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► Med - Pharmacology > Thyroid and Anti-thyroid Drugs > Flashcards

Thyroid and Anti-thyroid Drugs Flashcards

1
Q

What thyroid hormone is formed in greater amounts?

A

T4 (90%)

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2
Q

What are the 3 main proteins that transport T4?

A
  • Transthyretin
  • Thyroid Binding Globulin
  • Albumin
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3
Q

What enzyme converts T4 to T3?

A

5’-deiodinase

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4
Q

What is the effect of thyroid hormone on GH?

A

Increases GH

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5
Q

What is the function of thyroid hormone on uncoupling protein?

A

Increases it - generates heat

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6
Q

What is the effect of thyroid hormone on the beta-adrenergic receptors?

A

It will increase their number in the heart

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7
Q

What is the treatment for hypothyroidism?

A

T3 or T4

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8
Q

Levothyroxine

A

Mainly T4 so it is less potent and also safer but takes several weeks for action

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9
Q

What is the effect of T4 on warfarin?

A

Increases the effects of warfarin from protein displacement

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10
Q

What are the treatments for hyperthyroidism?

A
  • Surgery or radiation
  • Thioureylenes
  • beta-blockers
  • Corticosteroids
  • Iodide
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11
Q

Thioureylenes (Methimazole/Propylthiouracil)

A

Inhibit iodide organification via iodination and coupling

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12
Q

What is a unique action of PTU peripherally?

A

Inhibits peripheral conversion of T4 into T3

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13
Q

What is the more potent thioureylene?

A

Methimazole

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14
Q

What is the DOC for hyperthyroid pregnant women?

A

PTU

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15
Q

What are the main SE of PTU and methimazole?

A
  • Agranulocytosis
  • Granulocytopenia
  • Rash
  • Hypothyroidism
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16
Q

Iodide

A

At high doses it inhibits iodide uptake in the thyroid

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17
Q

What is iodide particularly useful for treating?

A

Thyroid Storm

18
Q

Radioactive Iodide MOA

A

Iodide is taken up and concentrated in the thyroid and the radiation leads to destruction of the gland to reduce activity

19
Q

Radioactive Iodide SE

A

Delayed hypothyroidism

20
Q

Beta Blockers

A

Blocks the beta receptors on the heart and decreases conversion of T3 to T4

21
Q

Anion Inhibitors (ClO4-, SCN)

A

Used only for diagnostic tools as they are highly toxic - compete with iodide uptake

22
Q

Thyroid Storm

A

Life threatening situation with large amounts of thyroid hormone - heat intolerance, sweating, tachycardia, etc.

23
Q

What is the treatment for thyroid storm?

A
  • Acetaminophen - anti-fever
  • beta-blockers
  • PTU
24
Q

Levothyroxine MOA

A

T4 analog converted into T3 which acts as an agonist of VDR

25
Q

Levothyroxine Indications

A

Hypothyroidism

26
Q

Levothyroxine SE

A
  • Hyperthyroidism with overdose
  • Risk of atrial fibrillation
  • Bone loss in postemenopausal women
27
Q

Liothyronine MOA

A

T3 analog and is active hormone that acts as an agonist of the VDR transcription factor

28
Q

Liothyronine Indications

A

Hypothyroidism when rapid onset of action is required - myxedema coma or radio iodine therapy for thyroid cancer

29
Q

Liothyronine SE

A

Risk of thyrotoxicosis with over dose

30
Q

What is a physiological example where TBG is increased and what is the response?

A

Pregnancy will have increased estrogen with increases TBG and leads to decreased T4 that is free reducing the effects of thyroid hormone.

31
Q

What is the DOC is almost all cases of hypothyroidism?

A

Levothyroxine

32
Q

Myxedema Coma

A

Decreased mental status, hypothermia, hypotension, bradycardia, hypoglycemia and hypoventilation - often precipitated by an acute stressor

33
Q

Propanolol MOA in Hyperthyroidism

A
  • Ameliorate adrenergic symptoms

- Inhibits the deiodinase enzyme that converts T4 into T3 (small effect/slow onset)

34
Q

Thioureylenes MOA

A
  • Inhibit Thyroid Peroxidase organification coupling

- PTU partially inibits peripheral deiodination of T4 to T3

35
Q

Thioureylenes SE

A
  • Skin Reactions – pruritus, rash and urticaria
  • Joint Pain‐ arthralgias and arthritis
  • Fever
  • ANCA
  • Hepatotoxicity
36
Q

Wolf-Chaikoff Effect

A

‐ negative feedback mechanism

‐ inhibits organification by inhibiting thyroid peroxidase

37
Q

How can cholestyramine be used in thyroid storm?

A

Blocks thyroid hormone reabsorption

38
Q

Amiodarone-induced Thyroid Disease

A

‐ high iodine content causes Wolff‐Chaikoff effect
‐ inhibits the deiodination of T4 to T3
‐ blocks binding of T3 to Thyroid Hormone Receptor
‐ direct toxic effect on thyroid follicular cells

39
Q

What is the treatment for thyroid carcinoma?

A

Complete surgical removal

40
Q

Thioureylenes (MMI/PTU) MOA

A

Inhibit Thyroid Peroxidase Organification Coupling

► Med - Pharmacology (74 decks)

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