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Endocrinology Flashcards

1
Q

Peptide vs. Steroidal Agents

A

Peptide- cell surface receptor, signal transduction pathway via receptor autophosphorylation/tyrosine kinase cascade, PLC, IP3, DAG, adenylate cyclase, cAMP, PKA, etc

Injected, short half-life, frequent dosages, not orally active

Steroidal- intracellular receptor (cytoplasmic or nuclear), ligand-receptor direct binding to DNA

Very lipophillic

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2
Q

Tissue specific effects of insulin

A

Muscle and adipocyte- stimulation of glucose uptake

Liver and muscle- inhib glycogenolysis, stim glycogen synthesis

Liver- inhib gluconeogenesis

Adipocyte and liver- inhib lipolysis, stim fatty acid synthesis and esterification

Adipose- stim LPL

Liver and adrenals- stim cholesterol synthesis

Hypothalamus- suppresses appetite

All cells- stim amino acid uptake, stim protein synthesis, inhib protein degradation, stim DNA synthesis and cell proliferation, inhib apoptosis

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3
Q

Insulin preparations

A

Short acting synthetic (given with zinc for stability, clear solutions, neutral pH):

lispro- reverses amino acids B28 and B29, decreased hexamer stability

aspart- replacement of B28 proline with aspartic acid, decreased hexamer stability

glulisine- replacement of B29 lysine with glutamic acid, replacement of B3 asparagine with lysine, decreased hexamer stability

Short-acting (given with zinc for stability):

Regular (crystalline)

Intermediate-acting:

NPH (isophane)- protamine (protein that binds insulin) combined with insulin in phosphate buffer, prefered over lente, given as 70% NPH and 30% regular insulin

Lente- precipitate of insulin with increased zinc in acetate buffer. Can’t premix this, so NPH is more preferred

Long-acting:

Ultralente- increased zinc concentrations in acetate buffer. Very variable, has been replaced by glargine and detemir.

Glargine- pH of 4.0, 2 arginine residues added to C terminus of B chain and replace asparagine A21 with glycine to stabilize hexamer formation

Detemir- deleted B30 threonine and attached myristic acid to B29 lysine to stabilize hexamer formation and increases albumin binding

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4
Q

Sulfonylureas

A

MOA- stimulated insulin release via closing ATP sensitive K channels, may also potentiate insulin exocytosis by direct effect on binding proteins in secretory granules

Orally Active

Side effect- hypoglycemia

1st gen- tolbutamide, chlorpropamide (alcohol induced flush, hyponatremia), tolazamide (longer half life so harder to manage blood sugar in elderly)

2nd gen (100x more potent than 1st gen, short half-life)- glyburide, glipizide, glimepiride

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5
Q

Meglitinides

A

Repaglinide and nateglinide

Similar MOA to sulfonylureas in closing K channels

No direct effect on insulin exocytosis

No sulfur in structure (differs from sulfonylureas), so they don’t have problems with allergic responses to sulfur

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6
Q

Metformin

A

Does not cause hypoglycemia bc does not increase insulin, but it does increase the peripheral actions of insulin through AMPK

Decreases hepatic glucose output

Contraindicated with renal impairment, hepatic disease, and history of lactic acidosis (this last one is not a big deal with metformin)

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7
Q

Pioglitazone, rosiglitazone, troglitazone

A

Thiazolidinediones (drug class)

Increases insulin action by increasing glucose transporters

Binds to nuclear receptors PPARgama, regulates gene transcription, especially GLUT4

Troglitazone associated with liver failure, but need to monitor liver function with all of these drugs

Side effects- fluid retention, edema, weight gain, increase risk of heart failure (rosiglitazone and pioglitazone), increase risk of MI and stroke (rosiglitazone), increase risk of bladder cancer (pioglitazone)

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8
Q

Acarbose and miglitol

A

alpha-glucosidase inhibitors

decrease carb absorption

side effects- flatulence, diarrhea, abdominal pain

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9
Q

Colesevelam

A

bile acid binding resin

By weird mechanisms, it also lowers blood glucose

Used for type II diabetes

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10
Q

Exenatide

A

glucagon-like peptide-1 analog (GLP-1)

augments glucose-dependent insulin secretion

given by injection

also liraglutide

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11
Q

Sitagliptin

A

inhibitor of dipeptidyl peptidase-4 (DPP-4), which is the enzyme that degrades incretins like GLP-1

also saxagliptin

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12
Q

Pramlintide

A

synthetic analog of amylin

modulates postprandial glucose levels

suppresses glucagon release

delays gastric emptying

CNS anorectic effects

given as preprandial subQ injection

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13
Q

Drug Interactions

A

Hypoglycemic- ethanol, salicylates, beta-antagonists

Hyperglycemic- epinephrine, beta2-agonists, glucocorticoids, tacrolimus, thiazide diuretics, ca-channel blockers, clonidine, phenytoin, glucagon, diazoxide (can treat hypoglycemic episodes by binding to K channel and keeping it open, decreasing insulin release)

B-agonists main effects are peripherally, not at the pancreas

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14
Q

Vasopressin (ADH)

A

Receptors:

V1- PLC, PI hydrolysis, Ca, PKC, acts on vascular smooth muscle

V2- adenylate cyclase, cAMP, PKA, acts on principal cells and renal collecting duct

Desmopressin is synthetic analog that hits V2 selectively

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15
Q

Desmopressin

A

selective V2 agonist on principal cells in collecting duct

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16
Q

Treatment for Central and Nephrogenic Diabetes Insipidus

A

Central- desmopressin, chlorpropamide (enhances signal transduction), carbamazepine, clofibrate

Nephrogenic- lots of water intake, thiazide diuretics, indomethacin, amiloride (for lithium induced DI)

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17
Q

Treatment for SIADH

A

Water restriction, hypertonic saline

Demeclocycline (intereferes with V2 signal transduction), loop diuretics, lithium (last resort)

Conivaptan and tolvaptan- ADH receptor antagonists

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18
Q

Oxytocin (Pitocin)

A

Stimulates uterine contraction

Stimulates milk ejection from mammary glands

Major use is to induce labor

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19
Q

Other agents that stimulate uterine contraction

A

Can use these to treat post-partum hemorrhage

PG analogs in therapeutic abortion- misoprostol (PGE1 analog), dinoprostone (PGE2 analog)

Ergonovine/methylergonovine

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20
Q

Tocolytic agents

A

These relax uterine smooth muscle to prevent or arrest preterm labor

Beta2 selective agonists- terbutaline, ritodrine: relax smooth muscle

Nifedipine- Ca channel blocker: relax smooth muscle

Indomethacin- PG biosynthesis inhibitor, can also cause pre-mature closure of ductus arteriosus (adverse effect)

Atosiban- oxytocin receptor antagonist

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21
Q

GH agents

A

Somatropin

Mecasermin- recombinant IGF1 with binding protein, given for GH resistance (like in Loron type dwarfism)

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22
Q

LH agent

A

hCG (human chorionic gonadotropin)- acts at LH receptor

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23
Q

FSH agents

A

Menotropins- LH and FSH activity (horse urine)

Urofolitropin- mainly FSH (horse urine)

Follitropin- recombinant FSH

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24
Q

TSH agent

A

Thyrotropin- diagnostic agent used for thyroid cancer to enhance radioactive iodine uptake

Don’t really use for treatment, too expensive and it would be dumb

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25
ACTH agent
Cosyntropin- diagnostic use
26
GHRH Agents
All diagnostic agents Sermorelin- some therapeutic use, hard to mimic the pulsatile release TRH and CRH
27
GnRH agents
gonadorelin- often given in pulsatile form (IV) to stimulate LH/FSH release, short-acting Long-acting agents (some LH/FSH stim, but later get suppression): leuprolide- subcutaneous histrelin- subcutaneous nafarelin- nasal spray goserelin- subcutaneous triptorelin- IM ganirelix- GnRH receptor antagonist cetrorelix- GnRH receptor antagonis used for adjunct to infertility treatment, treatment of precocious puberty, chemical castration, prostate and breast cancer, endometriosis, and leiyomyomasassss
28
D2 Receptor agonists
Used to treat pituitary adenoma, especially prolactinomas and GH adenomas Bromocriptine, cabergoline Used to decrease prolactin secretion, "paradoxical" used to decrease GH release
29
Somatostatin analogs
Used to treat pituitary adenomas Octreotide, lanreotide Resistant to enzyme degradation, longer half-life More selective action, more pituitary and less GI and pancreas
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GH receptor antagonist
Used to treat pituitary adenoma Pegvisomant
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Thyroid hormones
Levothryoxine- T4 Liothyronine- T3 Liotrix- T4 and T3 Use nuclear receptors Used to treat hypothyroidism, cretinism, suppresses TSH in treatment of thyroid cancer High doses causes cardiac arrhythmias Drug interactions- estrogens increase binding of T4 to TBG, glucocorticoids and androgens and salicylates decrease binding of T4 to TBG, propranolol and glucocorticoids and PTU and amiodarone and radiology contrast agents inhibit T4 to T3 conversion
32
Propylthiouracil
Inhibits thyroid hormone synthesis via a few different mechanisms: Inhibits peroxidase oxidation of iodide and inhibits coupling reactions of DIT and MIT. Inhibits peripheral deiodination of T4 to T3 (could make a difference if there is severe thyroid excess, would be better than methimazone in this regard) 75 min half-life (shorter than methimazole) Can cause agranulocytosis (rare), fever, rash
33
Methimazole
Inhibits peroxidase oxidation of iodide and inhibits coupling reactions of DIT and MIT Half life of 4-6 hours Less frequent dosing, easier for patients Can cause agranulocytosis (rare and would happen early on), fever, rash and obviously, hypothyroidism
34
Thiocyanate, perchlorate, fluroborate
Anti-thyroid drugs (ionic inhibitors) Interferes with iodide concentration via blocking iodide transporter. compete with Iodide. These are toxic agents and so not frontline drugs. Can get fatal aplastic anemia with perchlorate
35
Iodine131
Anti-thyroid agent Acts the same as regular iodine Used in older patients. Treatment with this often leads to hypothyroidism but it's easy to bring them back to euthyroidism via thyroid hormones Used to treat metastatic thyroid carcinoma along with TSH (enhance uptake of radioactive iodine) Contraindicated in pregnant patients and children I123 : diagnostic use
36
Glucocorticoids
Like other steroids, lipophilic and well absorbed *orally.* Once in cytosol binds to GR (HSP is kicked off) and diffuses to nucleus where transcription occurs. carbohydrate, protein, lipid "central sparing, peripheral wasting" **Uses:** *replacement therapy*, *Congential adrenal hyperplasia* (ex: 21 alpha hydroxylase def), inflammatory states, asthma, immunosuppressive (transplant), ulcerative colitis Overdose will look like a Cushing's patient. Exogenous cortisol will cause feedback inh on Pituitary will result in decreased ACTH: Adrenals will atrophy
37
Mineralocorticoids
Aldosterone Increased Na reabsorption in distal nephron/ collecting duct Increase water absorption, K secretion, H secretion, bicarbonate generation Fludrocortisone is an aldosterone like drug (125X) with cortisol effects 10X cortisol
38
Adrenocorticosteroids
**Adverse:** adrenal suppression during replacement therapy, fluid and electrolyte abnormalities, edema, hypertension, cataracts, osteoporosis, growth suppression in children In kidney, cortisol gets converted to cortisone by **11B-HSD** so that there are no aldosterone like effects by cortisol binding the MR. Enzyme inhibited by licorice Oral prednisone gets converted to prednisolone by the liver using 11B-HSD. With liver disease, give prednisolone, don't mess around. **Prednisone** is 4X GR and 0.8 MR. *Triamcinolone, Betamethazone, Dexamethasone* are 5X, 25X, 25X more potent on GR, respectively (and 0 on MR) Could be useful in treating someone with congestive heart failure; don't cause more water retention but could help other problem, like inflammatory state. **Dexamethasone suppression test:** If ACTH is suppressed, it is coming from pituitary (Cusing disease state). If not suppressed, look for ectopic source like lung carcinoma.
39
Spironolactone and eplerenone
MR (aldosterone) antagonist Side effects- hyperkalemia, metabolic acidosis, impotence, gynecomastia (androgen effects mainly spironolactone) Used when there is a state of corisol or aldosterone excess.
40
Mifepristone
GR antagonist (not a pure antagonist) Developed as a progestin receptor antagonist If treating a female patient at child bearing age, be cautious
41
Mitotane
Inhibits biosynthesis of adrenocorticosteroids Adrenal lytic agent, used to treat inoperable adrenocortical carcinoma.
42
Ketoconazole
Inhibits P45017alpha (17,20 lyase) and P450acc (at high doses) SCC cuts down everything (androgen, cortisol, aldosterone) so it's a messy approach to bring down adrenocorticoids anti-androgen
43
Metyrapone and etomidate
Anti-adrenocorticoids Inhibits P45011beta (11-hydroxylase)
44
Estrogens
Estradiol- rarely used because it has a very high first pass effect in liver **Ethinyl estradiol**- synthetic etrogen with ethinyl substitution at C17, decrease first pass hepatic metabolism, increase oral bioavailability, high potency, used as *oral contraceptive* **Estrone sulfate**- conjugated estrogen, *less potent*, used in *post-menopausal replacement therapy*. Worried about breat, ovarian, and uterine cancer with estrogen, so avoid high potency drugs like ethinyl estradiol. Adverse effects- thromboembolic disease (especially smokers), breast and uterine carcinoma (they are estrogen dependent cancers) Benefits- decreases pregnancies with associated pathologies, osteoporosis, vasomoter symptoms, cardiovascular disease (HDL up, LDL down), vaginitis, and skin thinning
45
Clomiphene
Anti-estrogen Primary estrogen antagonist effect in pituitary but it's not very good anywhere else. Pituitary doesnt sense estrogen levels so there is *no feedback inhibition*; FSH and LH will be increased, which is beneficial for fertility Main use is to induce ovulation
46
Fulvestrant
Anti-estrogen and selective estrogen receptor modifier Full estrogen receptor antagonist Used to treat breast cancer with disease progression after tamoxifen therapy
47
Tamoxifen and toremifene
**Tamoxifen**- mixed agonist and antagonist properties, anti-estrogen in breast cancer, estrogenic action on endometrium (negative: due to cancer), estrogenic bone actions (positive: less likely to cause osteoporosis) Main use is for breast cancer **Toremifene**- derivative of tamoxifen. "me too" drug
48
Raloxifene
Estrogenic in bone (positive effect) Anti-estrogen in breast and endometrium (positive effects) This drug is awesome, so why don't we use this all the time? The debate is, is it as good as tamoxifen in treating breast cancer? Time will tell.
49
Progesterone derivatives
progesterone is not too terribly useful by itself. High first pass metabolism by liver and low oral bioavailability **Hydroxyprogesterone caproate**- parenteral use only **Medroxyprogesterone acetate**- can be used orally, used in post-meopausal replacement therapy
50
19-nor compounds
Progesterone analogs Don't have carbon 19 (nor 19) **norethindrone, norgestrel**- potent and *high oral bioavailability*, used in oral contraceptives, androgenic Adverse: (acne, weight gain, lowers HDL, raises LDL) **norgestimate, desogestrel**- less androgenic activity **drospirenone-** progestin agonist, spironolactone derivative (MR antagonist) **mifepristone**- an anti-progestin, GR antagonist. RU-486 abortion drug with some controversy in this country
51
Mifepristone
Anti-progestin, receptor antagonist for abortions, signals there is no progestin and so there is a signal to menstruate. In the US, not approved for post-coital contraception
52
Oral Contraceptives
Estrogen stays the same (usually they build during menstrual cycle) so this is non-physiological estrogen and progestin combinations- can be monophasic, biphasic, or triphasic, suppresses LH/FSH and ovulation. \*don't be silly and memorize the composition of various oral contraceptives *monophasic* is the most non-physiologic. *Biphasic* has higher dose of progestin for the last 11 days. The first 10 days will have lower progestin so there will be less androgen side effects with biphasic preps. Why not take drug last 7 days? allow menstruation. *Triphasic* is safer than biphasic because every 7 days progestrone is increased stepwise. Triphasic is most physiologic of all of the preps. More important to take the pill every day! \***Dont let your girl take a triphasic and skip a day of taking the pill** **progestin only:** when there is a risk for estrogen related cancers. **norgestrel or norethindrone** (mini-pill) **norgestrel** (norplant) MPA (depo-provera) injections that can last months to years for convenience levonorgestrel (Plan B), ulipristal (progesterone receptor modulator, suppress LH surge and ovulation) Progestin only compds increase cervical mucus thickening (sperm barrier), alters endometrium to impain implantation
53
Hormone treatment of breast cancer
Selective estrogen receptor modifiers- tamoxifen, toremifene, raloxifene, fulvestrant Aromatase inhibitors (non-steroidal)- have a nitrogen-containing heterocyclic moiety, binds heme of cyp450, competitive reversible inhibitors of aromatase, **anastrozole, letrozole** Aromatast Inhibitors (steroidal)- similar to androgen substrates in structure, suicide inactivators (irreversible), very potent **exemestane**
54
Trastuzumab
Breast cancer treatment Monoclonal antibody directed against the gene product of HER2/erbB-2/NEU oncogene Inhibits tyrosine kinase activity (EGF receptor) of oncogene product 30-35% of breast cancers overexpress HER2/erbB-2, associated with highly metastatic, aggressive disease with poor prognostic outlook cardiovascular side effects
55
Lapatinib
Inhibits erbB-1 and erbB-2 tyrosine kinase activity Binds to internal site on receptor and also inhibits activity of truncated form of the HER2 receptor lacking binding domain Fairly new so not known if it's better than trastuzumab or not Like trastuzumab, used for Non estrogen dependent cancer?
56
Testosterone esters
Type of androgen Esterification makes it more lipid soluble **Testosterone propionate**- short acting (2-3 times/week) **Testosterone cypionate**- long acting (once every 2-4 weeks) **Testosterone enanthate**- long acting (once every 2-4 weeks) These are what we use, forget the oral androgens Used to treat- primary **hypogonadism** and improve nitrogen balance, also treat (rarely though) anemia, osteoporosis, and breast cancer
57
Danazol, fluoxymesterone, methyltestosterone
Testosterone that is alkylated at C-17alpha postions, this decreases hepatic metabolism, increases oral bioavailability, but unfortunately they hang out and increases hepatic toxicity. Oral androgens are rarely prescribed, but body builders still take these via black market. Used to treat hereditary angioneurotic edema
58
Leuprolide
Anti-androgen Long-acting GnRH analog downregulates receptor in pituitary and less FSH and LH Treatment in precocious puberty, prostate cancer
59
Ganirelix
Anti-androgen GnRH antagonist
60
Spironolactone
Anti-androgen CYP17 inhibitor Androgen receptor antagonist, used to treat hirsutism (lots of hair where it shouldn't be...ie bearded lady) in women
61
Finasteride and dutasteride
Anti-androgen 5alpha-reductase inhibitory (finasteride mainly Type II, and dutasteride Types I and II), decreases dihydrotestosterone action Used to treat BPH adn male pattern baldness
62
Androgen receptor antagonists
Flutamide, bicalutamide, nilutamide Increased LH and FSH due to less feedback inhibition, and increased testosterone levels (not desireable), so use GnRH analog in addition to negate this effect. Prostate cancer Rx Bicalutamide has less adverse effects
63
Drugs that inhibit sexual function
Anti-hypertensives (diuretics, beta-blockers, Ca channel blockers, vasodilators, alpha 2 agonists), psychiatric drugs (dopamine antagonists) with increased prolactin levels anti depressants (anti-cholinergic) alcohol, nicotine, digoxin, cimetidine, spironolactone, endocrine drugs
64
Drugs that increase sexual function
Pentoxifylline- "fluidize" RBCs, improve blood flow Yohimbine- alpha 2 receptor antagonist **Sildenafil**, tadalafil, vardenafil- cGMP phosphodiesterase inhibitor. color vision side effects Phentolamine- alpha receptor antagonist. Improves blood flow to tissues. Orthostatic hypotension Apomorphine- dopamine agonist Alprostadil- prostaglandin E1, intraurethral app, intracavernosal injection
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Metronidazole
Treatment of STDs Active against anaerobic protozoal parasites Treats T. Vaginalis Growing resistance to this
66
Quinolones
Treatment of STDs ciprofloxacin, levofloxacin, ofloxacin Treatment for chlamydia, gonorrhea Contraindicated in pregnancy
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Penicillin
Treatment of STDs Treats syphilis and sensitive gonococcal strains, although most gonococcal are penicillin resistant nowadays
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Ceftriaxone
Treatment of STDs 3rd gen cephalosporin Therapy of choice for gonorrhea
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Doxycycline
Treatment of STDs Treats chlamydia, but not recommended for gonococcal infections Safe for patients with renal impairment because it's not renally eliminated Not recommended in pregnancy
70
Azithromycin
Treatment of STDs Treatment of chlamydial infections and nongonococcal urethritis 1 time dose treatment
71
Acyclovir, valcyclovir, famciclovir
Treatment of STDs Treats HSV type 2 \*for pharm this phase, just know what drug used to treat which bug. He's not concerned with the other details
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Foscarnet and ganiclovir
Treatment of STDs Treats CMV infection
73
Vit D analogs
ergocalciferol- D2, Cholecalciferol- D3 require 25-hydroxylation in liver **calcifediol-** (25-OH -cholecalciferol), requires 1-hydroxylation in kidney: use if there is just a liver problem **calcitriol** (1,25-dihydroxycholecalciferol): if kidney problems use this drug
74
Calcitonin
Salmon form is more potent, has direct effect on osteoclast to decrease bone resorption, decrease calcium and phosphate reabsorption in kidney Used when there are hyperactive osteoclasts
75
Estrogens/Selective estrogen receptor modifier (SERM) effect on bone
Acts on osteoblasts to decrease osteoclast recruitment and activation Estrogens cause synthesis of OPG which is a decoy receptor for ODF (rank ligand). Less rank ligand will interact with the rank receptor on osteoclast and so less osteoclasts will be activated. Beneficial in osteoporosis by decreasing bone resorption Androgens can be converted to estrogens by aromatase so treating osteoporosis with androgen is maybe useful
76
PTH, Teriparatide
intermittent administration promotes bone growth, often combinde with alendronate Estrogens, calcitonin decrease bone loss; PTH actually causes bone *deposition*
77
Glucocorticoids affect on Ca, VitD, etc
antagonize vit D stimulated intestinal calcium absorption, stimulate renal calcium excretion, block bone collagen synthesis, increase PTH stimulated bone resportion Negative effect in terms of osteoporosis
78
Denosumab
Human monoclonal antibody against RANKL Mimics effect of OPG New again, awaiting results woman has osteoporosis but has risk for breast cancer (BRCA1/2) and so how do you treat her? Denosumab obviously
79
Other non-hormonal agents that act on Ca, bone mineralization, etc
Ca supplements: calcium chloride, calcium carbonate (oral) Thiazide diuretics- reduce renal Ca excretion, useful to inhibit renal Ca stone formation Fluoride- accumulates in bone and teeth, may stabilize hydroxyapatite, increases bone volume, may increase osteoblast activity, toxicities limit use. No good systemic way to administer
80
Cinacalcet
calcium sensor mimetic, enhances sensitivity of parathyroid gland to free ionized Ca to suppress PTH
81
Plicamycin
Cytotoxic antibiotic that also decreases plasma clacium concentrations by inhibitin bone resporption
82
Oral Sodium Phosphate
binds cree ionized Ca high risk procedures
83
Edetate disodium (EDTA)
Ca chelator high risk procedures
84
Bisphosphonates
Decrease osteoclast function/ decrease bone resorption Resembles pyrophosphate. Osteoclast eats it and apoptosis ensues etidronate, pamidronate, alendronate, risedronate, tiludronate, zoledronate, ibandronate retard formation and dissolution of hydroxyapatite, decreases osteoclast function etidronate and tiludronate- metabolized into ATP analot and accumulates in osteoclasts which impairs cell function and viability, induces apoptosis, no gastric irritation with etidronate alendronate- inhibit protein prenylation which is important for osteoclast function, less side effect of decrease bone mineralization all have gastric irritation except etidronate zoledronate has some renal toxicity
85
Treatment of osteoporosis
Estrogens (front line), bisphosphonates, Vit D analogs, calcitonin, Ca supplements, thiazides
86
Treatment of hypercalcemia
Bisphosphonates, calcitonin, plicamycin, gallium nitrate, phosphates, glucocorticoids
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Treatment of hypocalcemia
Vit D analogs, calcium supplements
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Treatment of hypoparathyroidism
Vit D analog
89
Treatment of hyperparathyroidism
Cinacalcet
90
Iodide
Wolf Chaicoff effect: give exogenous Iodide from sources like amiodarone, Lugol's soluthion, radiology contrast agents. Iodide is toxic to cell and there is a shut down in T4 and T3 synthesis. Quick effect to make someone euthyroid before surgery. Also for thyrotoxic crisis (thyroid storm) Thyroid escape: downregulate Na/I receptors and so high levels of Iodide will no longer inhibit thyroid hormone production (after about 10 days of experiencing wolff-chaikoff effect). So long term treatment choice would be PTU or methimazole

Pharmacology (12 decks)

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