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Pharmacology > Thyroid/Osteoporosis > Flashcards

Thyroid/Osteoporosis Flashcards

1
Q

what 2 medications specifically can induce hypothyroidism

A

amiodarone (Cordarone)

lithium (Eskalith)

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2
Q

how is primary hypothyroidism confirmed

A

elevated TSH and low free T4

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3
Q

how is secondary hypothyroidism due to pituitary dysfunction confirmed

A

loe free T4

low TSH levels

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4
Q

normal TSH

A

0.5-0.4

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5
Q

Thyroid hormone interactions

A

drugs that can interfere with absorption such as questran, sucralfate (carafate), aluminum containing antacids, and calcium carbonate

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6
Q

effect of increased estrogen on thyroid

A

increased estrogen production causes an increased in TBGs which, in turn, causes there to be more T4 in the bound inactive state rather than the free, active state. Will likely need higher dosages of thyroid hormone

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7
Q

drugs that can decrease the affinity of T4 and T3 to TBGs causing a transient increase in free T4 and T3 levels

A

salicylates

high doses of furosemide

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8
Q

thyroid hormone and coumadin

A

increases metabolism of vitamin k dependent clotting factors which raises the PT and risk of bleeding

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9
Q

other drugs that alter metabolism of thyroid hormone

A

phenytoin

carbamazepine (tegretol)

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10
Q

geriatric presentation of hypothyroid

A

may present with ataxia, paresthesias, and carpal tunnel syndrome
may also present with psychiatric manifestations such as depression and change in sensorium

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11
Q

Causes of hyperthyroidism

A 
graves disease (most common)
toxic nodular goiter
thyrotoxicosis factita (intentionally take high doses of thyroid hormone)
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12
Q

3 ways to treat hyperthyroidism

A

antithyroid drugs
radioactive iodine ablation (tx of choice for >40)
surgery

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13
Q

what happens to most patients with graves disease after treatment

A

they become hypothyroid

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14
Q

antithyroid drugs

A

methimazole (Tapazole)

propylthiouracil (PTU)

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15
Q

mech of action of antithyroid drugs

A

inhibits iodine organification

blocks conversion of T4 to T3 in the periphery

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16
Q

what should providers tell patients to report when taking antithyroid drugs

A

sore throat and fever as this could signify a potentially fatal agranulocytosis
must obtain a CBC and dc drug if WBC low

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17
Q

adjunctive agents used to manage hyperthyroidism

A

beta-blockers
iodine-containing compounds
lithium
glucocorticoids

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18
Q

geriatric presentation of hyperthyroidism

A

weakness, dyspnea, anorexia, depression, or constipation

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19
Q

drugs that can be affected when a hyperthyroid patient becomes euthyroid

A

increased effects of digoxin, metoprolol, and propranolol

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20
Q

treatment of patients with thyroid nodules that are not cancerous

A

radioactive iodine and surgery

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21
Q

subclinical thyroid disease

A

elevated TSH with a normal free T4 usually in a patient with no symptoms

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22
Q

subclinical hyperthyroid disease

A

low TSH with normal T4 and T3

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23
Q

Bone loss after age 30

A

occurs at about 10% each 10 years

24
Q

most common fractures in OP

A

vertebral compression fractures

fractures of distal radius and proximal femur

25
Q

makeup of long bones

A

thick outer layer of cortical (dense) bone and a thin inner layer of trabecular (spongy) bone

26
Q

makeup of short bones

A

mostly trabecular (spongy) bone with a thin layer of cortical (dense) bone

27
Q

what causes osteoporosis

A

an imbalance in bone remodeling that results in greater resorption than formation

28
Q

resorption-inhibiting drugs

A

estrogens
bisphosphonates
calcitonin
selective estrogen receptor modulators (SERMs)

29
Q

recommended dosage of calcium for postmenopausal women

A

1200-1500mg/day

30
Q

recommended dosage of vitamin D3 (OP)

A

800-1000 iu

31
Q

mech of action of biphosphonates

A

inhibit bone resorption and increase bone density

32
Q

bisphosphonates drugs

A

alendronate (Fosamax)
risedronate (Actonel)
ibandronate (Boniva)
zolendronic acid (Reclast)

33
Q

contraindications for bisphosphonates

A

history of esophageal problems, gastritis, or peptic ulcer disease

34
Q

side effects of bisphosphonates

A 
esophagitis
GI (diarrhea and abdominal pain)
35
Q

bisphosphonate interactions

A

absorption is decreased when taken with food, calcium, or iron

36
Q

mech of action of calcitonin

A

inhibits the action of osteoclasts
not effective at preventing bone loss early in the postmenopausal period but it does increase bone mass in the spine leading to less vertebral compression fractures

37
Q

adverse events of calcitonin

A

nasal route can cause rhinitis (inspect nasal mucosa q6mo for ulceration)

38
Q

SERMs mech of action

A

mimics the effects of estrogen on bones without replicating the stimulating effects of estrogen on the breast and uterus

39
Q

SERMs effect on fractures

A

reduce risk of vertebral fractures but do not affect hip fractures

40
Q

bonus of SERMs

A

decrease total cholesterol and LDL cholesterol

41
Q

SERM drug

A

raloxifene (Evista)

42
Q

Hormone modifier used to treat OP

A

Teriparatide (Forteo)

43
Q

Mech of action of Forteo (hormone modifier)

A

stimulates new bone formation in trabecular and cortical bone by stimulating osteoblastic activity over osteoclastic activity

44
Q

administration of Forteo (teriparatide) hormone modifier

A

subQ at 20mcg

45
Q

contraindications to forteo (teriparatide) hormone modifier

A 
pagets disease
children
previous bone radiation therapy
history of skeletal malignancy
metabolic bone disease
hypercalcemia
hyperparathyroidism
hx of kidney stones
46
Q

adverse events of forteo (teriparatide) hormone modifier

A

may increase calcium levels and increase risk of dig toxicity

47
Q

RANK ligand inhibitor drug

A

denosumab (Prolia)

48
Q

mech of action of denosumab (Prolia RANK ligand inhibitor

A

targets and binds RANK ligand, inhibiting osteoclast formation, function, and survival, keeping osteoclasts from resorbing bone

49
Q

dosage of denosumab (Prolia RANK ligand inhibitor

A

60mg subQ q6mo

50
Q

contraindication to denosumab (Prolia RANK ligand inhibitor

A

pregnancy and hypocalcemia

caution with: creat clearance >30, immunocompromised, hx of small bowel excision

51
Q

adverse effects of denosumab (Prolia RANK ligand inhibitor)

A

musculoskeletal pain, infection, arthralgia, myalgia, abdominal pain

52
Q

what must OP patients have in addition to medication

A

calcium and vitamin D supplementation

53
Q

1st line therapy for OP

A

raloxifene or bisphosphonate therapy is used for prevention, bisphophonates are used for treatment

54
Q

2nd line therapy for OP

A

calcitonin, hormone modifier, or RANK ligand inhibitor recommended for those who fail to respond to or cannot tolerate 1st line therapy

55
Q

raloxifene (SERM) contraindications

A

pregnancy, hx of thromboembolic events

56
Q

how often should the DEXA scan be performed

A

every 2 years

Pharmacology (11 decks)

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