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Pharmacology > Thyroid > Flashcards

Thyroid Flashcards

1
Q

Hyperthyroidism pharmacology?

A
  1. Anti-thyroid medication
  2. Iodine
  3. Radioactive idoine therapy
  4. Surgery
  5. Adjunct therapy: Propranolol , Ca2+ channel blockers and Glucocorticoids
  6. Thyroid Storm
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2
Q

Hypothyroidism pharmacology?

A
  1. Levothyroxine sodium(T4)
  2. Liothyroxine(T3)
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3
Q

Anti-thyroid medication ?

A

Carbimazole converted to an active metabolite methimazole

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4
Q

Carbimazole MOA?

A
  1. Decrease uptake & concentration of the inorganic iodine by the thyroid
  2. Decrease formation of di-iodotyrpsine & thyroxine

3.

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5
Q

Carbimazole conversion and effects on throid Hs

A

Once converted to Methimazole prevents thr thyroid peroxidase enzyme from coupling & iodinating the tyrosine residues on the thyroglobulin therefore decreasing the production of thyroid hormones(T2/4)J

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6
Q

Where is carbimazole not used and why?

A

Not used in inflammatory thyroid disease since the release of performed thyroid hormone is not inhibited

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7
Q

What is biosynthesis of T3 & T4

A

Dietary iodine(I) ingestion (Absorbed into bloods stream as iodide)
↓
Uptake of iodide(I-) by thyroid gland
↓
Synthesis of thyroglobulin(precursor of thyroid hormone
↓
Idodide(I-) oxidized into Iodine(I) by thyroid peroxidase (METHIMAZOLE)
↓
Iodination of thryoglobin tyrosine residues=Monoiodotyrosine(MIT) + Diiosotyrosine(DIT)
↓
Coupling of iodotyrosine residues(MIT & DIT) → T3/4

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8
Q

Carbimazole caution?

A

Pregnancy
-Relatively safe at doses < 20mg/day
-No breastfeeding
-Do not combine with thyroxine

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9
Q

Carbimazole DI?

A

Warfarin , Heparin

-Enhances anti-coagulant effect
-Adjust dosage to prothrombin time

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10
Q

Carbimazole A/E?

Uncommon(1)

&

Uncommon(4)

A

Common:
-Itching
-Skin rash

Uncommon:
-Agranulocytosis(Sore throat & fever)
-Cholestatic hepatitis
-Mild arthralgia
-Alopecia

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11
Q

Iodine drug?

A

Lugol’s solutions(Potassium Iodide)

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12
Q

Iodine/Lugol’s solutions(Potassium Iodide) MOA?

A
  1. ↓ Thyroglobulin proteolysis(Proteolytic processing) ∴ ↓ thyroid hormone secretion(T3/4)
  2. Temporary inhibition of iodine organification in the thyroid gland(Wolf-Chaikoff effect)
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13
Q

Wolf-Chaikoff effect?

A

Temporary inhibition of iodine organification in the thyroid gland

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14
Q

Wolf-Chaikoff effect after two-four weeks?

A

However, within two or four weeks of continual exposure to excess iodine organification and thyroid hormone biosynthesus resumes normally-Escape from the Wolff-Chaikoff effect)

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15
Q

Iodine effects of thyroid hormone?

A

↑ Iodine concentration inhibits thyroid hormone synthesis and release

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16
Q

Iodine caution(2)?

A
  1. Renal Impairement→Hyperkalemia
  2. Pregnancy→ Neonatal goiter
    →Neonatal hypothyroidism
    (No breastfeeding)
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17
Q

Iodine DI?

A

-ACE-Inhibitors
-K+-sparring diuretics

All cause K+ overload

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18
Q

Iodine A/E?

Common(2)
Less Common(4)
Prolonged use(4)

A

Common:
1. Gastric irritation ∴ taken with meals
2. Bloody diarrhoea

Less Common:
1. Arthralgia
2. Fever
3. Lymphadenopathy
4. Hypersensitivity

Prolonged use:
1. Metallic use
2. Conjunctivitis
3. Painful salivary glands
4. ↑ salivation

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19
Q

Iodine Indications?

A
  1. Preoperative preparation for thyroidectomy in Graves disease
    -Renders thyroid less vascular
  2. Thyroid Storm
    -Iodine blocks T4/T3 release within hours
  3. Adjunctive therapy to antithyroid agents in Graves disease
  4. Protective after radioioiodine therapy
    -Potassium iodidie blocks uptake of radioactive iodine isotopes by the thyroid glands thereby minimizing the risk of radiation-induced thyroid neoplasms
20
Q

Radioactive idoine therapy name?

A

Sodium iodide 131I -capsule

21
Q

Radioactive idoine therapy MOA?

A

Radioiodine-131 beta particles react with intracellular water in the thyroid gland to produce free radicals

-Destruction of the thyroid gland

22
Q

Radioactive iodine therapy Dosage?

A

First dose:
Symptoms improve after 2 weeks

Second dose:
Given 6-12 weeks later to prevent recurrence

23
Q

Radioactive iodine therapy CI?

A
  1. Pregnancy ∴ contraceptive advised for both treated men and women
  2. Paediatrics(not recommended)
  3. ↑Incidence of radiation-induced hypothyroidism
  4. Large toxic nodules goitres may require repeated doses
24
Q

Radioactive iodine therapy disadvantage/

A

↑Incidence of radiation-induced hypothyroidism

25
Q

Radioactive iodine therapy A/E?

A
  1. Painful radiation thyroiditis
  2. Radiation-induced thyroiditis
  3. Severe swelling
26
Q

Radioactive iodine therapy indications?

A
  1. Hyperthyroidism
  2. Pre-operatively to reduce the vascularity of the gland
  3. Post operatively in the case of carcinomas to reduce recurrence
27
Q

Surgery

A

Total or partial removal of the thyroid gland

&

Removal of bones of the orbit for decompression in the thyroid optic neuropathy

28
Q

Adjunct therapy?

A
  1. Propranolol
  2. Ca2+ channel blockers
  3. Glucocorticoids
29
Q

Propranolol

A

Indications:

Relieves tachycardia, tremors, palpitations, anxiety , state and tension

CI:

Cardiac Failure

30
Q

Ca2+ channel blockers effects(2)?

A

-Control tachycardia
-↓Supraventricular tachyarrthymias

31
Q

Glucocorticoids drug?

A

Prednisone

32
Q

Thyroid storm?

A

Life-threatening exaggerated manifestations of hyperthyroidism

  • Hyperthermia
    *Severe cardiac failure
    *Possible cardiac failure
    *Severe agitation/mental disorientation
    *Stupor & coma
33
Q

Glucocorticoids effects?

A

Control inflammation
*Thyroid optic neuropathy (pressure on optic nerve)
→ Loss of eyesights

34
Q

Thyroid storm intensive care?

A
  1. Carbimazole every 4-6hrs
  2. Iodine 8hrly
  3. Glucocorticosteridos hourly
  4. Propranolol hourly/Ca2+ - channel blockers
35
Q

Hypothyroidism drugs?

A
  1. Levothyroxine sodium(T4)
  2. Liothyroxine(T3)
36
Q

Levothyroxine sodium(T4)?

A

Synthetic thyroxine sodium

37
Q

Levothyroxine sodium(T4) caution?

A
  1. CVS disorders → Severe ischemic heart disease
    →Myocardial disease
  2. Geriatics→ Dosage with ↓ with age
  3. Paediatrics→ used with caution
  4. Pregnancy → Limited crossing of placenta (No known A/E)
38
Q

Levothyroxine sodium(T4) A/E?

A
  1. Dose related
    Symptoms of hyperthyroidism
39
Q

Levothyroxine sodium(T4) DI?

A
  1. *Calcium carbonate
    *Ferrous sulphate

All ↓ absorption of levothyroxine

  1. Cholestyramine → Binds thyroxine in GIT, prevents absorption
  2. Warfarin → ↑ Warfarin effects
  3. Oestrogen→↑serum thryoid binding globin and alter thryoxine requirements
  4. Sympathomimetics→Mutual increase in effects/CVS
  5. Oral antidiabetic agents and insulin→ Requirements may change if thryoxine initiated for withdrawn
40
Q

Levothyroxine sodium(T4) indications?

A

Pregnancy & congenital hypothyroidism -drug of choice

41
Q

Hypothyroidism pharmacology drugs?

A
  1. Levothyroxine sodium T3
  2. Liothryoxine(T3)
42
Q

Liothryoxine(T3)

  1. Response
  2. Strength
  3. Cautions
A
  1. Response very rapid thus given in acute situations only
  2. Strength
    5x stronger than levothryoxine
  3. Cautions in geriatics & paediatrics -tailor dose to individual requiremenys
43
Q

Liothryoxine(T3) I?

A
  1. Cases where rapid response is required (Emergencies)
  2. Hypothyroid coma
  3. Sever hypothyroid state
  4. 5’-deiodinase deficient patients
44
Q

Thyroid cancer

A

-Surgical Removal of carcinogenic nodules

-Benign nodules are harmless

45
Q

Goitrous thyroid disease

A

-Lack of dietary iodine-thyroid gland enlarges in an attempt to produce more hormone

-Iodine supplementtaion

-If goite is too large:
-Breathing/swallowing difficulty
-If no response to treatment-surgery

Pharmacology (44 decks)

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