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pharm II, exam 3 > Thyroid and Osteoporosis Drugs > Flashcards

Thyroid and Osteoporosis Drugs Flashcards

1
Q

Thyroid is regulated by

A
  • TSH
  • iodide
    • low iodide in diet would stimulate thyroid gland; high iodide in diet can inhibit thyroid hormone production but body can overcome this by homeostasis
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2
Q

function of thyroid hormones

A
  • increases basal level of metabolism
  • important for growth and maturation (including CNS)
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3
Q

hypothyroidism in children can lead to

A

cretinism

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4
Q

Which thyroid hormone is most prevalent

A

Thyroid glands makes more T4

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5
Q

Thyroid hormones act through which receptors

A
  • act through nuclear receptors
    • therapy takes time
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6
Q

How is T3 made

A
  1. secreted by thyroid
  2. metabolite of T4 by peripheral cells
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7
Q

Which thyroid hormone is more effective (biologically active)

A

T3 is 3-5x more effective than T4

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8
Q

clinical presentation

  • slow metabolic rate, weight gain, hypothermia
  • sensitivity to cold
  • fatigue
A

Hypothyroidism (low thyroid hormone)

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9
Q

DOC for hypothyroidism

A
  • Levothyroxine sodium (T4)
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10
Q

Dose of Levothyroxine sodium

A
  • drug levels must be carefully titrated to the individual
    • TSH levels
    • patient signs and symptoms
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11
Q

what is the major sign of primary hypothyroidism

A
  1. primary: failure of thyroid gland
  2. High TSH -> goiter
    • thyroid is growing too big
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12
Q

MOA of Liothyronine sodium

A
  • T3
  • used for initial therapy of severe hypothyroidism (rapid levels) but not maintenance
    • then switch over to levothyroxine sodium
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13
Q

clinical presentation

  • fast metabolsim
  • tachycarida
  • fatigue
  • hot
  • tremor
  • insomnia
  • diarrhea
A

hyperthyroidism

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14
Q

what is graves disease

A
  • antibodies to TSH receptor
  • stimulate gland to produce too much T3/T4
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15
Q

what is toxic nodular goiter

A
  • adenoma of the thyroid that produces too much thyroid hormone
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16
Q

List the treatment options of Hyperthyroidism

A
  1. remove gland: surgery
  2. destroy gland: 131 I
  3. decrease T4 and T3: Thioamides, iodide
  4. block the symptoms: B-blockers
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17
Q

List the Thioamides

A
  • Propylthiouracil
  • Methimazole : more potent
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18
Q

MOA of Thioamides

A
  • decrease synthesis and release of T4
  • Propylthiouracil: blocks conversion of T4 to T3
  • effects are gradual (use B-blockers)
    • circulating T3/T4 lasts a week or so
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19
Q

DOC graves disease

A

Methimazole

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20
Q

adverse effects of Propylthiouracil specifically

A
  • black box warning
    • severe liver injury, acute liver failure
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21
Q

When is Propylthiouracil used over Methimazole

A
  • allergy to Methimazole
  • early pregnancy
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22
Q

adverse effects of Thioamides

A
  • itching and skin rash
  • granulocytopenia
  • agranulocytosis
  • goiter: may need to add T4 to reduce TSH levels
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23
Q

MOA of Iodide

A
  • rapidly decreases synthesis and release of T4/T3
  • short term effect (2-8 weeks)
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24
Q

when is iodide indicated

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
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25
Q

MOA of radioactive iodine (131I)

A
  • small amounts uCi = diagnostic
  • large amounts mCi: destroys gland
26
Q

when is radioactive iodine (131I) used instead of thyroidectomy

A
  • used in elderly patients and those with heart disease
27
Q

adverse effects of radioactive iodine (131I)

A
  • thyroid storm risk
    • decrease risk by use of thioamide prior to tx
28
Q

MOA of Propranolol

A
  • beta blockers: decreases many of the signs and symtpoms of hyperthyroidism
  • specifically inhibits the peripheral conversion of T4 to T3
29
Q

when is Propranolol used in hyperthyroid patients

A
  • used to prepare for surgery and while waiting for thioamides or 131 I to take effect
30
Q

when is Propranolol contraindicated

A

asthma

31
Q

function of osteoclasts

A

break down and resorb bone

32
Q

function of osteoblasts

A

form and deposit bone

33
Q

human bone remodeling is dominant to what

A
  • resorption dominant:
  • 3 weeks required to dig a resorption pit
  • osteoblasts take 3-4 months to fill in new bone formation
  • ***decreasing bone resportion is key to osteoporosis tx
34
Q

function of parathyroid hormone

A
  • stimulated when blood calcium is low
  • increase circulating Ca2+ by
    • increase osteoclasts activity and number-> RANK ligand
    • increase renal ability to reabsorb calcium
      • decrease Ca2+ excretion
      • Increase PO4 excretion
    • stimulates production of calcitriol
35
Q

function of Vitamin D

A
  • increase circulating Ca2+ by
    • stimulating osteoclast activity through RANK ligand
    • stimulate collagen synthesis in osteoblasts
    • increases intestinal absorption
    • decrease renal excretion
  • works in conjunction with PTH
36
Q

function of calcitonin

A
  • secreted by circulating Ca2+ is too high
  • decreases circulating Ca2+ by
    • inhibiting osteoclasts to decrease bone resorption
  • will maintain bone in pregnancy and lactation
    • stimulated by estrogen
37
Q

what is going on in osteoporosis

A
  • amount of bone is decreased
  • structural integrity of trabecular bone is impaired
  • cortical bone becomes more porous and thinner
  • makes the bone weaker and more likely to fracture
38
Q

list the risk factors for osteoporosis

A
  • postmenopausal women
  • long-term glucocorticoid use
  • thyrotoxicosis
  • alcoholism
  • malabsorption syndrome
39
Q

DOC for post-menopausal osteoporosis

A

Bisphosphonates

40
Q

treatment options for osteoporosis

A
  • calcium + vitamin D
  • HRT
  • calcium-regulating hormones (PTH, calcitonin)
  • bisphosphonates: DOC
41
Q

use of calcium + vitamin D to tx osteoporosis, how is it given

A
  • not all calcium preparations are absorbed equally
    • chewable safest bet
  • vitamin D must be adequate for optimal absorption of calcium
  • *calcium and vit D can’t prevent or treat osteoporosis alone
42
Q

MOA of calcitonin (Miacalcin)

A
  • decreased bone resorption of Ca2+
  • antagonizes PTH hormone
43
Q

how is calcitonin (Miacalcin) given

A
  • nasal spray
  • injection
44
Q

adverse effects of calcitonin (Miacalcin)

A
  • nasal spray: rhinitis/sinusitis
  • injection: N/V
45
Q

what is Teriparatide

A
  • recombinant parathyroid hormone
  • intermittent administration produces bone growth​
46
Q

what is the only anabolic drug for osteoporosis

A

Teriparatide

47
Q

how is Teriparatide given

A

subcutaneous injection: intermittent- once or twice daily

48
Q

when is Teriparatide contraindicated

A
  • osteosarcoma
49
Q

MOA of Denosumab

A
  • antibody against RANK ligand, the factor made by osteoblasts that is necessary for formation of mature osteoclasts
  • inhibits bone resorption
  • DEN - density
  • OS: osteo
  • U: human
  • MAB: monoclonal antibody
50
Q

when is Denosumab indicated

A
  • osteoporosis in men and postmenopausal women at high risk for fx
51
Q

Denosumab increases bone mass and strength in both

A

cortical and trabecular bone

52
Q

adverse effects of denosumab

A
  • osteonecrosis of the jaw
  • hypocalcemia
53
Q

When is Denosumab contraindicated

A
  • hypocalcemia: fix first
  • pregnanc Category X
54
Q

how is Denosumab given

A
  • S.C. injection, once6 months
55
Q

List the Bisphosphonates

A
  • Alendronate
  • Risedronate
  • Ibandronate
  • Zoledronic Acid
  • off label use
    • Etidronate
    • Pamidronate
56
Q

MOA of Bisphosphonates

A
  • Phosphate-calcium-phosphate analogs of pyrophosphate
  • substitutes for PO4 in Ca2+ binding
    • incorporates into bone
    • inhibits osteoclast acitivity and bone resorption
      • drug will be in bone rest of life
57
Q

what special precautions must you know for the oral Bisphosphonates

A
  • absorption is very poor
  • must be taken on an empty stomach
  • 1/2 glass of water
  • stay upright for 30 minutes after taking it to decrease esophageal irritation
58
Q

adverse effects of oral Bisphosphonates

A
  • abd pain
  • upper GI irritation
  • esophageal ulceration
  • constipation
  • diarrhea
  • flatulence
59
Q

adverse effects of IV Bisphosphonates

A

renal toxicity if given too fast

60
Q

adverse effects of ALL adverse effects of oral Bisphosphonates

A
  • N/V
  • increased incidence of osteonecrosis of the jaw after major dental work
61
Q

Which of the Bisphosphonates are taken orally

A
  • Alendronate
  • Risedronate
  • Ibandronate
  • Etidronate:
62
Q

Which of the Bisphosphonates are taken through IV

A
  • Zoledronic Acid
  • Pamidronate
  • Etidronate
  • Ibandronate

pharm II, exam 3 (8 decks)

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