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P2 E3 Shea > Thyroid/Parathyroid 2 > Flashcards

Thyroid/Parathyroid 2 Flashcards

1
Q

increases in doses made on monthly basis

greater hepaotoxicity than MMI

which drug?

A

propothyrouracil (PTU)

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2
Q

possible teratogenic effects

more potent than PTU

changes in dose made on monthly basis

which drug?

A

Methimazole (MMI)

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3
Q

PK of PTU and MMI

A

peak serum concentration is 1 hr after digestion (well absorbed in GI tract)

minimal urinary excretion (less for MMI)

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4
Q

how long does it take sxs of PTU and MMI to diminish & thyroid hormone levels to return to normal?

A

4-8 wks

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5
Q

ADEs of what?

pruiritic maculopapular rash

benign transient leukopenia

agranulocytosis

hepatotoxicity

arthralgias & lupus-like syndrome

A

PTU & MMI

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6
Q

What drug do you give to pregnant pts w/hyperthyroidism and why?

A

PTU in 1st trimester: use lowest dose to maintain maternal T4 levels in high-normal range

teratogenic effects of MMI outweigh hepatotoxic effects of PTU

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7
Q

dosage unikely to produce fetal goiter

A

PTU <200mg

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8
Q

best tx for toxic nodules and toxic multinodular goiter

A

radioactive iodine (RAI)

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9
Q

RAI pros

A

cure hyperthyroidism

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10
Q

RAI cons

A
  1. permanent hypothyporidism (inevitable)
  2. defer pregnancy 6-12 months: no breast feeding
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11
Q

What would you use as an adjunct to RAI?

A

Potassium iodide (SSKI) should be added 3-7 days after RAI tx so radioactive thyroid can concentrate in the thyroid

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12
Q

When should Potassium iodide (SSKI) be administered in regards to surgery?

A

give 7-14 days before surgery

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13
Q

what medication is given for sx relief?

A

adrenergic blockers: propanolol

alt: clonidine, diltiazem

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14
Q

how does propanolol help hyperthyroidism?

A

decreases palpitations, anxiety, tremor, and heat intolerance

Used as adjunct to antithyroid

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15
Q

primary tx for thyrotoxicosis a/w thyroiditis

A

propanolol

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16
Q

CI of propanolol

A

dont use in pts with decompensated HF

sinus bradycardia

pts on MAOI or TCAs

spontaneous hypoglycemia

17
Q

ADEs of Propanolol

A

N/V

anxiety

insomnia

18
Q

Iodide MOA

A

graves: blocks thyroid hoemone release

inhibits biosynthesis: interferes w/intrathyroidal iodide utilization

decreased size/vascularity of gland

19
Q

how long does it take for sx improvement when using iodides?

20
Q

Concerning Iodides:

T/F: Even though there is a decrease in T4/T3 release, hormone synthesis continues at an accelerated rate, resulting in a gland rich in stored hormones.

21
Q

T/F: normal and hyperfunctioning thyroid escapes inhibitory effect in 1-2 weeks.

22
Q

ADEs of Iodides

A

salivary gland swelling

“iodism” –>burning mouth/throat, sore teeth & gums

gynecomastia

23
Q

what is thyroid storm

A

thyrotoxicosis so severe it causes decompensation

24
Q

what meds do you use for thyroid storm

A
  1. PTU or MMI
  2. sodium iodide
  3. lugols solution
  4. propanolol
  5. corticosteroids: dexamethasone, prednisone, methylprednisone or hydrocortisone
25
sx of hypoparathyroidism
usually asx **acute:** tetany **chronic:** lethargy, anxiety/depression, cataracts, coarse skin **systems affected:** endocrine/metabolic, MSK, CNS, opthomalogic, renal
26
what does disrupted PTH action result in
hypocalcemia hyperphosphatemia hypercalciuria
27
what is crucial for PTH secretion and activation of PTH receptor
magnesium
28
Tx for hypoparathyroidism
maintain serum Ca **8-8.5** oral Ca carbonate (ca salts) 1-3g a day calcitriol maintain serum Mg Phosphate binders thiazide diuretics + low salt diet
29
what should you use instead for geriatric pts w/ hypoparathyroidism on a PPI or those who have constipation on oral calcium carbonate (calcium salts)?
calcium citrate
30
what does the use of thiazide + low-salt diet prevent?
hypercalciuria nephrocalcinosis nephrolithiasis
31
monitoring goals for hypoparathyroidism
Ca **8-8.5** (if Ca\< 8, tx if asx) 24 hr urine Ca **\<300mg** Ca-phosphate **\<55mg** **Measure Ca, Phosphate, Mg, Cr weekly-monlthy** during initial management
32
Lab results for primary HPT
**PTH \> 3** (high)
33
lab results for non-PTH-mediatedhypercalcemia
PTH \< 3.0 (low)
34
Tx of Primary HPT
operative management is curative
35
tx of pts with primary HPT awaiting surgery
bisphosphonates (alendronate) **\*\*avoid in kidney dz\*\*** SERM (raloxifene)
36
secondary HPT tx
replace Ca vit D analogs (paricalcitol & calcitriol) phosphorous binding agents (sevelamer) calcimimetic (cinacalcet)
37

P2 E3 Shea (9 decks)

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