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REGUB > 28. Pharmacological Control of Thyroid and Parathyroid > Flashcards

28. Pharmacological Control of Thyroid and Parathyroid Flashcards

1
Q

Which iodine isotope is used for diagnosis?

A

123I

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2
Q

What are the treatment options for hyperthyroidism?

A

Short range emission radioactive iodine
Surgery
Thioureylenes
Adjunctive therapy

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3
Q

What iodine isotope is used in short range emission radioactive iodine treatment?

A

131I

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4
Q

How does short range emission radioactive iodine work?

A

Taken up and incorporated into thyroglobulin

Emits y and B rays which kills closest cells, therefore reducing amount of thyroid hormone produced

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5
Q

What is the dosing of short range emission radioactive iodine?

A

Single dose PO

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6
Q

What is the half life of radioactive iodine?

A

8 days but can be stored for 2 months

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7
Q

How long does it take for radioactive iodine to work?

A

2 weeks

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8
Q

What are the side effects of radioactive iodine?

A

Nausea

If too much thyroid killed it can result in hypothyroidism

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9
Q

What are the precautions when taking radioactive iodine?

A

No sex for 1 month

Don’t become pregnant for 6 months

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10
Q

Which is more common: total or subtotal thyroidectomy?

A

Subtotal

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11
Q

Name 2 thioureylenes

A

Carbimazole (prodrug) converted to methimazole

Propylthiouracil

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12
Q

How does carbimazole work?

A

Inhibits thyroperoxidase which normally adds iodine to thyroglobulin to produce thyroxine

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13
Q

How does propylthiouracil work?

A

Same as carbimazole plus

inhibits 5’-deiodinase which usually converts t4 to t3

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14
Q

What is the half life of methimazole and how long does it take to work?

A

half life: 3-15 hours

90% inhibition of thyroperoxidase in first 12 hours but it can take months to see clinical results as T4 can be stored

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15
Q

What are the adverse effects associated with thioureylenes?

A

Hypersensitivity reactions: granulocytopaenia, rash, hair loss etc

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16
Q

What agents are given as adjunctive therapy in hyperthyroidism?

A

B-adrenoceptor antagonists eg. propanolol, for relief of tremor, palpitations, heat intolerance
Steroids: anti-inflammatory reduce exophthalmos

17
Q

What agent is given in hypothyroidism?

A

Synthetic thyroxine which is converted to T3 within the body

18
Q

What are the treatment options for hyperparathyroidism?

A

Surgery
Calcimetrics
Bisphosphonates
Calcitonin

19
Q

What bone disorder is caused by:

a) hyperparathyroidism
b) hypoparathyroidism

A

a) osteoporosis

b) osteomalacia

20
Q

Name a calcimetric

A

Cinacalet

21
Q

How does cinacalet work?

A

Mimics calcium to reduce PTH release

Used in patients who are not good candidates for surgery

22
Q

Name 2 bisphosphonates

A

Alendronate

Risedronate

23
Q

What is the MOA of bisphosphonates?

A

Unsure but thought to inhibit osteoclasts which improve bone density

24
Q

What is the MOA of calcitonin?

A

Inhibits calcitonin osteoclast receptor

Has some analgesic properties

25
Q

Why is calcitonin not an effective drug?

A

PO broken down rapidly by aminopeptidases
IV is inconvenient
Nasal preparation not as effective as bisphosphonates

26
Q

What adjunctive therapy is given in hyperparathyroidism?

A

Analgesics: patient is in constant pain from micro fractures

27
Q

What are the treatment options for hypoparathyroidism?

A

Calcium salts
Vitamin D
Teriparatide

28
Q

Why are calcium salts not given IM?

A

Cause necrosis

given PO

29
Q

What are the side effects of calcium salts?

A

CKD
Kidney stones
Constipation

30
Q

What are the side effects of vitamin D?

A

Allergic skin reactions
Build up of calcium in arteries
Change cholesterol levels
Daytime sleepiness

31
Q

What route is teriparatide given?

A

Pen: injected IM in thigh or abdomen

32
Q

What is the MOA of teriparatide?

A

Recombinant PTH: stimulates osteoblasts to increase bone density

33
Q

What is a rare side effect of teriparatide?

A

Osteosarcoma

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