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Pharmacology II > Endocrine Drugs > Flashcards

Endocrine Drugs Flashcards

1
Q

Primary Hypothyroidism

A

TSH is working well
Thyroid gland is not working

High or normal TSH + low T4,T3 .

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2
Q

Primary treatment in Hypothyroidism

A

Hormone replacement : Levothyroxine ( synthetic T4) or Liothyronine ( T3 isomer )

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3
Q

Drug of choice in primary hypothyroidism (bad thyroid gland)

A

Synthetic thyroxine (T4) -Levothyroxine

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4
Q

Secondary hypothyroidism

A

Disease in Hypothalamus or the Ant. Pituitary

Both TSH and T4 are low .

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5
Q

Goal of therapy for hypothyroidism

A

1) reach euthyroid state ( Normal TSH and less symptoms )
2) reduce goiter size
3) Prevent thyroid cancer recurrence

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6
Q

Which lab to monitor primary hypothyroidism?

A

TSH

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7
Q

Dosage of Levothyroxine in young and healthy

A

50-200mcg per day

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8
Q

Who may need decreased dose of Levothyroxine?

A

1) Elderly

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9
Q

Who may need increased dose of Levothyroxine

A

Pregnant ( thyroid hormone requirement goes up )

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10
Q

1/2 life of Levothyroxine

A

7 to 10 days- meaning…

Patient will can miss several days of med without adverse consequences

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11
Q

If patient NPO how do you give Levothyroxine

A

Parenterally, give 80% of the usual PO dose

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12
Q

T3 Liothyronine

A

A)- Isomer of T3
B)- 2.5 to 3 times more potent then T4
C) rapid onset + short duration = not good for long term therapy

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13
Q

Hyperthyroidism : 3 treatment options

A

1- Anti-thyroid meds
2- Radioiodine
3- Surgery

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14
Q

Measuring TSH in hyperthyroidism

A

Determines diagnosis but not not degree/severity of disease .

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15
Q

Why do we measure T3 T4 in hyperthyroidism?

A

To assess efficacy of treatment

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16
Q

Can TSH be used to assess efficacy of hyperthyroidism treatment ?

A

Yes. But only once thyroid hormone steady state is achieved .
If TSH start getting too low again ( primary) or too high again (secondary ) treatment needs to be addressed

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17
Q

Primary hyperthyroidism

A 
Thyroid gland is making too much
TSH low ( no need to stimulate ) and T3 T4 high
18
Q

Secondary hyperthyroidism

A

Ant.pituitary or hypothalamus problem. Too much TSH

Both TSH and T3 T4 are elevated

19
Q

High TSH High T3/T4

A

Secondary hyperthyroidism

20
Q

Low/normal TSH and High T3/T4

A

Primary Hyperthyrodism

21
Q

What are the anti-thyroids used for hyperthyroidism?

A

Thianomides : Methimazole ( Tapazole) , PTU
Inhibitor of Iodide Transport
Iodide
Radioactive Iodine

22
Q

Prototype anti-thyroid

A

PTU

23
Q

Methimazole vs PTU 1/2 life

A 
Methimazole = 4-6 hrs = once a day dosing 
PTU= 75 mins = many times a day dosing
24
Q

Minor S/E of thianomides

A

Urticaria
Macular skin rash
GI discomfort
Arthralgia

25
Q

Rare but serious S/E of thianomines

A

Granulocytopenia : marked decrease in granulocytes ( a type of WBC)
Agranulocytosis: severe leukopenia
Occurs in the 1st 3 month of therapy

26
Q

Earliest sign of agranulocytosis

A

Pharyngitis and Fever

27
Q

Pharyngitis and Fever in pt receiving Methimazole or PTU :

A

Agranulocytosis; stop med at first sign for better recovery chance

28
Q

Which Thianomine is preferred in pregnancy and why

A

Propylthioracil ( PTU) has limited placental crossing .

29
Q

What S/E is associated specifically with PTU?

A

Hepatotoxicity

30
Q

Which Thianomine can appear in breast milk?

A

Methimazole ( Tapazole )

31
Q

Iodide as anti- thyroid med :-0 ?????

A

Yes… it’s a paradoxical treatment , is the oldest anti-thyroid therapy, and it is not fully understood why it works …(recall Iodide helps make more T3,T4 ..smh!)

32
Q

Most important clinical effect of high dose Iodide

A

Inhibits release of thyroid hormone

33
Q

Recommended regimen of iodide prior to thyroidectomy?

A

Oral Potassium Iodide ( decreases thyroid vascularity) and Propanolol

34
Q

S/E of chronic Iodide therapy

A

Recurrence of previously excessive thyroid gland activity

35
Q

How does Iodide stop TSH release within 24 hr?

A

Maybe by inhibiting TSH and cAMP

36
Q

Allergic reactions can happen with iodide along with …

A

Angiodema and Laryngeal edema

37
Q

Radioactive Iodine aka I-131 can destroy gland In …

A

6- 8 weeks
Drug so good it may even cause hypothyroidism .
Can cure in just 1 dose , some may get 1-2 more doses .

38
Q

I-131 is given on patients with

A

1) Graves disease

2) after euthyroidism achieved with Thianomine

39
Q

Peop patient on Radioactive Iodine , think…

A

Iatrogenic Hypothyroidism

*Iatrogenic( induced by medical intervention)

40
Q

I-131 C/I in pregnancy because

A

The thyroid of the fetus will concentrate it . ( it’s and isotope btw)

Pharmacology II (7 decks)

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