thyroid and adrenal drugs

Question 1

What drugs can be used to treat hyperthyroidism?

Answer 1

B- adrenoceptor antagonists for symptom relief

• thionamides
• iodine/iodide
• radioactive iodine

Question 2

Effects of B-adrenoceptor antagonist?

Answer 2

reduce some symptoms like tachycardia, dysrhythmias, angina, tremor, agitation

Question 3

uses of B-adrenoceptor antagonists?

Answer 3

hyperthyroid crisis, prepare for thyroidectomy, waiting for effects of thionamides or radioactive iodine

Question 4

MOA of thinoamides

Answer 4

inhibit iodination of tyrosine on thyroglobulin, leading to decreased T3/T4 synthesis, full effects seen a few weeks later after stores are depleted

Question 5

uses of thionamides

Answer 5

short term use before surgery, long-term use in Graves disease as an alternative to surgery or radioiodine

Question 6

ADRs of thionamides

Answer 6

cross placenta leading to congenital hypothyroidism, rashes in 2-2.5%, headaches, nausea, jaundice, joint pain, agranulocytosis leading to fever, mouth ulcers, sore throat, rash

Question 7

MOA of iodine

Answer 7

Wolff-Charikoff block: inhibit iodide organification and thyroid hormone synthesis

Question 8

uses of iodine

Answer 8

short term use, ~2 weeks, preparation for thyroidectomy, thyrotoxic crisis leads to decreased vascularity and gland size

Question 9

MOA of radioactive iodine

Answer 9

emits beta-particles

Question 10

Uses of radioactive iodine

Answer 10

hyperthyroidism and thyroid carcinoma, TFT - oral or i.v, .

Question 11

How long does radioactive iodine work for, how is it administered?

Answer 11

peak effects in 2-4 months, is an oral/single dose

Question 12

ADRs of radioactive iodine

Answer 12

hypothyroidism, thyroid cancer therefore not given in pregnant people or children

Question 13

Treatments for hypothyroidism

Answer 13

T4 and T3

Question 14

when is the max effect of T4?

Answer 14

10 days

Question 15

ADRS of T4

Answer 15

small doses in the elderly due to risk of angina, dysrhythmias, or heart failure

Question 16

how is T3 delivered?

Answer 16

i.v. speed of onset e.g. in myxoedema coma

Question 17

What drugs can cause hypothyroidism?

Answer 17

amiodarone - causing antidysrhythmias, iodinated contrast media.

Question 18

What drugs are used to treat hypercortisolism and hyperaldosteronism?

Answer 18

aminoglutethimide (inhibits cholesterol to pregnenolone) and ketoconazole (inhibits formation of corticosterone and hydrocortisone/cortisol)

Question 19

What drugs to treat hypocorticolism?

Answer 19

glucocorticoids, possible mineralocorticoid replacement therapy? + long term daily replacement therapy, additional cortisol for acute stressors