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Pharmacology > Thyroid and anti thyroid > Flashcards

Thyroid and anti thyroid Flashcards

0
Q

used in pyrotechniques before being used for the tx of hyperthyroidism

A

PERTECHNATE

PERCHLORATE

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1
Q

inhibits iodide trapping ➡️ hypothyroidism

A

THIOCYANATE

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2
Q

transport to apical membrane drug

A

PENDRINLODINE

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3
Q

a clinical manifestation similar to cretinism

patients have dwarfism and mental retardation

A

Pendrin syndrome

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4
Q

organification inhibition

A

IODIDES

THIONAMIDES

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5
Q

proteolysis drug

A

IODIDES

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6
Q

minimal effect of thiodamides

A

preipheral deiodinization

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7
Q

inhibition of conversion of T4 to T3

A

PTU>METHIMAZOLE

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8
Q

used for arrhythmia

there is greater risk of hypothyroidism due to inhibition of the conversion of T4 to T3

A

AMIODARONE

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9
Q

those without ISA including PROPRANOLOL and ACEBUTOLOL act by

A

inhibition of conversion to T3 and helps in reversal of hyperthyroidism

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10
Q

inhibition of conversion of T4 to T3

A

iodinated contrast media, steroids

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11
Q

decrease the metabolism by inhibition of thyroid hormone conversion

A

starvation
illness
trauma

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12
Q

most thyroid hormones are bound to

A

TBG

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13
Q

thyroid hormones are least bound to

A

albumin

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14
Q

increased TBG in

A

estrogen
pregnancy
oral contraceptive

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15
Q

if there is increase in tbg you need to increase the

A

thyroid hormones

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16
Q

decreased TBG by

A

androgens

steroids

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17
Q

increased displacement from TBG

A

SALICYLATES
MEFENAMIC ACID
FUROSEMIDE

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18
Q

inhibits T4 absorption

A 
CHOLESTYRAMINE
CHROMIUM PICONILATE
COLESTIPOL
CIPROFLOXACIN
PROTON PUMP INH
SURALFATE
AL OH
FE SULFATE
CA CARBONATE
COFFEE
BRAN
SOY
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19
Q

treatment for hypothyroidism

A

iodine supplementation

thyroid hormones

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20
Q

iodine dose for adults

A

150’ug per day

- 75 ug used for TH synthesis

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21
Q

iodine children dose

A

90-120 ug per day

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22
Q

pregnant women iodine

A

200ug per day

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23
Q

iodine supplementation can either lead to

A 
Wolff chaikoff (hypothyroidism)
Jod Basedow (hyperthyroidism)
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24
Q

moa of thyroid hormones

A

binds with receptors in the nucleus, mitochondria and plasma membranes

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25
Q

large number of thyroid hormone receptors are found in

A 
pituitary
liver
kidney
heart
skeletal muscle
lungs
intestines
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26
Q

affinity of the receptor site for T4 is

A

low

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27
Q

uses of thyroid hormones

A

hypothyroidism as a result of RAI therapy and surgery, myxedemam cretinism, excessive administration of anti- thyroid drugs

simple goiter without hyperthyroidism

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28
Q

thyroid preparations

A 
synthetic LEVOTHYROXINE
LIOTHYRONINE
dessicated thyroid
LIOTRIX
THYROGLOBULIN 
I-LEVOTHYROIXINE Na
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29
Q

stable uniformity of contents, low cost, lack of allergenic proteins, easily measurable, long half life

A

SODIUM LEVOTHYROXINE
T4, Eltroxin, Letter
25,50,100mcg tab

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30
Q

not available

more unstable,3-4 times more potent, shorter half life, higher cost, hard to measure, more AE

A

LIOTHYRONINE
T3,Cytomel,Tertoxin
20 mcg tab

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31
Q

unstable presence of protein antigenicity, rarely used

A

dessicated thyroid

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32
Q

used for short term reversal of TSH levels
given during thyroid storm
uniform ratio of T3,T4

A

LIOTRIX

thyroixine,liothyronine

33
Q

infant and children mgt of hypo

A

10-15ug/kg/day

34
Q

adults mgt hypo

A

1.7ug/kg/day

35
Q

myxedema coma dose

A

50-100 ug/day with 500 ug loading dose

36
Q

hypo after graves

A

75-125 ug/day

increased by 25-50ug

37
Q

older px hypo

A

12.5-25 per day

⬆️25 ug every 2 weeks

38
Q

pregnant women hypo

A

30-50% increase in dose

TSH: 0.5-3.0 mU/L

39
Q

subclinical hypothyroidism

A

treat TSH > 10 mU/l

40
Q

initial tx in graves dse

A

antithyroid drugs

41
Q

main tx for graves dse

A

thyroidectomy

42
Q

antithyroid drugs

A

THIAMIDES
IODIDES
RADIOACTIVE IODINE
PROPRANOLOL

43
Q

acts on iodine organification in the thyroid gland and deiodinase rxn in the cells of other tissues in the body

A

THIOAMIDES

44
Q

prep of THIOAMIDES

A

METHIMAZOLE
PROPYLTHIOURACIL
CARBIMAZOLE

45
Q

moa of thioamides

A

inhibit synthesis of thyroid hormones primarily by inhibiting organification of Iodine and coupling of the iodotyrosines

inhibit peripheral conversion of T4 to T3

may have direct effect on the immune by decreasing circulating thyroid stimulating ab and restoration of normal suppressor activity

46
Q

absorption of thioamides

A

almost completely absorbed

47
Q

thioamides peak serum levels attained at

A

1 hour after admin

48
Q

serum half life of PTU

A

1-1.5 hours

49
Q

serum half life of METHIMAZOLE

A

5 hours

50
Q

10 x more potent thioamide

A

METHIMAZOLE

51
Q

more strongly protein bound - used in pregnancy

A

PTU

52
Q

concentrated in fetal thyroid

A

METHIMAZOLE

53
Q

admin of PTU

A

every 6-8 hours

3-4 x a day

54
Q

METHIMAZOLE admin

A

once a day

55
Q

thioamide slower renal excretion

A

METHIMAZOLE

56
Q

Most common ae of thioamides

A

maculopapular rash

57
Q

AE of thioamides

A

maculopapular rash
benign transient leukopenia
agranulocytosis

58
Q

converted to METHIMAZOLE in vivo

A

CARBIMAZOLE

59
Q

methimazole dose

A

10-29 mg q8-12 hours

titrated to 2.5-10mg

60
Q

PTU dosing

A

100-200 mg q6-8 hours
titrated to 25-50 mg
must be titrated every month

61
Q

assessment of thioamide tx

A

6-8 weeks (FT4, FT3)

30-50% euthyroid in 18-24 months

62
Q

not mainstay tx for hyperthyroidism

inhibits iodide organification and proteolysis and peripheral deiodination rxn

A

IODIDES

63
Q

iodides can lead to

A

hyperthyroidism-Jod basedow phenomenone

64
Q

iodide dose

A

6mg per day in 2-7 days

65
Q

iodides in pregnancy

A

CI

crosses the placenta

66
Q

iodides in nuclear accidents

A

inhibits attachment of radioactive iodine in the receptor thus prevention of radioactive absorption to the cell

67
Q

AE of iodides

A 
iodism acneiform rash similar to bromism
swollen salivary glands
mucous membrane ulcerations
conjunctivitis
rhinorrhea
drug fever
metallic taste
bleeding disorders
rarely anaphylactoid reactions
68
Q

given as an adjunct

can alleviate clinical condition without an effect on thyroid hormones

given only to those who respond to thioamide

A

BETA blockers

69
Q

moa of beta blockers

A

acts on adrenergic receptors or iodinase 2 enzyme (converts t4 to t3)

70
Q

beta blocker on iodinase 2 enzyme

A

has little effect because it acts on the peripheral iodinase reaction

71
Q

blockers without ISA

A

PROPRANOLOL
METOPROLOL
ATENOLOL

72
Q

most commonly used given 4 times a day

A

PROPRANOLOL

40-80mcg q6 (160mg/day)

73
Q

METOPROLOL amt

A

100 mg q12 twice a day

74
Q

ATENOLOL amt

A

100 mg OD once a day

75
Q

only isotope used in thyrotoxicosis

A

131 iodine

76
Q

dose of radioactive iodine

A

185-555 mbq

77
Q

PTU should be stopped before radioactive iodine tx

A

3-4 weeks

78
Q

METHIMAZOLE, CARBIMAZOLE should be stopped before radioactive iodine tx

A

3 days only

79
Q

in 5-10 yrs radioactive iodine leads to

A

hypothyroidism

80
Q

after tx of RAI treat px with

A

antithyroid for 3-6 months

81
Q

patient tx with RAI should be isolated for

A

8 days

Pharmacology (8 decks)

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