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Pharm exam 4 > Thyroid and Antithryoid > Flashcards

Thyroid and Antithryoid Flashcards

1
Q

drugs that are thyroid preps

A

Levothyroxine (T4)

Liothyronine (T3)

Liotrix (T3, T4)

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2
Q

Adjunct therapy agents

A

propranolol

diltiazem

barbituates

bile acide sequetrants

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3
Q

Thyroid hormone synthesis:

iodide uptake into thyroid gland by the 1

2 mediated oxidation of iodide to iodine

A
  1. sodium/iodide symporter

2. peroxidase

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4
Q

when is transcription repressed

A

absence of thyroid hormone; unbound T3 receptor

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5
Q

what converts T4 to T3

A

5’-deiodinase

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6
Q

when is thyroid synthesis inhibited and when is it promotes

A

High = inhibit NIS, iodination, hormone release

Low = stimulate TSH release and T3 production

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7
Q

what is the goal in treating hypothyroidism

A

increase [T4] in blood

normalize TSH

alleviate sx

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8
Q

what is the tx of choice for hypothyroidism

A

Levothyroxine

  • activation of T3 receptors
  • 7 day T1/2
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9
Q

why treating hypothyroidism what is a special consdieration that needs to be addressed?

A

Coronary artery disease

  • in elderly there is often underlying CAD. Thyroid hormone is protective. Tx. must be done carefully not to provoke arrhythmias, angina, or MI
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10
Q

In graves disease autoantibodies stimulate TSH receptors and increase production of T3 and T4; would you expect TSH levels to be high or low

A

low

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11
Q

how would you treat hyperthryoidism

A

methimazole

propylthiouracil

(thioamides)

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12
Q

MOA of thioamides

A

inhibit peroxidase rxn, iodine organification, and coupling of iodotyrosines

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13
Q

what is a consideration for the use of thioamides

A

low levels cross placental barrier - risk of fetal hypothyroidism

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14
Q

which thioamide would be preferred if femaile is in 1st trimester of pregnancy? why?

A

Propylthiouracil - more bound to plasma proteins

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15
Q

which thioamide is used for thyroid storm due to rapid absorption

A

propylthiouracil

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16
Q

which thioamide has a black box warning for severe hepatitis

A

propylthiouracil

17
Q

what does the antithyroid agents potatssium iodide and lugol’s solution due to iodide stores?

A

increases intraglandular iodide stores thus delaying onset of thioamide therapy

18
Q

why are iodides often used in combo with other agents

A

normally only inhibit for 2-8 weeks

- escape inhibition due to decrease in sodium/iodide transporter expression

19
Q

withdrawal from iodides will produce ___

A

thyrotoxicosis

20
Q

what drugs are useful for thyroid storms

A

Propylthiouracil

Iodides

Adjuncts - propranolol, atenolol, metoprolol

21
Q

what drugs can be useful for preoperative preparation for surgery due to its impact on hyperplastic glands - decreases vascularity, size and fragility

A

Iodides - potassium iodide and Lugol’s solution

22
Q

adverse effects of iodides

A

Cold sx - HA, sneezing, cough

23
Q

MOA of radioactive iodines in tx hyperthyroidism

A

beta rays destroy parenchymal cells f thyroid

gama rays can be used in detecting [RAI] remaining in thyroid glands

24
Q

why when treating hyperthyroidism with radioactive iodine do you often end up having to treat hypothyroidism

A

complete ablation can occur

25
Q

After radioactive iodine tx what should be used to control hyperthyroidism while waiting for effect

A

beta blockers

iodide

or antithyroid drug

26
Q

what is radioactive iodine therapy contraindicated for

A

pregnancy - concentrate in fetal thyroid

27
Q

what are the anion inhibitors in treating hyperthyroidism

A

perchlorate

pertechnetate

thiocyanate

28
Q

MOA of anion inhibitors

A

inhibit energy dependent uptake of iodide into the thryoid cell that is mediated by the sodium/iodide transporter

29
Q

Effects of anion inhibitors can be overcome by what?

A

large doses of iodide

30
Q

what type of hyperthyroidism do anion inhibitors treat

A

iodide-induced hyperthyroidism

31
Q

adverse effect of perchlorate (anion inhibitor)

A

aplastic anemai

32
Q

what is the major clinical use of propranolol in adjunct therapy

A

control tachycardia, HTN, and A fib

also inhibits conversion of T4 to T3

33
Q

what adjunct can control tachycardia in asthmatics

A

diltiazem

34
Q

what adjunct increase T4 metabolism

A

barbituates

35
Q

what adjunct increases biliary T4 excretion

A

bile acid sequestrants

36
Q

which drug for hyperthyroidism can cause rash, nausea, GI distress, agranulocytosis, altered taste and smel

A

Methimazole (taste/smell in particular)

propylthiouracil (severe hepatitis too_

37
Q

what hyperthyroidism drugs can cause a metallic taste, sore gums and teeth, skin lesions, hypersensitivity, angioedema, laryngeal edema, goiter if taken during pregnancy

A

Potassium iodide

Lugol’s solution

Pharm exam 4 (15 decks)

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