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BCPS > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Graves disease

A

Autoimmune disorder where thyroid-stimulating antibodies directed at thyrotropin receptors mimic TSH and stimulate T3 & T4

Hyperthyroid

Elevated T4, decreased TSH

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2
Q

Hyperthyroid disorders

A

Graves
Pituitary adenoma
Toxic adenoma
Toxic multinodular goiter (Plummer)
Painful subacute thyroiditis
Drug induced (thyroid hormone, amiodarone)

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3
Q

Propylthoiuracil MOA, dosing, BBW, ADR

A

MOA: Inhibits iodination and synthesis of thyroid hormone; blocks T4>T3 conversion in periphery

50-150mg TID

BBW: hepatotoxicity

ADR: rash, arthralgia/lupus-like, fever, agranulocytosis

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4
Q

Methimazole MOA, dosing, ADR

A

MOA: Inhibits iodination and synthesis of thyroid hormone

DOC for Graves

10-30mg daily

ADR: Embryopathy risk in first trimester, rash, arthralgia/lupus like, fever, agranulocytosis

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5
Q

Methimazole, PTU onset, treatment duration (Graves)

A

Max effect 4-6 months

Treatment may be 12-18 months

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6
Q

Iodines & Iodides MOA, efficacy

A

Lugol’s solution, saturated solution of potassium iodide, potassium iodide tablets

MOA: inhibit release of stored thyroid hormone; decreases size of gland before surgery

Efficacy of 7-14 days - use prior to surgery, after ablative therapy, or acutely in thyroid storm

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7
Q

Teprotumumab

A

Insulin-like growth factor-1 receptor inhibitor

Use for thyroid eye disease

IV route

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8
Q

Thyroid storm treatment

A

1) Propylthiouracil 500-1000mg load
2) Iodide therapy 1 hr after PTU load to block hormone release
3) Hydrocortisone 300mg IV load
3) then PTU 250mg q4h, hydrocortisone 100mg q8h
4) Propranolol or esmolol
5) APAP for fever - do not use NSAID

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9
Q

Hashimoto

A

Autoimmune-induced thyroid injury resulting in decreased thyroid secretion (antibodies: antithyroid peroxidase, antithyroiglobulin)

Hypothyroid

Elevated TSH, low T4

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10
Q

DOC for Hashimoto

A

Levothyroxine

Other forms no longer recommended

60mg dessicated thyroid = 100mcg levothyroxine

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11
Q

Levothyroxine dosing Hashimoto, efficacy

A

1.6 mcg/kg using IBW

Lower if older patient

CV disease: 12.5-25mcg daily

Check again in 4-8 weeks

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12
Q

IV levothyroxine to PO

A

75% PO dose

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13
Q

Levothyroxine dose subclinical hypothyroid

A

Elevated TSH, normal T4
25-75mcg

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14
Q

Myxedema Coma therapy

A

severe, life-threatening hypothyroid

1) 200-400mcg IV levothyroxine followed by 1.6mcg/kg/day
2) Broad spectrum antibiotics
3) Hydrocortisone 100mg q8H

Measure T3 every 1-2 days and adjust levothyroxine dose

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15
Q

Pituitary hormone & secretion inhibitor in Acromegaly

A

H: Growth hormone
I: Somatostatin or insulin-like growth factor-1

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16
Q

Acromegaly diagnosis

A

Test: OGTT
Result: Increased insulin-like growth factor-1, increased GH

Would expect increased IGF-1 to suppress GH.

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17
Q

Acromegaly Treatment of Choice

A

Surgical resection of tumor

18
Q

Dopamine agonists

A

Bromocriptine (daily dosing), Cabergoline (weekly dosing)

Acromegaly: bromocriptine
Hyperprolactinemia: cabergoline
Cushing: cabergoline
T2DM: bromocriptine

19
Q

Ocreotide

A

Somatostatin analog that blocks GH secretion (endogenous somatostatin is secretion inhibitor for GH)

Used in acromegaly

SC, PO, or LAI

20
Q

Pegvisomant

A

GH receptor antagonist that inhibits IGF-1 synthesis in liver (mediator in GH activity)

SC daily

Used in acromegaly

21
Q

Somatropin

A

Recombinant GH used for GH deficiency

22
Q

Pituitary hormones

A

Growth hormone (GH)
Adrenocorticotropic hormone (ACTH)
Thyroid-stimulating hormone (TSH)
Prolactin
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)

23
Q

Adrenal hormones

A

MIneralocorticoids (aldosterone)
Cortisol
Sex hormones (estradiol, testosterone)

24
Q

Cushing sydrome

A

Excessive ACTH secretion results in excessive cortisol secretion due to pituitary adenoma

Cortisol is the primary secretion inhibitor for ACTH. An adenoma prevents this negative feedback loop from working.

Will have normal/elevated plasma ACTH, MRI to confirm

25
Q

Cushing treatment of choice

A

Surgical resection of tumor

26
Q

Pasireotide

A

MOA: somatostatin analog blocks ACTH secretion

Not effective for adrenally caused Cushing

BID SC inj

27
Q

Drugs that inhibit Cortisol Synthesis

A

Osilodrostat
Ketoconazole
Mitotane
Etomidate
Metyrapone

May use in Cushing Syndrome

28
Q

DOC for hyperaldosteronism

A

Spironolactone

Alt: eplerenone, amiloride

29
Q

Addison disease

A

Primary adrenal insufficiency

Cortisol, aldosterone, androgen deficiencies

Cosyntropin (synthetic ACTH) test diagnoses this

30
Q

Addison disease treatment

A

1) Hydrocortisone 15mg/day (or prednisone, cortisone, dexamethasone equiv)

2) Fludrocortisone 0.05-0.2mg/day

3)DHEA 25-50mg IF female & low energy, libido

31
Q

How to time steroid dose in Addison disease

A

2/3 in AM, 1/2 in PM

32
Q

Cortisone 25mg =

A

Hydrocortisone 20mg
Prednisone 5mg
Prednisolone 5mg
Triamcinolone 4mg
Methylprednisolone 4mg
Dexamethasone 0.75mg

33
Q

Weight loss therapy goal

A

5-10% over 6 months

34
Q

When to start pharmacology tx in obesity

A

-Obese (BMI >30) after trying lifestyle modifications

-BMI >=27 with significant comorbidities (DM, HTN, dyslipidemia)

35
Q

Orlistat

A

MOA: reduces fat absorption by inhibiting gastric/pancreatic lipases

Need multivitamin as reduces absorption of fat-soluble vitamins

Available OTC at reduced dose (60 vs 120mg TID PC)

AE: GI related - fecal urgency, incontinence, oily stools

FDA warning: hepatotoxicity, kidney stones

36
Q

Phentermine/Topiramate ER

A

Monitor after 12 weeks: If <3% weight loss, increase dose

Monitor again after 12 weeks: If <5% weight loss, taper slowly off to prevent seizure

Fetal toxicity

37
Q

Bupropion/Naltrexone ER

A

Titrate weekly from 1 daily to 2 BID

CI: uncontrolled HTN, seizure, anorexia/bulimia, drug/alcohol withdrawal)

D/C if <5% weight loss after 12 weeks

38
Q

GLP-1 for weight loss

A

Liraglutide, Semaglutide

Same starting dose but Higher target doses than diabetes
L: 0.6 > 3mg daily
S: 0.25 > 2.4mg weekly

D/C if <4% weight loss over 16 weeks or cannot tolerate

39
Q

Tirzepatide - weight loss

A

GLP1 agonist & GIP agonist
2.5-15mg SC weekly

CV benefit

40
Q

How does PCOS happen?

A

Androgen excess

Insulin resistance > Increased insulin secretion > Stimulates androgen secretion > Increases LH with normal or low FSH > Decrease follicular maturation > anovulation

41
Q

Fertility drugs for PCOS

A

Clomiphene
Gonadotroptin or Gonadotropin-releasting hormone
Letrozole (DOC*)

42
Q

Symptom improvement meds for PCOS

A

Estrogen/progestin hormonal birth control
Metformin
Spironolactone
Pioglitazone (not really recommended)

BCPS (9 decks)

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