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IPAP > Pharm Block 3: Thy, Hypo, Lipid > Flashcards

Pharm Block 3: Thy, Hypo, Lipid Flashcards

1
Q

What roles to TH orchestrate within the body?

A 
Homeostasis
Metabolism
Growth
Development
Kids- growth/development
Adults- metabolic stability
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2
Q

Function of TSH

A

Stimulates thyroid to iodinize thyroglobulin and produce T3/T4

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3
Q

Funtion of Thyroid Peroxidase

A

Oxidizes iodide to iodine to make TH

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4
Q

What protein carries T3/T4?

A

Thyroxine Binding Globulin

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5
Q

T4 is converted to T3 in ___

A

Peripheral tissue
Liver is primary site of T3 production
T3- 3-5x greater activity
T4- longer t1/2

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6
Q

T3/4 bind to what 3 proteins?

A

TGB- thyroxine binding globulin
TBP- thyroxine binding pre-albumin
Albumin

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7
Q

TSH is AKA

A

Thyrotropin alfa (Thyrogen)

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8
Q

Define Hypothyroidism

A

Dec TH production
Primary- majority= Hashimotos
Secondary- hypothalamus/pituitary insufficiency or drug induced (Lithium)

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9
Q

What are the TSH and FT4 levels in primary hypothyroidism?

Secondary?

A 
1*=  High TSH, low FT4
2*= Low TSH and low FT4
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10
Q

Hyposecretion of T3 and T4 in adults causes ?

A

Nontoxic goiter

Constant TSH stimulation but no T3/T4= hypertrophy

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11
Q

Define Cretinism

A

Untreated hypothyroidism in infants/kids

Hypothyroidism that has inhibited body/brain development

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12
Q

What are the treatment goals for hypothyroidism

A

Normalize TSH and FT4
Minimize Sx
Minimize long term consequences

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13
Q

What is the drug name for Synthetic T3

A

Liothyronine

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14
Q

What is the drug name for Synthetic T4

A

Levothyroxine- DOC for thyroid replacement

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15
Q

What is the drug name for Synthetic T4:T3 (4:1)

A

Liotrix

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16
Q

What is the drug name for thyroid replacements from animal sources?

A

Dessicated Thyroid- Armour

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17
Q

MOA of thyroid replacement meds

A

Provide exogneous thyroid in doses adjusted every 6 wks w/ recommendations to take in AM on empty stomach

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18
Q

What needs to be monitored in Thyroid Repalcement PTs

A

TSH/FT4 baseling and every 6-8wks until normal, then every 6-12mon
S/Sx of improvement/hyperthyroidism

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19
Q

What decreased absorptions does thyroid meds cause?

A

Dec abosprtion of Antacids, Ferrous SUlfate, Bile Acid sequestarants, Acid Reducers or Sucralfate

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20
Q

What drugs interact with thyroid replacement meds and increase clearance?

A

Phenytoin
Carbamazepine
Rifampin

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21
Q

What drugs interact with thyroid replacement and decrease FT4?

What drugs can prevent conversion of T4 to T3

A

Estrogens

Amiodarone, Propranolol

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22
Q

How are Warfarin and Thyroid replacement meds related?

A

Warfarin inverse to thyroid hormone

Hyperthyroid= Dec Vit K= Dec coagulation

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23
Q

S/Sx of Myxedema Coma and how it’s treated

A

Weak, stupor, hypotherm/vent/glycemia/Na, shock and death

Levothyroxine IV 300-400mcg
Hydrocortisone until coexisting adrenal suppression is ruled out

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24
Q

What are the TSH and FT4 levels in Hyperthyroidism

A

Low TSH

High FT4

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25
# Define Thyrotoxic Crisis Define Thyroid Storm
Excessive amount of thyroid hormone Emergency characterized w/ decompensated thyrotoxicosis, fever, Tachy, delirum, N/V/D
26
Define Toxic Diffuse Goiter
Most common cause of hyperthyroidism | Thyroid stimulating Abs on TSH receptors mimic TSH and stimulate T3/4 production
27
What is the second most common cause of Hyperthyroidism
Drug induced
28
Define Pituitary Adenoma
Excessive TSH secretion doesn't respond to normal T3 feedback
29
Define Plummer's Dz
Toxic Multi-Nodular Adeonoma | Autonomous nodules hyperfunction causing excess thyroid secretion
30
Define Painful Sub-Acte Thyroiditis
Inflammation of gland by virus invasion of parenchym causing hormone release
31
Define Toxic Adenoma
Least common | Hot nodule, operating independently of pituitary and TSH
32
What are the treatment foals for hyperthyroidism
Minimize/eliminate Sx and consequences | Eliminate excess hormone and normalize TSH/FT4 levels
33
What are methods of treatment approaches for hyperthyroidism
Thionamides- block synthesis Iodides- block release Radioactive Isotope- ablates gland Adrenergic blockers- controls Sx
34
What are the Thionamide drug names?
Propylthiouracil | Methimazole
35
What are the Iodides drug names
K iodide- SSKI, Lugols solution
36
What are the drug names of radioisotopes used to ablate thyroid gland?
Sodium Iodide 131
37
What adrenergic blockers are used for hyperthyroidism
BB- esp Propranolol
38
What is the treatment of choice for non-pregnant PTs +21y/o with Graves, Multinodular or Toxic adenoma?
Radioactive Iodine | Also most cost effectice
39
What is the treatment of choice for severe hyperthyroidism
Surgery Also for PTs unwilling/unable to take anti-thyroid drugs Pregnancy
40
When are anti-thyroid pharmacotherapies used for hyperthyroidism?
Likely to achieve remission in 1yr Refusal of ablation/surgery Failed ablation/surgery Mod/severe exophthalmos
41
MOA of Thioamide
Inhibits thyroid peroxidase which blocks iodination and sythesis of thyroid hormones
42
What is the preferred med for Graves Dz?
Methimazole unless in 1st trimester then PTU is preferred, 10x potent, dose Q1D, Pregnancy Cat D, DOC for long term Propythiouracil- 1st trimester, thyroid storm and adverse reactions to methimazole (other than agranulocytosis or hepatitis), higher incidence of liver failure
43
How long is Thioamide use expected before improvement is seen?
3-8wks r/u w/ radioiodine or surgery Remission: 20%; TSH and T4 normal for 1 yr after d/c
44
What needs to be monitored in PTs on Thioamide
Baseline CBC w/ differential LFTs w/ bilirubin CBC w/ Diff and d/c if agranulocytosis occurs Jaundice
45
What drugs does Thioamide interact with?
Rad. Io 131- d/c Thioamide 3-5 days prior | Iodides- inc stores od iodine and may delay onset of Thioamide
46
Adverse effects of Thioamide
``` Black Box- liver injury/failure Cholestatic jaundice Agranulocytosis Leukopenia Arthralgia, Lupus like Rash ```
47
MOA of Iodides
Inhibits hormonal secretion in hrs to temporarily inhibit thyroid hormone synthesis Red vascularity to reduce size prior to ectomy
48
When are Iodides used?
Pre-op prep for Graves Dz Protection prior to radiation exposure May exacerbate hyperthyroidism
49
Adverse effects of Iodides?
``` Rash Hypersalivation Swollen/sore gums Metallic tase Itch Rhinitis ```
50
Don't use Iodides with what drugs?
RI 131- d/c 3-4 days prior | Lithium
51
Potassium iodide also used for ?
Antiseptic Expectorant Reduce thyroid cancer after nuclear accident
52
MOA of RI131 What is monitored
Accumulates in thyroid and emits B/G radiation to destroy thyroids tissue Neg pregnancy must be confirmed 48hrs pre-treatment TSH and FT4 at 4-6wk intervals?
53
Adverse effects of TI131
Hypothyroidism Pain Exophalmosis exacerbation, esp in smokers
54
Contraindications of using RI131
Pregnant Breast feeding Severe ophthalmopathy
55
Non-Sel BBs used in hyperthyroidism
Propranolol Nadolol Metoprolol Esmolol
56
What drugs can't be used w/ BBs in hyperthyroidism
B2 agonists | Non-DHP CCBs- can be used in PTs w/ tachy who are contraindicated to use BBs
57
Define Thyrotoxicosis Factitia
Low TSH, High FT4 | Any state of excess hormone including ingestion and itis
58
What drugs are used to managing thyroid storms?
``` Propylthiouracil SSKI Propranolol (Diltiazem if BBs are contraindicated) Acetaminophen Hydrocortisone Cholestyramine ```
59
What are the major lipids in the body?
CHolesterol Triglycerides Phospholipids
60
What is cholesterol needed for?
Bile acids Steroids Cell membrane- phospholipid bilary
61
Define TG
Fat from 3 FAs to supply energy to muscles
62
Systemic circulating cholesterol comes from what wo sources?
Endongenous- liver; HMG-COA to mevalonate catalyzed by HMG-CoA Reductase (rate limiting step of synthesis) and this is the site of Statin action Exogenous- diet
63
How are cholesterol and TGs carried through the body?
Lipoproteins
64
What is the make up of chylomicrons
TGs: 85-95% Cholesteral: 3-6% Protein: 1-2% (higher protein=higher density)
65
What is the make up of VLDLs
TGs 50-60 Cholesterol 20-30 Protein 6-10
66
What is the make up of LDLs
Cholesterol 50-60 Proteins 18-22 TGs 5-10
67
What is the make up of HDLs
Protein 45-55 Cholesterol 5-20 TGs 5-10
68
What are the AKAs for HDL, LDL, and Chylomicrons
HLD- apo-A1 LDL- apo-B100 Chylo- apo B-48
69
Define Type 1 Lipid Abnormality
Chylomicrons Familial hyperchylomiconemia Not associated w/ inc CHD No drug treatments
70
Define Type 2A Lipid Abnormality
LDL Familial Hypercholestolermia, Polygenic Hypercholesterolemia Most common Ischemic heart Dz accelerated
71
Type 2A Lipid Abnormality
Cholestyramine and niacin or, Statin Lomitapide Mipomersen
72
Define Type 2B Lipid Abnormality
LDL and VLDL Familial Combined Hyperlipidemia Common, from over production of VLDL in liver Same diet/treatment as 2A
73
Define Type 3 Lipid Abnormality
Familial Dysbetalipoproteinemia IDL, LDL 1 Inc/poorly used IDL from mutant Apolipoprotein E Xanthomas and VascDz in middle age
74
How are Type 3 Lipid Abnormality treated
Diet | Niacin and Fenofibate or a statin
75
Define Type 4 Lipid Abnormality
VLDL Family Hypertriglyceridemia, Isolated hypertriglyceridemia Common dz from inc production/dec removal of VLDL and TG PT obese, DM, and hyperuremic
76
How are Type 4 Lipid Abnormality treated
Niacin and or Fenofibrate
77
Define Type 5 Lipid Abnormality
VLDL and Chylomicrons Familial Mixed Hypertricyleridemia Inc production/dec removal of VLDL in adults obese or DM
78
How are Type 5 Lipid Abnormality treated
Niacin and/or Fenofibriate or statin
79
# Define Secondary Prevention Define Primary Prevention
PTs w/ previous CHD event | PTs w/ no Hx of CHD w/ A-Sx dyslipidemia
80
Total cholesterol ranges HDL ranges
<200 desireable >240 high >280 very high <40, low/bad >60 high/good
81
LDL ranges TG ranges
<100 optimum 160-189 high >190 very high <150 normal 100-499 high >500 very high
82
Factors used to assess need for statin therapy
``` Non hispanic/Caucasion/AfAm 40-79 W-W/out Diabetees LDL 70-189 w/out hx of ASCVD No statin therapy ```
83
What are the 4 major statin benefit groups
1- ASCVD- primary prevention LDL >190 40-75y/o w/ DM and LDL 70-189 40-75y/o w/ LDL 70-189 and ASCVD >7.5%
84
What are the types of Hypolipidemic Agents
HMG-CoA Reductase Inhibitors (statins) Alteration Lipid/Lipoprotein metabolism (Niacin, Fibric Acid, PCSK9 Inhib) BAS- Colisterpol, Cholestyramine, Colesevelam( Absorption Inhibitor (Ezetimibe)
85
MOA of HMG-CoA Reductase Inhibitors
Inhibit first step of sterol synthesis by blocking Hydroxymethylglutaryl CoA reductase and depletes the intracellular supply of cholesterol
86
When are HMG-CoA Reductase Inhibitors clinically used?
DOC for high LDL and or CHD/risk | Not for under 18y/o
87
What are the clinical effects of HMG-CoA Reductase Inhibitors
Best PO med for reducing LDL | Reduce coronary events/CHD mortality/stroke
88
When do HMG-CoA Reductase Inhibitors need to be taken?
PM to increased efficacy and coincides with night upturn of cholesterol biosynthesis at night
89
What are the two exceptions for Statin dosing at night?
Atorva | Rosuva
90
How long of a period needs to pass between changing statin dosages?
4wks
91
What are the adverse effects of HMG-CoA Reductase Inhibitors?
Myalgia Mypoathy Rhabdo Liver toxicity- obtain baseline LFTs and at 6 and 12wks
92
What 2 statins don't require dose adjustments for reduced renal function? What one is not highly protein bound?
Atrova and Pita Pravastatin (may displace warfarin)
93
Absolute contraindications for using HMG-CoA Reductase Inhibitors
Liver Dz Pregnancy X Nursing
94
Drug interactions of HMG-CoA Reductase Inhibitors
``` P450 (except Prava and Fluva) Grapefruit Red Yeast Rice- contains monacolin K (inc myopathy and rhabdo risk) Fibric Acid derivatives Gemfibrozil Niacin ```
95
What drug is considered best for lowering TGs?
Fibric acid derivatives, PPAR-a agonists which inc speed of chylomicron/VLDL removal
96
What drug is used to lower TGs but may also cause an increase of HDL?
Fibrates
97
When are Fibrates used clinically?
Hypertriglyeridemias when VLDL predominates Dysbetalipoproteinemia HIV hypertriglyceridema Option for PTs who can't use statins
98
What are the drug names in Fibrates
Fibric Acid Derivative= Gemfibrozil (take w/ food) Fenofibrate Fenofibric acid
99
What are the averse effects of statin? What monitoring is done?
Myopathy/rhabdo when Genfibrozil used w/ statin HA, rash, GU malignancy Monitor LFTs when used w/ statin
100
Avoid using Gemfibrozil w/ ? | Contraindications for using Fibrates?
Any statin Liver/kidney/biliary dz
101
MOA of B3 What is used for?
Inhibits formation/secretion of VLDL and inhibit lypolysis Best for raising HDL PTs intolerable to statin
102
PTs with Heterozygous Familial Hypercholesterolemia use what med combo?
Niacin w/ resin/HMG-CoA reductase inhibitor
103
Adverse effects of using NIacin
Flushing/warmth (red w/ aspirin 30m prior) | GI upset
104
Adverse effects of Niacin? Contraindications for use?
Liver toxicity Hyperuricemia/glycemia Liver Dz, Gout, peptic ulcer, allegy Monitor LFTs at base, 6-12wks and annual
105
MOA of BABA
Bind to bile salts leading to more cholesterol being converted to bile salts w/out being absorbed
106
When are BABAs used?
PTs can't use statins | T2DM adjunt
107
What are the names of the BABAs?
Colistepol- Cat B Cholestyramine- Cat C Colesevelam- Cat B
108
Adverse effects and contraindications of using BABAs?
GI distress Constipation Dec drug absorption Inc TG >400
109
What is the name of the selective cholesterol absorption inhibitor drug
Ezetimibe Inhibits absorption in small intestine of all cholesterols
110
When is Ezetimibe used?
Adjunct to statins | Reduces LDL in Primary Hyperlipidemia and Homozygous Family Hyperlipid
111
What are the Ezetimibe combos?
Take 2hrs prior or 4 hrs after Atrovastatin/Eze Simbastatin/Eze
112
MOA of PCSK9 Inhibitors
Inhibits enzyme from binding to LDLReceptors and promote LDL degradation in liver
113
Clinical uses of PCSK9 Inhibitors
Effective LDL lowering | Adjunt w/ diet and max statin dose
114
Adverse effects of PCSK9 Inhibitors
Nasopharyngitis Influenza Site reactions
115
What are the names of the PCSK9 inhibitors
Alirocumab | Evolocumab
116
Use of Omega 3 FAs
Lowering TG Modest HDL increase May raise LDL if TG is high
117
What are the medications for Omega 3 FAs?
Lovaza (burps, fish taste aversion, dyspepsia) Icosapent Ethyl- only has EPA
118
When is Icosapent Ethyl used
Adjunct to diet to reduce TGs in PTs w/ severe hypertriglyceridemia
119
Use for Psyllium
Metamucil | Bulk forming laxative w/ LDL lowering abilities
120
Pharmacological applications for Hypothalamus/Pituitary
Replace hormone deficiency Antagonist for excess hormone production Dx for endocrine issues
121
Use of CRH in clinical
Dx agent between Pituitary (Cushings) and Ectopic production of ACTH
122
What happens to PT with Cushings who receives CRH
Corticoreline Ovine Triflutate ACTH and cortisol secretions Ectopic production won't respond
123
What is the HPA axis
``` Hypothatlamus CRH Ant Pituitary ACTH Adrenal Cortex CORT ```
124
Function of pulsatile and sustaine GnRH
``` P= stimulate gonadotroph cell to release LH and FSH until puberty S= inhibit release of FSH and LG resulting in hypogonadism ```
125
Role of FSH in men and women
``` W= ovarian follicle development M= Regulate spermatogenesis ```
126
Role of LH in men and women
``` W= stimulates androgen production in folicular stage of menstrual cycle M= testosterone synthesis stimulation in Leydig cells ```
127
When are GnRH or LHRH used clinically
``` Treat infertility Precocious puberty Transgenders Prostate cancer Assisted reproductive technology Ovarian suppression ```
128
Adverse effets of GnRH and LHRH use
Flare of of dz in first week of therapy Hot flash Erectile impotence Dec libido
129
LHRH is released by the ___ in a ___ manner
Hypothalamus | Pulsatile
130
What hormone is under study for it's role in aiding/developing prostate cancer?
FSH
131
What are the names of the GnRH/LHRH drugs
``` Goserelin Leuprolide Nafarelin Histrelin Acetate Triptorelin ```
132
What are the approved scenarios for using GnRH and LHRH
Prostate cancer Enometriosis Central Precocious Puberty (Nafarelin)
133
MOA of GnRH Antagonists
Suppresses LH and FSH | Turns GnRH receptor off to avoid testosterone surges
134
What drugs are used as GnRH antagonists to inhibit premature LH surges in women undergoing ovarian hyperstimulation procedures?
Ganireliz Cetrorelix Men w/ prostate cancer= Degarelix
135
What are the Ant Pituitary Hormones
``` G FLAT GH TSH ACTH FSH LH PRL ```
136
What inhibits growth hormone/somatotropin
Somatostatin | IGF-1
137
What inhibits TSH
T3/T4
138
What inhibits ACTH
Cortisol
139
What inhibits FSH
Inhibin | Estrogen
140
What inhibits LH
Estrogen Progestine Testosterone
141
What inhibits PRL
Dopamine
142
What causes Acromegaly and Gigantism
Pituitary adenoma secreting growth hormone
143
What causes hyperprolactinemia
Prolactinoma | CNS lesion
144
What are the three hyper secretion Dzs
Acromegaly Gigantism Hyperprolactinemia
145
What are the hyposecretory Dzs
GH deficiency | Panhypopituitarism
146
What drugs are used for Acromegaly
Somatostatin analogs GHR Antagonist Dopamine antagonists
147
Somatostatin inhibits release of ?
GH Glucagon Insulin Gastrin
148
When is Somatostatin used?
Acromegaly Vasoactive Intestinal peptide secretory diarrhea Esophageal varices bleeding
149
What are the Somatostatin drugs?
Octreotide | Lanreotide- Acromegaly only
150
MOA of Pegvisomant
Blocks GH binding and DEC IGF-1 levels Used in Acromegaly resistant/intolerable to other therapies
151
When can GH therapy be used for kids?
Inadequate GH- Turner, Noonan Synd Chronic renal insufficiency Catch-up if failing at 2-4yrs Prader-Willi Syndrome
152
When can GH therapy be used for adults?
HIV wasting GH deficiency replacement Short bowel syndrome
153
What is the use of TSH
Thyrotropin Dx agent for detecting thyroglobulin from cancer after extomy Thyrotropin Alfa
154
What is ACTH used for?
Differentiate between Addisons 1* or 2* pituitary disorder Cosyntropin
155
What are the FSH LH drug names
Follitropin alfa Follitropin beta Urofollitropin- urine of post-menopause women Lutropin alfa- LH
156
What drugs are used for hyperprolactinemia
D2 Agonists- Bromocriptine or Cabergoline
157
What are the two Posterior pituitary hormones
ADH (AVP) | Oxytocin
158
When is ADH clinically used?
DI Esophageal varices Vasodilatory shock
159
When is Desmopressin used?
``` DI Polyuria/dipsia Hemophilia A von Willebrand Dz Nocturnal enuresis ```
160
Treatment of hyponatremia needs to be weighed against the risk of inducing ?
Central Pontine Myelinolysis
161
What are the treatment goals of SIADH
Raise serum Na by 0.5-1 mEq/hr | No more than 10-12 mEq in first 24hrs
162
What drugs can be used as vasopressin antagonists for SIADH
Conivaptan- hospitalized PT | Tolvaptan- PT w/ HF and SIADH
163
What causes oxytocin to be released
Neuroendocrine reflex
164
What is oxytocin used for in clinic
Stimulate lactation Labor induction Post-partum bleeding
165
What drug has off label use for stimulating lactation in women
Metoclopramide

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