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Pharm 2 > thyroid and pituitary > Flashcards

thyroid and pituitary Flashcards

1
Q

thyroid makes more t3 or t4?

A

t4

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2
Q

t3 or t4 bioactive?

A

t3

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3
Q

TSH level in hyperthyroidism

A

low

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4
Q

what vitamin interferes w/ thyroid testing?

A

biotin

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5
Q

1 cause of correctable intellectual disability

A

iodine deficiency

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6
Q

amiodarone, lithium,, tyrosine kinase inhibitors (sunitinib, sorafenib; 50%) can all cause ____

A

hypothyroidism

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7
Q

1st line for hypothyroidism

A

levothyroxine

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8
Q

counseing for levothyroxine

A

Take on empty stomach w/ water only
* 30min-1 hour before breakfast
* Take at night
* Careful w/ soy products – can decrease absorption of levothyroxine

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9
Q

DI: Aluminum containing antacids
o PPIs
o Bile acid sequestrants
o Iron supplements
o Calcium supplements
o Ciprofloxacin
o Estrogens (OCPs)
o Grapefruit

A

Drugs impairing levothyroxine absorption, separate administrations times by 4 hrs

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10
Q

how long to monitor TSH after initial dose or dose change of levothyroxine

A

6 wks. then 6-12 months

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11
Q

levothyroxine dosing for in pregnancy / OCPs

A

dose needs to be higher. separate prenatal vitamin by 3 hrs

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12
Q

dosing of levothyroxine

A

1.6mcg/kg

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13
Q

AEs of excessive dosing: Cardiac: heart failure, angina, MI, tachycardia, palpitations, Afib
§ Skeletal: reduced bone density
* Increased risk of fracture; similar profile to osteoporosis
§ GI disturbances: abdominal cramps, diarrhea

A

levothyroxine

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14
Q

indication: thioureas / thioamides

A

hyperthyroidism

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15
Q

class: Propylthiouracil (PTU), Methimazole (Tapazole)

A

thioureas / thioamides

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16
Q

MOA: inhibit enzyme thyroid peroxidase
* Prevents conversion of iodide to iodine à functional T4/T3 cannot be made

A

thioureas

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17
Q

thiourea that blocks conversion of t4/t3 in periphery

A

PTU

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18
Q

thiourea used in 1st trimester of pregnancy

A

PTU

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19
Q

AEs: Higher risk of teratogenicity; aplasia cutis

A

methimazole

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20
Q

AEs: Arthralgias, lupus-like symptoms
* Fever
* Rash
* Transient leukopenia
* Agranulocytosis (rare, but serious)
* Hepatotoxicity w/ both, but more severe w/ PTU

A

thioureas

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21
Q

monitoring if on thioureas

A

baseline CBC, LFTs

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22
Q

add __ to thioureas

A

BB

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23
Q

1st line BB for hyperthyroidism

A

propranolol

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24
Q

MOA: block many hyperthyroidism manifestations mediated by B adrenergic receptors
* Some T4 to T3 conversion is blocked

A

BB

25
Q

CI for radiactive iodine

A

pregnancy / breastfeeding

26
Q

counseling for radioactive iodine

A

maintain 6ft distance and avoid public transport for several days. don’t get pregnant for 6 months. no intercourse for few days

27
Q

class:
SSKI – saturated solution of potassium iodide
§ Lugol’s solution – potassium iodine-iodide

A

iodide solutions

28
Q

MOA: acutely block thyroid hormone release, inhibit thyroid biosynthesis, decreases size and
vascularity of thyroid glands

A

iodide solutions

29
Q

iodide solutions before or after radiactive iodine albation

A

after only

30
Q

iodide solutions as monotherapy?

A

no

31
Q

AEs:
* Rash, metallic taste, mucous membranes ulcerations, fever

A

iodide solutions

32
Q

1st line for thyroid storm

A

PTU (preferred) or methimazole

33
Q

give ___ 2nd in thyroid storm

A

Iodide solution: SSKI or Lugol’s solution

34
Q

Most abundant hormone produced by anterior pituitary lobe

A

GH

35
Q

first test to do if suspected acromegaly

A

serum IGF-1. will be elevated

36
Q

1st line treatment for acromegaly

A

surgery

37
Q

1st line med for acromegaly

A

Somatostatin (GHIH) analogs – first line medication
o Octreotide (sandostatin), Lanreotide, Pasireotide

38
Q

MOA: mimic endogenous somatostatin and bind to somatostatin receptors in pituitary
* Inhibits GH and subsequently IGF-1

A

Somatostatin (GHIH) analogs

39
Q

best efficacy somatostatin

A

pasireotide

40
Q

AEs:
§ GI disturbances
§ Biliary sludge
§ Asymptomatic gallstones
§ May alter balance of counterregulatory hormones (glucagon, insulin, GH) à hyper or
hypoglycemia
§ Higher incidence of hyperglycemia w/ DM
§ May suppress pituitary release of TSH à hypothyroidism

A

somatostatin analogs

41
Q

monitoring for somatostatin analogs

A

thyroid function and glucose

42
Q

drug cautions w/ somatostatin analogs

A

Caution with insulin, oral hypoglycemic agents, BB, CCB à sinus bradycardia, conduction
abnormalities, arrhythmias

43
Q

class: Pegvisomant (Somavert)

A

GH receptor antagonist

44
Q

Most effective agent in normalizing IFG-1 concentration in acromegaly

A

Pegvisomant (Somavert)

45
Q

main AE of Pegvisomant (Somavert)

A

hepatoxicity

46
Q

Pegvisomant (Somavert) is a great option for acromegaly pts w/ _____

A

DM

47
Q

class: Cabergoline, Bromocriptine

A

dopamine agonists

48
Q

monitoring while on dopamine agonists

A

echos

49
Q

these meds can cause….
Somatostatin analogs, GnRH agonists (ex: octreotide), methoxamine, phentolamine, isoproterenol,
glucocorticoids, methylphenidate, amphetamine derivatives

A

GH deficiency

50
Q

main pharm tx for GH deficiency

A

Recombinant Human Growth Hormone (somatotropin)

51
Q

time of day to administer Recombinant Human Growth Hormone (somatotropin)

A

evening

52
Q

AEs:
§ Edema, arthralgia, myalgia, carpal tunnel syndrome, benign increases in ICP (HA, vision
changes, AMS)
* Adults > children

A

Recombinant Human Growth Hormone (somatotropin)

53
Q

Recombinant Human Growth Hormone (somatotropin) CIs

A

Patients w/ active malignancy and obese/respiratory compromise in a child w/ Prader-Willi
syndrome

54
Q

prolactin is inhibited by ____

A

dopamine

55
Q

most common endocrine disorder of hypothalamic-pituitary-axis

A

hyperprolactinemia

56
Q

Any medications that antagonize dopamine or stimulate prolactin can induce hyperprolactinemia
such as ______

A

o Risperidone (major!), metoclopramide, antidepressants, cimetidine, methyldopa, verapamil

57
Q

1st line med for hyperprolactinemia

A

dopamine agonists (cabergoline)

58
Q

Women who become pregnant while taking a dopamine agonist should _____

A

discontinue treatment to
minimize fetal exposure

Pharm 2 (29 decks)

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