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Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what level of TSH is diagnostic for overt hypothyroidism

A

TSH > 10

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2
Q

what are 2 hormone replacement products for thyroid?

A

Levothyroxine (synthetic T4)

-Liothyronine (T3)

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3
Q

What is Liotrix?

A

synthetic LT4 and T3 combination product - never use; unpredictable an toxic potential

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4
Q

what is the treatment of choice for hypothyroidism?

A

Levothyroxine (synthetic LT4)

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5
Q

between LT4 and T3, which has the longer 1/2 life?

A

LT4! (1/2 life is 7-10 days)

t3 1/2 life is 24 hours

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6
Q

when is the ONLY time to consider giving patient T3?

A

when they have impaired conversion of T4 to T3

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7
Q

Why is Armour thyroid and ratio products like Liotrix never used?

A

risk of toxicity and unpredictable outcomes; also no benefit when compared to Levothyroxine

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8
Q

what is the MOA of levothyroxine?

A

synthetic LT4; mimics normal physiology of thyroid gland

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9
Q

when do you recheck TSH levels?

A

6-8 weeks after initiation of levothyroxine

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10
Q

you see a patient 6 weeks after initiating Levo; his TSH are not yet at goal. What do you do?

A

change the dose by 10-20% and follow up in another 6-8 weeks

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11
Q

T or F: small differences in Levothyroxine can make big differences in TSH levels

A

TRUE

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12
Q

what is the biggest risk of overtreating a patient with Levothyroxine?

A

cardiac issues - A.fib

also depression, osteoporosis

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13
Q

when do you advise your patient to take their Levothyroxine?

A

best when taken in the EVENING on empty stomach

can also take in a.m. 1-2 hours before breakfast/other meds

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14
Q

to avoid drug-drug interactions, pt should take LT4 2 hours before or 6 hours AFTER to reduce the risk of interaction with which types of medications?

A

calcium
iron
multivitamins
prenatal vitamins

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15
Q

after patient is stable (euthyroid), how often should they come in for monitoring/re-checking levels

A

6-12 months (more often if pregnant)

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16
Q

T or F: always write the prescription for Levo in mg.

A

FALSE! correct units are mcg!

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17
Q

what level of TSH is diagnostic of HYPERTHYROIDISM?

A

TSH < 0.5

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18
Q

what is the most common cause of hyperthyroidism?

A

Graves Disease

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19
Q

Subclinical hyperthyroidism may become OVERT if:

A 
iodine excess
infection
stress
smoking
lithium
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20
Q

Treatment Hyperthyroidism

A

Beta Blockers (to block palpitations, tremor, anxiety) + PUT/MMI

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21
Q

Specifically what type of Beta Blockers are used for treatment of hyperT

A

NON-SELECTIVE (propranolol or nadolol)

-these impair the conversion of T4 to T3

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22
Q

you’re supposed to use nonselective betablockers to treat HyperT in patients EXCEPT THOSE WITH

A

asthma or decompensated HF

use atenolol, clonidine, verapamil, diltiazem

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23
Q

What are some other methods used to reduce thyroid hormone synthesis?

A

Iodide, anti-thyroid drugs(PTU/MMI), radioactive iodine, surgery

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24
Q

What is the MOA of iodide?

A

blocks thyroid’s uptake of iodine, inhibiting synthesis and release of thyroid hormone

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25
Q

T or F: it’s ok to use iodide to treat thyroid storm BEFORE radioactive iodine treatment

A

FALSE!!! this will inhibit the concentration of radioactivity in thyroid, AKA thyroid won’t be able to take up the iodine

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26
Q

What are the 2 most common antithyroid drugs used to treat hyperthyroidism?

A

Propylthiouracil (PTU)

Methimazole (MMI)

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27
Q

MOA PTU and MMI

A

interferes with synthesis of thyroid hormones by interfering with iodine incorporation. Also has immunosuppressive effects (helps in Graves)

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28
Q

This antithyroid drug specifically inhibits conversion of T4–> T3

A

PTU

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29
Q

This medication is the primary therapy for Graves and to prepare for surgery or radioactive iodine administration

A

PTU/MMI

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30
Q

how often to monitor patient’s being treated for Graves with MMI

A

every 4-6 weeks until stable (then decrease to maintain euthyroid)

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31
Q

What is the significance of patients who are TSHR-Sab (+)

A

these patients almost ALWAYS relapse (Graves disease)

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32
Q

what is the black box warning for PTU

A

severe liver injury (only use if can’t tolerate MMI)

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33
Q

what is agranulocytosis?

A

decrease in WBC, presenting in first 3 months of MMI/PTU treatment as sudden fever, malaise, sore throat
-may develop sepsis and die

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34
Q

what to do if patient on MMI experiences agranulocytosis

A

D/C antithyroid drug immediately - give Abx if afebrile, and consider filgrastim

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35
Q

what is the option for thyroid ablation without surgery

A

radioactive iodine

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36
Q

how to manage patient while going through radioactive iodine

A

put them on BB and MMI; the process is slow and need to address symptoms and prevent thyroid storm in the meantime

37
Q

Contraindications for MMI/PTU?

A

pregnancy

breastfeeding

38
Q

what is the consequence of radioactive iodine treatment?

A

usually will develop hypothyroidism, as thyroid gets damaged. They will then need Levothyroxine

39
Q

what is the 1/2 life of radioactive iodine?

A

8 days

40
Q

how do we treat a pregnant patient for hyperthyroidism/thyrotoxicosis

A

PTU in 1st trimester (MMI is teratogenic here) –> then MMI in 2/3 trimesters

41
Q

Which drug is safer in 2nd and 3rd trimester: MMI or PTU?

A

MMI

42
Q

What causes thyroid storm?

A 
radioactive iodine treatment
withdrawal from antithyroid drug (MMI/PTU)
infection
trauma
surgery
43
Q

this life-threatening disorder can be caused by severe thyrotoxicosis

A

Thyroid storm

44
Q

Treatment thyroid storm

A

BB + large doses PTU/MMI + APAP + antiarrhythmics

45
Q

Causes of PRIMARY Hypothyroidism

A

autoimmune thyroid (Hashimotos
iatrogenic (surgery/radiation)
Drugs
thyroiditis (postpartum_

46
Q

what is the name for the T3 product?

A

Liothyronine

47
Q

What is the combination T4/T3 product?

A

Liotrix (not used in modern therapy due to unpredictable and toxic potential)

48
Q

what can happen regarding the bones when we overtreat with thyroid meds?

A

Osteoporosis

49
Q

what type of beta blocker is preferred for treating hyperT?

A

nonselective

propranolol or nadolol

50
Q

what types of patients do you need to avoid using non=selective BB in treating Hypert

A

asthma

heart failure

51
Q

what is radioactive iodine used for?

A

Given to Graves’ patients 7-14 days before surgery

also reduces hormone release during thyroid storm

52
Q

when is one time to NOT use iodide for treating hyperthyroid?

A

before radioactive iodine treatment (use MMI)

53
Q

AE iodid

A

gynecomastia, hypersensitivity, iodism

54
Q

what medication is the best to prescribe in large doses during thryroid storm?

A

MMI (longer 1/2 life)

55
Q

after you reach euthyroid in treating apatient with hyperthyroidism, what do you do next?

A

decrease the dose, overtreating leads to hypothyroid

56
Q

what is the black box warning of PTU

A

severe liver injury w/ PTU (only use if can’t tolerate MMI)

57
Q

what is the MOA of radioactive iodine?

A

produces thyroid ablation without surgery

58
Q

treating a patient with radioactive iodine is a SLOW process; what do you administer in the meantime?

A

BB + MMI (to address symptoms and prevent thyroid storm)

59
Q

when is radioactive iodine contraindicated?

A

pregnancy and lactation

60
Q

your patient is newly pregnant and being treated for her hyperthyroidism. What medication should she start on in the 1st trimester?

A

PTU is safest in 1st trimester; switch to MMI during 2nd and 3rd trimesters

61
Q

a patient comes into the ED with high fever, tachypnea, tachycardia, severely dehydrated. you suspect Thyroid storm. What is the treatment of choice?

A

BB + LARGE dose MMI + APAP, antiarrhythmics, IV hydrocortisone

62
Q

which 4 drugs can cause thyroid disease?

A

Amiodarone (hypo/Hyper)
Lithium (hypoT)
Interferon-alpha (hypo)
tyrosine kinase

63
Q

regarding drug-induced thyroid disease, what would a patient be using interferon alpha for and how would you manage the new onset thyroid issue it caused?

A

taking it for Hepatitis C; start them on Levothyroxine (LT4) and re-evaluate in 6 months

64
Q

A patient is taking tyrosine kinase inhibitors, and can develop thyroid disorder. What would they be taking this for?

A

cancer, including thyroid cancer

imatinib
(sunitinib)
Sorafenib)

65
Q

There are 2 systemic glucocorticoids used to treat chronic adrenal insufficiency. What are they?

A

Hydrocortisone (short 1/2 life)

Prednisone (long half life)

66
Q

How do you treat a patient with addisons disease?

A

need mineralcorticoid replacement (Fludrocortisone)

67
Q

You are seeing a patient for Cushing’s syndrome; how do you handle this if it’s due to medication vs. tumor?

A

REMOVE TUMOR or D/C steroids gradually

68
Q

what are the 2 drugs used for inhibitors of adrenal steroidogenesis (cushings)

A

ketoconazole

Metyrapone

69
Q

MOA metyrapone

A

reduces cortisol and corticosterone production (suppresses aldosterone synthesis)

70
Q

MOA: Ketoconazole

A

antifungal; blocks enzymes in steroid biosynthetic pathway

71
Q

Adverse effects of ketoconazole

A

gynecomastia, decreased libido, adrenal insufficiency, hepatotoxicity

72
Q

T or F: ketoconazole works slow

A

FALSE - works fast

73
Q

if adrenal steroidogenesis inhibitors are not tolerated for treating Cushings, there is an adrenolytic agent. What is its name

A

Mitotane

74
Q

MOA mitotane

A

inhibits steroidogenesis at LOW DOSES (adrenolytic at high dose)

75
Q

Steroid tapering is only necessary if used longer than

A

> 3 weeks

76
Q

How do you taper a steroid for patients?

A

stable decrease of 10-20% dose

77
Q

what are the 3 classes of medications used to treat acromegaly?

A

Somatostatin analog
GH receptor antagonists
Dopamine agonists

78
Q

acromegaly is caused by overproduction of GH, often caused by ___

A

pituitary adenoma

79
Q

Octreotide

Lanreotide

A

Somatostatin analogs (Acromegaly)

80
Q

MOA octreotide/Lanreotide

A

Inhibits GH by binding somatostatin receptors in pituitary; reduces pituitary tumor size

81
Q

what is the name of the GH receptor antagonist?

A

Pegvisomant (blocks action of GH)

82
Q

we already know that bromocriptine is a dopamine receptor agonist - what is the other one used in GH oversecretion?

A

Cabergolamine (better tolerated)

83
Q

contraindications of dopamine agonists?

A

uncontrolled HTN, ischemic disease, PVD

84
Q

you are seeing a patient who is thinking about trying to get pregnant. She is taking Cabergolamine. What do you advise?

A

she needs to stop this 1 month before conception (it has a long 1/2 life)

85
Q

what is the treatment for GH deficiency?

A

Somatotropins (omnitrope, nutropin, Humatrop)

86
Q

when is the best time to administer (inject) somatotropins?

A

in the evening, as most of GH secretion occurs during sleep

87
Q

contraindications of somatotropin

A

cancer/tumors
prader-willi syndrome
obese
respiratory impairments

88
Q

thyroid hormones are important for:

A

fetal growth and development, regulation of energy metabolism

89
Q

iodism is an adverse effect of iodide treatment. What does this look like?

A

palpitations, depression, weight loss, pustular skin eruptions

Pharmacology (12 decks)

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