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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
Q

Define Thyrotoxic Crisis

Define Thyroid Storm

A

Excessive amount of thyroid hormone

Emergency characterized w/ decompensated thyrotoxicosis, fever, Tachy, delirum, N/V/D

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26
Q

Define Toxic Diffuse Goiter

A

Most common cause of hyperthyroidism

Thyroid stimulating Abs on TSH receptors mimic TSH and stimulate T3/4 production

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27
Q

What is the second most common cause of Hyperthyroidism

A

Drug induced

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28
Q

Define Pituitary Adenoma

A

Excessive TSH secretion doesn’t respond to normal T3 feedback

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29
Q

Define Plummer’s Dz

A

Toxic Multi-Nodular Adeonoma

Autonomous nodules hyperfunction causing excess thyroid secretion

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30
Q

Define Painful Sub-Acte Thyroiditis

A

Inflammation of gland by virus invasion of parenchym causing hormone release

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31
Q

Define Toxic Adenoma

A

Least common

Hot nodule, operating independently of pituitary and TSH

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32
Q

What are the treatment foals for hyperthyroidism

A

Minimize/eliminate Sx and consequences

Eliminate excess hormone and normalize TSH/FT4 levels

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33
Q

What are methods of treatment approaches for hyperthyroidism

A

Thionamides- block synthesis
Iodides- block release
Radioactive Isotope- ablates gland
Adrenergic blockers- controls Sx

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34
Q

What are the Thionamide drug names?

A

Propylthiouracil

Methimazole

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35
Q

What are the Iodides drug names

A

K iodide- SSKI, Lugols solution

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36
Q

What are the drug names of radioisotopes used to ablate thyroid gland?

A

Sodium Iodide 131

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37
Q

What adrenergic blockers are used for hyperthyroidism

A

BB- esp Propranolol

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38
Q

What is the treatment of choice for non-pregnant PTs +21y/o with Graves, Multinodular or Toxic adenoma?

A

Radioactive Iodine

Also most cost effectice

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39
Q

What is the treatment of choice for severe hyperthyroidism

A

Surgery
Also for PTs unwilling/unable to take anti-thyroid drugs
Pregnancy

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40
Q

When are anti-thyroid pharmacotherapies used for hyperthyroidism?

A

Likely to achieve remission in 1yr
Refusal of ablation/surgery
Failed ablation/surgery
Mod/severe exophthalmos

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41
Q

MOA of Thioamide

A

Inhibits thyroid peroxidase which blocks iodination and sythesis of thyroid hormones

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42
Q

What is the preferred med for Graves Dz?

A

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

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43
Q

How long is Thioamide use expected before improvement is seen?

A

3-8wks r/u w/ radioiodine or surgery

Remission: 20%; TSH and T4 normal for 1 yr after d/c

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44
Q

What needs to be monitored in PTs on Thioamide

A

Baseline CBC w/ differential
LFTs w/ bilirubin

CBC w/ Diff and d/c if agranulocytosis occurs
Jaundice

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45
Q

What drugs does Thioamide interact with?

A

Rad. Io 131- d/c Thioamide 3-5 days prior

Iodides- inc stores od iodine and may delay onset of Thioamide

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46
Q

Adverse effects of Thioamide

A 
Black Box- liver injury/failure
Cholestatic jaundice
Agranulocytosis
Leukopenia
Arthralgia, Lupus like
Rash
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47
Q

MOA of Iodides

A

Inhibits hormonal secretion in hrs to temporarily inhibit thyroid hormone synthesis
Red vascularity to reduce size prior to ectomy

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48
Q

When are Iodides used?

A

Pre-op prep for Graves Dz
Protection prior to radiation exposure
May exacerbate hyperthyroidism

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49
Q

Adverse effects of Iodides?

A 
Rash
Hypersalivation
Swollen/sore gums
Metallic tase
Itch
Rhinitis
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50
Q

Don’t use Iodides with what drugs?

A

RI 131- d/c 3-4 days prior

Lithium

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51
Q

Potassium iodide also used for ?

A

Antiseptic
Expectorant
Reduce thyroid cancer after nuclear accident

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52
Q

MOA of RI131

What is monitored

A

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?

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53
Q

Adverse effects of TI131

A

Hypothyroidism
Pain
Exophalmosis exacerbation, esp in smokers

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54
Q

Contraindications of using RI131

A

Pregnant
Breast feeding
Severe ophthalmopathy

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55
Q

Non-Sel BBs used in hyperthyroidism

A

Propranolol
Nadolol
Metoprolol
Esmolol

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56
Q

What drugs can’t be used w/ BBs in hyperthyroidism

A

B2 agonists

Non-DHP CCBs- can be used in PTs w/ tachy who are contraindicated to use BBs

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57
Q

Define Thyrotoxicosis Factitia

A

Low TSH, High FT4

Any state of excess hormone including ingestion and itis

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58
Q

What drugs are used to managing thyroid storms?

A 
Propylthiouracil
SSKI
Propranolol (Diltiazem if BBs are contraindicated)
Acetaminophen
Hydrocortisone
Cholestyramine
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59
Q

What are the major lipids in the body?

A

CHolesterol
Triglycerides
Phospholipids

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60
Q

What is cholesterol needed for?

A

Bile acids
Steroids
Cell membrane- phospholipid bilary

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61
Q

Define TG

A

Fat from 3 FAs to supply energy to muscles

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62
Q

Systemic circulating cholesterol comes from what wo sources?

A

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

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63
Q

How are cholesterol and TGs carried through the body?

A

Lipoproteins

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64
Q

What is the make up of chylomicrons

A

TGs: 85-95%
Cholesteral: 3-6%
Protein: 1-2% (higher protein=higher density)

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65
Q

What is the make up of VLDLs

A

TGs 50-60
Cholesterol 20-30
Protein 6-10

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66
Q

What is the make up of LDLs

A

Cholesterol 50-60
Proteins 18-22
TGs 5-10

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67
Q

What is the make up of HDLs

A

Protein 45-55
Cholesterol 5-20
TGs 5-10

68
Q

What are the AKAs for HDL, LDL, and Chylomicrons

A

HLD- apo-A1
LDL- apo-B100
Chylo- apo B-48

69
Q

Define Type 1 Lipid Abnormality

A

Chylomicrons
Familial hyperchylomiconemia
Not associated w/ inc CHD
No drug treatments

70
Q

Define Type 2A Lipid Abnormality

A

LDL
Familial Hypercholestolermia, Polygenic Hypercholesterolemia
Most common
Ischemic heart Dz accelerated

71
Q

Type 2A Lipid Abnormality

A

Cholestyramine and niacin or,
Statin

Lomitapide
Mipomersen

72
Q

Define Type 2B Lipid Abnormality

A

LDL and VLDL
Familial Combined Hyperlipidemia
Common, from over production of VLDL in liver
Same diet/treatment as 2A

73
Q

Define Type 3 Lipid Abnormality

A

Familial Dysbetalipoproteinemia
IDL, LDL 1
Inc/poorly used IDL from mutant Apolipoprotein E
Xanthomas and VascDz in middle age

74
Q

How are Type 3 Lipid Abnormality treated

A

Diet

Niacin and Fenofibate or a statin

75
Q

Define Type 4 Lipid Abnormality

A

VLDL
Family Hypertriglyceridemia, Isolated hypertriglyceridemia
Common dz from inc production/dec removal of VLDL and TG
PT obese, DM, and hyperuremic

76
Q

How are Type 4 Lipid Abnormality treated

A

Niacin and or Fenofibrate

77
Q

Define Type 5 Lipid Abnormality

A

VLDL and Chylomicrons
Familial Mixed Hypertricyleridemia
Inc production/dec removal of VLDL in adults obese or DM

78
Q

How are Type 5 Lipid Abnormality treated

A

Niacin and/or Fenofibriate or statin

79
Q

Define Secondary Prevention

Define Primary Prevention

A

PTs w/ previous CHD event

PTs w/ no Hx of CHD w/ A-Sx dyslipidemia

80
Q

Total cholesterol ranges

HDL ranges

A

<200 desireable
>240 high
>280 very high

<40, low/bad
>60 high/good

81
Q

LDL ranges

TG ranges

A

<100 optimum
160-189 high
>190 very high

<150 normal
100-499 high
>500 very high

82
Q

Factors used to assess need for statin therapy

A 
Non hispanic/Caucasion/AfAm
40-79
W-W/out Diabetees
LDL 70-189 w/out hx of ASCVD
No statin therapy
83
Q

What are the 4 major statin benefit groups

A

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
Q

What are the types of Hypolipidemic Agents

A

HMG-CoA Reductase Inhibitors (statins)
Alteration Lipid/Lipoprotein metabolism (Niacin, Fibric Acid, PCSK9 Inhib)
BAS- Colisterpol, Cholestyramine, Colesevelam(
Absorption Inhibitor (Ezetimibe)

85
Q

MOA of HMG-CoA Reductase Inhibitors

A

Inhibit first step of sterol synthesis by blocking Hydroxymethylglutaryl CoA reductase and depletes the intracellular supply of cholesterol

86
Q

When are HMG-CoA Reductase Inhibitors clinically used?

A

DOC for high LDL and or CHD/risk

Not for under 18y/o

87
Q

What are the clinical effects of HMG-CoA Reductase Inhibitors

A

Best PO med for reducing LDL

Reduce coronary events/CHD mortality/stroke

88
Q

When do HMG-CoA Reductase Inhibitors need to be taken?

A

PM to increased efficacy and coincides with night upturn of cholesterol biosynthesis at night

89
Q

What are the two exceptions for Statin dosing at night?

A

Atorva

Rosuva

90
Q

How long of a period needs to pass between changing statin dosages?

A

4wks

91
Q

What are the adverse effects of HMG-CoA Reductase Inhibitors?

A

Myalgia
Mypoathy
Rhabdo
Liver toxicity- obtain baseline LFTs and at 6 and 12wks

92
Q

What 2 statins don’t require dose adjustments for reduced renal function?

What one is not highly protein bound?

A

Atrova and Pita

Pravastatin (may displace warfarin)

93
Q

Absolute contraindications for using HMG-CoA Reductase Inhibitors

A

Liver Dz
Pregnancy X
Nursing

94
Q

Drug interactions of HMG-CoA Reductase Inhibitors

A 
P450 (except Prava and Fluva)
Grapefruit
Red Yeast Rice- contains monacolin K (inc myopathy and rhabdo risk)
Fibric Acid derivatives
Gemfibrozil
Niacin
95
Q

What drug is considered best for lowering TGs?

A

Fibric acid derivatives, PPAR-a agonists which inc speed of chylomicron/VLDL removal

96
Q

What drug is used to lower TGs but may also cause an increase of HDL?

A

Fibrates

97
Q

When are Fibrates used clinically?

A

Hypertriglyeridemias when VLDL predominates
Dysbetalipoproteinemia
HIV hypertriglyceridema
Option for PTs who can’t use statins

98
Q

What are the drug names in Fibrates

A

Fibric Acid Derivative= Gemfibrozil (take w/ food)
Fenofibrate
Fenofibric acid

99
Q

What are the averse effects of statin?

What monitoring is done?

A

Myopathy/rhabdo when Genfibrozil used w/ statin
HA, rash, GU malignancy

Monitor LFTs when used w/ statin

100
Q

Avoid using Gemfibrozil w/ ?

Contraindications for using Fibrates?

A

Any statin

Liver/kidney/biliary dz

101
Q

MOA of B3

What is used for?

A

Inhibits formation/secretion of VLDL and inhibit lypolysis

Best for raising HDL
PTs intolerable to statin

102
Q

PTs with Heterozygous Familial Hypercholesterolemia use what med combo?

A

Niacin w/ resin/HMG-CoA reductase inhibitor

103
Q

Adverse effects of using NIacin

A

Flushing/warmth (red w/ aspirin 30m prior)

GI upset

104
Q

Adverse effects of Niacin?

Contraindications for use?

A

Liver toxicity
Hyperuricemia/glycemia

Liver Dz, Gout, peptic ulcer, allegy
Monitor LFTs at base, 6-12wks and annual

105
Q

MOA of BABA

A

Bind to bile salts leading to more cholesterol being converted to bile salts w/out being absorbed

106
Q

When are BABAs used?

A

PTs can’t use statins

T2DM adjunt

107
Q

What are the names of the BABAs?

A

Colistepol- Cat B
Cholestyramine- Cat C
Colesevelam- Cat B

108
Q

Adverse effects and contraindications of using BABAs?

A

GI distress
Constipation
Dec drug absorption

Inc TG >400

109
Q

What is the name of the selective cholesterol absorption inhibitor drug

A

Ezetimibe

Inhibits absorption in small intestine of all cholesterols

110
Q

When is Ezetimibe used?

A

Adjunct to statins

Reduces LDL in Primary Hyperlipidemia and Homozygous Family Hyperlipid

111
Q

What are the Ezetimibe combos?

A

Take 2hrs prior or 4 hrs after

Atrovastatin/Eze
Simbastatin/Eze

112
Q

MOA of PCSK9 Inhibitors

A

Inhibits enzyme from binding to LDLReceptors and promote LDL degradation in liver

113
Q

Clinical uses of PCSK9 Inhibitors

A

Effective LDL lowering

Adjunt w/ diet and max statin dose

114
Q

Adverse effects of PCSK9 Inhibitors

A

Nasopharyngitis
Influenza
Site reactions

115
Q

What are the names of the PCSK9 inhibitors

A

Alirocumab

Evolocumab

116
Q

Use of Omega 3 FAs

A

Lowering TG
Modest HDL increase
May raise LDL if TG is high

117
Q

What are the medications for Omega 3 FAs?

A

Lovaza (burps, fish taste aversion, dyspepsia)

Icosapent Ethyl- only has EPA

118
Q

When is Icosapent Ethyl used

A

Adjunct to diet to reduce TGs in PTs w/ severe hypertriglyceridemia

119
Q

Use for Psyllium

A

Metamucil

Bulk forming laxative w/ LDL lowering abilities

120
Q

Pharmacological applications for Hypothalamus/Pituitary

A

Replace hormone deficiency
Antagonist for excess hormone production
Dx for endocrine issues

121
Q

Use of CRH in clinical

A

Dx agent between Pituitary (Cushings) and Ectopic production of ACTH

122
Q

What happens to PT with Cushings who receives CRH

A

Corticoreline Ovine Triflutate

ACTH and cortisol secretions
Ectopic production won’t respond

123
Q

What is the HPA axis

A 
Hypothatlamus
CRH
Ant Pituitary
ACTH
Adrenal Cortex
CORT
124
Q

Function of pulsatile and sustaine GnRH

A 
P= stimulate gonadotroph cell to release LH and FSH until puberty
S= inhibit release of FSH and LG resulting in hypogonadism
125
Q

Role of FSH in men and women

A 
W= ovarian follicle development
M= Regulate spermatogenesis
126
Q

Role of LH in men and women

A 
W= stimulates androgen production in folicular stage of menstrual cycle
M= testosterone synthesis stimulation in Leydig cells
127
Q

When are GnRH or LHRH used clinically

A 
Treat infertility
Precocious puberty
Transgenders
Prostate cancer
Assisted reproductive technology
Ovarian suppression
128
Q

Adverse effets of GnRH and LHRH use

A

Flare of of dz in first week of therapy
Hot flash
Erectile impotence
Dec libido

129
Q

LHRH is released by the ___ in a ___ manner

A

Hypothalamus

Pulsatile

130
Q

What hormone is under study for it’s role in aiding/developing prostate cancer?

A

FSH

131
Q

What are the names of the GnRH/LHRH drugs

A 
Goserelin
Leuprolide
Nafarelin
Histrelin Acetate
Triptorelin
132
Q

What are the approved scenarios for using GnRH and LHRH

A

Prostate cancer
Enometriosis
Central Precocious Puberty (Nafarelin)

133
Q

MOA of GnRH Antagonists

A

Suppresses LH and FSH

Turns GnRH receptor off to avoid testosterone surges

134
Q

What drugs are used as GnRH antagonists to inhibit premature LH surges in women undergoing ovarian hyperstimulation procedures?

A

Ganireliz
Cetrorelix

Men w/ prostate cancer= Degarelix

135
Q

What are the Ant Pituitary Hormones

A 
G FLAT
GH
TSH
ACTH
FSH
LH PRL
136
Q

What inhibits growth hormone/somatotropin

A

Somatostatin

IGF-1

137
Q

What inhibits TSH

A

T3/T4

138
Q

What inhibits ACTH

A

Cortisol

139
Q

What inhibits FSH

A

Inhibin

Estrogen

140
Q

What inhibits LH

A

Estrogen
Progestine
Testosterone

141
Q

What inhibits PRL

A

Dopamine

142
Q

What causes Acromegaly and Gigantism

A

Pituitary adenoma secreting growth hormone

143
Q

What causes hyperprolactinemia

A

Prolactinoma

CNS lesion

144
Q

What are the three hyper secretion Dzs

A

Acromegaly
Gigantism
Hyperprolactinemia

145
Q

What are the hyposecretory Dzs

A

GH deficiency

Panhypopituitarism

146
Q

What drugs are used for Acromegaly

A

Somatostatin analogs
GHR Antagonist
Dopamine antagonists

147
Q

Somatostatin inhibits release of ?

A

GH
Glucagon
Insulin
Gastrin

148
Q

When is Somatostatin used?

A

Acromegaly
Vasoactive Intestinal peptide secretory diarrhea
Esophageal varices bleeding

149
Q

What are the Somatostatin drugs?

A

Octreotide

Lanreotide- Acromegaly only

150
Q

MOA of Pegvisomant

A

Blocks GH binding and DEC IGF-1 levels

Used in Acromegaly resistant/intolerable to other therapies

151
Q

When can GH therapy be used for kids?

A

Inadequate GH- Turner, Noonan Synd
Chronic renal insufficiency
Catch-up if failing at 2-4yrs
Prader-Willi Syndrome

152
Q

When can GH therapy be used for adults?

A

HIV wasting
GH deficiency replacement
Short bowel syndrome

153
Q

What is the use of TSH

A

Thyrotropin
Dx agent for detecting thyroglobulin from cancer after extomy

Thyrotropin Alfa

154
Q

What is ACTH used for?

A

Differentiate between Addisons 1* or 2* pituitary disorder

Cosyntropin

155
Q

What are the FSH LH drug names

A

Follitropin alfa
Follitropin beta
Urofollitropin- urine of post-menopause women
Lutropin alfa- LH

156
Q

What drugs are used for hyperprolactinemia

A

D2 Agonists- Bromocriptine or Cabergoline

157
Q

What are the two Posterior pituitary hormones

A

ADH (AVP)

Oxytocin

158
Q

When is ADH clinically used?

A

DI
Esophageal varices
Vasodilatory shock

159
Q

When is Desmopressin used?

A 
DI
Polyuria/dipsia
Hemophilia A
von Willebrand Dz
Nocturnal enuresis
160
Q

Treatment of hyponatremia needs to be weighed against the risk of inducing ?

A

Central Pontine Myelinolysis

161
Q

What are the treatment goals of SIADH

A

Raise serum Na by 0.5-1 mEq/hr

No more than 10-12 mEq in first 24hrs

162
Q

What drugs can be used as vasopressin antagonists for SIADH

A

Conivaptan- hospitalized PT

Tolvaptan- PT w/ HF and SIADH

163
Q

What causes oxytocin to be released

A

Neuroendocrine reflex

164
Q

What is oxytocin used for in clinic

A

Stimulate lactation
Labor induction
Post-partum bleeding

165
Q

What drug has off label use for stimulating lactation in women

A

Metoclopramide

IPAP (212 decks)

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