Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology Test #3 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What are drugs that increase TGB (will lead to hypothyroidism)?

A

Estrogen

Tamoxifen

Heroin

Methadone

Fluorouracil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are drugs that decrease TGB (will lead to hyperthyroidism)?

A

Androgens

Anabolic Steroids

Slow Release Nicotinic Acid

Glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are drugs that decrease TSH?

A

Dopamine

Glucocorticoids

Octretide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are drugs that decrease T3/T4?

A

Lithium

Iodide

Iodine preparations

Radiocontrast Dyes

Amiodarone (could also increase)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common hyperthyroid disorder?

A

Grave’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which population is most commonly affected by Grave’s Disease?

A

40-60 yo women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the presentation of Grave’s Disease (hyperthyroidism)?

A

Nervousness

Palpitations

Fatigue

Weight Loss

Thinning Hair

Proptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the labs of Grave’s Disease (hyperthyroidism)?

A

Low TSH

Elevated Free/Total T3/T4

Increased Radioactive Iodine Uptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you treat Grave’s Disease (hyperthyroidism)?

A

Anti-thyroids

Radioactive Iodine

Thyroidectomy

Symptomatic Treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What class of drugs are anti-thyroids?

A

Thioamides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the first line thioamides used to treat Grave’s Disease?

A

Methimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Can methimazole used for lactating women?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If methimazole doesn’t work, or you have a pregnant woman, what is the name of the drug that would be used?

A

PTU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Besides pregnancy, what can PTU be used for?

A

Thyroid Storm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the benefits of using methimazole or PTU for Grave’s Disease (hyperthyroidism)?

A

Low Cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the negatives of using methimazole or PTU for Grave’s Disease (hyperthyroidism)?

A

Low Cure Rate

Hope For Spontaneous Remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the mode of action of methimazole and PTU?

A

Inhibits T3/T4 Synthesis

**PTU inhibits peripheral conversion of T4 –>T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where are thiomides metabolized?

A

Liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How are thioamides eliminated?

A

Renal

Mostly as metabolites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 1/2 lifes of methimazole and PTU?

A

Methimazole = 5 - 13 hours

PTU = 1 - 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When would you want to follow up with patients on methimazole/PTU?

A

Initial T4 testing after 4 weeks of treatment, then every 4-8 weeks

After remission retest T4 every 1 - 3 months for 6 months to a year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the adverse drug reactions for methimazole/PTU?

A

GI Upset

Arthralgia

Allergic Reactions

Agranulocytosis –> granuloycyte count < 250/mm3; Fever, sore throat, bleeding, bruising, malaise, stomatitis (Tx = stop med/broad spectrum Abx)

Hepatotoxicity (higher risk w/ PTU) –> check LFTs in pts showing signs of liver damage (jaundice, joint pain, abdominal pain, light stool, dark urine, GI upset or fatigue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the mode of action of iodides (for the treatment of hyperthyroidism)?

A

Inhibit T3/T4 Release and synthesis

Reduce Vascularity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When do you start seeing the effects of iodides?

A

24 Hours

Max effect in 10 - 15 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the iodide of choice to treat Grave’s Disease (hyperthyroidism)?

A

Potassium Iodide (liquid form)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the names of the 2 potassium iodide solutions?

A

Saturated Solution = SSKI

Lugol’s Solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the use of iodides in the treatment of thyroid disease?

A

Reduce vascularity prior to thyroid surgery

Prepare pts w/ Grave’s Dz for surgery

Decrease thyroid iodine accumulation during thyrotoxic crisis

Prevent thyroid uptake of radioactive iodine (when its being used for something other than hyperthyroidism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the adverse drug reactions of potassium iodide?

A

Rash

GI Upset

Paresthesia

Immune Hypersensitivity Reaction

Salivary Gland Swelling

Iodism:
        Burning in mouth or throat
        Metallic taste
        Sore teeth and gums 
        Cold symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Is lithium recommended for treatment of Grave’s Disease (hyperthyroidism)?

A

No! TEST QUESTION!

Causes: Tremor, polyuria, renal failure, seizure, arrhythmia, bradycardia, suicide, toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why are beta blockers used in the treatment of Grave’s Disease (hyperthyroidism)?

A

Symptomatic Treatment: Tachycardia, Palpitations, Tremor

Thyrotoxicosis

Pre-op (adjunct to potassium iodide, radio iodine, antithyroid drugs for Grave’s or toxic nodules)

Thyroid Storm

Monotherapy for thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which beta blockers are used for symptomatic treatment of Grave’s Disease (hyperthyroidism)?

A

Propranolol

Nadolol

Atenolol

Metoprolol

Esmolol

32
Q

What is the mode of action of radioactive iodine (RAI) used to treat Grave’s Disease (hyperthyroidism)?

A

Disrupts Hormone Synthesis By Incorporating Itself

33
Q

How is radioactive iodine (RAI) given?

A

Oral Solution

34
Q

What are the contraindications of radioactive iodine use?

A

Pregnancy

Lactation

Thyroid Cancer

35
Q

What are the adverse drug reactions of radioactive iodine (RAI)?

A

Dysphagia

Thyroid Tenderness

36
Q

What is the follow up recommendations for radioactive iodine (RAI)?

A

Check T3/T4, 1 - 2 months after treatment

Hypothyroidism occurs 4 weeks after treatment –> Tx w/ T4 replacement

37
Q

What is thyroid storm?

A

Crisis!

38
Q

What is thyroid storm caused by?

A

Surgery

Anesthesia

Thyroid Manipulation

Abrupt discontinuation of Hyperthyroid meds

39
Q

How does thyroid storm present?

A

High Fever

Tachycardia

A-Fib

CHF

Tachypnea

Delirium

Coma

Nausea/vomitting/diarrhea

40
Q

What is the treatment for thyroid storm?

A

Aggressive!

Antithyroid Medication (30 - 60 min before iodide)

Inorganic Iodide

Supportive Care

Beta Blockers

Corticosteroids

41
Q

What are the specific drugs used to treat thyroid storm?

A

PTU = first line

Methimazole

SSKI

Hydrocortisone = 1st line corticosteroid

Dexamethasone = 2nd line corticosteroid

Propranalol = 1st line beta blocker

Esmolol = 2nd line beta blocker and is IV Tx

42
Q

What are the labs for subclinical hyperthyroidism?

A

Low TSH

T3/T4 = normal

43
Q

How would you treat subclinical hyperthyroidism?

A

Type 1 = Methimazole

Type 2 = Glucocorticoids

BUT hard to distinguish so treat w/ both

44
Q

What are the 3 hypothyroidism disorders that we need to know?

A

Hashimoto’s Thyroiditis = most common; women > men

Iatrogenic = drugs/surgery/radioation; initial Tx for hyperthyroidism

Iodine Deficiency = endemic hypothyroidism

45
Q

What are some drugs that can induce hypothyroidism?

A

Amiodarone

Sunitinib

Lithium

Interferon

Thalidomide

Bexarotene

Anti-thyroid meds

46
Q

What are the labs of sub-clinical hypothyroidism?

A

TSH = High

T3/T4 = Normal

**treat if TSH > 10 mIU/L

47
Q

What disease is myxedema (symptoms associated w/ hypothyroidism) associated with?

A

Coronary Artery Disease

48
Q

Why do you need to treat myxedema?

A

Avoid Cardiac Event

49
Q

What is myxedema coma?

A

Result of untreated hypothyroidism

50
Q

How do you treat myxedema coma?

A

ICU

IV levothyroxine

51
Q

What is the presentation of hypothyroidism?

A

Dry Skin

Cold Intolerance

Weight Gain

Constipation

Weakness

Lethargy

Depression

Periorbital Puffiness

Coarse skin/hair

High TSH

Low Free T4

Positive antibodies

52
Q

What is the treatment of hypothyroidism?

A

Thyroid Supplements (natural/synthetic)

Synthetic L-thyroxine (levothyroxine) (firstline)

53
Q

What is important to educate patients about when using synthetic L-thyroxine (levothyroxine)?

A

Important to consistently use same formula

different brands have slightly different formulas, so speak w/ provider before switching

54
Q

What is a natural thyroid supplement?

A

Desiccated thyroid (from hog, sheep, or beef thyroid gland)

55
Q

When should Levothyroxine (T4) be taken?

A

Empty Stomache

56
Q

How is levothyroxine metabolized?

A

Liver = 80% –> active metabolite

Renal = deiodination

Enterohepatic recirculation

57
Q

How is levothyroxine eliminated?

A

Renal = 80%

Fecal = 20%

58
Q

What is the 1/2 life of levothyroxine?

A

6 - 7 days

59
Q

What is the follow up recommendations for levothyroxine (T4) treatment?

A

Adjust every 4 - 8 weeks based on TSH levels

60
Q

Why isn’t Liothyronine (T3) used to treat hypothyroidism?

A

High Cost

High Risk of Cardiac Event

Difficult to Monitor

61
Q

Why isn’t Liotrix (combo) used to treat hypothyroidism?

A

High Cost

Lack of Therapeutic Rationale

62
Q

When do you do follow TSH/T4 testing for a patient being treated for hypothyroidism?

A

Every 4 - 8 weeks until euthyroid –> every 6 - 12 months

63
Q

What are the adverse drug reactions for hypothyroid drugs?

A

Uncommon @ appropriate dose

Allergic Reaction (uncommon w/ synthetics)

Arrhythmia

MI

Infertility

Weight Loss

Heat Intolerance

Bone Fractures

64
Q

How would you treat a pregnant woman for hypothyroidism?

A

Increase dose by 30%

Want to test thyroid function every 2 - 3 weeks (goal will depend on trimester)

65
Q

What does amiodarone (treats arrhythmias) do to the thyroid?

A

Increase or Decrease T3/T4 levels

66
Q

What do you want to do to thyroid meds if your pt is also on digoxin?

A

Decrease Thyroid Med (cause it’ll increase digoxin)

67
Q

What are diabetic patients with hypothyroidism at greater risk of?

A

Hyperglycemia –> want to increase insulin dose and monitor blood sugars

68
Q

What are the normal values of thyroid function tests?

A

Total T4 = 4.8 - 10.4 mcg/dL

Free T4 = 0.8 - 2.7 ng/dL

Total T3 = 60 - 181 mcg/dL

Free T3 = 230 - 420 pg/dL

TSH = 0.4 - 4 mIU/L

69
Q

What happens if remission is not achieved with thioamides?

A

Radioactive Iodine

Thyroidectomy

70
Q

What is the mode of action of radioactive iodines?

A

Disrupts hormone synthesis by incorporating into thyroid hormone and thyroglobulin

Follicles necrose/breakdown

Small vessels w/in thyroid gland are destroyed

71
Q

What is the 1/2 life of radioactive iodine?

A

5 days

72
Q

What causes subclinical hyperthyroidism?

A

Amiodarone induced

Type 1 = induced by iodine w/in amiodarone

Type 2 = no underlying thyroid dz, drug causing it to release hormone

73
Q

When do you want to initiate Tx for subclinical hyperthyroidism?

A

TSH < 0.1 mIU/L

74
Q

What are the lab findings of Hashimoto’s?

A

+ Antithyroglobulin antibody (ATgA)

+ Antimicrosomal antibody (AMA)

↑ Cholesterol, LDH, AST, ALT, CPK

75
Q

How does the IV dose of levothyroxine differ from oral dose?

A

Decreased by 50%

**possible test question

76
Q

If you’re treating a pt for hyperthyroidism what would you want to do to their warfarin?

A

Lower the dose of warfarin –> hyperthyroid meds will increase the metabolism of clotting factors so you don’t need as much warfarin

77
Q

If you’re treating a pt for hypothyroidism what would you want to do to their warfarin?

A

Increase the dose of warfarin –> hypothyroid meds decrease metabolism of clotting factors so you need more warfarin

Pharmacology Test #3 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions