Block 1 Exam (thyroid & CONTRACEPTION) Flashcards
Describe the following for a thyroid storm (thyrotoxic crisis)
What are the lab findings?
What are the treatments?
labs:
Dangerously high T3 & T4 levels
Rx:
B-blockers
Propranolol
Thioamides (pref PTU)
Potassium iodide (SSKI)
Steroids ( reduce T4 to T3 conversion & sup immuno damage)
labs:
Dangerously high T3 & T4 levels
Rx:
B-blockers
Propranolol
Thioamides (pref PTU)
Potassium iodide (SSKI)
Steroids ( reduce T4 to T3 conversion & sup immuno damage)
Describes which condition based on labs & rx?
thyroid storm (thyrotoxic crisis)
Describe the following for hyperthyroidism:
What are the labs?
What are the symptoms?
What are the treatments?
Labs:
Low TSH
High T3 & T4 levels
Symptoms:
1) Heat intolerance
2) Weight loss
3) Tachycardia
4) Increased activity
Rx:
Thioamides (PTU or Methimazole) **
Iodides (KI or Lugol)
B-Blockers (propranolol)
131I (radioactive iodine)
Labs:
Low TSH
High T3 & T4 levels
Symptoms:
1) Heat intolerance
2) Weight loss
3) Tachycardia
4) Increased activity
Rx:
Thioamides (PTU or Methimazole) **
Iodides (KI or Lugol)
B-Blockers (propranolol)
131I (radioactive iodine)
Describes which condition?
Hyperthyroidism
Describe the following for hypothyroidism:
What are the labs?
What are the symptoms?
What are the treatments?
Labs:
High TSH
Low T3 & T4 levels
Symptoms:
1) Cold intolerance
2) Weight gain
3) Loss of appetite
4) constipation
5) brittle nails
Rx:
Levothyroxine
Liothyronin
“T3/4 are LLow in Hypo”
Labs:
High TSH
Low T3 & T4 levels
Symptoms:
1) Cold intolerance
2) Weight gain
3) Loss of appetite
4) constipation
5) brittle nails
Rx:
Levothyroxine
Liothyronin
Describes which condition?
Hypothyroidism
Describe the following for Levothyroxine (T4):
What is the MOA?
What are the side effects?
-kids vs adults
What are the complications?
Can be given oral/IV it is the preferred thyroid supp to give.
MOA:
Give on an empty stomach to increase T4 levels (safe than T3 because of its consistent potency & long duration of action). The T4 will be converted to T3 in the body
Side effects:
Kids (restlessness, insomnia, & acc bone maturation)
Adults:
-Nervousness
Heat intolerance
Tachycardic episodes
Bone loss
Comps:
A fibrillation
Osteoprosis
What are the clinical uses of Levothyroxine?
Clinical uses
1) Hypothyroidism
2) Non-toxic goiters
3) Cretinism
4) Myxedema coma
5) Hashimoto’s (Hypothyroidism)
6) chronic non-healing ulcers
7) obstinate constipation
Can be given oral/IV it is the preferred thyroid supp to give.
MOA:
Give on an empty stomach to increase T4 levels (safe than T3 because of its consistent potency & long duration of action). The T4 will be converted to T3 in the body
Side effects:
Kids (restlessness, insomnia, & acc bone maturation)
Adults:
-Nervousness
Heat intolerance
Tachycardic episodes
Bone loss
Comps:
A fibrillation
Osteoporosis
Describe which medication
Levothyroxine
Describe the MOA of propranolol (B-blocker)
&
What is its clinical use?
MOA:
It blocks the conversion of 4 to T3 by inhibiting 5 deiodinase
Rx: Hyperthyroidism
MOA:
It blocks the conversion of 4 to T3 by inhibiting 5 deiodinase
Rx: Hyperthyroidism
Describes which type of drug
Propranolol (B-blocker)
Describe the following for a myxedema coma:
What causes it?
What are the symptoms?
What are the treatments?
Causes:
Severe-longstanding-untreated hypothyroidism causes it
Symptoms:
1) Progressive stupor
2) Hypothermia
3) Hypoventilation
4) Hypoglycemia
5) Hyponatremia
6) Water intoxication shock & death
Rx:
Supportive care (ventilator)
Correct the hyponatremia
IV Levothyroxine (T4)
IV hydrocortisone
Causes:
Severe-longstanding-untreated hypothyroidism causes it
Symptoms:
1) Progressive stupor
2) Hypothermia
3) Hypoventilation
4) Hypoglycemia
5) Hyponatremia
6) Water intoxication shock & death
Rx:
Supportive care (ventilator)
Correct the hyponatremia
IV Levothyroxine (T4)
IV hydrocortisone
Describes which condition?
myxedema coma
Describe the following for potassium iodide:
What is the MOA?
It inhibits thyroid hormone synthesis via a Saturated solution of potassium iodide which blocks TPO & proteolysis reducing T4 levels & preventing hormone release into the blood
(Wolff-Chaikoff effect (inhibition of iodotyrosines & iodothyronin synthesis)
It inhibits thyroid hormone synthesis via a Saturated solution of potassium iodide which blocks TPO & proteolysis reducing T4 levels & preventing hormone release into the blood
(Wolff-Chaikoff effect (inhibition of iodotyrosines & iodothyronin synthesis)
Describes the MOA of which drug?
potassium iodide
Describe the following for potassium iodide:
What are the clinical uses?
Thyrotoxicosis (thyroid storm)
Pre-op prep for surgery (firm & avascular for thyroidectomy)
Protect thyroid from radioactive iodide (nuclear fallot)
Thyrotoxicosis (thyroid storm)
Pre-op prep for surgery (firm & avascular for thyroidectomy)
Protect thyroid from radioactive iodide (nuclear fallot)
Are all clinical uses of which drug?
potassium iodide:
Describe the following for potassium iodide:
What are the side effects?
1) Hypokalemia
2) Jod-Basedow phenomenon (iodide induced hyperthyroidism)
3) Induced hypothyroidism
4) Thyroid escape (long term use after 10-15 days it’s no longer therapeutic)
5) Angioedema (acute)
6) Cutaneous hemorrhages (acute)
7) Eosinophilia (acute) & enlarged LN
1) Hypokalemia
2) Jod-Basedow phenomenon (iodide induced hyperthyroidism)
3) Induced hypothyroidism
4) Thyroid escape (long term use after 10-15 days it’s no longer therapeutic)
5) Angioedema (acute)
6) Cutaneous hemorrhages (acute)
7) Eosinophilia (acute) & enlarged LN
Describes the side effects of which drug
Potassium iodide
Who is at risk of developing JBD (iodide induced hyperthyroidism) when taking potassium iodide ?
Patients with:
grave disease
Endemic goiters
Thyroid adenoma
Toxic multinodular goiter
Describe the following for Radioactive iodide (131I):
MOA
SIDE EFFECT
Pretreat with perchlorate/or/pertechnatate to inhibit the potency of the ratioactive iodine
MOA:
iT SHRINKS THE THYROID (EUTHYROID OR HYPOTHYROID)
Side effects:
1) HYPOTHYROIDSIM (80%)
2) Fetal hypothyroidism
Pretreat with perchlorate/or/pertechnatate to inhibit the potency
MOA:
iT SHRINKS THE THYROID (EUTHYROID OR HYPOTHYROID)
Side effects:
1) HYPOTHYROIDSIM (80%)
2) Fetal hypothyroidism
Describes which drug?
Radioactive (131I) iodine
Describe the MOA of polythiouracil (PTU)
1) It blocks TPO (thyroid peroxidase from oxidizing iodide (organification) & it decreases the conversion of T4 to T3 by blocking 5’-deiodinase
1) It blocks TPO (thyroid peroxidase from oxidizing iodide (organification) & it decreases the conversion of T4 to T3 by blocking 5’-deiodinase
Describes the MOA of which drug?
Propylthiouracil (PTU)
What are the side effects of Propylthiouracil (PTU)?
1) Pruritic skin rash (when meds are stopped)
2) Agranulocytosis (fever)
3) Aplastic anemia
4) Hepatotoxicity ***
1) pruritic skin rash (when meds are stopped)
2) Agranulocytosis (fever)
3) Aplastic anemia
4) Hepatotoxicity ***
Are side effects of which drug?
Propylthiouracil
What are the clinical uses of Propylthiouracil?
Hyperthyroidism
Graves disease (preggos esp)
Thyrotoxic crisis/storm
What is the MOA of methimazole?
Same as PTU it blocks PTO to reduce thyroid hormone synthesis via preventing T4-to-T3 conversion by blocking 5 deiodinase
What are the side effects & clinical uses of methimazole?
Side effects:
1) Pruritic skin rash
2) Agranulocytosis
3) Aplastic anemia
4) Aplasia cutis
5) Choanal or esophageal (rare)
Uses:
Hyperthyroidism
Graves
Thyrotoxic crisis/storm
Avoid in preggos (only after 1st trimester)
“Meth heads dion’t need AA”
Side effects:
1) Pruritic skin rash
2) Agranulocytosis
3) Aplastic anemia
4) Aplasia cutis
5) Choanal or esophageal (rare)
Uses:
Hyperthyroidism
Graves
Thyrotoxic crisis/storm
Avoid in preggos (only after 1st trimester)
Describes the side effects & uses of which drug?
Methimazole
Describe the following iodine processing pathway & where the following drugs inhibit it
PTU
Methimazole
Iodides
1) iodide is taken up
2) Thyroglobulin’s are made from AA’s
3) PTO results in Iodination (coupling) of tyrosyl groups
THIOAMIDES (PTU & METH) inhib
IODIDES (IK)
4) Organification of tyrosine residues to make MIT or DIT
IODIDES INHIBIT
5) Proteolytic release of hormones in the blood
IODIDES INHIB
6) T3/T4 get to tissue & are converted to T3 via 5-deiodinase
THIAMIDE (PTU) INHIBITS
What pathway is gastrin involved in?
Phospholipase C via the inositol triphosphatases
Hormones:
ADH
Calcitonin
Glucagon
GHRH
ACTH
TSH
FSH/LH
PTH
all require which pathway
cAMP (protein kinase A)
cAMP (protein kinase A) PATHWAY INCLUDES WHICH TYPES OF HORMONES?
Hormones:
ADH
Calcitonin
Glucagon
GHRH
ACTH
TSH
FSH/LH
PTH
Nuclear/intracellular receptors are for which hormones?
Steroid hormones
Thyroid hormones
Vitamin D
Retinols (Vit A)
Steroid hormones
Thyroid hormones
Vitamin D
Retinols (Vit A)
mOVE VIA WHICH TYPE OF RECEPTOR PATHWAYS
Nuclear/intracellular pathway
Receptor tyrosine kinase pathway is for which hormones?
Insulin
EGF
IGF
FGF
TGF
Insulin
EGF
IGF
FGF
TGF
All you which pathway
RTK path
The IP3 (phospholipase C) pathway involves which hormones with which 2 secondary messengers
2nd cAMP:
TSH
GHRH
CRH
ACTH
ADH (V2)
HISTAMINE H2 (SKIN/LING)
LH/FSH
2nd IP3
Gastrin
TRH
ADH (V1)
GnRH
Histamine HI (stomach)
Angiotensin II
wHICH HORMONES USE cGMP pathway
ANP
BNP
NO
Which proteins use JAK/STAT
Bone marrow:
Erythropoietin
G-CSF
Thrombopoietin
Post pituitary:
Prolactin
Growth hormone
Interleukins
INF-y
IL-2 & 6
