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Pharm II > Thyroid Drugs > Flashcards

Thyroid Drugs Flashcards

1
Q

What is the pathway for thyroid hormones being released onto the target tissue? (5 steps)

A

CNS → Hypothalamus (TRH) → Pituitary (TSH) → Thyroid (T3/T4) → Target tissue

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2
Q

T3 and T4 provide negative feedback to what?

A

Pituitary and hypothalamus

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3
Q

Thyroid hormones are regulated by what 2 things?

A

TSH and iodide

high iodide will block thyroid hormone production

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4
Q

How do thyroid hormones affect BMR?

A

Increase

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5
Q

Due to the fact that thyroid hormones are important for growth/ maturation (including CNS), hypothyroidism in children is concerning because it can lead to what?

A

Cretinism

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6
Q

Is T3 or T4 more effective and why?

A

T3

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7
Q

What type of receptors do T3 and T4 act through?

A

Nuclear receptors (slow effect in body)

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8
Q

Myxedema is hypo or hyperthyroidism?

A

Hypothyroidism

myxedema coma = severe hypothyroidism

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9
Q

Do you have high or low levels of TSH with hypothyroidism?

A

High (primary cause of thyroid gland failure)

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10
Q

Pt presents with slow BMR, hypothermia (cold intolerance), fatigue +/- goiter. What are you concerned for?

A

Hypothyroidism

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11
Q

Pt presents with fast BMR, tachycardia, fatigue, hot (heat intolerant), tremor, insomnia, and diarrhea. What are you concerned for?

A

Hyperthyroidism

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12
Q

What are the 2 most common causes of hyperthyroidism?

A

Grave’s disease and toxic nodular goiter

Grave’s = autoimmune disease, activate Ab to TSH receptor

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13
Q

What are the treatment options for hyperthyroidism? (3)

A

Surgery, decrease T4/T3, block sxs with beta-blockers

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14
Q

Propranolol and metoprolol drug class?

A

Beta-adrenergic blocking agents

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15
Q

Levothyroxine drug class?

A

Thyroid hormone replacement

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16
Q

Liothyronine sodium drug class?

A

Thyroid hormone replacement

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17
Q

Desiccated thyroid drug class?

A

Thyroid hormone replacement

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18
Q

Methimazole drug class?

A

Thioamides

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19
Q

What do thioamides do?

A

Inhibit thyroid hormone synthesis

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20
Q

Propylthiouracil (PTU) drug class?

A

Thioamides

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21
Q

Iodide drug class?

A

Thioamides

22
Q

Radioactive iodine (131 I) drug class?

A

Thioamides

23
Q

What is the MOA for Levothyroxine?

A

T4- produces N levels of T3/T4 (carefully titrated to individual)

24
Q

What is the DOC for hypothyroidism?

A

Levothyroxine

25
Q

What are the important pharmacokinetic properties of Levothyroxine?

A

t1/2 = 7 days = ~5 weeks for steady state

26
Q

What is the MOA for Liothyronine?

A

T3

27
Q

When is Liothyronine used?

A

Initial hypothyroid treatment (not maintenance)

28
Q

What are the important pharmacokinetic properties of Liothyronine?

A

t1/2 = 24 hours, shorter duration (than T4)

29
Q

What is the MOA for Desiccated thyroid?

A

Mix of T4 and T3 from pigs

30
Q

When is Desiccated thyroid used?

A

Hypothyroid (pts with deficiency in peripheral deiodinase enzyme)

31
Q

What are the SEs for all thyroid hormone replacement drugs?

A

Hyperthyroidism

fast BMR, tachycardia, fatigue, hot (heat intolerant), tremor, insomnia, and diarrhea

32
Q

What is the MOA for Propylthiouracil (PTU)?

A

Blocks conversion of T4 to T3

33
Q

When is Propylthiouracil (PTU) used?

A

Hyperthyroid if allergic to Methimazole or pregnant

34
Q

What are the contraindications for Propylthiouracil (PTU)?

A

Severe liver injury, acute liver failure (black box warning)

Only use low doses in pregnancy

35
Q

What is the MOA for Methimazole?

A

Potent inhibitor of T4 synthesis

36
Q

What is the DOC for hyperthyroid?

A

Methimazole (unless allergic or pregnant, then use PTU)

37
Q

What is the 1st line treatment for Grave’s disease? (2)

A

Methimazole and PTU

use with beta blocker because effects are gradual as circulating T3/T4 levels last about a week

38
Q

What are the SEs of Methimazole and PTU? (4)

A

Itching, skin rash, reversible granulocytopenia/ agranulocytosis, goiter

39
Q

What is the MOA for iodide?

A

Decreases synthesis and release of T4/T3 (short term effect ~2-8 weeks)

40
Q

When specifically is iodide used in the treatment of hyperthyroid?

A

7-10 days prior to surgery (to prevent thyroid storm) and radioactive emergencies (competes with radioactive iodide to prevent binding)

41
Q

What is the MOA for Radioactive iodine (131 I)?

A

Taken into gland specifically

42
Q

What is the use of Radioactive iodine (131 I) in small amounts (µCi)?

A

Diagnostic

43
Q

What is the use of Radioactive iodine (131 I) in large amounts (mCi)?

A

Gland destruction

44
Q

In patients where surgery for the treatment of hyperthyroid is indicated but cannot be tolerated, what drug should be used?

A

Radioactive iodine (131 I)

45
Q

What is the definitive pharmacologic treatment for Grave’s?

A

Radioactive iodine (131 I)

46
Q

What is the preferred treatment for toxic nodular goiter?

A

Radioactive iodine (131 I)

47
Q

What are the SEs of Radioactive iodine (131 I)? (2)

A

Thyroid storm (decrease risk with thioamide), can cause hypothyroidism over time

48
Q

What are the contraindications to Radioactive iodine (131 I)? (3)

A

Pregnancy, nursing, mother’s who lack childcare

49
Q

What is the MOA for propranolol and metoprolol?

A

Non-specific beta blockers

50
Q

What is the preferred beta blocker and why?

A

Propranolol (also inhibits peripheral conversion of T4 to T3)

51
Q

What is the use of propranolol and metoprolol?

A

Decrease sxs of hyperthyroidism

52
Q

What is the contraindication to propranolol and metoprolol?

A

Asthma (use CCBs instead)

Pharm II (13 decks)

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