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NR565 PHARMACOLOGY FINAL.
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NR565 PHARMACOLOGY FINAL.
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NR565 PHARMACOLOGY FINALSignspoandposymptomspoofpohypothyroidismpo-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;
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