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Endo II Exam 2 > Pharmacotherapy of Thyroid Disease > Flashcards

Pharmacotherapy of Thyroid Disease Flashcards

1
Q

levothyroxine

A

T4

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2
Q

liothyronine

A

T3

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3
Q

methimazole

A

antithyroid agent

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4
Q

propylthiouracil

A

PTU

antithyroid agent

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5
Q

potassium iodide

A

antithyroid agent

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6
Q

NIS

A

sodium iodine symporter
-transport of iodine into thyroid gland

inhibited by SCN-, TcO4-, ClO4-

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7
Q

pendrin

A

transport of iodide to follicular lumen

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8
Q

thyroidal peroxidase

A

oxidizes iodide to iodine

then to MIT and DIT (organification)

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9
Q

thyroglobulin

A

combines with iodine to form thyroid hormones

two DIT in TH - T4
DIT and MIT in TH - T3

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10
Q

thyroid hormone release

A

exocytosis and proteolysis of thyroglobulin at apical colloid border

high levels of iodide blocks the proteolysis

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11
Q

ratio of T4 to T3

A

5:1

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12
Q

thyroid hormone transport

A

plasma protein bound
-to thyroxine binding globulin (TBG)

0.04% in free form

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13
Q

3-5-3 triiodothyronine

A

T3

3-4x more potent

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14
Q

3-3-5 triiodothyronine

A

rT3

inactive

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15
Q

amiodarone

A

inhibits 5’ deiodinase for T4 to T3

low T3 and high rT3

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16
Q

block conversion of T4 to T3

A 
amiodarone
iodinate contrast media
beta blockers
corticosteroids
illness
starvation
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17
Q

TSH signaling

A

adenylyl cyclase

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18
Q

T4 and T3 feedback

A

negative on hypothalamus and pituitary

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19
Q

acute psychosis or cold

A

activate thyroid axis

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20
Q

somatostatin and dopamine

A

inhibit TSH release

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21
Q

large amounts of iodine

A

inhibit TSH release

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22
Q

thyroid hormone MOA

A

T4 to cytoplasm - 5 deiodinase converts to T3

T3 to nucleus

thyroid receptor bound to DNA at TRE

T3 binds TR - displaces corepressor and allows binding of coactivator

binds RXR on TRE - activates gene transcription

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23
Q

thyroid effects

A

activation of nuclear receptors lead to protein synthesis

lag time of effects - hours or days

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24
Q

warm, sweaty, tachycardia, increased appetite, nervous

A

hyperthyroid

25
Q

cool, pale, bradycardia, decreased appetite, lethargic

A

hypothyroid

26
Q

hyperthyroid T3 and T4

A

clearance increased

half life decreased

27
Q

hypothyroid T3 and T4

A

clearance decreased

half life increased

28
Q

agents increase CYP and enhance thyroid hormone degradation

A 
rifampin
phenobarbital
carbamazepine
phenytoin
HIV protease inhibitor
29
Q

agents interfere T4 absorption

A 
oral bisphosphanate
bile acid sequestrant
cipro
PPIs
sucralafate
antacids
bran
soy
coffee
30
Q

agents induce autoimmune thyroid disease

A

IFN-alpha
IFN-beta
lithium
amiodarone

31
Q

agents inhibit conversion T4 to T3

A 
radiocontrast
amiodarone
beta-blocker
corticosteroid
PTU
32
Q

levothyroxine

A

T4

-preferred - cheaper, easy lab monitoring, long half life

33
Q

liothyronine

A

T3

  • 3-4x more potent
  • shorter half life

risk of cardiotoxicity

34
Q

cardiac disease

A

no T3

35
Q

thioamides

A

methimazole

PTU

36
Q

methimazole MOA

A

inhibit thyroid peroxidase
-block organification
block coupling MIT and DIT

37
Q

propylthiouracil MOA

A

inhibit thyroid peroxidase
-block organification
block coupling MIT and DIT

38
Q

methimazole vs. PTU

A

methimazole is DOC
-10x more potent

both cross placenta - to fetal thyroid - risk hypothyroidism

39
Q

pregnancy antithyroid drug

A

PTU - first trimester

more protein bound - so crosses placenta less readily

40
Q

thyroid storm

A

PTU

41
Q

severe hepatitis

A

PTU black box warning

42
Q

agranulocytosis

A

in PTU and methimazole

43
Q

anion inhibitors

A

perchlorate
pertechnetate
thiocyanate

competitively inhibit iodide transport

44
Q

potassium iodide MOA

A

inhibit iodide organification and hormone release

inhibit hormone release and decrease size and vascularity of hyperplastic gland

45
Q

reduction in size of hyperplastic gland

A

potassium iodide

46
Q

acneiform rash and swollen salivary glands

A

seen with potassium iodide - adverse effect

47
Q

radioactive iodide MOA

A

emission of beta rays
-destruction of thyroid gland

concentrates in thyroid and stored in follicles

48
Q

DOC for hashimotos

A

levothyroxine - T4

drug levels reached in 6-8 weeks

49
Q

restlessness, insomnia and accelerated bone grwoth

A

thyroxine in children

50
Q

nervous, heat intolerance, palps, tachy, weight loss

A

thyroxine in adults

51
Q

myxedema coma

A

end stage of untreated hypothyroid
-medical emergency

intubation, ventilation - drugs IV**

52
Q

a fib and osteoporosis

A

overtreatment with T4

53
Q

hypothyroid women

A

often infertile

54
Q

pregnancy

A

important to replace thyroid hormones in hypothyroid mother

-important for fetal brain

55
Q

young patient, small gland, mild graves tx

A

medical - methimazole (or PTU)

56
Q

old patient, large gland, MNG graves tx

A

surgical - thyroidectomy

treat with antithyroid until euthyroid**

potassium iodide - to diminish vascularity

57
Q

radioiodine tx o fgraves

A

without heart disease over 21yo

58
Q

adjuncts to antithyroid meds

A

beta blockers

diltiazem (CCB)

59
Q

tx of thyroid storm

A 
beta blockers
potassium iodide
PTU
hydrocortisone
supportive therapy

Endo II Exam 2 (16 decks)

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