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Systemic Pharma- Respiratory + Endocrine > thyroid > Flashcards

thyroid Flashcards

1
Q

1st line tx for Hyperthyroidism

A

Radioactive Iodine - 131I

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2
Q

MoA of Radioactive Iodine

A

It destroys the thyroid gland through a cytotoxic effect (medaited by B cells)

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3
Q

131 I destorys the thyroid gland through a cytotoxic effect , mediated by B cells. this is Restricted to cells of the ———–

A

Thyroid follicles

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4
Q

Amdinistration route of Radioactive iodine

A

Oral

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5
Q

Radioactive Iodine effects seen after ——— and maximal effects ———

A

1-2 months, max effects 2 months later

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6
Q

Adverse effects of Radioactive iodine

A

Hypothyroidism

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7
Q

Can Radioactive iodine be given to pregnant women and children?

A

Best Avoided

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8
Q

Thioureylenes examples

A

Carbimazole,
methimazole (active metabolite of carbimazole), propylthiouracil - PTU

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9
Q

MoA of Carbimazole

A

competitively inhibit the thyroperoxidase catalysed oxidation reactions

Note:
thryoid peroxidase fxn:
–> Coupling, organification of iodine, oxidation of iodine and thyroglobulin

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10
Q

Clinical response of Thioureylenes may take ——-

A

several weeks

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11
Q

Which Thioureylenes is preferred in the tx of hyperthyroidism

A

Methimazole –> except during the the 1st trimester of pregenancy
* in this case we give Prophylthiouracil

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12
Q

You have a pregenant women in her first trimester w/ Hyperthyroidism. What drug will you administer?

A

Propylthiouracil during the 1st trimester, then switched to Methimazole in the 2nd trimester

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13
Q

Why is Propylthiouracil preferred in pregenancy during the 1st trimester over Methimazole?

A

Methimazole is teratogenic (aplasia cutis) during the 1st trimester

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14
Q

MoA of Propylthiouracil

A

Reduces Deiodination of thyroxin (T4) in peripheral tissues
* (5’ deiodinase inhibition)

* Thioureylene

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15
Q

AE of Prophylthiouracil

A

Hepatotoxicity
BUT safer in pregenacy (1st tri)

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16
Q

which drug acts more rapidly Methimazole or Propylthiouracil

A

Propylthiouracil

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17
Q

AE of Thioureylenes

A

1) Rashes
2) Headache
3) nausea
4) Jaundice
5) Neutroepnia and Agranulocytosis(Rare but fatal)
* therefore, monitor WBC

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18
Q

What fatal AE do Thioureyelenes cause

A

Neutropenia and agranulocytosis

19
Q

Clinical name for Iodine?

A

Lugol’s Iodine

20
Q

Clinical uses of Lugol’s Iodine

A
  • Preparation for thyroidectomy
  • As part of the treatment of severe thyrotoxic crisis (thyroid storm)
21
Q

For how many days, prior to a thyroidectomy, should a pateint be taking Lugol’s iodine to attain maximal pharmacological effects?

A

10-15 days

22
Q

AE of Lugol’s Iodine

A

1) Allergic rxn
2) Lacrimation
3) Conjuctivitis
4) pain in the Salivary gland
5) Cold-like syndrome

23
Q

Which drug causes the following side effects: lacrimation, conjuctivities, pain in the salivary glands, headaches and congestion ?

A

Lugol’s Iodine

24
Q

Administration of Lugol’s Iodine

A

Oral in a soulution w/ potassium iodide

25
Q

Lugol’s Iodine temporarily inhibites the release of ————— homrones

A

Thyroid (TH)

26
Q

MoA of Lugol’s Iodine

A
  • Converted to Iodide (I-) in vivo
  • Temporarily inhibits the release of TH –> marked reduction of vascularity and size of gland
27
Q

What drug can you administer to reduce signs and symptoms of Hyperthyroidism (Tachycardia, dysrhythmias, tremor, agitation)?

A

Beta-blockers

28
Q

Clinical uses of Beta -blockers in the tx of Hyperthyroidism

A

1) decreases signs and symptoms of hyperthyroidism
2) Acute Hyperthyroid crisis (thyroid storm)
3) Preperation of thyrotoxic patients for surgery

29
Q

55 yr women w/ Grave’s disease , upon examination Exopthalmos was evident. tx with an eyedrop is recomended. what drug is appropriate to admisinister to this patient?

A

Guanethidine (Eye drops)

30
Q

MoA of Guanethidine

A
  • Noradrenergic-blocking agent
  • Relaxes smooth muscle that causes eyelid retraction
31
Q

1st line tx in Hypothyroidism

A

T4 analouge - Levothyroxine

32
Q

Why do we administer T4 analouges insteade of T3 analouges in Hypothyroidism tx?

A

T3 analouge -Liothyronine are given for acute emergencies

33
Q

Administration route of Liothyronine

A

IV (emergency)

* T3 Analouge

34
Q

Administration route of Levothyroxine

A

Oral formualtion

* T4 Analogue

35
Q

clinical uses of Liothyronine

A

Acute Hypothyroidism emergencies
* Short duration of axn (faster onset)

36
Q

Which has a faster-onset , Liothyronine or Levothyroxine?

A

Liothyronine (T3 Analogue)

37
Q

Iodine deficieny in Hypothyroidism is treated w?

A

Iodide

38
Q

Example of Hypothyrodism disease

A

Hashimoto thyroditis

39
Q

What are Thyroid replacement therapies?

A
  • Levothyroxine (T4 Analogue)
  • Liothyronine (T3 Analogue)
40
Q

AE of Replacement therapy (Liothyronine, Levothyroxine)

A
  • Hyperthyroidism
  • Tremors
  • Heat intolerance
  • Angina pectoris
  • Cardiac dysrhythmias
  • Cardiac failure
  • Increased bone resorption -Osteoporosis
41
Q

Drugs that may affect thyroid function

A

1) Amiodarone
- Rich in iodine
- Can cause hyperthyroidism or hypothyroidism

2) Iodine-containing radiocontrast agents drugs
- Iopanoic acid
- Hypothyroidism

3) Sulfonamides
- E.g. sulfonyureas
- Hypothyroidism

4) Lithium
- Hypothyroidism

42
Q

Drugs that reduce TSH release

A

Somatostatin
(aka Growth hormone inhibitor hormone)

43
Q

**

Drugs used for Thyroid strom tx?

A

1) Lugol’s iodine
2) Beta-blockers
3) Glucocorticoids
4) PTU

Systemic Pharma- Respiratory + Endocrine (6 decks)

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