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Therapeutics 2 Kappa Epsilon > Thyroid > Flashcards

Thyroid Flashcards

1
Q

T4 or T3 is more potent?

A

T3

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2
Q

Thyroid hormones will cause ________ sensitivity

A

cathecholamine

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3
Q

_____ has to be converted to _____ before it can bind (T4 or T3 in which blank?

A

T4 –> T3

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4
Q

Process of biosynthesis of thyroid Hormones:
1st step:
_____ enters from ______ via ______

A

iodine; plasma; Na symporter

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5
Q

Process of biosynthesis of thyroid Hormones:
2nd step
____, an iodine channel, puts Iodine into the follicle ____

A

pendrin; colloid

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6
Q

Process of biosynthesis of thyroid Hormones:
3rd Step
Iodine is oxidized into _____ or _____

A

MIT or DIT

aka mono-iodine or di-iodine

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7
Q

Process of biosynthesis of thyroid Hormones:
4th step:
Iodine gets added to ________

A

thyroglobulin

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8
Q

Process of biosynthesis of thyroid Hormones:
5th step:
_________ of rings occurs

A

conjugation

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9
Q

Process of biosynthesis of thyroid Hormones:
6ht step
_______ produces protein and either thyroxine or triiodothyronine

A

Proteolysis

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10
Q

Hypothalamus release ______ to stimulate ______ pituitary

A

TRH; anterior

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11
Q

Physiological effects of thyroid hormones

A
  • growth/development
  • Thermoregulation
  • BMR
  • Protein Synthesis
  • Catecholamine Sensitivity
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12
Q

Physiological effects of thyroid hormones
Growth and Development:
No T3 leads to _______ which is essential for ____ development

A

cretinism; brain

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13
Q

Physiological effects of thyroid hormones:
Protein Synthesis
(anabolic or catabolic) at normal levels
and
(anabolic or catabolic) at elevated levels

A

anabolic; catabolic (at high thyroid levels - BMR too high proteins will be broken down)

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14
Q

Physiological effects of thyroid hormones:
Metabolic Effects
- increase _____ and ____

A

BMR; oxygen consumption

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15
Q

Physiological effects of thyroid hormones:
Metabolic Effects
starvation will decrease _____ and thyroid receptor

A

T3

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16
Q

Physiological effects of thyroid hormones:
Thermogenesis
________ (increase or decrease) resting heat production

A

increase

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17
Q

Metabolism of Thyroid hormones:
it gets ________
it will be excreted in ______

A

deiodized; the bile;

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18
Q

Causes of HYPOthyroidism

A
  • Hashimotos Thyroiditis
  • Destruction of removal of gland
  • iodine deficiency
  • Congenital
  • Secondary - TSH deficiency
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19
Q

Hypothyroidism has nontoxic or toxic goiter

A

NONTOXIC! (thyroid is just stimulated a lot bc of low thyroid)

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20
Q

Hyperthyroidism has nontoxic or toxic goiter

A

toxic! seen in graves disease

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21
Q

possible causes of Hyperthyroidism

A
  • graves disease
  • Adenoma making T3 (multi or uni nodular goiter)
  • subacute thyroiditis
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22
Q

Toxicity that can be seen with thyroid hormone replacement therapy

A
  • nervousness
  • heat intolerance
  • weight loss
  • tachycardia
  • atrial fibrillation
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23
Q

what is subactue thyroiditis

A

viral infection of thyroid gland

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24
Q

what is graves disease

A

autoimmune thyroid stimulating IgG

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25
Q

Thyroid Replacement Therapy Options:

Natural replacement comes form bovine and porcine - ______ blood levels tho

A

variable - inconsistent then - not good for thyroid!

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26
Q

Thyroid Replacement Therapy Options:
Synthetic thyroid:
Levothyroxine is (T3 or T4) and has a (slow or fast) onset?

A

T4; slow (slow bc T4 –> T3)

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27
Q

Thyroid Replacement Therapy Options:
Synthetic Thyroid
Liothyronnine is (T3 or T4) and has a (slow or fast) onset?

A

T3; fast!

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28
Q

Thyroid Replacement Therapy Options:
Synthetic Thyroid
Liotrix is (T3 or T4) and has a (slow or fast) onset?

A

its a mixture of both T3 and T4! more T4 than T3) not sure about timing…

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29
Q

Main Options for Treating Hyperthyroidism

A
  • Antithyroid Drug Therapy (Thioamides)
  • Thyroidectomy
  • Destruction of gland w/ radioactive iodine
  • Other drug therapies….
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30
Q

Metabolism of thyroid hormones:

______ to form glucuronide or sulfate w/ phenolic group

A

conjugated

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31
Q

Metabolism of thyroid hormones:

conjugated to form glucuronide or sulfate w/ __________

A

phenolic group

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32
Q

What are some “off label” drugs that are used to treat hyperthyroidism/help with symptoms - and how do they help?

A
  • Propranolol (for tachycardia)
  • Diltiazem (for tachycardia)
  • Barbiturates (inducing enzymes that will lower T4 levels)
  • Bile acid sequesterants: lower t4 levels by increasing excretion
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33
Q

What drugs are Thioamides

A
  • methimazole

- propylthiouracil

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34
Q

Thioamides are used to treat ________

A

thyrotoxicosis

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35
Q

Thioamides inhibit _______ to block ______ and ________

A

inhibit thyroid peroxidase; block iodine organification and coupling of iodotyrosines

36
Q

Thioamides - onset is ~ _______

A

3 - 4 weeks aka kinda slow

37
Q

Side effects of Thioamides

A
  • Nausea/GI distress
  • Altered sense of taste and smell (methimazole)
  • Maculpapular pruritic rash (most common)
  • Agranulocytosis
38
Q

what is “iodine organification”

A

I- is put on thyroglobulin with the help of H2O2 as the oxidizer

39
Q

Radioactive Iodine used for Hyperthyroidism:

  • ____ is emitted
  • localized destruction of _______
  • Can pregnant women/nursing moms do this?
  • is administered as _______
A

B-rays; thyroid follicles; No!; Na(131)I

40
Q

Larges dose of _______ inhibits iodine organification

A

Iodine

41
Q

what is Lugols Solution? and what is it used for

A

Aqueous solution of elemental I and KI; used as an antiseptic/disinfectant

42
Q

Treatment for Thyroid Storm

A
  • KI solution
  • beta-blocker
  • antithyroid drugs
43
Q

Electrophysiology of the Heart:
K+ channel or Na+ Channel -
which one has a very quick onset and which one has a slower onset?

A

K+ - slower

Na+ - fast

44
Q

Explain the components of the resting membrane potential

A

Na/Ca on outside of cell and K+ inside cell

V. Positive outside

45
Q

Explain components of the depolarization membrane potential

A

Na+ comes INTO the cell which makes the inside of the cell positive

46
Q

Explain components of the repolarization membrane potential

A

K+ goes to the outside of the cell - to make the inside of the cell negative again.

47
Q

what is HCN channel

A

hyperpolarization activated cyclic nucleotide gated channel - NON SELECTIVE CATION channel

48
Q

HCN channel is responsible for the _______ current

A

pacemaker

49
Q

Pacemaker Current: determines the rate of what?

A

diastolic depolarization

50
Q

Sympathetic Control of Heart:

Sympathetic Nerve will release ______

A

norepinephrine

51
Q

Sympathetic Control of Heart:

NE binds to _______ receptor and ________ the concentration of cAMP which activates ________

A

beta-adrenergic; increases; HCN channel

52
Q

Sympathetic Control of Heart:

Activating HCN Channel will _______ diastolic Na+ conductance will ______ time to next spike

A

INCREASE; shorten

53
Q

Parasympathetic Control of Heart:

_________ will bind to _______ and Gby is released from Ga

A

acetylcholine; Muscarinic

54
Q

Parasympathetic Control of Heart:

the _______ channel is involved

A

K+; GIRK

55
Q

Parasympathetic Control of Heart:

increased K+ conductance causes __________ and ____ time to next spike

A

hyperpolarization; delays

56
Q

Selected Thyroid Tests for Adults

A

TSH/Free T4;

Test for Autoimmunity: ATgA; TPO-Ab; TRAb

57
Q

Drug Inducing Causes for Hyperthyroidism:

A

Iodinated Compounds
Amiodarone
Interferons
Lithium

58
Q

Treatment Options for Hyperthyroidism

A
  • Thioamides (Propylthiouracil, Methimazole)
  • RAI (radioactive iodine)
  • Surgery (thyroidectmy)
59
Q

Drug of Choice for Hyperthyroidism and WHY?

A

Methimazole;

Once a day dosing, good for 2nd and 3rd trimester, no black box warning; Does NOT need renal adjustment

60
Q

Why would propylthiouracil be a good choice for hyperthyroidism?

A
  • if 1st trimester of Pregnancy

- if pt has thyroid storm issue (because it blocks T4–>T3 conversion

61
Q

which thioamide needs renal adjustment?

A

propylthiouracil

62
Q

Thioamide Adverse Effects:

A

GI - N/V - take with meals (divided doses)

Rash
- can be systemic or non systemic;

Agranulocytosis

Hepatitis

63
Q

Thioamide Adverse Effects:

If pt comes in and has maculopapular rash and no systemic symptoms - what should be done?

A

give diphenhydramine/other antihistamines - and try another thioamide

64
Q

Thioamide Adverse Effects:

If pt comes in has wheals/hives/SOB - what should be done?

A

this is “anaphylactoid type 1” - stop drug! and do NOT try a different thioamide - must do surgery or RAI

65
Q

Warning Signs for pt to know about if thioamide causes Agranulocytosis

A
  • flu like symptoms/FEVER (bc have low neutrophil count)/mouth sores/sore throat
66
Q

how often to check for efficacy of a thioamide

A

Q4 - 8 weeks until euthyroid;

67
Q

RAI - treatment for hyperthyroidism:

__________ of thyroid gland with ________ isotope

A

SLOW DESTRUCTION; radioactive (131)I

68
Q

Note about RAI for hyperthyroidism and Pregnancy

A

CONTRAINDICATED: separate pregnancy/lactation/planning pregnancy for 4 -6 months

69
Q

How does a pt take RAI?

A

in water- colorless/tasteless

70
Q

Counseling Points for RAI:

A

Avoid physical contact due to possible radioactive emission ~ 5 days (avoid kids and babies!)
Also note about not trying to become pregnant

71
Q

In Hyperthyroidism avoid what kind of agents?

A

agents with intrinsic sympathomimetic activity (acebutolol, carteolol, penbutolol, pindolol)

72
Q

What are possible adjunctive treatments for Hyperthyroidism?

A

Use Cardioselective Beta-Blockers! (only for short term - just to control HR)
- Propranolol, Metoprolol, Atenolol
(Alt. Calcium channel blockers - Diltiazem/Verampil)

73
Q

Drug Induced Causes for Hypothyroidism

A
  • Amiodarone
  • Lithium
  • Interferons
  • Bexarotene
74
Q

Possible Hypothyroid Supplements

A
  • LEVOTHYROXINE (1st choice!)
  • Liothyronnine
  • Liotrix
  • Dessicated Thyroid (Natural option)
75
Q

Dosing for healthy adult for thyroid supplementation

A

1/6 mcg/kg/day

use IBW for obese patients

76
Q

starting dose of levothyroxine for elderly patient with hypothyroidism

A

<1.6 mcg/kg/day

aka start 25 - 50 mcg/day

77
Q

starting dose of levothyroxine for CVD patient with hypothyroidism

A

start 12.5 mcg/day - 25 mcg/day

78
Q

starting dose of levothyroxine for patient that has had hypothyroidism for more than 1 year

A

start 25 mcg/day

79
Q

Liothyronine is ____ (T3 or T4)

A

T3 - rapidly absorbed

80
Q

Liothyronine has what kind of risk

A

cardiac toxicity - because rapid absorption of T3 –> hyperthyroid symptoms possible

81
Q

Possible reasons for a patient to still have high/fluctuating TSH despite a high levothyroxine dose (> 200 mcg/day)

A
  • poor adherence
  • drug-food interaction
  • drug-drug interaction
82
Q

Drug Interactions for levothyroxine that will decrease T4 absorption

A
  • bile acid sequestrant
  • Antacids
  • Ferrous Sulfate
  • Calcium supplement
  • Sucralfate
83
Q

Drug Interactions for levothyroxine that will increase serum TBG concentration

A

Estrogen

84
Q

Drug Interactions for levothyroxine that will increase the T4 requirement/cause more of a need for supplementation

A
  • Enzyme inducers! (Phenytoin, phenobarbitol, carbamazepine, rifampin)
85
Q

Levothyroxine and pregnancy: adjust by _____ mcg and check every _______

A

25; trimester

86
Q

Immediately after delivery of baby —- levothyroxine dose should _______ and be checked _______

A

resume to original (pre-pregnancy) dose; in 6 - 8 weeks

Therapeutics 2 Kappa Epsilon (22 decks)

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