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Pharm SJSM > Block 1 Exam (thyroid & CONTRACEPTION) > Flashcards

Block 1 Exam (thyroid & CONTRACEPTION) Flashcards

1
Q

Describe the following for a thyroid storm (thyrotoxic crisis)

What are the lab findings?

What are the treatments?

A

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)

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2
Q

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?

A

thyroid storm (thyrotoxic crisis)

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3
Q

Describe the following for hyperthyroidism:

What are the labs?

What are the symptoms?

What are the treatments?

A

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)

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4
Q

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?

A

Hyperthyroidism

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5
Q

Describe the following for hypothyroidism:

What are the labs?

What are the symptoms?

What are the treatments?

A

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”

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6
Q

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?

A

Hypothyroidism

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7
Q

Describe the following for Levothyroxine (T4):

What is the MOA?

What are the side effects?
-kids vs adults

What are the complications?

A

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

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8
Q

What are the clinical uses of Levothyroxine?

A

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

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9
Q

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

A

Levothyroxine

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10
Q

Describe the MOA of propranolol (B-blocker)
&
What is its clinical use?

A

MOA:
It blocks the conversion of 4 to T3 by inhibiting 5 deiodinase

Rx: Hyperthyroidism

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11
Q

MOA:
It blocks the conversion of 4 to T3 by inhibiting 5 deiodinase

Rx: Hyperthyroidism

Describes which type of drug

A

Propranolol (B-blocker)

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12
Q

Describe the following for a myxedema coma:

What causes it?

What are the symptoms?

What are the treatments?

A

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

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13
Q

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?

A

myxedema coma

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14
Q

Describe the following for potassium iodide:

What is the MOA?

A

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)

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15
Q

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?

A

potassium iodide

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16
Q

Describe the following for potassium iodide:

What are the clinical uses?

A

Thyrotoxicosis (thyroid storm)
Pre-op prep for surgery (firm & avascular for thyroidectomy)
Protect thyroid from radioactive iodide (nuclear fallot)

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17
Q

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?

A

potassium iodide:

18
Q

Describe the following for potassium iodide:

What are the side effects?

A

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

19
Q

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

A

Potassium iodide

20
Q

Who is at risk of developing JBD (iodide induced hyperthyroidism) when taking potassium iodide ?

A

Patients with:

grave disease
Endemic goiters
Thyroid adenoma
Toxic multinodular goiter

21
Q

Describe the following for Radioactive iodide (131I):

MOA

SIDE EFFECT

A

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

22
Q

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?

A

Radioactive (131I) iodine

23
Q

Describe the MOA of polythiouracil (PTU)

A

1) It blocks TPO (thyroid peroxidase from oxidizing iodide (organification) & it decreases the conversion of T4 to T3 by blocking 5’-deiodinase

24
Q

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?

A

Propylthiouracil (PTU)

25
Q

What are the side effects of Propylthiouracil (PTU)?

A

1) Pruritic skin rash (when meds are stopped)
2) Agranulocytosis (fever)
3) Aplastic anemia
4) Hepatotoxicity ***

26
Q

1) pruritic skin rash (when meds are stopped)
2) Agranulocytosis (fever)
3) Aplastic anemia
4) Hepatotoxicity ***

Are side effects of which drug?

A

Propylthiouracil

27
Q

What are the clinical uses of Propylthiouracil?

A

Hyperthyroidism
Graves disease (preggos esp)
Thyrotoxic crisis/storm

28
Q

What is the MOA of methimazole?

A

Same as PTU it blocks PTO to reduce thyroid hormone synthesis via preventing T4-to-T3 conversion by blocking 5 deiodinase

29
Q

What are the side effects & clinical uses of methimazole?

A

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”

30
Q

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?

A

Methimazole

31
Q

Describe the following iodine processing pathway & where the following drugs inhibit it

PTU
Methimazole
Iodides

A

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

32
Q

What pathway is gastrin involved in?

A

Phospholipase C via the inositol triphosphatases

33
Q

Hormones:
ADH
Calcitonin
Glucagon
GHRH
ACTH
TSH
FSH/LH
PTH

all require which pathway

A

cAMP (protein kinase A)

34
Q

cAMP (protein kinase A) PATHWAY INCLUDES WHICH TYPES OF HORMONES?

A

Hormones:
ADH
Calcitonin
Glucagon
GHRH
ACTH
TSH
FSH/LH
PTH

35
Q

Nuclear/intracellular receptors are for which hormones?

A

Steroid hormones
Thyroid hormones
Vitamin D
Retinols (Vit A)

36
Q

Steroid hormones
Thyroid hormones
Vitamin D
Retinols (Vit A)

mOVE VIA WHICH TYPE OF RECEPTOR PATHWAYS

A

Nuclear/intracellular pathway

37
Q

Receptor tyrosine kinase pathway is for which hormones?

A

Insulin
EGF
IGF
FGF
TGF

38
Q

Insulin
EGF
IGF
FGF
TGF

All you which pathway

A

RTK path

39
Q

The IP3 (phospholipase C) pathway involves which hormones with which 2 secondary messengers

A

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

40
Q

wHICH HORMONES USE cGMP pathway

A

ANP
BNP
NO

41
Q

Which proteins use JAK/STAT

A

Bone marrow:
Erythropoietin
G-CSF
Thrombopoietin

Post pituitary:
Prolactin
Growth hormone

Interleukins
INF-y
IL-2 & 6

42
Q
A

Pharm SJSM (23 decks)

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