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Pharmacology: Exam 3 > Thyroid, Parathyroid, and Steroids > Flashcards

Thyroid, Parathyroid, and Steroids Flashcards

1
Q

TRH

A

Thyrotropin Releasing Hormone

-stimulates anterior pituitary to secrete TSH

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2
Q

TSH

A

Thyroid Stimulating Hormone

-stimulate thyroid to secrete T3 and T4

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3
Q

T3

A

Tri iodo thyronine

  • Active
  • 10% of secreted thyroid hormone
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4
Q

T4

A
  • Converted to T3 in the liver

- 90% of secreted thyroid hormone

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5
Q

Hypothyroidism

A

Decreased secretion of thyroid hormones

  • Primary causes: Hashimoto’s, removal of thyroid, thyroid gland ablation, drug induced
  • Secondary causes: pituitary issue
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6
Q

Signs and Symptoms of Hypothyroidism

A
  • Bradycardia
  • Feeling cold
  • Decreased appetite
  • Weight gain
  • Constipation
  • Fatigue
  • Dry Skin
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7
Q

Levothyroxine

A

Synthetic T4 that must be converted to active form in periphery

  • Monitor TSH
  • Can cause nausea, vomiting, diarrhea, and insomnia
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8
Q

Levothyroxine DDIs

A
  • Phenytoin, Carbamazepine
  • Warfarin
  • Fiber, Cholestyramine
  • Sucralfate
  • Rifampin
  • Calcium, antacids
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9
Q

Administer Levothyroxine

A

Give 30-60 minutes prior to any meal or other medications

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10
Q

Liothyronine

A

Synthetic T3

-Does not need to be converted but not as reliable or efficacious & short half life

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11
Q

Liothyronine ADRs

A

Severe cardiac effects: tachycardia, arrhythmia, MI, hypotension

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12
Q

Desiccated Thyroid

A

Mix of T3 and T4 from ground up pig thyroid

-monitor TSH frequently because of issues with consistency

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13
Q

Hyperthyroidism

A

Increased thyroid hormone activity
-causes: graves’ disease, Plummer’s disease, Iodine induced, Excessive Pituitary TSH, Excessive ingestion of thyroid hormone, Thyroiditis, Lithium

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14
Q

Signs and symptoms of Hyperthyroidism

A 
Palpitations/Tachycardia
Irritability
Nervousness/tremor
Increased bowel movements
Goiter
Hunger
Heat intolerance
Weight loss
Insomnia
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15
Q

Thioamides MOA

A

STOP synthesis of thyroid hormones via inhibition of thyroid peroxidase (for Hyperthyroidism)

  • drug is iodinated instead of iodide
  • no effect on circulating T3 or T4
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16
Q

Thioamides Drugs

A

Methimazole (Preferred)

Propylthiourazil (frequent 3x dosing and expensive)

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17
Q

Thioamides ADRs

A 
Edema
Alopecia
Possible Agranulocytosis
Liver Damage
Vasculitis with Propylthiouracil
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18
Q

Sodium Iodide (Radioactive I)

A

Used for Hyperthyroidism; mimics iodide and is taken up by thyroid

  • destroys gland cells, shrinks size of thyroid
  • Used in thyroid cancer treatment
  • Watch for hypothyroidism
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19
Q

Potassium Iodide

A

STOP release of thyroid hormones and hormone synthesis

  • use with thioamides
  • used in hyperthyroidism thyroid storm
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20
Q

Parathyroid Hormone (PTH)

A

Released from the parathyroid gland in response to decreased calcium levels
-PTH receptor on osteoclasts that moves calcium from bone into bloodstream

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21
Q

Osteoclasts

A

Bone Resorption

-used in bone removal; releases calcium and phosphorus

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22
Q

Osteoblasts

A
  • Bone Formation

- used in bone building; fill in empty spaces of bone with collagen and calcium/phosphate crystals

23
Q

Cinacalcet MOA

A

Used in hyperparathyroidism; increased sensitivity of calcium sensing receptor; decreases PTH, calcium and phosphorous which prevents progressive bone disease

24
Q

What is Cinacalcet approved for?

A
  • Hypercalcemia (Primary hyperparathyroidism and parathyroid carcinoma)
  • Chronic Kidney Disease (secondary hyperparathyroidism)
  • NO in hypocalcemia
25
Q

Osteoporosis/Osteopenia

A

Decreased bone strength, quality, and mineral density (increased fracture risk)

26
Q

Osteoporosis/osteopenia risk factors

A
  • Elderly (more resorption than formation after age 30)
  • post menopausal women (estrogen)
  • medications
  • low dietary calcium
27
Q

Calcium and Vitamin D

A

Vitamin D increases calcium absorption in the intestines and reabsorption in the kidneys

28
Q

Vitamin D supplements

A

Cholecalciferol (D3): more potent, longer acting
Ergocalciferol (D2)
Calcitriol- synthetic analog
Doxecalciferol- metabolized in liver, can use in kidney dysfunction

29
Q

Bisphosphonates

A

GOLD STANDARD for osteoporosis treatment

  • Decreases rate of bone resorption via inhibition of osteoclasts and osteoclast precursors (osteoclast apoptosis)
  • Long half life: infrequent dosing
30
Q

Bisphosphonate drugs

A

Alendronate
Ibandronate
Risendronate
Zoledronic Acid

31
Q

Bisphosphonates ADRs

A 
Hypocalcemia
Hypophosphatemia
Myalgia
Osteonecrosis of the jaw*
Erosive Esophagitis*
32
Q

Calcitonin

A

Used for pain relief associated with osteoporotic vertebral fractures

  • PTH antagonism, inhibiting bone resorption (activation of calcitonin receptors on osteoclasts inhibits osteoclast activity
  • IV or intranasal administration
33
Q

Teraparatide and Abaloparatide

A

For Moderate to Severe Osteoporosis (daily SC injection)

-Recombinant formulation of endogenous PTH: stimulates OSTEOBLAST function for new bone formation

34
Q

Teraparatide and Abaloparatide ADR

A

BBW: osteosarcoma

  • Mild hypercalcemia
  • Orthostatic hypotension
35
Q

Denosumab

A 
SC Injection (every 6 mo)
-Monoclonal antibody; RANKL inhibitor used to reduce bone resorption via blocking osteoclast activity
36
Q

Denosumab ADR

A

Injection site reaction

possible increased risk of infection

37
Q

Estrogen

A

Reduces osteoclast activity (does’t reverse loss)

-decreased vasomotor symptoms

38
Q

Raloxifene

A

Selective Estrogen Receptor Modulator (SERM)

-estrogen agonist in the bone to prevent bone loss- decrease bone resorption

39
Q

Raloxifene ADR

A

Vasomotor symptoms (hot flashes)

40
Q

Cushing Syndrome

A

Increased ACTH production, leading to high circulating cortisol levels
-tumor on pituitary gland or excessive glucocorticoid administration (use surgery or stop medication)

41
Q

Hyperaldosteronism

A
  • adrenal gland produce too much aldosterone

- treat with aldosterone antagonist

42
Q

Addison’s disease (primary adrenal insufficiency)

A
  • An autoimmune disorder where not enough corticosteroids produced endogenously
  • Treated with glucocorticoids and mineralocorticoid replacement
43
Q

Secondary Adrenal Insufficiency

A
  • Pituitary gland cannot produce enough ACTH

- Tumor: surgical removal

44
Q

Cortisol

A
  • Regulates metabolism, cardiovascular function, growth, inflammation, and immunity
  • Negative feedback system
  • Activates glucocorticoid receptors
  • Glucocorticoids mimic the actions of cortisol
45
Q

Glucocorticoids Therapeutic Use

A
  • Inflammation
  • Immunosuppression
  • Replacement in adrenal insufficiency
46
Q

Glucocorticoid Receptor Agonists

A 
Betamethasone
Budesonide
Clobetasol
Cortisone
Dexamethasone
Fluticasone
Hydrocortisone
Methylprednisone
Mometasone
Prednisolone
Prednisone
Triamcinolone
47
Q

HPA Axis Suppression

A
  • After ~1 week of glucocorticoid use, cortisol production is suppressed via negative feedback
  • Abrupt cessation can lead to acute adrenal insufficiency for 2-3 days
  • TAPER so body can readjust HPA axis
48
Q

Glucocorticoids ADE

A 
Hyperglycemia
Immunosuppression
Insomnia
Psychological effects
Osteoporosis
Lipolysis
Hormonal changes
Hypertension
Slowed growth in children
Muscle issues
Ocular issues
49
Q

Avoiding glucocorticoid ADRs

A
  • Use small dose in short duration

- local administration

50
Q

Mineralocorticoids

A

Predominantly activated by endogenous aldosterone

51
Q

Fludrocortisone

A

Mineralocorticoid receptor agonist

  • similar to aldosterone: increased reabsorption of sodium and loss of potassium
  • ADR: Dose dependent hypertension
52
Q

Aldosterone Antagonists

A
  • Used in primary aldosteronism
  • Competes with aldosterone receptors in distal tubules, increasing sodium and water excretion while preserving potassium
  • Used in CHF, resistant hypertension, cystic acne
53
Q

Aldosterone Antagonist drugs

A

Spironolactone

Eplernone

54
Q

Aldosterone Antagonist ADRs

A

Hyperkalemia
Gynecomastia
Impotence

Pharmacology: Exam 3 (5 decks)

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