This document provides guidelines for the treatment of hypothyroidism with levothyroxine. It recommends levothyroxine as the standard treatment and provides goals for clinical and biochemical treatment targets. It discusses factors that influence levothyroxine dosing and provides guidance on administration and monitoring in special populations like pregnancy, elderly patients, and hospitalized patients. The document also makes recommendations on managing patient comorbidities, adherence issues, and inappropriate prescribing of levothyroxine to euthyroid individuals.
The document provides guidance for healthcare professionals on managing hypothyroidism in GCC countries. It recommends screening high-risk patients for hypothyroidism by measuring thyroid stimulating hormone levels. It provides an algorithm for classifying and managing patients with overt or subclinical hypothyroidism, including starting doses and dose adjustments of levothyroxine treatment based on factors like age, weight, pregnancy status, and medical conditions. The guidance emphasizes lifelong treatment and monitoring to maintain thyroid hormone levels within target ranges and minimize health risks from untreated hypothyroidism.
This document provides guidelines for the management of hypothyroidism in GCC countries. It recommends screening high-risk groups for hypothyroidism through TSH level testing. A diagnosis of overt or subclinical hypothyroidism is made based on elevated TSH and normal or low FT4 levels. Levothyroxine is the standard treatment and dosing is based on factors like age, weight, pregnancy status, and comorbidities. Treatment goals are to maintain TSH levels in the reference range through dose adjustments based on repeat testing. Special considerations are given for elderly patients, pregnant women, and refractory cases.
This document discusses posology, which is the science of determining safe and effective drug doses. It explains that the dose is usually expressed as a range, with a minimum dose to produce the intended effect and a maximum tolerated dose. Many factors affect the appropriate dose for a given patient, including age, sex, pregnancy status, body weight, disease severity, route of administration, and genetic differences. Close monitoring of these factors is needed to determine a safe individualized dosage.
Therapeutic drug monitoring (TDM) involves analyzing drug concentrations in blood to ensure dosage is therapeutic and not toxic. TDM is indicated when the therapeutic index is narrow, drug effects vary between patients, or changes in a patient's condition could affect drug levels. Common drugs monitored include cardiac medications, antibiotics, antiepileptics, psychotherapeutics, and immunosuppressants. Factors like absorption, distribution, metabolism, and excretion influence circulating drug concentrations.
Drugs acting on the GI system include:
- Antiemetics which prevent nausea and vomiting like ondansetron and metoclopramide.
- Laxatives and purgatives like lactulose, bisacodyl, and docusate which are used to treat constipation.
- Antacids such as aluminum hydroxide, magnesium hydroxide, and calcium carbonate which neutralize stomach acid.
- Cholinergic drugs which increase GI motility and secretions. Anticholinergic drugs block acetylcholine and decrease motility and secretions.
Drugs acting on the GI system include:
- Antiemetics which prevent nausea and vomiting like ondansetron and metoclopramide.
- Laxatives and purgatives like lactulose, bisacodyl and docusate to treat constipation.
- Antacids like aluminum hydroxide and magnesium hydroxide to neutralize gastric acid.
- Proton pump inhibitors like omeprazole and pantoprazole to reduce acid production for ulcers.
- Antidiarrheals like loperamide and diphenoxylate to decrease diarrhea.
power point presentation on obesity by Rajeshwaree Netha (Doctor of pharmacy).
contents included are Introduction,pathophyisiology,clinical presentation (signs and symptoms of obesity disorder) ,Treatment,goals of treatment, general approach, Pharmacological treatment, and Evaluation of therapeutic outcomes.
The document provides guidance for healthcare professionals on managing hypothyroidism in GCC countries. It recommends screening high-risk patients for hypothyroidism by measuring thyroid stimulating hormone levels. It provides an algorithm for classifying and managing patients with overt or subclinical hypothyroidism, including starting doses and dose adjustments of levothyroxine treatment based on factors like age, weight, pregnancy status, and medical conditions. The guidance emphasizes lifelong treatment and monitoring to maintain thyroid hormone levels within target ranges and minimize health risks from untreated hypothyroidism.
This document provides guidelines for the management of hypothyroidism in GCC countries. It recommends screening high-risk groups for hypothyroidism through TSH level testing. A diagnosis of overt or subclinical hypothyroidism is made based on elevated TSH and normal or low FT4 levels. Levothyroxine is the standard treatment and dosing is based on factors like age, weight, pregnancy status, and comorbidities. Treatment goals are to maintain TSH levels in the reference range through dose adjustments based on repeat testing. Special considerations are given for elderly patients, pregnant women, and refractory cases.
This document discusses posology, which is the science of determining safe and effective drug doses. It explains that the dose is usually expressed as a range, with a minimum dose to produce the intended effect and a maximum tolerated dose. Many factors affect the appropriate dose for a given patient, including age, sex, pregnancy status, body weight, disease severity, route of administration, and genetic differences. Close monitoring of these factors is needed to determine a safe individualized dosage.
Therapeutic drug monitoring (TDM) involves analyzing drug concentrations in blood to ensure dosage is therapeutic and not toxic. TDM is indicated when the therapeutic index is narrow, drug effects vary between patients, or changes in a patient's condition could affect drug levels. Common drugs monitored include cardiac medications, antibiotics, antiepileptics, psychotherapeutics, and immunosuppressants. Factors like absorption, distribution, metabolism, and excretion influence circulating drug concentrations.
Drugs acting on the GI system include:
- Antiemetics which prevent nausea and vomiting like ondansetron and metoclopramide.
- Laxatives and purgatives like lactulose, bisacodyl, and docusate which are used to treat constipation.
- Antacids such as aluminum hydroxide, magnesium hydroxide, and calcium carbonate which neutralize stomach acid.
- Cholinergic drugs which increase GI motility and secretions. Anticholinergic drugs block acetylcholine and decrease motility and secretions.
Drugs acting on the GI system include:
- Antiemetics which prevent nausea and vomiting like ondansetron and metoclopramide.
- Laxatives and purgatives like lactulose, bisacodyl and docusate to treat constipation.
- Antacids like aluminum hydroxide and magnesium hydroxide to neutralize gastric acid.
- Proton pump inhibitors like omeprazole and pantoprazole to reduce acid production for ulcers.
- Antidiarrheals like loperamide and diphenoxylate to decrease diarrhea.
power point presentation on obesity by Rajeshwaree Netha (Doctor of pharmacy).
contents included are Introduction,pathophyisiology,clinical presentation (signs and symptoms of obesity disorder) ,Treatment,goals of treatment, general approach, Pharmacological treatment, and Evaluation of therapeutic outcomes.
This document discusses drug interactions, which occur when two drugs are administered together and one modifies the effects of the other. It describes several types of interactions, including drug-drug, drug-food, and drug-environment. Interactions can be quantitative, increasing or decreasing a drug's effects, or qualitative, producing abnormal or new responses. The mechanisms of interactions include pharmaceutical, pharmacokinetic, and pharmacodynamic effects. It is important for doctors to consider potential interactions when prescribing multiple medications to a patient.
Psycotropics, anti psycotics 1st and second generation,anti parkinsons, anti depressants mood stabilizers, sedative hypnotics side effects, management of side effects
The document discusses physiological changes with aging and their implications for pharmacotherapy in elderly patients. It notes that aging results in changes to absorption, distribution, metabolism and excretion of drugs. This can increase the risk of adverse drug reactions and interactions due to altered pharmacokinetics and pharmacodynamics. The role of clinical pharmacists is highlighted in optimizing drug therapy for elderly patients by identifying inappropriate prescribing, ensuring proper dosing and monitoring for safety issues like non-compliance and polypharmacy. Guidelines for prescribing in elderly emphasize starting with low doses and simplifying drug regimens.
The document discusses several issues related to prescribing medications for elderly patients, noting that while the elderly population takes a significant amount of prescription and non-prescription drugs, they are also at higher risk for adverse drug reactions, drug-drug interactions, and under-prescribing of needed medications due to changes in pharmacokinetics and pharmacodynamics that occur with aging. It emphasizes the importance of considering an individual's overall health status and potential for drug interactions when determining the appropriate medication regimen for elderly patients.
Pharmacotherapy considerations in elderly adultsSafaa Ali
Pharmacotherapy considerations in elderly adults focuses on how aging affects the body's processing of drugs. Key changes include reduced absorption in the gastrointestinal tract, altered distribution in tissues due to changes in body composition, and decreased metabolism and excretion due to reduced liver and kidney function. These pharmacokinetic changes mean drugs for elderly patients often require dosage adjustments to avoid adverse drug reactions. Common issues include increased risk of drug interactions due to slower drug clearance and greater sensitivity to pharmacodynamic effects like sedation or hypotension.
This document summarizes drugs acting on the GI system. It discusses antiemetics which prevent nausea and vomiting like ondansetron, domperidone, and cyclizine. Emetics like ipecac and apomorphine induce vomiting. Laxatives like lactulose, bisacodyl, and docusate are used to treat constipation. Antacids like aluminum hydroxide and magnesium hydroxide neutralize stomach acid. Proton pump inhibitors like omeprazole and pantoprazole inhibit acid secretion. Antidiarrheals like loperamide and diphenoxylate decrease intestinal motility. Histamine receptor blockers like cimetidone and ranitidine inhibit
Levothyroxine 50mcg and 100mcg tablets pil, taj pharmaceuticals.Taj Pharma
This document is a patient information leaflet for Levothyroxine 50mcg and 100mcg tablets manufactured by Taj Pharma. It provides information about what levothyroxine is used for, how to take it properly, possible side effects, drug interactions and storage instructions. Specifically, levothyroxine is used to treat hypothyroidism by replacing thyroid hormone that the body cannot produce on its own. It must be taken as directed by a doctor and blood tests are needed to monitor treatment. Common side effects include headache, flushing and weight loss but more severe reactions like a thyroid crisis require immediate medical attention.
Title: Clinical Pharmacy: Enhancing Patient Care through Medication Optimization
Description:
Welcome to the world of Clinical Pharmacy, where pharmaceutical expertise meets patient-centered care! In this SlideShare presentation, we dive into the fascinating realm of Clinical Pharmacy, exploring its vital role in healthcare and how it contributes to improved patient outcomes.
Clinical Pharmacy is an evolving field that combines the knowledge of pharmacology and therapeutics with direct patient care. It focuses on the optimization of medication therapy to ensure safe, effective, and personalized treatment regimens for patients of all ages. This SlideShare presentation provides a comprehensive overview of Clinical Pharmacy, highlighting its significance in modern healthcare settings.
Within this presentation, we explore the key pillars of Clinical Pharmacy, including:
1. Medication Therapy Management: Discover how Clinical Pharmacists work collaboratively with healthcare teams to optimize medication therapy. Learn about the process of medication reconciliation, drug therapy monitoring, and medication counseling to enhance patient adherence and safety.
2. Pharmacotherapy Expertise: Gain insights into the in-depth knowledge of Clinical Pharmacists in pharmacology, drug interactions, and pharmacokinetics. Understand how this expertise helps them make evidence-based decisions, select appropriate medications, and customize treatment plans to individual patient needs.
3. Translational Research: Explore the role of Clinical Pharmacists in conducting research to bridge the gap between scientific discoveries and clinical practice. Learn how they contribute to the development and evaluation of new therapies, ensuring their safety, efficacy, and cost-effectiveness.
4. Interprofessional Collaboration: Recognize the importance of collaboration among healthcare providers in achieving optimal patient outcomes. Explore how Clinical Pharmacists actively engage with physicians, nurses, and other healthcare professionals to provide comprehensive patient care.
5. Patient Education and Advocacy: Delve into the patient-centered approach of Clinical Pharmacy, emphasizing the significance of patient education, shared decision-making, and promoting medication adherence. Understand how Clinical Pharmacists empower patients to actively participate in their treatment plans.
By the end of this SlideShare presentation, you will have a deeper understanding of Clinical Pharmacy's multifaceted nature and its pivotal role in enhancing patient care. Whether you are a healthcare professional seeking to expand your knowledge or a curious individual interested in the intersection of pharmacy and patient care, this presentation is an excellent resource to explore the exciting world of Clinical Pharmacy.
Join us on this enlightening journey, and let Clinical Pharmacy open doors to new perspectives and possibilities for improved patient outcomes and healthcare excellence.
This document provides guidelines for perioperative care in elective colorectal surgery as part of an Enhanced Recovery After Surgery (ERAS) protocol. It makes recommendations for several preadmission items including preadmission counselling and education, preoperative optimization of medical conditions, prehabilitation, preoperative nutrition, management of anemia, and prevention of postoperative nausea and vomiting. The recommendations are based on reviews of the available evidence and are intended to reduce complications and facilitate early recovery after colorectal surgery.
1) Resistant hypertension is defined as blood pressure remaining above goal despite use of 3 antihypertensive agents including a diuretic. 2) Maximizing diuretic therapy is a primary treatment recommendation, through drugs like chlorthalidone and loop diuretics. 3) Adding an aldosterone antagonist like spironolactone is also effective, though it requires monitoring of potassium levels.
Levetiracetam is a broad-spectrum newer antiepileptic drug approved in 1999. It has fewer drug interactions than older AEDs due to simpler pharmacokinetics without enzyme induction. Its unique mechanism of action involves synaptic vesicle protein SV2A. Common adverse effects are mild and reversible. Lacosamide approved in 2008 is indicated as adjunctive therapy for focal seizures. It is initiated at 50mg twice daily and increased weekly by 100mg with a maximum of 400mg daily due to potential CNS and gastrointestinal side effects.
This document provides an overview of pharmacokinetics, specifically focusing on absorption. It defines pharmacokinetics as the study of what the body does to drugs. The four main processes are absorption, distribution, metabolism, and excretion (ADME). Absorption is defined as the passage of drugs through cell membranes to reach the site of action. The main mechanisms of absorption are described as simple diffusion, active transport, facilitated diffusion, and pinocytosis. Factors that influence absorption, such as drug properties and gastrointestinal factors, are also discussed.
Peptic ulcer disease and acid suppression therapyOmer Khan
This document summarizes acid suppression therapy for peptic ulcer disease. It discusses the regulation of gastric acid secretion and classification of drugs used to treat peptic ulcers. It focuses on proton pump inhibitors, including their mechanism of action, uses, adverse effects and drug interactions. It also discusses potential adverse consequences of long-term PPI use, such as rebound hypersecretion of acid upon withdrawal and increased risk of fractures and pneumonia.
HYPOTHYROIDISM (MSN-1) Notes of hypothyroidism which includes definition, cau...ninamavancy321
Notes of hypothyroidism which includes definition, causes, clinical manifestations, diagnostic evaluation and nursing management .
Made by Ms. Vancy Ninama (Nursing Tutor)
This document summarizes geriatric pharmacology and aging-related changes. It discusses theories of aging, how aging affects drug absorption, distribution, metabolism, and excretion. It also covers age-related changes in drug sensitivity and interactions, principles of prescribing for older adults, and common diseases in the elderly. Potential anti-aging therapies like calorie restriction, DHEA, and estrogen/progesterone are also mentioned.
This document summarizes information on various chronic kidney disease, renal failure, and endocrine topics:
1. It provides guidance on protecting the kidneys from acute renal failure through adequate hydration. Calcium carbonate or gluconate can be used for hyperkalemia in renal failure patients. Drugs like sitagliptin, voriconazole, fluconazole and insulin glargine require dosage adjustments in renal impairment.
2. It also discusses treatments for chronic kidney disease complications like anemia (erythropoietin), hyperphosphatemia (sevelamer), and urinary incontinence (oxybutynin or tolterodine).
3. For endocrine topics
Supportive care involves preventing and managing the adverse effects of cancer and its treatment across the entire cancer experience. This includes managing physical and psychological symptoms. Palliative care focuses on pain management and addressing other distressing symptoms while incorporating psychosocial and spiritual support. Supportive care includes symptom control and psychosocial support, while palliative care becomes the main focus when curative treatment is no longer effective or desired. The document discusses various symptoms experienced by cancer patients and their management, including pain, xerostomia, oral mucositis, nausea, diarrhea, dermatitis, and nutritional issues.
drugs used in hormonal disorders supplementation.pptxJayesh Patidar
This document discusses several classes of drugs used to treat hormonal disorders and for contraception and abortion. It provides details on mechanisms of action, examples of drugs and their doses, indications for use, adverse effects, contraindications, drug interactions, and nursing responsibilities for:
- Insulin and oral hypoglycemics for diabetes mellitus
- Thyroid supplements and suppressants for hypothyroidism and hyperthyroidism
- Anabolic steroids to promote tissue building
- Oral contraceptives and other estrogens/progestins for contraception
- Corticotrophins, gonadotrophins, and other hormones
Appetite stimulants and suppressants-Anorexiants,PharmacologyNishanth Arunodayam
This document summarizes appetite stimulants and suppressants. It was prepared by Nishanth K P, a 6th semester B.Pharm student. Appetite stimulants like megestrol and dronabinol are used to increase appetite in conditions causing weight loss like cancer. Appetite suppressants or anorexiants include amphetamine, fenfluramine, sibutramine, and rimonabant which act centrally or on the GI tract to reduce appetite and treat obesity. Common side effects of these drugs include nausea, dry mouth, insomnia, and increased heart rate.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Pharmacotherapy considerations in elderly adults focuses on how aging affects the body's processing of drugs. Key changes include reduced absorption in the gastrointestinal tract, altered distribution in tissues due to changes in body composition, and decreased metabolism and excretion due to reduced liver and kidney function. These pharmacokinetic changes mean drugs for elderly patients often require dosage adjustments to avoid adverse drug reactions. Common issues include increased risk of drug interactions due to slower drug clearance and greater sensitivity to pharmacodynamic effects like sedation or hypotension.
This document summarizes drugs acting on the GI system. It discusses antiemetics which prevent nausea and vomiting like ondansetron, domperidone, and cyclizine. Emetics like ipecac and apomorphine induce vomiting. Laxatives like lactulose, bisacodyl, and docusate are used to treat constipation. Antacids like aluminum hydroxide and magnesium hydroxide neutralize stomach acid. Proton pump inhibitors like omeprazole and pantoprazole inhibit acid secretion. Antidiarrheals like loperamide and diphenoxylate decrease intestinal motility. Histamine receptor blockers like cimetidone and ranitidine inhibit
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This document is a patient information leaflet for Levothyroxine 50mcg and 100mcg tablets manufactured by Taj Pharma. It provides information about what levothyroxine is used for, how to take it properly, possible side effects, drug interactions and storage instructions. Specifically, levothyroxine is used to treat hypothyroidism by replacing thyroid hormone that the body cannot produce on its own. It must be taken as directed by a doctor and blood tests are needed to monitor treatment. Common side effects include headache, flushing and weight loss but more severe reactions like a thyroid crisis require immediate medical attention.
Title: Clinical Pharmacy: Enhancing Patient Care through Medication Optimization
Description:
Welcome to the world of Clinical Pharmacy, where pharmaceutical expertise meets patient-centered care! In this SlideShare presentation, we dive into the fascinating realm of Clinical Pharmacy, exploring its vital role in healthcare and how it contributes to improved patient outcomes.
Clinical Pharmacy is an evolving field that combines the knowledge of pharmacology and therapeutics with direct patient care. It focuses on the optimization of medication therapy to ensure safe, effective, and personalized treatment regimens for patients of all ages. This SlideShare presentation provides a comprehensive overview of Clinical Pharmacy, highlighting its significance in modern healthcare settings.
Within this presentation, we explore the key pillars of Clinical Pharmacy, including:
1. Medication Therapy Management: Discover how Clinical Pharmacists work collaboratively with healthcare teams to optimize medication therapy. Learn about the process of medication reconciliation, drug therapy monitoring, and medication counseling to enhance patient adherence and safety.
2. Pharmacotherapy Expertise: Gain insights into the in-depth knowledge of Clinical Pharmacists in pharmacology, drug interactions, and pharmacokinetics. Understand how this expertise helps them make evidence-based decisions, select appropriate medications, and customize treatment plans to individual patient needs.
3. Translational Research: Explore the role of Clinical Pharmacists in conducting research to bridge the gap between scientific discoveries and clinical practice. Learn how they contribute to the development and evaluation of new therapies, ensuring their safety, efficacy, and cost-effectiveness.
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5. Patient Education and Advocacy: Delve into the patient-centered approach of Clinical Pharmacy, emphasizing the significance of patient education, shared decision-making, and promoting medication adherence. Understand how Clinical Pharmacists empower patients to actively participate in their treatment plans.
By the end of this SlideShare presentation, you will have a deeper understanding of Clinical Pharmacy's multifaceted nature and its pivotal role in enhancing patient care. Whether you are a healthcare professional seeking to expand your knowledge or a curious individual interested in the intersection of pharmacy and patient care, this presentation is an excellent resource to explore the exciting world of Clinical Pharmacy.
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1) Resistant hypertension is defined as blood pressure remaining above goal despite use of 3 antihypertensive agents including a diuretic. 2) Maximizing diuretic therapy is a primary treatment recommendation, through drugs like chlorthalidone and loop diuretics. 3) Adding an aldosterone antagonist like spironolactone is also effective, though it requires monitoring of potassium levels.
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This document provides an overview of pharmacokinetics, specifically focusing on absorption. It defines pharmacokinetics as the study of what the body does to drugs. The four main processes are absorption, distribution, metabolism, and excretion (ADME). Absorption is defined as the passage of drugs through cell membranes to reach the site of action. The main mechanisms of absorption are described as simple diffusion, active transport, facilitated diffusion, and pinocytosis. Factors that influence absorption, such as drug properties and gastrointestinal factors, are also discussed.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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7. Guidelines for the Treatment of
Hypothyroidism: Prepared by the American
Thyroid Association Task Force on Thyroid
Hormone Replacement
Jonklaas Jacqueline, Bianco Antonio C.,
Bauer Andrew J., Burman Kenneth D.,
Cappola Anne R., Celi Francesco S., Cooper
David S., Kim Brian W., Peeters Robin P.,
Rosenthal M. Sara, and Sawka Anna M..
Thyroid. December 2014, 24(12): 1670-1751
9. Is levothyroxine monotherapy considered to be
the standard of care for hypothyroidism?
Recommendation
• Levothyroxine is recommended as the
preparation of choice for the treatment of
hypothyroidism due to its efficacy in resolving
the symptoms of hypothyroidism, long-term
experience of its benefits, favorable side effect
profile, ease of administration, good intestinal
absorption, long serum half-life, and low cost.
Strong recommendation. Moderate
quality evidence.
10. What are the clinical and biochemical goals for
levothyroxine replacement in primary
hypothyroidism?
Recommendation
• Levothyroxine replacement therapy has three main
goals. These are (i) to provide resolution of the
patients' symptoms and hypothyroid signs,
including biological and physiologic markers of
hypothyroidism, (ii) to achieve normalization of
serum thyrotropin with improvement in thyroid
hormone concentrations, and (iii) to avoid
overtreatment (iatrogenic thyrotoxicosis), especially
in the elderly. Strong recommendation.
Moderate quality evidence.
11. Are clinical parameters such as cold sensitivity and dry
skin useful by themselves for assessing adequacy of
levothyroxine replacement in primary hypothyroidism?
Recommendation
• Although it may be helpful to follow changes in
clinical symptoms longitudinally in patients
treated for hypothyroidism, symptoms alone
lack sensitivity and specificity and therefore are
not recommended for judging adequacy of
replacement in the absence of biochemical
assessment. Weak recommendation. Low-
quality evidence.
13. Is there a clinical rationale for prescribing
brand-name levothyroxine preparations in
preference to generic levothyroxine?
Recommendation
• Prescription of brand name levothyroxine, or
alternatively maintenance of the same generic
preparation, is advised. Switches between
levothyroxine products could potentially result
in variations in the administered dose and
should generally be avoided for that reason.
Weak recommendation. Low-quality
evidence (for general populations)
15. How should levothyroxine administration be timed with
respect to meals and beverages in order to maintain
maximum, consistent absorption?
Recommendation
• Because co-administration of food and
levothyroxine is likely to impair levothyroxine
absorption, we recommend that, if possible,
levothyroxine be consistently taken either 60
minutes before breakfast or at bedtime (3 or
more hours after the evening meal) for optimal,
consistent absorption. Weak
recommendation. Moderate quality of
evidence.
16. Are there medications and supplements that should not
be co-administered with levothyroxine in order to avoid
impaired absorption?
Recommendation
• We recommend that where feasible, levothyroxine
should be separated from other potentially
interfering medications and supplements (e.g.,
calcium carbonate and ferrous sulfate). A 4-hour
separation is traditional, but untested. Other
medications (e.g., aluminum hydroxide and
sucralfate) may have similar effects, but have been
insufficiently studied. Weak recommendation.
Weak quality evidence.
17. Are there gastrointestinal conditions that should be
considered when a patient's levothyroxine dose is much
higher than expected?
Recommendation
• In patients in whom levothyroxine dose
requirements are much higher than expected,
evaluation for gastrointestinal disorders such
as Helicobacter pylori–related gastritis, atrophic
gastritis, or celiac disease should be considered.
Furthermore, if such disorders are detected and
effectively treated, re-evaluation of thyroid function
and levothyroxine dosage is recommended. Strong
recommendation. Moderate quality of
evidence.
18. Are different levothyroxine products associated with different
absorption, such that a switch to a different brand name or generic
is associated with a significantly different serum TSH?
Recommendation
• Because use of different levothyroxine products
may sometimes be associated with altered serum
TSH values, a change in an identifiable
formulation of levothyroxine (brand name or
generic) should be followed by re-evaluation of
serum TSH at steady state. Weak
recommendation. Low-quality evidence.
19. What medications may alter a patient's
levothyroxine requirement by affecting either
metabolism or binding to transport proteins?
Recommendation
• Initiation or discontinuation of estrogen and androgens
should be followed by reassessment of serum
thyrotropin at steady state, since such medications may
alter the levothyroxine requirement. Serum thyrotropin
should also be reassessed in patients who are started on
agents such as tyrosine kinase inhibitors that affect
thyroxine metabolism and thyroxine or triiodothyronine
deiodination. Serum thyrotropin monitoring is also
advisable when medications such as phenobarbital,
phenytoin, carbamazepine, rifampin, and sertraline are
started. Strong recommendation. Low-quality
evidence.
21. What factors determine the levothyroxine dose
required by a hypothyroid patient for reaching
the appropriate serum TSH goal?
Recommendation
• When deciding on a starting dose of levothyroxine,
the patient's weight, lean body mass, pregnancy
status, etiology of hypothyroidism, degree of
thyrotropin elevation, age, and general clinical
context, including the presence of cardiac disease,
should all be considered. In addition, the serum
thyrotropin goal appropriate for the clinical
situation should also be considered. Strong
recommendation. Moderate quality
evidence.
22. Levothyroxine Dosage
• Based on body weight, hypothyroid patients with
minimal endogenous thyroid function require
LT4 doses of 1.6–1.8 μg/kg of actual body weight.
• LT4 doses in thyroid cancer patients requiring
TSH suppression are generally higher and on the
order of 2.1–2.7 μg/kg.
23. What is the best approach to initiating
and adjusting levothyroxine therapy?
Recommendation
• Thyroid hormone therapy should be initiated as an
initial full replacement or as partial replacement
with gradual increments in the dose titrated upward
using serum thyrotropin as the goal. Dose
adjustments should be made when there are large
changes in body weight, with aging, and with
pregnancy, with thyrotropin assessment 4–6 weeks
after any dosage change. Strong
recommendation. Moderate quality of
evidence.
24. What are the potential deleterious
effects of excessive levothyroxine?
Recommendation
• The deleterious health effects of iatrogenic
thyrotoxicosis include atrial fibrillation and
osteoporosis. Because of these effects we
recommend avoiding thyroid hormone excess
and subnormal serum thyrotropin values,
particularly thyrotropin values below 0.1 mIU/L,
especially in older persons and postmenopausal
women. Strong recommendation.
Moderate quality evidence.
25. What are the potential deleterious
effects of inadequate levothyroxine?
Recommendation
• The adverse effects of thyroid hormone deficiency
include detrimental effects on the serum lipid
profile and progression of cardiovascular disease.
We recommend that patients with overt
hypothyroidism be treated with doses of
levothyroxine that are adequate to normalize serum
thyrotropin levels, in order to reduce or eliminate
these undesirable effects. Strong
recommendation. Moderate quality
evidence.
27. What is the appropriate management of
perceived allergy to the constituents of
levothyroxine or intolerance to levothyroxine?
Recommendation
• Perceived allergy or intolerance to levothyroxine
can be managed by changing the dose or
product, including consideration of gel capsules,
and possibly by treating concomitant iron-
deficiency anemia. In selected cases, a
consultation with an allergist may be
appropriate. Weak recommendation. Low-
quality evidence
28. How do co-existent medical conditions affect
the management of levothyroxine replacement
therapy?
Recommendation
• We recommend considering patients' underlying
medical conditions (such as atherosclerotic heart
disease) in order to establish realistic treatment
goals and avoid exacerbation of underlying
comorbidities. Weak recommendation.
Low-quality evidence.
29. How do co-existent psychosocial, behavioral,
and mental health conditions affect the
management of levothyroxine therapy?
Recommendation
• The treatment goals of hypothyroidism are the
same for patients with psychosocial, behavioral,
and mental health conditions, as for the general
population. Strong recommendation. Low-
quality evidence.
31. How should levothyroxine therapy be managed
in the elderly with hypothyroidism?
Recommendation
• In general, levothyroxine should be initiated
with low doses, and the dose titrated slowly
based on serum thyrotropin measurements. It
should be recognized that normal serum
thyrotropin ranges are higher in older
populations (such as those over 65 years), and
that higher serum thyrotropin targets may be
appropriate. Strong recommendation.
Moderate quality evidence.
32. How should levothyroxine therapy be managed
in pregnant women with hypothyroidism?
Recommendation
• Women with overt hypothyroidism should receive
levothyroxine replacement therapy with the dose
titrated to achieve a thyrotropin concentration
within the trimester-specific reference range. Serial
serum thyrotropin levels should be assessed every 4
weeks during the first half of pregnancy in order to
adjust levothyroxine dosing to maintain thyrotropin
within the trimester specific range. Serum
thyrotropin should also be reassessed during the
second half of pregnancy. Strong
recommendation. Moderate quality
evidence.
33. TSH Range For Each Trimester
• first trimester: 0.1–2.5 mIU/L
• second trimester: 0.2–3.0 mIU/L
• third trimester: 0.3–3.0 mIU/L
34. How should levothyroxine therapy be managed
in individuals who have elevated serum
thyrotropin values due to nonadherence?
Recommendation
• If prescription of daily levothyroxine is not
successful in maintaining a normal serum
thyrotropin, weekly oral administration of the
full week's dose of levothyroxine should be
considered in individuals in whom adherence
cannot otherwise be sustained. Weak
recommendation. Low-quality evidence
36. What biochemical goals should be employed for
levothyroxine replacement in patients with
secondary hypothyroidism?
Recommendation
• In patients with secondary hypothyroidism, the
primary biochemical treatment goal should be to
maintain the serum free thyroxine values in the
upper half of the reference range. Strong
recommendation. Moderate quality
evidence
37. Are clinical parameters useful for assessing
adequacy of levothyroxine replacement in
patients with secondary hypothyroidism?
Recommendation
• Although it may be helpful to follow changes in
clinical parameters in patients treated for
secondary hypothyroidism, such parameters
alone lack sensitivity and specificity. Weak
recommendation. Moderate quality
evidence
39. Is there a role for the use of levothyroxine to treat
biochemically euthyroid patients with symptoms that
overlap with those of hypothyroidism?
Recommendation
• We strongly recommend against the use of
levothyroxine treatment in patients who have
nonspecific symptoms and normal biochemical
indices of thyroid function because no role exists
for use of levothyroxine in this situation. Strong
recommendation. High-quality evidence.
40. Is there a role for the use of levothyroxine to
treat euthyroid patients with depression?
Recommendation
• We recommend against the routine use of
levothyroxine for the treatment of euthyroid
individuals with depression due to a paucity of
controlled data examining treatment efficacy in
this setting. Weak recommendation. Low-
quality evidence.
41. Is there a role for the use of levothyroxine to
treat euthyroid patients with obesity?
Recommendation
• We recommend against the treatment of obesity
with levothyroxine in euthyroid individuals due
to a lack of treatment efficacy for this condition
Strong recommendation. Moderate
quality evidence.
42. Is there a role for the use of levothyroxine to
treat euthyroid patients with urticaria?
Recommendation
• We recommend against the treatment of
urticaria with levothyroxine in euthyroid
individuals due to a lack of treatment efficacy for
this condition. Strong recommendation.
Moderate quality evidence.
44. In hospitalized but not critically ill patients with known pre-
existing hypothyroidism, should levothyroxine therapy be re-
evaluated based on an elevated serum thyrotropin measurement?
Recommendation
• In hospitalized patients with a pre-established
diagnosis of hypothyroidism who are found to
have an elevated thyrotropin measurement,
consideration should be given to institution or
adjustment of levothyroxine replacement.
Strong recommendation. Low-quality
evidence.
45. In hospitalized but not critically ill patients in whom levothyroxine
replacement is instituted or increased, should the therapeutic goal
be normalization of serum thyrotropin?
Recommendation
• The therapeutic goal of levothyroxine
replacement in noncritically ill patients is long-
term normalization of serum thyrotropin when
steady-state thyroid hormone levels are
achieved. Strong recommendation. Low-
quality evidence.
46. In hospitalized but not critically ill patients treated with
levothyroxine replacement what formulation and route
of administration are recommended?
Recommendation
• For hospitalized but not critically ill patients,
oral levothyroxine treatment is recommended. If
this is not feasible, other enteral routes can be
used. Weak recommendation. Low-quality
evidence.
47. In hospitalized but not critically ill patients about to be
treated with levothyroxine should the possibility of
adrenal insufficiency be excluded?
Recommendation
• For hospitalized but not critically ill patients
who are about to be treated with levothyroxine,
the possibility of adrenal insufficiency should be
considered. If there is sufficient clinical or
biochemical evidence to consider this diagnosis,
adrenal insufficiency should be ruled out or
empiric treatment should be provided. Strong
recommendation. Low-quality evidence