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Pharmacology Block 9 > Thyroid hormones and Anti Thyroid Hormones > Flashcards

Thyroid hormones and Anti Thyroid Hormones Flashcards

1
Q

TSH is a

A

Glycoprotein

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2
Q

How many alpha and beta subunits does TSH have?

A

6- alpha and 1-beta

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3
Q

The beta subunit of TSH is what gives it its

A

Specific functionality

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4
Q

what is thyrotropin alpha?

A

It is a recombinant form of TSH used in performing certain tests in patients who have or have had thyroid cancer

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5
Q

Thyrotropin alpha is used for?

A

Used along with a radioactive agent to destroy remaining thyroid tissue in certain patients who have had their thyroid gland removed because of thyroid cancer

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6
Q

What is the MOA of thyrotropin alpha?

A

Binds to the thyrotropin receptors found on any residual thyroid cells or tissues. This stimulates radioactive iodine uptake for better radiodaignostic imaging

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7
Q

During fetal development, TSH affects the

A

Brain

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8
Q

TSH induces growth, development, maturation of

A

Sperms and oocytes

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9
Q

TSH induces growth, development, maturation of

A

Osteoblasts and osteocytes

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10
Q

TSH induces the growth, development, and differentiation of adipose tissue in which places?

A

Retroocular, pretibial, abdominocentral

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11
Q

In the kidneys, TSH is going to induce the growth, development and maturation of the

A

Epithelial cells

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12
Q

TSH induces the growth, maturation and differentiation of

A

Immune cells

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13
Q

TSH plays a role in the maturation of the

A

Embryo

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14
Q

The TSH receptor is a..

A

7 transmembrane receptor embedded within the plasma membrane and a short cytoplasmic tail

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15
Q

Which two TSHR activation pathways exist?

A

AC activation by Gs

PLC activation by Gq

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16
Q

The sodium/iodide symporter belongs to which human transport family?

A

SLC5

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17
Q

Where is the sodium/iodide symporter expressed?

A

Salivary gland ductal cells, breast tissue during lactation, lung airway epithelial cells, intestinal enterocytes, epithelial and parietal stomach cells, placenta and testicular cells

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18
Q

Pendred syndrome is characterized by?

A

Goiter and hearing loss

Autosomal recessive disorder

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19
Q

Pendrine is a

A

SLC26 transporter

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20
Q

Thyroglobulin is a

A

Glycoprotein composed of two subunits

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21
Q

Which protein has the higher affinity towards T3 and T4?

A

Thyroxine-binding globulin

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22
Q

Which protein is the larger transporter of thyroid hormone?

A

Albumin

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23
Q

What molecule is needed to activate the receptor and induce gene expression?

A

T3

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24
Q

What is the best treatment for hypothyroidism?

A

L-T4

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25
Q

Thyroid hormone replacement must occur on a

A

Empty stomach

- with no other medications or foods beyond water ideally consumed for at least 1 hour after ingestion

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26
Q

Repeated thyrotropin measurement should be performed in approximately how many weeks?

A

6

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27
Q

Do proton pump inhibitors affect the absorption of L-T4?

A

No

28
Q

Does cholestyramine affect the absorption of L-T4?

A

Yes, best absorption with a 5 hour separation of drug and L-T4

29
Q

Do H2 blockers affect the absorption of L-T4?

A

No

30
Q

Does colesevelam negatively affect the absorption of levothyroxine?

A

Yes

31
Q

Does selevamer affect the absorption of levothyroxine?

A

Yes

32
Q

Does sucralfate affect the absorption of levothyroxine?

A

Yes reduced and delayed peak absorption

33
Q

Does raloxifene affect the absorption of levothyroxine?

A

Yes, lower peak T4 levels with raloxifene

34
Q

Does calcium carbonate affect the absorption of levothyroxine?

A

Yes

35
Q

Do the proton pump inhibitors alter the interaction of the levothyroxine with their receptors?

A

Yes

36
Q

Hyperthyroidism treatment should be divided into

A

Symptomatic and target treatment

37
Q

What medication is given for the symptomatic treatment of hyperthyroidism?

A

Beta blockers

38
Q

Patients with overt Grave’s disease should be treated with

A

RAI therapy, ATD’s or thyroidectomy

RAI- radioactive iodine therapy
ATD- anti thyroid drugs

39
Q

What is the first line treatment for the symptomatic managment of hyperthyroidism?

A

Beta blockers such as propanolol, atenolol, metoprolol, nadolol, esmolol

40
Q

If a patient with hyperthyroidism is experiencing cardiovascular symptoms, what medication would be most appropriate?

A

Atenolol

41
Q

In a patient with thyrotoxicosis, propanolol or nadolol would be better for a patient with

A

Central nervous system symptoms

42
Q

What other drug can be given in a patient with thyrotoxicosis who has cardiovascular symptoms?

A

Metoprolol

43
Q

Lets say you have a patient with thyrotoxicosis who is nursing or is pregnant, which drug would you give them?
(You have to choose a beta blocker)

A

Propanolol

44
Q

If you have a pregnant patient with thyrotoxicosis which beta blocker should you avoid?

A

Atenolol

45
Q

Lets say you have a patient with thyrotoxicosis who is in the ICU which beta blocker would you give them?

A

Esmolol

46
Q

Can you use radio active iodine therapy in a pregnant patient?

A

No

47
Q

If you have a patient with hyperthyroidism who is seeking RAI therapy under what circumstances should you not perform this type of therapy?

A

Pregnancy, lactation, thyroid cancer, suspision of thyroid cancer, planning pregnancy in 4-6 months

48
Q

Under what circumstances should you not give a patient with hyperthyroidism ATD’s?

A

If they have any adverse reactions to them

49
Q

If you have a patient with hyperthyroidism who is seeking surgery, under what circumstances should you not perform surgery?

A

Cardiopulmonary disease, end-stage cancer, avoid surgery in the first and third trimester of pregnancy

50
Q

What drugs are used to treat thyroid storm?

A

Propylthiouracil, methimazole, propanolol, iodine, hydrocortisone

51
Q

Propylthiouracil blocks what?

A

New hormone synthesis

52
Q

what does methimazole do?

A

Blocks T4 to T3 conversion

Blocks new hormone synthesis

53
Q

Which drug may block T4-T3 conversion in high doses?

A

Propanolol

54
Q

Which drug should not be started until 1 hour after antithyroid drugs?

A

Iodine (saturated solution of potassium iodide)

55
Q

Methimazole is good for which types of patients?

A

Those for whom more aggressive options such as surgery or radioactive iodine therapy is innappropriate

56
Q

Propylthiouracil is the active metabolite of which pro-drug?

A

Carbimazole

57
Q

Methimazole inhibits

A

Thyroid peroxidase

58
Q

Methimazole becomes what?

A

Iodinated itself and interferes with the iodination of thyroglobulin

59
Q

Methimazole binds directly to ?

A

Thyroglobulin or direct inhibition of thyroglobulin itself

60
Q

Should propylthiouracil be used in the pediatric population?

A

No

61
Q

Should PTU be used in patients with liver impairment?

A

No

62
Q

PTU can cause fetal what?

A

Cretinism and goiter

63
Q

Methimazole causes

A

Fetal anatomical abnormalities

64
Q

If you have a patient with subclinical hyperthyroidism and he or she had a TSH of less than 0.1 mU/L do you treat them?

A

Yes

65
Q

If a patient is pregnant and she has Grave’s disease, when is the ideal time to peform a thyroidectomy?

A

Second trimester

Pharmacology Block 9 (7 decks)

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