Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

(89 cards)

Start Studying
1
Q

what level of TSH is diagnostic for overt hypothyroidism

A

TSH > 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are 2 hormone replacement products for thyroid?

A

Levothyroxine (synthetic T4)

-Liothyronine (T3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Liotrix?

A

synthetic LT4 and T3 combination product - never use; unpredictable an toxic potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the treatment of choice for hypothyroidism?

A

Levothyroxine (synthetic LT4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

between LT4 and T3, which has the longer 1/2 life?

A

LT4! (1/2 life is 7-10 days)

t3 1/2 life is 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when is the ONLY time to consider giving patient T3?

A

when they have impaired conversion of T4 to T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is Armour thyroid and ratio products like Liotrix never used?

A

risk of toxicity and unpredictable outcomes; also no benefit when compared to Levothyroxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the MOA of levothyroxine?

A

synthetic LT4; mimics normal physiology of thyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

when do you recheck TSH levels?

A

6-8 weeks after initiation of levothyroxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

you see a patient 6 weeks after initiating Levo; his TSH are not yet at goal. What do you do?

A

change the dose by 10-20% and follow up in another 6-8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T or F: small differences in Levothyroxine can make big differences in TSH levels

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the biggest risk of overtreating a patient with Levothyroxine?

A

cardiac issues - A.fib

also depression, osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when do you advise your patient to take their Levothyroxine?

A

best when taken in the EVENING on empty stomach

can also take in a.m. 1-2 hours before breakfast/other meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

to avoid drug-drug interactions, pt should take LT4 2 hours before or 6 hours AFTER to reduce the risk of interaction with which types of medications?

A

calcium
iron
multivitamins
prenatal vitamins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

after patient is stable (euthyroid), how often should they come in for monitoring/re-checking levels

A

6-12 months (more often if pregnant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

T or F: always write the prescription for Levo in mg.

A

FALSE! correct units are mcg!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what level of TSH is diagnostic of HYPERTHYROIDISM?

A

TSH < 0.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the most common cause of hyperthyroidism?

A

Graves Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Subclinical hyperthyroidism may become OVERT if:

A 
iodine excess
infection
stress
smoking
lithium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment Hyperthyroidism

A

Beta Blockers (to block palpitations, tremor, anxiety) + PUT/MMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Specifically what type of Beta Blockers are used for treatment of hyperT

A

NON-SELECTIVE (propranolol or nadolol)

-these impair the conversion of T4 to T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

you’re supposed to use nonselective betablockers to treat HyperT in patients EXCEPT THOSE WITH

A

asthma or decompensated HF

use atenolol, clonidine, verapamil, diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are some other methods used to reduce thyroid hormone synthesis?

A

Iodide, anti-thyroid drugs(PTU/MMI), radioactive iodine, surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the MOA of iodide?

A

blocks thyroid’s uptake of iodine, inhibiting synthesis and release of thyroid hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
T or F: it's ok to use iodide to treat thyroid storm BEFORE radioactive iodine treatment
FALSE!!! this will inhibit the concentration of radioactivity in thyroid, AKA thyroid won't be able to take up the iodine
26
What are the 2 most common antithyroid drugs used to treat hyperthyroidism?
Propylthiouracil (PTU) | Methimazole (MMI)
27
MOA PTU and MMI
interferes with synthesis of thyroid hormones by interfering with iodine incorporation. Also has immunosuppressive effects (helps in Graves)
28
This antithyroid drug specifically inhibits conversion of T4--> T3
PTU
29
This medication is the primary therapy for Graves and to prepare for surgery or radioactive iodine administration
PTU/MMI
30
how often to monitor patient's being treated for Graves with MMI
every 4-6 weeks until stable (then decrease to maintain euthyroid)
31
What is the significance of patients who are TSHR-Sab (+)
these patients almost ALWAYS relapse (Graves disease)
32
what is the black box warning for PTU
severe liver injury (only use if can't tolerate MMI)
33
what is agranulocytosis?
decrease in WBC, presenting in first 3 months of MMI/PTU treatment as sudden fever, malaise, sore throat -may develop sepsis and die
34
what to do if patient on MMI experiences agranulocytosis
D/C antithyroid drug immediately - give Abx if afebrile, and consider filgrastim
35
what is the option for thyroid ablation without surgery
radioactive iodine
36
how to manage patient while going through radioactive iodine
put them on BB and MMI; the process is slow and need to address symptoms and prevent thyroid storm in the meantime
37
Contraindications for MMI/PTU?
pregnancy | breastfeeding
38
what is the consequence of radioactive iodine treatment?
usually will develop hypothyroidism, as thyroid gets damaged. They will then need Levothyroxine
39
what is the 1/2 life of radioactive iodine?
8 days
40
how do we treat a pregnant patient for hyperthyroidism/thyrotoxicosis
PTU in 1st trimester (MMI is teratogenic here) --> then MMI in 2/3 trimesters
41
Which drug is safer in 2nd and 3rd trimester: MMI or PTU?
MMI
42
What causes thyroid storm?
``` radioactive iodine treatment withdrawal from antithyroid drug (MMI/PTU) infection trauma surgery ```
43
this life-threatening disorder can be caused by severe thyrotoxicosis
Thyroid storm
44
Treatment thyroid storm
BB + large doses PTU/MMI + APAP + antiarrhythmics
45
Causes of PRIMARY Hypothyroidism
autoimmune thyroid (Hashimotos iatrogenic (surgery/radiation) Drugs thyroiditis (postpartum_
46
what is the name for the T3 product?
Liothyronine
47
What is the combination T4/T3 product?
Liotrix (not used in modern therapy due to unpredictable and toxic potential)
48
what can happen regarding the bones when we overtreat with thyroid meds?
Osteoporosis
49
what type of beta blocker is preferred for treating hyperT?
nonselective | propranolol or nadolol
50
what types of patients do you need to avoid using non=selective BB in treating Hypert
asthma | heart failure
51
what is radioactive iodine used for?
Given to Graves' patients 7-14 days before surgery | also reduces hormone release during thyroid storm
52
when is one time to NOT use iodide for treating hyperthyroid?
before radioactive iodine treatment (use MMI)
53
AE iodid
gynecomastia, hypersensitivity, iodism
54
what medication is the best to prescribe in large doses during thryroid storm?
MMI (longer 1/2 life)
55
after you reach euthyroid in treating apatient with hyperthyroidism, what do you do next?
decrease the dose, overtreating leads to hypothyroid
56
what is the black box warning of PTU
severe liver injury w/ PTU (only use if can't tolerate MMI)
57
what is the MOA of radioactive iodine?
produces thyroid ablation without surgery
58
treating a patient with radioactive iodine is a SLOW process; what do you administer in the meantime?
BB + MMI (to address symptoms and prevent thyroid storm)
59
when is radioactive iodine contraindicated?
pregnancy and lactation
60
your patient is newly pregnant and being treated for her hyperthyroidism. What medication should she start on in the 1st trimester?
PTU is safest in 1st trimester; switch to MMI during 2nd and 3rd trimesters
61
a patient comes into the ED with high fever, tachypnea, tachycardia, severely dehydrated. you suspect Thyroid storm. What is the treatment of choice?
BB + LARGE dose MMI + APAP, antiarrhythmics, IV hydrocortisone
62
which 4 drugs can cause thyroid disease?
Amiodarone (hypo/Hyper) Lithium (hypoT) Interferon-alpha (hypo) tyrosine kinase
63
regarding drug-induced thyroid disease, what would a patient be using interferon alpha for and how would you manage the new onset thyroid issue it caused?
taking it for Hepatitis C; start them on Levothyroxine (LT4) and re-evaluate in 6 months
64
A patient is taking tyrosine kinase inhibitors, and can develop thyroid disorder. What would they be taking this for?
cancer, including thyroid cancer | imatinib (sunitinib) Sorafenib)
65
There are 2 systemic glucocorticoids used to treat chronic adrenal insufficiency. What are they?
Hydrocortisone (short 1/2 life) | Prednisone (long half life)
66
How do you treat a patient with addisons disease?
need mineralcorticoid replacement (Fludrocortisone)
67
You are seeing a patient for Cushing's syndrome; how do you handle this if it's due to medication vs. tumor?
REMOVE TUMOR or D/C steroids gradually
68
what are the 2 drugs used for inhibitors of adrenal steroidogenesis (cushings)
ketoconazole | Metyrapone
69
MOA metyrapone
reduces cortisol and corticosterone production (suppresses aldosterone synthesis)
70
MOA: Ketoconazole
antifungal; blocks enzymes in steroid biosynthetic pathway
71
Adverse effects of ketoconazole
gynecomastia, decreased libido, adrenal insufficiency, hepatotoxicity
72
T or F: ketoconazole works slow
FALSE - works fast
73
if adrenal steroidogenesis inhibitors are not tolerated for treating Cushings, there is an adrenolytic agent. What is its name
Mitotane
74
MOA mitotane
inhibits steroidogenesis at LOW DOSES (adrenolytic at high dose)
75
Steroid tapering is only necessary if used longer than
>3 weeks
76
How do you taper a steroid for patients?
stable decrease of 10-20% dose
77
what are the 3 classes of medications used to treat acromegaly?
Somatostatin analog GH receptor antagonists Dopamine agonists
78
acromegaly is caused by overproduction of GH, often caused by ___
pituitary adenoma
79
Octreotide | Lanreotide
Somatostatin analogs (Acromegaly)
80
MOA octreotide/Lanreotide
Inhibits GH by binding somatostatin receptors in pituitary; reduces pituitary tumor size
81
what is the name of the GH receptor antagonist?
Pegvisomant (blocks action of GH)
82
we already know that bromocriptine is a dopamine receptor agonist - what is the other one used in GH oversecretion?
Cabergolamine (better tolerated)
83
contraindications of dopamine agonists?
uncontrolled HTN, ischemic disease, PVD
84
you are seeing a patient who is thinking about trying to get pregnant. She is taking Cabergolamine. What do you advise?
she needs to stop this 1 month before conception (it has a long 1/2 life)
85
what is the treatment for GH deficiency?
Somatotropins (omnitrope, nutropin, Humatrop)
86
when is the best time to administer (inject) somatotropins?
in the evening, as most of GH secretion occurs during sleep
87
contraindications of somatotropin
cancer/tumors prader-willi syndrome obese respiratory impairments
88
thyroid hormones are important for:
fetal growth and development, regulation of energy metabolism
89
iodism is an adverse effect of iodide treatment. What does this look like?
palpitations, depression, weight loss, pustular skin eruptions

Pharmacology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions