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Pharmacology II-Exam 2 > Endocrine-thyroid > Flashcards

Endocrine-thyroid Flashcards

1
Q

Action of Follicle cells (Acini) in the thyroid gland

A

Stores thyroglobulin & thyroid hormone

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2
Q

What does the thyroid gland do?

A

Maintains optimal metabolism for tissue function

Autonomic innervation

Hypothalamus (TRH)….pituitary (TSH)…thyroid (THs)

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3
Q

What are the thyroid hormones?

A

T3 (triiodothyronine)-active form

T4 (thyroxine)

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4
Q

T3 is synthesized from________or_______in peripheral tissues

A

Tyrosine metabolism

OR

Conversion of T4

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5
Q

T3 can increase_________&______ and cause________

A

O2 consumption & metabolism

Protein catabolism

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6
Q

T4 is synthesized from

A

Tyrosine

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7
Q

T4 is the pro hormone for

A

T3

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8
Q

T4 accounts for _____of TH

A

80%

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9
Q

T4 physiologic effects is related to

A

Conversion & action of T3

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10
Q

Calcitonin is released by

A

Thyroid gland

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11
Q

Calcitonin is a ______hormone

A

Polypeptide

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12
Q

Calcitonin decreases concentration of ______ions ini plasma

A

Ca+

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13
Q

Decreased concentration of Ca+ ions ini the plasma_____, ______&______

A

Weakens osteoclasts

Strengthens osteoblasts

Decreases renal tubular reabsorption oof Ca & Phosphate

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14
Q

What is primary hypothyroidism?

A

Deficient thyroid hormone production

Iodine Deficiency

Autoimmune disease

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15
Q

What is secondary (central) hypothyroidism?

A

Dysfunctional pituitary gland or hypothalamus

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16
Q

What is exogenous hypothyroidism?

A

Caused by a medication side effect, by surgery or radiation of neck/head

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17
Q

How to manage hypothyroidism

A

TH replacement therapy

Monitor TSH/free T4

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18
Q

What is Levothyroxine (Synthroid)

A

Synthetic thyroxine T4

19
Q

MOA of levothyroxine

A

Conversion of T4 to T3 ini peripheral tissues

T3 will then bind thyroid hormone receptors and affect DNA transcription

DNA transcription will increase metabolism/SNS activity/growth & development

20
Q

What is Liothyronine

A

A synthetic isomer oof triiodothyronine (T3) and is 3x more potent than levothyroxine

21
Q

What do clinical trials say about Liothyronine

A

Little to no effect on hypothyroid symptoms, so may be prescribed T4-T3 combo

22
Q

Levothyroxine may cause_______with _______&______

A

Synergistic

Anticoagulants & Epi

23
Q

Abnormal thyroids in a patient will cause

A

Exaggerated response to anesthetics & opioids, causing sedation & delayed emergence

Respiratory depression & muscle weakness

Vasopressor-Resistance HOTN

Bradycardia & diastolic dysfunction

Diminished response to alpha/beta adrenergic drugs

Metabolic abnormalities like hypoglycemia, anemia & hypothermia

24
Q

What is hypothyroid effect on MAC?

A

No effect

25
Q

What is HYPERthyroidism

A

Excess production & secretion of thyroid hormone

26
Q

What are some disease processes related to hyperthyroidism

A

Graves disease (autoimmune disorder of TSH-receptor antibodies)

Hashitoxicosis (Autoimmune)

Toxic adenoma/goiter (hyperplasia or thyroid follicular cells)

27
Q

What is the treatment of hyperthyroidism

A

Anti-thyroid drugs

Radioiodine

Surgery

Monitor TSH/T3/T4

28
Q

What are risk factors for thyroid storm?

A

Surgery

Trauma/acute illness

Pregnancy

29
Q

Symptoms of thyroid storm

A

Hyperthermia

Agitation/delirium/seizures

Tachy/Afib

HF

Jaundice & diarrhea

30
Q

What drug can treat hyperthyroidism

A

Thionamides

31
Q

MOA for Thionamides

A

Inhibit thyroid peroxidase (will decrease oxidation of thyroid hormone)

Inhibits formation of TH

Reduces concentrations of antithyrotropin-receptor antibodies

PTU also inhibits deiodiniation of T4 to T3

32
Q

What should be monitored with Thionamides

A

Serum T4 & T3 assessment of euthyroid state

33
Q

Thionamides adverse effects

A

Urticaria/skin rash
Arthralgia
GI issues
Agranulocytosis
Granulocytopenia
Hepatic toxicity
Monitor WBC

34
Q

Potassium Iodides treat

A

Hyperthyroid

35
Q

Two Potassium Iodides medications

A

Potassium Iodide

Or

Potassium iodide-iodine (Lugols)

36
Q

MOA for Potassium Iodides

A

Decreases iodine uptake by thyroid, TH synthesis & release/thyroid size, & thyroid vascularity

37
Q

Adverse effects of Potassium Iodides

A

Allergic reaction (rare)-angioedema or laryngeal edema risk

Bleeding disorder

38
Q

What is the definitive treatment for Graves

A

Radioactive Iodine

39
Q

MOA for Radioactive Iodine

A

Rapid & efficient uptake by the thyroid gland cells

Iodine isotopes trapped in thyroid

Beta rays destroy cells w/minimal to no damage to surrounding tissues

40
Q

Precautions of Radioactive Iodine

A

Hypothyroidism risk

Contraindicated in pregnancy

41
Q

Adverse effects of Radioactive Iodine

A

Radiation toxicity

Infertility

42
Q

Anesthesia considerations with hyperthyroidism

A

CV risk like arrhythmia, tachycardia, ischemia or HF

43
Q

CV risk associated with hyperthyroidism are best controlled by a

A

BETA Blocker (propranolol) IV to inhibit conversion of T4 to T3, which will control tachycardia, HTN and fever

0.5-1mg over 10min

44
Q

What 2 medication can be given together ini high risk patients requiring urgent surgery for hyperthyroidism?

A

Iodine & thionamides

Pharmacology II-Exam 2 (5 decks)

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