Block 1 Exam (thyroid & CONTRACEPTION) Flashcards by isabelle courtney

Describe the following for a thyroid storm (thyrotoxic crisis)

What are the lab findings?

What are the treatments?

labs:
Dangerously high T3 & T4 levels

Rx:
B-blockers
Propranolol
Thioamides (pref PTU)
Potassium iodide (SSKI)
Steroids ( reduce T4 to T3 conversion & sup immuno damage)

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labs:
Dangerously high T3 & T4 levels

Rx:
B-blockers
Propranolol
Thioamides (pref PTU)
Potassium iodide (SSKI)
Steroids ( reduce T4 to T3 conversion & sup immuno damage)

Describes which condition based on labs & rx?

thyroid storm (thyrotoxic crisis)

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Describe the following for hyperthyroidism:

What are the labs?

What are the symptoms?

What are the treatments?

Labs:
Low TSH
High T3 & T4 levels

Symptoms:
1) Heat intolerance
2) Weight loss
3) Tachycardia
4) Increased activity

Rx:
Thioamides (PTU or Methimazole) **
Iodides (KI or Lugol)
B-Blockers (propranolol)
131I (radioactive iodine)

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Labs:
Low TSH
High T3 & T4 levels

Symptoms:
1) Heat intolerance
2) Weight loss
3) Tachycardia
4) Increased activity

Rx:
Thioamides (PTU or Methimazole) **
Iodides (KI or Lugol)
B-Blockers (propranolol)
131I (radioactive iodine)

Describes which condition?

Hyperthyroidism

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Describe the following for hypothyroidism:

What are the labs?

What are the symptoms?

What are the treatments?

Labs:
High TSH
Low T3 & T4 levels

Symptoms:
1) Cold intolerance
2) Weight gain
3) Loss of appetite
4) constipation
5) brittle nails

Rx:
Levothyroxine
Liothyronin

“T3/4 are LLow in Hypo”

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Labs:
High TSH
Low T3 & T4 levels

Symptoms:
1) Cold intolerance
2) Weight gain
3) Loss of appetite
4) constipation
5) brittle nails

Rx:
Levothyroxine
Liothyronin

Describes which condition?

Hypothyroidism

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Describe the following for Levothyroxine (T4):

What is the MOA?

What are the side effects?
-kids vs adults

What are the complications?

Can be given oral/IV it is the preferred thyroid supp to give.

MOA:
Give on an empty stomach to increase T4 levels (safe than T3 because of its consistent potency & long duration of action). The T4 will be converted to T3 in the body

Side effects:
Kids (restlessness, insomnia, & acc bone maturation)

Adults:
-Nervousness
Heat intolerance
Tachycardic episodes
Bone loss

Comps:
A fibrillation
Osteoprosis

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What are the clinical uses of Levothyroxine?

Clinical uses
1) Hypothyroidism
2) Non-toxic goiters
3) Cretinism
4) Myxedema coma
5) Hashimoto’s (Hypothyroidism)
6) chronic non-healing ulcers
7) obstinate constipation

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Can be given oral/IV it is the preferred thyroid supp to give.

MOA:
Give on an empty stomach to increase T4 levels (safe than T3 because of its consistent potency & long duration of action). The T4 will be converted to T3 in the body

Side effects:
Kids (restlessness, insomnia, & acc bone maturation)

Adults:
-Nervousness
Heat intolerance
Tachycardic episodes
Bone loss

Comps:
A fibrillation
Osteoporosis

Describe which medication

Levothyroxine

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Describe the MOA of propranolol (B-blocker)
&
What is its clinical use?

MOA:
It blocks the conversion of 4 to T3 by inhibiting 5 deiodinase

Rx: Hyperthyroidism

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MOA:
It blocks the conversion of 4 to T3 by inhibiting 5 deiodinase

Rx: Hyperthyroidism

Describes which type of drug

Propranolol (B-blocker)

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Describe the following for a myxedema coma:

What causes it?

What are the symptoms?

What are the treatments?

Causes:
Severe-longstanding-untreated hypothyroidism causes it

Symptoms:
1) Progressive stupor
2) Hypothermia
3) Hypoventilation
4) Hypoglycemia
5) Hyponatremia
6) Water intoxication shock & death

Rx:
Supportive care (ventilator)
Correct the hyponatremia
IV Levothyroxine (T4)
IV hydrocortisone

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Causes:
Severe-longstanding-untreated hypothyroidism causes it

Symptoms:
1) Progressive stupor
2) Hypothermia
3) Hypoventilation
4) Hypoglycemia
5) Hyponatremia
6) Water intoxication shock & death

Rx:
Supportive care (ventilator)
Correct the hyponatremia
IV Levothyroxine (T4)
IV hydrocortisone

Describes which condition?

myxedema coma

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Describe the following for potassium iodide:

What is the MOA?

It inhibits thyroid hormone synthesis via a Saturated solution of potassium iodide which blocks TPO & proteolysis reducing T4 levels & preventing hormone release into the blood

(Wolff-Chaikoff effect (inhibition of iodotyrosines & iodothyronin synthesis)

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It inhibits thyroid hormone synthesis via a Saturated solution of potassium iodide which blocks TPO & proteolysis reducing T4 levels & preventing hormone release into the blood

(Wolff-Chaikoff effect (inhibition of iodotyrosines & iodothyronin synthesis)

Describes the MOA of which drug?

potassium iodide

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Describe the following for potassium iodide:

What are the clinical uses?

Thyrotoxicosis (thyroid storm)
Pre-op prep for surgery (firm & avascular for thyroidectomy)
Protect thyroid from radioactive iodide (nuclear fallot)

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Thyrotoxicosis (thyroid storm)
Pre-op prep for surgery (firm & avascular for thyroidectomy)
Protect thyroid from radioactive iodide (nuclear fallot)

Are all clinical uses of which drug?

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potassium iodide:

Describe the following for potassium iodide:

What are the side effects?

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1) Hypokalemia
2) Jod-Basedow phenomenon (iodide induced hyperthyroidism)
3) Induced hypothyroidism
4) Thyroid escape (long term use after 10-15 days it’s no longer therapeutic)
5) Angioedema (acute)
6) Cutaneous hemorrhages (acute)
7) Eosinophilia (acute) & enlarged LN

Describes the side effects of which drug

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Potassium iodide

Who is at risk of developing JBD (iodide induced hyperthyroidism) when taking potassium iodide ?

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Patients with:

grave disease
Endemic goiters
Thyroid adenoma
Toxic multinodular goiter

Describe the following for Radioactive iodide (131I):

MOA

SIDE EFFECT

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Pretreat with perchlorate/or/pertechnatate to inhibit the potency of the ratioactive iodine

MOA:
iT SHRINKS THE THYROID (EUTHYROID OR HYPOTHYROID)

Side effects:
1) HYPOTHYROIDSIM (80%)
2) Fetal hypothyroidism

Pretreat with perchlorate/or/pertechnatate to inhibit the potency

MOA:
iT SHRINKS THE THYROID (EUTHYROID OR HYPOTHYROID)

Side effects:
1) HYPOTHYROIDSIM (80%)
2) Fetal hypothyroidism

Describes which drug?

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Radioactive (131I) iodine

Describe the MOA of polythiouracil (PTU)

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1) It blocks TPO (thyroid peroxidase from oxidizing iodide (organification) & it decreases the conversion of T4 to T3 by blocking 5’-deiodinase

Describes the MOA of which drug?

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Propylthiouracil (PTU)

What are the side effects of Propylthiouracil (PTU)?

1) Pruritic skin rash (when meds are stopped) 2) Agranulocytosis (fever) 3) Aplastic anemia 4) Hepatotoxicity ***

1) pruritic skin rash (when meds are stopped) 2) Agranulocytosis (fever) 3) Aplastic anemia 4) Hepatotoxicity *** Are side effects of which drug?

Propylthiouracil

What are the clinical uses of Propylthiouracil?

Hyperthyroidism Graves disease (preggos esp) Thyrotoxic crisis/storm

What is the MOA of methimazole?

Same as PTU it blocks PTO to reduce thyroid hormone synthesis via preventing T4-to-T3 conversion by blocking 5 deiodinase

What are the side effects & clinical uses of methimazole?

Side effects: 1) Pruritic skin rash 2) Agranulocytosis 3) Aplastic anemia 4) Aplasia cutis 5) Choanal or esophageal (rare) Uses: Hyperthyroidism Graves Thyrotoxic crisis/storm Avoid in preggos (only after 1st trimester) "Meth heads dion't need AA"

Methimazole

Describe the following iodine processing pathway & where the following drugs inhibit it PTU Methimazole Iodides

1) iodide is taken up 2) Thyroglobulin's are made from AA's 3) PTO results in Iodination (coupling) of tyrosyl groups THIOAMIDES (PTU & METH) inhib IODIDES (IK) 4) Organification of tyrosine residues to make MIT or DIT IODIDES INHIBIT 5) Proteolytic release of hormones in the blood IODIDES INHIB 6) T3/T4 get to tissue & are converted to T3 via 5-deiodinase THIAMIDE (PTU) INHIBITS

What pathway is gastrin involved in?

Phospholipase C via the inositol triphosphatases

Hormones: ADH Calcitonin Glucagon GHRH ACTH TSH FSH/LH PTH all require which pathway

cAMP (protein kinase A)

cAMP (protein kinase A) PATHWAY INCLUDES WHICH TYPES OF HORMONES?

Hormones: ADH Calcitonin Glucagon GHRH ACTH TSH FSH/LH PTH

Nuclear/intracellular receptors are for which hormones?

Steroid hormones Thyroid hormones Vitamin D Retinols (Vit A)

Steroid hormones Thyroid hormones Vitamin D Retinols (Vit A) mOVE VIA WHICH TYPE OF RECEPTOR PATHWAYS

Nuclear/intracellular pathway

Receptor tyrosine kinase pathway is for which hormones?

Insulin EGF IGF FGF TGF

Insulin EGF IGF FGF TGF All you which pathway

RTK path

The IP3 (phospholipase C) pathway involves which hormones with which 2 secondary messengers

2nd cAMP: TSH GHRH CRH ACTH ADH (V2) HISTAMINE H2 (SKIN/LING) LH/FSH 2nd IP3 Gastrin TRH ADH (V1) GnRH Histamine HI (stomach) Angiotensin II

wHICH HORMONES USE cGMP pathway

ANP BNP NO

Which proteins use JAK/STAT

Bone marrow: Erythropoietin G-CSF Thrombopoietin Post pituitary: Prolactin Growth hormone Interleukins INF-y IL-2 & 6

Block 1 Exam (thyroid & CONTRACEPTION) Flashcards

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