Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Endocrinology > Hyperthyroidism Pharmacology > Flashcards

Hyperthyroidism Pharmacology Flashcards

1
Q

Drugs that inhibit TRH or TSH secretion without hypo/hyper thyroidism

A

bromocriptine, cabergoline, levodopa, corticosteroids, somatostatin, octreotide, metformin, interleukin-6, bexarotene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Drugs that inhibit thyroid hormone synthesis with hypothyroidism

A

iodides, amiodarone, lithium, thioamides, tyrosine, kinase inhibitors, HIV protease inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can Amiodarone induce hypothyroidism?

A

blocks peripheral conversion of T4 to T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can Amiodarone induce hyperthyroidism?

A

iodine induced mechanism (pt. with underlying thyroid disease)
inflammatory mechanism - leakage of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you treat Amiodarone induced hypothyroidism?

A

replace with levothyroxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you treat Amiodarone induced hyperthyroidism in patients with underlying thyroid disease (multinodular goiter)?

A

antithyroid medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you treat Amiodarone induced hyperthyroidism due to inflammatory mechanisms?

A

corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does Warfarin affect a patient with hyperthyroidism? What do you do to compensate?

A

increases catabolism of clotting factors

lower the Warfarin dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most common cause of hyperthyroidism?

A

Graves Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What lab value can you detect in a patient with Graves Disease?

A

thyrotropin receptor antibodies (TRAb)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Two types of Thioamides

A

methimazole and propylthiouracil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do thioamides prevent thyroid hormone synthesis?

A

inhibit thyroid peroxidase-catalyzed reactions

block iodine organification that leads to synthesis of T3 and T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is special about propylthiouracil (PTU)?

A

blocks conversion of T4 to T3 in peripheral tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Preferred pharmacotherapy treatment for hyperthyroidism

A

methimazole (MMI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How long does it take for thioamides to become effective?

A

3-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which thioamide is preferred in the first trimester during pregnancy?
Why?

A

propylthiouracil (PTU)

high protein bound (75-85%) so less effect on the fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When starting antithyroid medication what tests do you want to order at baseline?

A

CBC and LFT

[low WBC count and abnormal LFT most likely]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do you measure every 2-4 months in a patient on antithyroid medication?

A

free T4 and total T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When prescribing an antithyroid medication when can you expect symptom improvement?

A

within 3-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When do you reduce the antithyroid dose?

A

as soon as signs of HYPOthyroidism develop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the most favorable outcomes for remission in a patient with hyperthyroidism?

A

> 40 years old, small goiter, short duration of disease, no prior relapse with antithyroid drugs, duration of therapy 1-2 years, low TSAb titers at baselie or a reduction with treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

At the end of antithyroid drug therapy what would qualify the patient as being in remission?

A

low or undetectable levels of TRAb

normal seurm TSH, FT4, amd TT3 for 1 year after discontinuing the drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If your patient relapses after being treated with antithyroid drugs, what is the next line of therapy?

A

radioactive iodine (RAI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are some rare adverse effects in antithyroid medications?

A

agranulocytosis
vasculitis
hepatic damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the black box warning for propylthiouracil?
hepatic damage [severe liver injury and acute liver failure]
26
Common side effects of antithyroid medications
mild uticarial papular rash arthralgias GI intolerance
27
In a patient with hyperthyroidism who is taking Warfarin what lab value will be increased? Why?
INR | increased catabolism of vitamin K dependent clotting factors
28
MOA of radioactive iodine (RAI) treatment
taken up and concentrated in the thyroid gland - damages thyroid gland without affecting other tissues
29
Who is RAI treatment contraindicated in?
pregnancy/nursing [planning pregnancy in 4-6 mo] | thyroid cancer
30
How well is RAI absorbed?
rapidly after oral administrations - 90% in 60 min
31
How is RAI excreted?
renally (37-75%) | feces (~10%)
32
How long is the half life of RAI?
8 days
33
Prior to treating a female patient with RAI what do you want to obtain ___ hours prior to administering the therapy?
48 hours | pregnancy test
34
When treating hyperthyroidism with RAI, how long should you wait after giving the 1st dose to administer the 2nd dose?
6 months
35
What are some predictors of success in RAI therapy?
higher ablative dose, female, lower FT4 at diagnosis, absense of palpable goiter
36
Within first 1-2 months after RAI what lab values do you want to assess?
free T4, total T3, TSH
37
Once RAI becomes effective the patients will appear more as ____ and you will need to start the patient on _____
hypothyroid | thyroid hormone replacement therapy [dose based on FT4]
38
Mild adverse effects seen in RAI therapy
mild thyroid tenderness and dysphagia
39
Rare adverse effects seen in RAI therapy
hypersensitivity radiation induced thyroiditis cardiovascular events and tachycardia
40
After being treated with RAI when can men and women conceive?
women - stable euthyroidism is established | men - after 3-4 months
41
Why do you give antithyroid drugs up to 3 days prior to starting RAI and reinstituting 4 days after RAI treatment?
deplete thyroid hormone content within the gland
42
What do you start prior to RAI to minimize risk of hyperthyroidism and thyroid storm?
beta-blocker
43
What do patients want to avoid in their diet when going on RAI treatment?
iodine - cows milk, dairy, fish, seaweed, eggs, chocolate, iodized salt
44
What do you want to educate your patient on with RAI therapy?
adequate hydration frequent voiding [enhance excretion] stimulate salivary flow [gum or candy] avoid close contact with others
45
What three things do you use to pretreat a hyperthyroid patient prior to surgery?
methimazole propranolol iodide
46
Why do you give a patient propranolol prior to thyroid surgery?
antagonizes sympathetic/adrenergic effects of thyrotoxicosis reduces tachycardia, tremor, stare relieves palpitations, anxiety, tension control HTN and A-fib
47
Why do you give a patient iodide prior to thyroid surgery?
decrease vascularity of thyroid
48
Who benefits from taking propranolol prior to thyroid surgery?
> 60 years old HR > 90 beats/min CVD
49
At high doses what effect might propranolol have?
block peripheral T4 to T3 conversion
50
Preferred beta-blocker in pregnant/lactating women
propranolol
51
Which beta-blocker is used for thyrotoxicosis in ICU setting or storm? Why?
Esmolol | IV infusion
52
MOA of iodide salts and iodine
inhibits thyroid hormone biosynthesis - blocks thyroid hormone release - decrease size nad vascularity of thyroid gland
53
Disadvantages of iodide salts and iodine
increase intraglandular stores of iodine [delays onset of thioamide therapy and prevents use of RAI for weeks]
54
Two therapeutic uses for iodide salts and iodine
adjunctive preop prep for thyroidectomy | treatment of thyroid storm [with other therapies]
55
uncommon and reversible adverse effects of iodide salts and iodine
acneiform rash, swollen salivary glands, mucous membrane ulcers, conjunctivitis, rhinorrhea, drug fever, metallic taste, bleeding disorders, rare anaphylatic reacitons
56
What medication should be continued through RAI treatment?
beta-blocker
57
what can precipitate a thyroid storm?
infection, trauma, surgery, RAI, withdrawal from antithyroid medication
58
Signs and symptoms of thyroid storm
decompensated thyrotoxicosis, high fever, tachycardia, tachypnea, dehydration, delirium, coma, nausea, vomiting, diarrhea
59
therapeutic measures of thyroid storm
supress thyroid hormone formation and secretion treatment of precipitating event supportive care
60
when treating a patient with thyroid storm, what should you administer first?
antithyroid drug - methimazole or propylthiouracil
61
In thyroid storm, after administering antithyroid drug what else does the patient need?
iodine hydrocortisone propranolol [or esmolol if need IV]
62
in treating a patient with thyroid storm what is the overall goal of therapy?
blocking conversion of T4 to T3

Endocrinology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions