Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 3 module 1 > Thyroid and calcium homeostasis > Flashcards

Thyroid and calcium homeostasis Flashcards

1
Q

What medications can you prescribe for hypothyroidism

A

Levothyroxine (T4)
Liothyrine (T3)
Liotrix (T3+T4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the goals of treating hypothyroidism

A

provide resolution in patients symptoms

Achieve normalization of serum thyrotropin (TSH) w/ improvement in thyroid hormone concentrations

avoid over treatment - especially in elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What may decrease absorption of T4

A

Aluminum and magnesium containing antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the PK of T4

A

Metabolized in the liver
eliminated in bile
half life 7 days
deiodinated in patients tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the PK of T3

A

Oral
short half life
metabolized by liver
eliminated in bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is important to teach patients when prescribing T4

A

Needs to be on an empty stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some adverse effects of T3

A

Increased risk of cariotoxicity
transient hyperthyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is T3 alone typically prescribed

A

When patient comes in and has myxedema coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some medications for hyperthyroidism

A

methimazole
propylthiouracil
propranolol
iodine + potassium iodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drugs are Thiomides

A

Propylthiouracil (PTU)
Methimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the MOA of PTU and methimazole

A

Inhibit thyroid hormone synthesis and thyroperoxidase

PTU also inhibits D1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the DOC for thyroid storms

A

PTU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which thioamide is preferred in early pregnancy

A

PTU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which thioamide is preferred in 2nd and 3rd trimester

A

methimazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the side effects for thioamides

A

Teratogenic
Hepatotoxicity
BM suppression (Agranulocytosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the advantage of methimazole over PTU

A

Methimazole has clinical advantages and is less toxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the MOA of propranolol

A

Non-selective beta blocker
Inhibits deiodination of T4
reduces circulating T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the PK of propranolol

A

IV in emergent settings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the adverse effects of propranolol

A

Decrease CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the MOA of iodine and KI

A

Inhibition of biosynthesis (iodination of tyrosine)

inhibition of secretion of T3/T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When are the effects of iodine at their max

A

10 days post admin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the adverse effects of iodine

A

exacerbation of hyperthyroidism
mucosal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the indications for potassium iodide

A

Preoperative preparation for thyroidectomy in Graves disease to decrease gland vascularity

thyroid storm

combo treatment to improve short term control of graves

S/P admin of radioiodine in Graves disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is potassium iodine used most commonly

A

used to treat severe hyperthyroidism and to protect the thyroid gland when using radiopharmaceuticals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the PK of radioactive iodine

A

orally admin. as sodium iodide

rapidly absorbed into thyroid causing local destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How long does it take to inactivate the thyroid after taking radioactive iodine

A

6-18weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the indications for radioactive iodine

A

Graves
Toxic adenoma
multi nodular goiter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are clinical presentations of hypercalcemia

A

Shortened QT wave
ST depression
AV blocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some common causes of hypercalcemia

A

hyperparathyroidism
malignancy
thiazides
lithium
pancreatitis
granulomatous disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some options for treating hypercalcemia

A

IV hydration
calcitonin
bisphosphonates
loop diuretis
glucocorticoids
denosumab
dialysis

31
Q

What is the treatment for low to moderate hypercalcemia

A

hydration and fix underlying causes

32
Q

How do you treat severe hypercalcemia

A

Calcitonin
Zoledronic acid
Denosumab

33
Q

What is the job of calcitonin

A

Stimulates Ca2+ deposites in bones and decrease uptake in the kidney

34
Q

What is the job of vitamin D

A

Increase intestinal and renal uptake of Ca2+ and stimulates release from bones to stimulate bone mineralization

35
Q

What does estrogen do

A

Inhibits apoptosis in osteoblasts
Induces apoptosis in osteoclasts

estrogen deficiency leads to excess remodeling and bone resorption = osteoporosis

36
Q

A low or intermittent levels of PTH, what effect does it have

A

anabolic effects of osteoblasts

37
Q

If there is Hugh PTH levels, what is the cause

A

catabolic effects of osteoblasts

38
Q

What is the MOA of bisphosphonates

A

Inhibits osteoclast activity which reduces bone resorption and turnover

39
Q

What are medications that are bisphosphonates

A

Alendronate
Risendronate
Zoledronic acid
Ibandronate

40
Q

What is the indication for alendronate

A

Osteoporosis
pagets
Osteopenia in non-ambulatory pts

41
Q

What is the indication for risedronate

A

Osteoporosis
pagets

42
Q

What is the indication for ibandronate

A

Osteoporosis

43
Q

What is the indication for Zoledronic acid

A

osteoporosis
malignant hypercalcemia
bone metastesis
multiple myeloma

44
Q

What are the side effects of bisphosphonates

A

Bone/joint/muscle pain
Nausea, heartburn, diarrhea
Upper GI irritation (Alendronate)
Headache
Atypical femur fractures
osteonecrosis of jaw
Hypcalcemia

45
Q

What are contraindications for bisphosphonates

A

Esophageal disorders
renal insufficiency
hypocalcemia
Taking with food (30-60 min before food)

46
Q

What is the MOA of calcitonin

A

Antagonizes effects of PTH
inhibits osteoclast activity
promotes renal secretion of Ca2+

47
Q

What are the indications for calcitonin

A

Hypercalcemia
pagets disease
Post menopausal osteoporosis
pain from osteoporotic fx

48
Q

What are adverse effects of calcitonin

A

Rhinitis
epistaxis
back pain
N/V
bronchospasm
hypocalcemia
anaphylaxis

49
Q

What is the MOA of vitamin D

A

Cholecalciferol is a provitamin. The active metabolites 1,25-dihydroxyvitamin D which stimulates Ca2+ absorption from the small intestine to promote bone mineralization

50
Q

What are the indications for vitamin D

A

Deficiency
Osteoporosis
Hypoparathyroidism

51
Q

What are the adverse effects of vitamin D

A

Well tolerated

52
Q

What are contraindications for Vitamin D

A

Hypercalcemia
Primary hyperparathyroidism
Sarcoidosis

53
Q

What is the MOA of Calcitriol

A

Vit. D analog that stimulates intestinal Ca2+ absorption which decreases PTH synthesis and stimulate bone mineralization

54
Q

What are the indications for Calcitriol

A

Renal failure
Hypoparathyroidism
rickets
hypophosphatemia

55
Q

What are the adverse effects of Calcitriol

A

Hypercalcemia
hyperphosphatemia
N/V

56
Q

What are the contraindications for calcitriol

A

Pancreatitis
soft tissue calcification
arrhythmias

57
Q

What is the MOA of denosumab

A

Recombinant antibody that inhibits RANK-L to bind to RANK (antiresorptive)

58
Q

What are the indications for Denosumab

A

Osteoporosis
Unable to tolerate/unresponsive to bisphosphonates

renal impairment

59
Q

What are the side effects of denosumab

A

Osteonecrosis of jaw
atypical subtrochanteric fracture
bone pain

60
Q

What are the contraindications of denosumab

A

Hypocalcemia

61
Q

What is the MOA of Teriparatide (Recombinate PTH)

A

Anabolic affect on bone metabolism by stimulating bone formation and activating bone remodeling

treatment <2yrs / lifetime

62
Q

What are the indications for teriparatide

A

Osteoporosis

63
Q

What are the side effects of teriparatide

A

Generally well tolerates
hypercalcemia/hypercalciuria
orthostatic hypertension

64
Q

What is the BBW for teriparatide

A

Osteosarcoma

65
Q

What are the contraindications for teriparatide

A

Hypercalcemia
severe renal impairment

66
Q

What is the MOA for Raloxifene

A

Selective estrogen receptor modifier (SERM)

acts like estrogen adonis in the bone, decreasing bone resorption and overall bone turnover = increase in bone density

67
Q

What are the indications of Raloxifene

A

postmenopausal Osteoporosis

68
Q

What are adverse effects of Raloxifene

A

Hot flashes
leg cramps
peripheral edema
DVT/PE

69
Q

What are the contraindications for Raloxifene

A

History of DVT/PE
pregnancy

70
Q

How do Thiazides effect calcium levels

A

Decrease urinary excretion Ca2+

inhibits secretion of calcium sometimes leading to hypercalcemia

71
Q

How to loop diuretics effect calcium levels

A

Increases urinary calcium concentration

useful with hypercalcemia because it stimulates Ca2+ excretion

72
Q

What therapeutic effects do the fluoride ions have on the body

A

Increases osteoblast activity
increase bone density
*fx risk NOT reduced

73
Q

What are the toxic effects of the fluoride ion

A

GI effects (N/V & Diarrhea)
Renal/cardiac dysfunction

Pharm 3 module 1 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions