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Thyroid Drugs Flashcards

1
Q

Which calcium compound requires stomach acid for absorption?

A

Calcium carbonate

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2
Q

What should be included in oral calcium preparations? Why?

A

Vitamin D

It increases intestinal absorption of Ca2+

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3
Q

Which is preferred: Calcium gluconate or calcium chloride? Why?

A

Calcium gluconate

It produces less venous irritation

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4
Q

What is the MOA of Ergocalciferol?

A

Vit D compound

  • regulates absorption of Ca and PO4 from the small intestine
  • Inhibits PTH synthesis and release
  • Increases bone formation
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5
Q

What are the indications of ergocalciferol?

A
  • Vit D-dependent rickets
  • Hypocalcemia due to hypoparathyroidism
  • Tetany
  • Chronic renal dialysis
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6
Q

What are the contraindications of Ergocalciferol?

A
  • Pregnancy
  • History of renal stones
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7
Q

What are the SE of Ergocalciferol?

A
  • GI:
    • Metallic taste
    • Vomiting
  • CNS
    • Weakness
    • Headache
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8
Q

What side effect can occur when taking ergocalciferol with magnesium-containing antiacids?

A

hypermagnesemia

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9
Q

What side effect can occur when taking ergocalciferol with barbiturates?

A

Vitamin D deficiency

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10
Q

What side effect can occur when taking ergocalciferol with phenytoin?

A

Vitamin D deficiency

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11
Q

Ergocalciferol

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Vit D3 analog
    • absorption of Ca and PO4 from intestines
    • inhibits PTH
    • Overall: increases Ca and bone formation
  • IND
    • Rickets
    • Hypocalcemia from Hypoparathyroidism
    • Tetany
    • Chronic renal dialysis
  • SE
    • GI: metallic taste, vomiting
    • CNS: weakness, headache
  • CON
    • pregnancy
    • History of renal stones
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12
Q

What is the MOA of bisphosphonates?

A
  • Inhibit mevalonate pathway in osteoclasts
  • Slow or block bone resorption
    • lower serum Ca lvls
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13
Q

Alendronate

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Bisphosphonate
    • Inhibits mevalonate pathway in osteoclasts
    • Slow or block bone resorption (lower serum Ca lvls)
  • IND
    • Osteoporosis
    • Paget’s Disease
  • SE
    • Esophageal erosion in patients who cannot remain upright
    • Initial increase in bone pain in Paget’s
    • Nausea
    • Diarrhea
  • CON
    • Pregnancy
    • Renal dysfunction
      • interfere with excretion
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14
Q

Etidronate

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Bisphosphonate
    • Inhibits mevalonate pathway in osteoclasts
    • Slow or block bone resorption (lower serum Ca lvls)
  • IND
    • Hypercalcemia of malignancy
  • SE
    • Esophageal erosion in patients who cannot remain upright
    • Nausea
    • Diarrhea
  • CON
    • Pregnancy
    • Renal dysfunction
      • interfere with excretion
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15
Q

Risedronate

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Bisphosphonate
    • Inhibits mevalonate pathway in osteoclasts
    • Slow or block bone resorption (lower serum Ca lvls)
  • IND
    • Osteoporosis
    • Paget’s Disease
  • SE
    • Esophageal erosion in patients who cannot remain upright
    • Initial increase in bone pain in Paget’s
    • Nausea
    • Diarrhea
  • CON
    • Pregnancy
    • Renal dysfunction
      • interfere with excretion
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16
Q

Pamidronate

  • MOA
  • IND
  • SE
  • ​CON
A
  • MOA
    • Bisphosphonate
    • Inhibits mevalonate pathway in osteoclasts
    • Slow or block bone resorption (lower serum Ca lvls)
  • IND
    • Paget’s Disease
    • Hypercalcemia of malignancy
    • Osteolytic bone lesions
  • SE
    • Esophageal erosion in patients who cannot remain upright
    • Initial increase in bone pain in Paget’s
    • Nausea
    • Diarrhea
  • CON
    • Pregnancy
    • Renal dysfunction
      • interfere with excretion
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17
Q

Tiludronate

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Bisphosphonate
    • Inhibits mevalonate pathway in osteoclasts
    • Slow or block bone resorption (lower serum Ca lvls)
  • IND
    • Osteoporosis
    • Paget’s Disease
  • SE
    • Esophageal erosion in patients who cannot remain upright
    • Initial increase in bone pain in Paget’s
    • Nausea
    • Diarrhea
  • CON
    • Pregnancy
    • Renal dysfunction
      • interfere with excretion
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18
Q

Ibandronate

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Bisphosphonate
    • Inhibits mevalonate pathway in osteoclasts
    • Slow or block bone resorption (lower serum Ca lvls)
    • (-) osteoclasts
  • IND
    • Osteoporosis
  • SE
    • Esophageal erosion in patients who cannot remain upright
    • Initial increase in bone pain in Paget’s
    • Nausea
    • Diarrhea
  • CON
    • Pregnancy
    • Renal dysfunction
      • interfere with excretion
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19
Q

Zoledroic Acid

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Bisphosphonate
    • Inhibits mevalonate pathway in osteoclasts
    • Slow or block bone resorption (lower serum Ca lvls)
  • IND
    • Osteoporosis
    • Paget’s Disease
    • Hypercalcemia of malignancy
    • Osteolytic bone lesion
  • SE
    • Esophageal erosion in patients who cannot remain upright
    • Initial increase in bone pain in Paget’s
    • Nausea
    • Diarrhea
  • CON
    • Pregnancy
    • Renal dysfunction
      • interfere with excretion
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20
Q

What is the MOA of Calcitonin?

A
  • Binds osteoclasts and raises cAMP
    • inhibits bone resorption
    • lowers Ca lvls
  • Increased excretion of Ca, PO4, Na from kidney
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21
Q

What are the therapeutic uses of calcitonin?

A
  • Osteoporosis
    • only in women who can’t tolerate other treatments
  • Paget’s Disease
  • Hypercalcemia
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22
Q

What are the side effects of Calcitonin use?

A
  • Flushing
  • Rash
  • Urinary frequency
  • injection site inflammation
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23
Q

What are the contraindications of Calcitonin use?

A
  • Could exacerbate:
    • Renal dysfunction
    • Pernicious anemia
  • salmon/fish allergies (for salmon calcitonin)
24
Q

Calcitonin

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Binds osteoclasts and raised cAMP
      • bone resorption
      • lowers Ca lvls
  • IND
    • Osteoporosis
      • In women who can’t tolerate other treatments
    • Paget’s Disease
    • Hypercalcemia
  • SE
    • Flushing
    • Rash
    • Urinary frequency
  • CON
    • Renal dysfunction
    • Pernicious anemia
25
Q

Raloxifene

  • MOA
  • IND
  • SE
A
  • MOA
    • Estrogen agonist in bone
    • Estrogen antagonist in endometrium and breast
      • decreased cancer risk
  • IND
    • Osteoporosis in women with breast cancer or endometrial cancer
  • SE
    • venous thromboembolism
      • increased hepatic sythesis of clotting factors
26
Q

How do estrogens affect bone?

A
  • suppresses transcription of IL-6
    • induces osteoclast proliferation
  • Osteoclast apoptosis
  • Increased osteoblasts and osteocytes
27
Q

Plicamycin

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • inhibits osteoclasts
    • block action of PTH
    • interrupts DNA-directed RNA synthesis
  • IND
    • Paget’s disease
    • Hypercalcemia
  • SE
    • Myelosuppression
    • Coagulation disorders
  • CON
28
Q

Fluoride

  • MOA
  • IND
  • SE
A
  • MOA
    • Mitogen for osteoblasts
    • increases trabecular bone mass
  • IND
    • Possibly osteoporosis
  • SE
    • risk of osteosclerosis
29
Q

Strontium ranelate

  • MOA
  • IND
  • SE
A
  • MOA
    • decreases osteoclast, increases osteoblast activity
    • marker for bone formation
  • IND
    • None in US
  • SE
    • Heart complications including heart attack
30
Q

Why is Strontium ranelate not used in the US?

A
  • SE: heart complications including heart attacks
31
Q

What is the MOA of Parathyroid Hormone?

A
  • MOA
    • intermittent stimulation of bone cells increases remodeling with more bone formed than resorbed
32
Q

Teriparatide

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • intermittent stimulation of bone cells increases remodeling with more bone formed than resorbed
  • IND
    • Osteoporosis
      • Postmenopausal
      • In Men
  • SE
  • CON
    • those with risk of osteosarcoma
33
Q

Denosumab

  • MOA
  • IND
  • SE
A
  • MOA
    • Ab that inactivates RANK ligand
    • Prevents recruitment and function of osteoclasts
  • IND
    • Osteoporosis
  • SE
    • musculoskeletal pain
    • hypercholesterolemia
    • cystitis
34
Q

What is the MOA of Prednisone?

A

glucocorticoid: inhibits osteoblast activity

35
Q

What are the clinical uses of Calcitriol?

A
  • Secondary hyperparathyroidism
  • Secondary hypoparathyroidism
  • Rickets
  • Osteoporosis
36
Q

What is the drug of choice for thyroid hormone replacement?

A

Levothyroxine (T4)

37
Q

What is the drug of choice for pituitary TSH suppressive therapy in patients with thyroid cancer?

A

Levothyroxine (T4)

38
Q

What are the indications for Levothyroxine?

A
  • Thyroid hormone replacement
  • pituitary TSH suppresive therapy in patients with thyroid cancer
  • Myxedema coma
39
Q

What are the adverse effects of Liothyronine?

A

Adverse cardiac effects

(Cardiac arrest)

40
Q

What is Liotrix?

A

Mix of both T3 and T4 synthetic hormones

(T4:T3 is 4:1)

41
Q

What is the MOA of thioamines?

A
  • Compete with thyroglobulin for oxidized iodide in the process of
    • organification and
    • coupling
    • (both by thyroid peroxidase)
  • Inhibits T4/T3 peripheral conversion
42
Q

Propylthiouracil

  • MOA
  • IND
  • SE
A
  • MOA
    • inhibits both:
      • Thyroid peroxidase (organification)
      • T4/T3 conversion (peripheral conversion)
  • IND
    • Hyperthyroidism
    • Preferred in pregnancy
  • SE
    • depletes prothrombin (bleeding)
    • liver injury
    • transient leucopenia to severe agranulocytosis
    • goiter
43
Q

Methimazole

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Inhibits only thyroid peroxidase (organification)
  • IND
    • Hyperthyroidism
  • SE
    • Bone marrow suppression
      • requires transfusion
    • Liver injury
    • Goiter
  • CON
    • Pregnancy
44
Q

To what is Carbimazole converted after absorption?

A
  • MOA
    • Converted to Methimazole after absorption
45
Q

Which thyoamine is preferred for pregnant women?

A

Propylthiouracil

46
Q

What is the Wolff-Chaikoff effect?

A

High levels of iodide inhibit thyroid synthesis and release

47
Q

Potassium iodide

  • MOA
  • IND
  • SE
  • CON
A
  • MOA
    • Wolff-Chaikoff effect
      • raises levels of iodide to inhibit TH synthesis
  • IND
    • Acute thyrotoxicosis
    • Radiation emergencies
      • blocks thyroid function
    • Thyroid surgery
      • reduces syze and vascularity of the thyroid
  • SE
    • Hypothyroidism
    • May worsen toxic goiter
  • CON
48
Q

What is the therapeutic use of thyrotropin alpha?

A
  • Test thyroid function
  • Thyroidectomy (Radioactive Iodine Ablasion)
    • ​Increase TSH
    • Increase radioactive iodine uptake
49
Q

What is the MOA of radioactive iodide isotope 131I-?

A
  • Emits ß-rays toxic to cell
  • Enters follicular cells thru Na/I symporter
  • Selective destruction of thyroid gland
50
Q

What are the SEs of Radioactive iodide isotope 131 I-?

A
  • Hypothyroidism
  • Ophalmopathy in Grave’s disease
51
Q

What are the contraindications of Iodide treatment (radioactive, potassium iodide, sodium iodide)?

A
  • Pregnancy
  • Breast-feeding
    • enters breast milk
  • Pulm edema
  • TB
52
Q

What is the MOA and therapeutic use of ß blockers such as propanolol?

A
  • MOA:
    • inhibits peripheral T4/T3 conversion
  • IND
    • Thyroid storm (Hyperparathyroidism)
53
Q

Ipodate

  • MOA
  • IND
A
  • MOA
    • Radiocontrast
    • Inhibits peripheral T4/T3 conversion
  • IND
    • Acute Graves disease (emergency situation)
    • Acute thyroid storm (emergency situation)

Not FDA approved

54
Q

What is the effect of Lithium on the thyroid? What can be a potential complication?

A
  • Effect:
    • inhibits TH release
  • Complication:
    • Hypothyroidism
55
Q

Amiodarone

  • MOA
  • IND
  • SE
A
  • MOA
    • Antiarrhythmic
    • (-) 5’ deiodinase
      • decreased peripheral conversion
      • increased rT3
  • IND
    • Thyrotoxicosis
    • Thyroiditis
  • SE
    • Hypothyroidism
      • Metabolism releases iodide (can cause Wolff-Chaikoff effect)
    • Hyperthyroidism
      • in thyrotoxicosis and thyroiditis
56
Q

What is the MOA of Corticosteroids regarding thyroid function?

A

Inhibit peripheral conversion ((-)5’ deiodinase)

Pharmacology (12 decks)

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