Uterine, Thyroid, & Osteoporosis Drugs Flashcards

Question

Progesterone - Indications/Therapeutics

Answer 1

• More effective than placebo in maintaining the length of pregnancy when given prophylactically from the 16th - 37th week of pregnancy or until delivery – Not effective for acute treatment • Recommended for high risk women with a history of preterm birth • Approved for use in ART to maintain the luteal phase following IVF or ICSI.

Answer 2

• T4, produces normal levels of T3 and T4 • Drug of choice for hypothyroidism • Drug levels must be carefully titrated to the individual – TSH levels & Patient Sx • T4 levels change slowly (t½= 7 days), ~5 weeks for steady state

Answer 3

• T3; t½= 24 hrs, shorter duration of action than T4 • Used for initial therapy (quicker steady state), not maintenance

Answer 4

• Mix of T4 and T3 hormones from pigs -> natural hormones • Batch potency can vary • Pts w/ deficiency in the peripheral deiodinase enzyme may respond better to this drug.

Answer 5

Propylthiouracil (PTU) and Methimazole (Tapazole®)

Answer 6

``` • Inhibits the synthesis T4 – Methimazole more potent • PTU -> blocks conversion of T4 to T3 • Effects are gradual (use b-blockers) – Circulating T3/T4 lasts a week or so ```

Answer 7

• First line of treatment for Graves’ – Medical management • Used with other treatments -> ↓thyroid storm risk

Answer 8

• Black Box Warning for PTU – Severe liver injury, acute liver failure – Methimazole DOC in most cases • Methimazole allergies and pregnancy -> PTU • Itching and skin rash –most common • Granulocytopenia and agranulocytosis – Reversible – Watch for sore throat, do blood test • Headaches, nausea, jaundice, myalgia, arthralgia, lymphadenopathy, psychosis, lupus-like syndrome • Goiter - may need to add T4 to reduce TSH levels • Keep dose low in pregnancy - Prevent cretinism and goiter in fetus

Answer 9

• Iodide rapidly decreases synthesis and release of T4/T3 • Short-term effect (2-8 weeks)

Answer 10

• Decreases vascularity and thyroid content of gland • Used for 7-10 days before surgery – Can decrease likelihood of thyroid storm • Can use in radioactive emergencies

Answer 11

• 131I taken into the gland specifically – Small amounts μCi = diagnostic – Large amounts mCi = destroys gland

Answer 12

• Used in elderly patients and those with heart disease – Definitive treatment for Graves’, but thioamides preferred • Preferred treatment for toxic nodular goiter -> specific destruction -> euthyroid

Answer 13

• Usually causes hypothyroidism over time • Thyroid storm risk – Decrease risk by use of thioamide (not iodide!) prior to treatment

Answer 14

• Pregnancy, nursing, or mothers who lack childcare

Answer 15

• Non-specific β-blocker • Propranolol specifically inhibits the peripheral conversion of T4 to T3

Answer 16

• ↓many of the Sx of hyperthyroidism • Used to prepare for surgery and while waiting for thioamides or 131I to take effect

Answer 17

• C/I: Asthma – use CCBs instead

Answer 18

* ↓ Bone resorption of Ca2+ * Antagonizes parathyroid hormone * ↓ Bone pain and loss * ↑ Bone density * ↓ Osteoporotic fractures

Answer 19

* Nasal spray | * Injection

Answer 20

* Osteoporosis – (not 1st line) | * Paget’s disease

Answer 21

* May cause allergic reactions * Nasal rhinitis/ sinusitis -> nasal spray * Nausea and vomiting -> injection

Answer 22

Teriparatide (Forteo®) Abaloparatide (TYMLOS®) rhPTH(1-84) (NATPARA®)

Answer 23

• PTH and PTHrP both bind to the PTH Receptor type 1 (PTHR1) on the osteoblast and activate it. • There are two conformations of PTHR1, RG and R0, which are pro-osteoblast or pro-osteoclast, respectively. Teriparatide -or- Abaloparatide: More osteoblast activity -> Osteoporosis rhPTH(1-84): More osteoclast activity -> Hypoparathyroidism

Answer 24

• Subcutaneous injection – Teriparatide: peaks in 30 min, gone in 3 hours -> Intermittent

Answer 25

* Hypercalcemia and hypercalciuria * Injection site reactions * Dizziness, leg cramps * Abaloparatide: hyperuricemia

Answer 26

• Osteosarcoma (Black Label Warning) – ↑ in rats, but not in humans yet – Be careful in patients susceptible to any osteosarcoma (Paget’s disease, radiation therapy, open epiphyses, history)

Answer 27

• Antibody against receptor activator of nuclear factor kappa-beta ligand (RANKL) • Inhibits bone resorption • Antibody to RANK-Ligand -> inhibits RANKL – Factor made by osteoblasts that is necessary for the formation of mature osteoclasts

Answer 28

• Osteoporosis in men and postmenopausal women at high risk for fractures • ↑ Bone mass and strength in both cortical and trabecular bone

Answer 29

• S.C. injection, once/6 months

Answer 30

* Hypocalcemia(2%) | * Osteonecrosis of the jaw in cancer studies

Answer 31

``` •Absolute C/I: – Hypocalcemia, fix first – Pregnancy – Cat X • Relative – Chronic Kidney Disease – Patients at risk for serious infections (RANK-RANKL signaling in lymphocytes ```

Answer 32

Alendronate (Fosamax) - Oral Risedronate (Actonel) - Oral Ibandronate (Boniva) - Oral, I.V. Zoledronic Acid (Zometa) - I.V.

Answer 33

``` • P-C-P bond analogs of pyrophosphate • Substitutes for PO4 in Ca2+ binding – Incorporates into bone • Inhibits osteoclast activity and bone resorption – Mechanism still not clear ```

Answer 34

``` • First line of treatment (DOC) for post-menopausal osteoporosis • Paget’s Disease • Osteopenia -> may not be needed • Reduce the incidence of fractures • Improve the quality of life ```

Answer 35

• ORAL preparations: absorption is very poor – Must be taken on an empty stomach! – 1/2 glass of water – Stay upright for 30 min after taking it to decrease esophageal irritation • Others are IV injection only • Given anywhere from once/day to once/year

Answer 36

• Oral -> abdominal pain, upper GI irritation, esophageal ulceration, constipation, diarrhea, and flatulence • I.V. -> renal toxicity if given too fast • Nausea, vomiting • May cause a mild hypocalcemia • Possible atrial fibrillation • ↑ Incidence of osteonecrosis of the jaw after major dental work • 2010 FDA safety communication: atypical bone fractures of the femur with long-term bisphosphonate therapy

Answer 37

• Oral: inability to stand/sit upright or esophageal disease • IV: renal disease

Uterine, Thyroid, & Osteoporosis Drugs Flashcards

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