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Endo II > thyroid pharm > Flashcards

thyroid pharm Flashcards

1
Q

Thyroid agents

A

levothyroxine (T4)

liothyronine (T3)

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2
Q

antithyroid agents

A

methimazole
PTU
potassium iodine
radioactive iodine

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3
Q

what will block the Na/I cotransporter?

A

thiocyanate (SCN)
pertechnetate
perchlorate

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4
Q

high intrathyroidal iodine can block what?

A

thyroidal peroxidase

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5
Q

what can inhibit 5’deiodinase

A 
amiodarone
iodinated contrast media
beta-blockers
corticosteroids 
severe illness
starvation
PTU
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6
Q

MOA of thyroid hormones

A
  • T4 -> T3 via cytoplasmic 5-deiodinase
  • T3 into nucleus
  • TR bound to DNA TRE
  • T3 binds TR and displaces corepressor
  • activated TR binds RXR -> transcription
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7
Q

T4 absorption

A

in duodenum and ileum

must be given 1 hr before meals or 4 hours after meals and other drugs

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8
Q

which thyroid drug more bioavailable?

A

liothyronine

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9
Q

severe myxedema with ileus

A

can decrease absorption of TH and should be given IV

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10
Q

metabolism of TH in hyperthyroidism

A

clearance is increased

half-life is decreased

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11
Q

metabolism of TH in hypothyroidism

A

clearance is decreased

half-life is increased

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12
Q

agents which increase hepatic metabolism of TH

A 
rifampin
phenobarbital
carbamazepine
phenytoin
HIV protease
inhibitors
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13
Q

agents which interfere with T4 absorption

A 
PO biophosphates
bile acid sequestrants
cipro
proton pump inhibitors
sucralfate
anacids
bran
soy
coffee
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14
Q

agents which induce autoimmune thyroid disease

A

interferon
lithium
amiodarone

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15
Q

what is the TH drug of choice

A

levothyroxine

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16
Q

why is liothyronine not the drug of choice

A

it is more potent, but has shorter half life and must be dosed more often
more expensive
difficult to monitor
has greater cardiotoxicity effects

17
Q

desiccated TH

A

never should be used

18
Q

thioamides MOA

A 
prevent TH synthesis:
block peroxidase
block organification
blocks coupling of MIT and DIT to TG
PTU also inhibits T4 -> T3
onset of action is 3-4wks
19
Q

methimazole

A

drug of choice
10x more potent then PTU
completely absorbed
safe for breast feeding

20
Q

PTU

A

used in pregnancy and thyroid storm

21
Q

thioamides common ADRs

A

most common is maculopapular rash
fever
GI and nausea

22
Q

thioamides rare ADRs

A 
urticarial rash
vasculitis
lupus-like rxn
lymphadenopathy
hypoprothrombinemai
exfoliative dermatitis
acute arthralgias
cholestatic jaundice
23
Q

block box warning of PTU

A

severe hepatitis

24
Q

most dangerous complication of thioamides

A

agranulocytosis (<500)
must discontinue
cannot switch they x-react

25
Q

potassium iodide MOA

A

inhibit iodine organification and hormone release
decrease size and vasulcarity of gland
*inhibits hormone release

26
Q

uses of potassium iodine

A

thyroid storm
preoperative reduction of hyperplastic gland
block thyroidal uptkae of radioactive isotopes in radiation emergency
never can be used alone b/c effects wear off in 2-8 weeks and will become have rebound
avoid if near future radiation Tx will be used

27
Q

ADRs of potassium iodine

A 
uncommon
rash
swollen salivary glands
mucous membrane ulcerations
conjuctivitis
rhinorrhea
drug fever
metallic taste
bleeding
anaphylaxis
28
Q

CI of potassium iodine

A

pregnancy

29
Q

CI of radioactive iodine

A

pregnancy or breast feeding

30
Q

adrenoreceptor-blockers

A

metroprolol
propanolol
atenolol

31
Q

how long does it take for levothyroxine to reach steady state

A

6-8wks

32
Q

myxedema common

A

end stage of untreated hypothyroidism
medical emergency
ICU with intubation and mechanical ventilation
loading IV levothyroxine
hydorcortisone IV
if they have coronary aa disease must correct very cautiously

33
Q

what is the preferred patient population for antithyroidal drugs

A

young patients with small glands and mild disease

34
Q

thyroidectomy preferred patient population

A

large glands or multi-nodular goiters

must obtain euthyroid via pharm before sugery

35
Q

RAI preferred patient population

A

almost everyone 21+

heart disease

36
Q

adjunct to antithyroid therapy

A

beta-blockers

diltiazem

37
Q

thyroid storm

A 
beta blocker
potassium iodine
PTU
hydorcortisone
supportive therapy
if really bad can give oral bile sequestrants, plasmapheresis, or peritoneal dialysis

Endo II (15 decks)

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