hyperthyroid meds
Methimazole and PTU are used to treat this condition.
What is hyperthyroidism (Graves’ disease)?
Levothyroxine replaces this thyroid hormone.
T4 (thyroxine).
Famotidine reduces stomach acid by blocking these receptors
Histamine-2 receptors.
PPIs reduce stomach acid by blocking this enzyme system.
The proton pump (H+/K+ ATPase).
Metoclopramide increases this GI action.
Gastric emptying / GI motility.
Main action of methimazole and PTU.
Block thyroid hormone synthesis.
When should levothyroxine be taken?
In the morning on an empty stomach.
Common indication for famotidine.
GERD, ulcers, heartburn.
PPIs are commonly used for this condition.
GERD, ulcers, Barrett’s esophagus.
Common indications for dopamine antagonists.
Nausea, vomiting, gastroparesis.
Serious adverse effect requiring immediate medical attention.
Agranulocytosis (fever, sore throat).
Signs of overtreatment (too much thyroid hormone).
Tachycardia, anxiety, weight loss — symptoms of hyperthyroidism.
Unlike PPIs, H2 blockers can cause this CNS effect in older adults.
Confusion.
Major long-term risk of PPI use affecting bones.
Osteoporosis or increased fracture risk.
Serious movement disorder adverse effect with these drugs.
Tardive dyskinesia or EPS.
PTU has an additional benefit compared to methimazole.
Can block conversion of T4 → T3.
This supplement interferes with levothyroxine absorption.
Calcium OR iron — separate by 4 hours.
Patient teaching regarding timing of famotidine for heartburn.
Take 30 minutes before meals or at bedtime.
Patient teaching regarding timing of omeprazole.
Take 30–60 minutes before meals.
Patient teaching regarding activities requiring alertness.
May cause drowsiness — avoid driving or machinery.
Important patient teaching related to infection risk.
Report fever or sore throat right away.
Why patients should not switch levothyroxine brands without provider approval.
Different brands may have different potency; can destabilize thyroid levels.
Long-term use of H2 blockers may reduce absorption of this vitamin.
Vitamin B12.
Long-term PPI use increases risk of this intestinal infection.
C. diff.
Metoclopramide is contraindicated in GI obstruction because it does this.
Increases peristalsis (can worsen obstruction).