Brainscape's Knowledge GenomeTM

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


See full index

Pharm Exam III > Thyroid and osteoporosis > Flashcards

Thyroid and osteoporosis Flashcards

1
Q

Levothyroxine sodium (Synthroid)

A
  • T4 produces normal levels of T3 and T4
  • DOC for hypothyroidism
  • Drugs levels must be carefully titrated to the individual (TSH levels; Patient S&S)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Liothyronine sodium (Cytomel)

A
  • T3; short half life and duration of action
  • Used for initial therapy (rapid levels) but not maintenance
  • Many drug interactions
  • Side effects similar to hyperthyroidism (reduce dosage or stop for a few days and resume at a lower dose)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment for hyperthyroidism

A
  • Remove the gland by surgery
  • Destroy the gland by 131 iodine
  • Decrease T4 and T3 by thioamides, iodide
  • Block the symptoms by beta blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Thioamides-Propylthiouracil (PTU) and Methimazole (Tapazole) MOA

A
  • Decreases synthesis and release of T4
  • Methimazole more potent
  • PTU–>blocks conversion of T4 to T3
  • Effects are gradual (use beta blockers)
  • Circulating T3/T4 lasts a week or so**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Thioamides indications/therapeutic effects

A
  • First line of treatment for Graves’ (DOC)**
  • Used in conjunction with other treatments
  • Reduces thyroid storm risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Thioamides adverse effects

A
  • Black box warning for PTU** (severe liver injury, acute liver failure)
  • Methimazole DOC in most cases (unless there are allergies and early pregnancy**)
  • Itching and skin rash**
  • Granulocytopenia and agranulocytosis** (reversible, watch for sore throat, do blood test)
  • Goiter**-may need to add T4 to reduce TSH levels
  • Keep dose low in pregnancy (prevent cretinism and goiter in fetus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Iodide MOA

A
  • Iodide rapidly decreases synthesis and release of T4/T3

- Short term effect (2-8 weeks)

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

Iodide indications/therapeutic effects

A
  • Decreases vascularity** and thyroid content of gland
  • Used for 7-10 days before surgery (can decrease likelihood of thyroid storm)
  • Can use in radioactive emergencies**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Radioactive iodide-131 I MOA

A
  • 131 iodide taken into the gland specifically
  • Small amounts (micro)=diagnostic
  • Large amounts (milli)=destroys gland
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Radioactive iodide indications/therapeutic effects

A

-Used in elderly patients and those w/heart disease

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

Radioactive iodide adverse effects

A
  • usually cause hypothyroidism over time

- Thyroid storm risk-decrease risk by use of thioamide (not iodide!) prior to treatment

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

Propanolol (inderal) MOA

A
  • Beta blocker: decreases many of the S&S of hyperthyroidism

- Propanolol specifically inhibits the peripheral conversion of T4 to T3

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

Propanolol indications/therapeutic effects

A

-Used to prepare for surgery and while waiting for thioamides or radioactive iodide to take effect

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

Propanolol contraindications/precautions

A

asthma

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

Calcitonin (Miacalcin)

A
  • Decreases bone resorption of calcium**
  • Antagonizes parathyroid hormone**
  • Decreases bone pain and loss
  • Increases bone density
  • Decreases osteoporotic fractures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Calcitonin (Miacalcin) indications

A
  • Osteoporosis (not 1st line)

- Paget’s disease

17
Q

Calcitonin Pharmacokinetics

A
  • Nasal spray

- Injection

18
Q

Calcitonin adverse effects

A
  • May cause allergic reactions
  • Nasal rhinitis/sinusitis*–>nasal spray
  • Nausea and vomiting*–>injection
19
Q

Teriparatide (Forteo)

A
  • Recombinant parathyroid hormone**
  • PTH stimulates remodeling, causing resorption and new bone formation
  • Intermittent administration produces bone GROWTH** (only anabolic drug for osteoporosis)
  • Actions diminish w/time use antiresorptive agent after 18-24 months
20
Q

Teriparatide indications

A
  • Treatment for osteoporosis

- Hypoparathyroidism

21
Q

Teriparatide pharmacokinetics

A

-Subcutaneous injection (intermittent-once or twice daily)

22
Q

Teriparatide adverse effects

A
  • Hypercalcemia and hypercalciuria
  • Injection site reactions
  • Dizziness, leg cramps
23
Q

Teriparatide contraindications/precautions

A
  • Osteosarcoma (black label warning)**

- Be careful in patients susceptible to any osteosarcoma (pager’s disease, radiation therapy, open epiphyses, hx)

24
Q

Denosumab (prolia)

A
  • Antibody against receptor activator of nuclear factor kappa-beta ligand (RANKL)
  • New treatment for osteoporosis

(DEN=density, OS=osteo, U= human, MAB=monoclonal antibody)

25
Q

Denosumab MOA

A
  • Inhibits bone resorption

- Antibody to RANK-Ligand, the factor made by osteoblasts that is necessary for the formation of mature osteoclasts **

26
Q

Denosumab indications/therapeutic effects

A
  • Osteoporosis in men and postmenopausal women at high risk for fractures**
  • Increases bone mass and strength in both cortical and trabecular bone**
27
Q

Denosumab pharmacokinetics

A

S.C. injection, once/6 months

28
Q

Denosumab adverse effects

A
  • Hypocalcemia
  • Cellulitis, eczema
  • Osteonecrosis of the jaw* in cancer studies
29
Q

Denosumab ABSOLUTE contraindications/precautions

A
  • Hypocalcemia* (fix first)

- Pregnancy-Cat X

30
Q

Denosumab RELATIVE contraindications/precautions

A
  • Chronic kidney disease

- Patients at risk for serious infections (RANK-RANKL signaling in lymphocytes)

31
Q

Bisphosphanates (FDA approved=Alendronate [Fosamax], Risedronate [Actonel], Ibandronate [boniva], zoledronic acid [zometa])

(Off label use=Etidronate [didronel], pamidronate [aredia])

A
  • P-C-P bond analogs of pyrophosphate
  • Substitutes for PO4 in calcium binding** (incorporates into bone, inhibits bone resorption)
  • Powerful drugs
  • May not be needed for patients w/osteopenia?
  • Long term effects still unknown
32
Q

Bisphosphanates MOA

A
  • Inhibits osteoclast activity and bone resorption
  • Bisphosphanates actually strengthen bone
  • Mechanism still unclear
33
Q

Bisphosphanates indications

A
  • First line of treatment (DOC) for post-menopausal osteoporosis**
  • Paget’s disease
34
Q

Bisphosphanates pharmacokinetics

A
  • Oral preparations: absorption is very poor**
  • MUST be taken on an empty stomach** (1/2 glass water; stay upright for 30 min after taking it to decrease esophageal irritation)
  • Others are IV injection only
  • Given anywhere from once/day to once/year
35
Q

Bisphosphanates adverse effects-oral

A

-Abdominal pain, upper GI irritation, esophageal ulceration, constipation, diarrhea, and flatulence

36
Q

Bisphosphanates adverse effects-IV

A

-Renal toxicity if given too fast

37
Q

Bisphosphanates adverse effects-all

A
  • Nausea vomiting**
  • May cause a mild hypocalcemia
  • Possible atrial fibrillation
  • Increased incidence of osteonecrosis of the jaw** after major dental work

Pharm Exam III (11 decks)

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