KG - Pharm 2 Exam 3, Thyroid

Question 1

thyroid is regulated by ___ & ____

Answer 1

TSH & IODIDE

Question 2

thyroid hormones increase ____

Answer 2

basal level of METABOLISM

Question 3

thyroid hormones are important for ___ & ___

Answer 3

GROWTH & MATURATION (incl CNS)

Question 4

what could hypothyroidism in children lead to?

Answer 4

CRETINISM

Question 5

gen info thyroid hormones?

Answer 5

• T4 more prevalent
• T3 secreted by thyroid & is metabolite of T4 by PERIPHERAL CELLS
• T3 3-5X MORE EFFECTIVE THAN T4
• ACT THROUGH NUCLEAR RECEPTORS

Question 6

signs/symptoms hypothyroidism

Answer 6

• SLOW metabolic rate
• SENSITIVITY TO COLD
• FATIGUE
• puffiness
• high TSH (primary hypo)
• goiter?

Question 7

levothyroxine sodium?

Answer 7

T4

• DOC = HYPOTHYROIDISM
• DRUG LEVELS MUST BE TITRATED TO PT
• • base on symptoms & TSH of pt

Question 8

liothyronine sodium?

Answer 8

T3

- used for initial therapy, not maintenance

Question 9

hypothyroidism - side effects/what to do?

Answer 9

• side effects similar to hyperthyroidism

- reduce dosage or stop for few days, resume at lower dose

Question 10

signs/symptoms hyperthyroidism?

Answer 10

• FAST metabolism
• arrhythmias, TACHYCARDIA
• FATIGUE
• HOT, sweating
• TREMOR
• INSOMNIA
• DIARRHEA, n/v, weight loss

Question 11

causes hyperthyroidism?

Answer 11

Grave’s dz

• antibodies to TSH receptor
• stim gland to make too much T3/T4

Toxic nodular goiter
- adenoma of thyroid that produces too much thyroid hormone

Question 12

tx of hyperthyroidism?

Answer 12

• SURGERY
• 131 I (radioactive iodide)
• LOWER T3/T4 w/ thioamides, iodide
• block symptoms w/ BETA BLOCKERS

Question 13

consequences thyroidectomy & 131I?

Answer 13

hypothyroidism

Question 14

risk tx w/ 131I?

Answer 14

thyroid storm

Question 15

DOC Grave’s?

Answer 15

pharmacologic tx

Question 16

propylthiouracil (PTU) & methimazole - MOA

Answer 16

• decr synthesis/release T4
• effects gradual - use beta blocker until effects seen
• CIRCULATING T3/T4 LASTS A WEEK OR SO

Question 17

which is more potent - methimazole or PTU?

Answer 17

methimazole

Question 18

PTU/methimazole - indications/therapeutic effects?

Answer 18

• DOC Grave’s dz

- used w/ other txs - reduces thyroid storm risk

Question 19

PTU only - MOA

Answer 19

blocks conversion T4 to T3

Question 20

PTU/methimazole - adverse effects?

Answer 20

• SEVERE LIVER INJURY, ACUTE LIVER FAILURE
• -> use methimazole
• ITCHING/RASH (most common)
• GRANULOCYTOPENIA & AGRANULOCYTOSIS
• ha, nausea, jaundice, myalgia, arthralgia, lymphadenopathy,psychosis
• GOITER
• keep low dose in pregnancy

Question 21

PTU or methimazole w/ early pregnancy?

Answer 21

PTU

Question 22

PTU or methimazole w/ allergies?

Answer 22

PTU

Question 23

iodide - MOA?

Answer 23

• rapidly DECREASE SYNTHESIS & RELEASE T3/T4

- SHORT TERM EFFECT (2-8 wks)

Question 24

iodide - indications/therapeutic effects?

Answer 24

• DECREASES VASCULARITY and thyroid content of gland
• used 7-10 days before surgery (decr chance of thyroid storm)
• use in RADIOACTIVE EMERGENCIES

Question 25

131I - MOA?

Answer 25

taken up by gland

• small amts = diagnostic
• large amts = destroys gland

Question 26

131I - indications/therapeutic effects?

Answer 26

• ELDERLY, pts w/ HEART DISEASE

Question 27

131I - adverse effects?

Answer 27

• can cause hypothyroidism w/ time

- thyroid storm risk (decr risk by use of thioamide prior to tx)

Question 28

propranolol - MOA?

Answer 28

beta blocker - INHIBITS PERIPHERAL CONVERSION OF T4 to T3

Question 29

propranolol - indications/therapeutic effects?

Answer 29

• prepare for surgery
• used while waiting for thioamides & 131I to take effect
• can stop symptoms of hyperthyroidism (tachycardia, tremors, etc)

Question 30

propranolol - contraindications?

Answer 30

asthma