourpohealthcarepoproviderpoifpoyoupoarepobreast-
feedingpotopodiscussporiskspotopothepobaby.
Havepoyourpobaby'spothyroidpocheckedpoifpoyoupoarepousingpothispodrugpoandpobreast-
feeding.
Agranulocytosispoispothepomostpodangerouspotoxicityporiskpoforpothispomedicationpobutpoisp
overyporare.poSorepothroatpoandpofeverposhouldpobeporeportedpoimmediately.po


PatientpoTeachingpoforpoLevothyroxinepo-poans--
workspobestpoifpoyoupotakepoitpoonpoanpoemptypostomach,po30potopo60pominutespobeforepo
breakfast.
takepothepomedicinepoatpotheposamepotimepoeachpoday.

IdealpoHbA1Cpogoalpoforpodiabetic,ponon-pregnantpoadultspo-poans--lesspothanpo7%.

HbA1Cpo8%po-poans--
historypoofposeverepohypoglycemia,polimitedpolifepoexpectancy,poorpoadvancedpomicrovas
cularpoorpomacrovascularpocomplications

HBA1CpoValuepoconsideredpodiagnosticpoofpodiabetes.po-poans--
apovaluepoofpo6.5%poorpogreater

HbA1CpoMeasuringpoIntervalpo-poans--
everypo3pomonthspountilpovaluepoispo<7%;poeverypo6pomonthspothereafter

HbA1CpoGoalpoforpoOlderpoAdultspo-poans--<7.5%po[58pommol/
mol]),powhilepothosepowithpomultiplepocoexistingpochronicpoillnesses,pocognitivepoimpairme
nt,poorpofunctionalpodependenceposhouldpohavepolesspostringentpoglycemicpogoalspo(such
poaspoA1Cpo<8.0-8.5%po[64-69pommol/mol]).


CriteriapoforpothepoDiagnosispoofpoDiabetespoMellituspo-poans---
Fastingpoplasmapoglucosepo≥126pomg/dL
-Randompoplasmapoglucosepo≥po200pomg/dLpoplusposymptomspoofpodiabetes
-Oralpoglucosepotolerancepotestpo(OGTT):po2-hpoplasmapoglucosepo≥200pomg/dLcor
-HemoglobinpoA1cpo6.5%poorpohigher

T1DMpoEtiologypoandpoMOApo-poans--
Autoimmunepoprocess;poLosspoofpopancreaticpoβpocells;