Pharm Quiz 5 - Moore TS

Question 1

In the hypothalamic pituatary thyroid axis, what is secreted by each?

Answer 1

Hypothalamus - TRH
Ant. Pituatary - TSH
Thyroid - T3, T4

Question 2

Thyroid hormone has negative feedback on what?

Answer 2

both TRH and TSH release

Question 3

What is thyroid hormones backbone?

Answer 3

2 tyrosine molecules with ether linkage (MIT: 1 iodine, DIT: 2 iodines)

Question 4

What linkages form T3?

Answer 4

DIT + MIT

Question 5

What molecule is formed by DIT + MIT?

Answer 5

rT3

Question 6

What linkages form T4?

Answer 6

DIT + DIT

Question 7

What is the main thyroid hormone secreted by thyroid gland?

Answer 7

T4 (thyroxine)

Question 8

What enzyme catalyzes T4 into T3?

Answer 8

Iodothuronine 5’ deiodinase

Question 9

How do the three types of Iodothronine 5’ deiodinase differ? (action and location)

Answer 9

type 1 - serum in liver and kidneys
type 2 - intracellular (pituatary, brain, fat)
type 3 - converts T4 to rT3

Question 10

What is the half life of T3 and T4 in humans and dogs?

Answer 10

human T3 - 1 day
dog T3- 5-6 hours
human T4- 6 days
dog T4 - 8-16 hours

Question 11

Why do thyroid hormones in humans have longer half life?

Answer 11

more thyroid hormone bound to proteins, less degradation

Question 12

What percent of T3 is from T4?

Answer 12

80%

Question 13

Which thyroid hormone has greatest activity? by how much?

Answer 13

T3 has 4x activity of T4

Question 14

What is the role of rT3?

Answer 14

no activity

Question 15

What are the 3 proteins that bind to thyroid hormones?

Answer 15

Thyroxine binding pre-albumin
Albumin
TGB

Question 16

What protein do humans have 3 times as much of compared to dogs?

Answer 16

TGB (thyroxine binding globulin)

Question 17

What are the % thyroid hormones protein bound in humans and dogs?

Answer 17

Human T3: 99.8%
Human T4: 99.98%
Dog T3: 99%
Dog T4: 99%

Question 18

What is cretinism?

Answer 18

thyroid deficiency - retarded dwarf

Question 19

What are the calorgenic effects of thyroid hormone?

Answer 19

increased metabolism, increased body temp

Question 20

Why does a hypothyroid dog have high serum cholesterol?

Answer 20

decreased lipolysis(?) and bile secretion

Question 21

How would low thyroid levels affect the skin?

Answer 21

follicle atrophy, bilateral alopecia, myxedema, tragic face

Question 22

How does low thyroid cause facial nerve paralysis?

Answer 22

decreased conduction velocity in CNS

Question 23

What are GI signs of hypothyroidism?

Answer 23

decreased motility

Question 24

What are the repro effects of hypothyroidism?

Answer 24

male - testicular atrophy

female - irregular cycles, abortion

Question 25

What causes primary hypothyroidism? How many % of cases?

Answer 25

Lymphocytic thyroiditis (95%)

Question 26

What causes secondary hypothyroidism? How many % of cases?

Answer 26

destruction of thyrotrophs in pituatary by tumor (5%)

Question 27

Which replacement thyroid hormone is used in dogs?

Answer 27

T3 (L-thyroxine)

Question 28

Serum T4 levels should be checked how often in patients on Thyroxine?

Answer 28

1-2x per year

Question 29

What is the most common cause of hyperthyroidism in cats?

Answer 29

thyroid adenoma

Question 30

How does methimazole decrease thyroid synthesis?

Answer 30

inhibits peroxidase (iodination and coupling of thyroglobulin)

Question 31

Why would it be a good idea to reversibly treat hyperthyroidism initially? (using methimazole)

Answer 31

in case kidneys cant handle decreased BP

Question 32

What does the blood work of a hypothyroid dog look like?

Answer 32

normocytic, normochromic, non regen anemia, hypercholesteremia

Question 33

What are the discharge instructions for cats treated with radioiodine?

Answer 33

special handling of feces and urine | keep away from pregnant women and children

Question 34

What are some concerns with surgical thyroidectomy?

Answer 34

parathyroid gland

Question 35

What kind of drug can alleviate some of the symptoms of hyperthyroidism?

Answer 35

beta blockers

Question 36

What do alpha, beta, and delta cells secrete? effect on glucose levels?

Answer 36

alpha: glucagon - increase beta: insulin and amylin -->decrease delta: somatostatin

Question 37

What glucose transporters is in all mammalian tissue?

Answer 37

GLUT 1and GLUT 3

Question 38

What glucose transporter is in the liver and pancreas B cells?

Answer 38

GLUT 2

Question 39

What glucose transporter is located in muscle and fat cells?

Answer 39

GLUT 4

Question 40

What glucose transpporter is in small intestines?

Answer 40

GLUT 5

Question 41

What happens to beta cells when they are stimulated?

Answer 41

depolarized

Question 42

What are the 4 stimulators of insulin secretion?

Answer 42

glucose, AA, fatty acids, GI hormones

Question 43

What are the 2 inhibitors of insulin secretion?

Answer 43

somatostatin | alpha 2 agonists

Question 44

What causes the central form of diabetes insipidus?

Answer 44

decreased ADH from posterior pituatary

Question 45

What causes the nephrogenic form of diabetes insipidus?

Answer 45

cells in kidney cant respond to ADH

Question 46

What defines type 1 diabetes?

Answer 46

insulin dependent, doesnt produce insulin

Question 47

What defines type 2 diabetes?

Answer 47

insulin resistance - cats

Question 48

What are the steps in ketoacidosis?

Answer 48

insulin deficiency -->metabolism of triglycerides/muscle -->FFA -->ketones

Question 49

What are normal blood glucose levels?

Answer 49

80-120 mg/dl

Question 50

What are 2 consequences of chronic hyperglycemia?

Answer 50

glycated proteins -- nerve and bv damage | neural and ocular damage (sorbitol)

Question 51

What is the diet recommended for dogs with diabetes? cats?

Answer 51

dog - high fiber, complex carbs | cat - high protein, low carbs

Question 52

Which insulin type can be given to cats to put them in remission from diabetes?

Answer 52

Glargine insulin

Question 53

What is insulins effect on carb metabolism?

Answer 53

increase glucose uptake/glycogen synthesis increased glycolysis decreased gluconeogenesis

Question 54

How does insulin effect fat metabolism?

Answer 54

increased storage, increased lipogenesis, decreased lipolysis

Question 55

How does insulin effect protein metabolism?

Answer 55

increased AA uptake, synthesis and decreased degradation

Question 56

What receptor is associated with glucose uptake in fat cells?

Answer 56

tyrosine kinase receptor

Question 57

How does insulin affect potassium in the body?

Answer 57

activated Na/K ATPase, increased K intracellularly

Question 58

What insulin is most similar to dog insulin?

Answer 58

hog

Question 59

What insulin is most similar to cat insulin? How much do they differ?

Answer 59

Bovine - differ by 1 AA in A chain

Question 60

Cattle, sheep, horses, and dog insulin differ in how many AA?

Answer 60

3 AA in A chain

Question 61

How many units of insulin per mL are held in a U-40 syringe? U-100 syringe?

Answer 61

``` U-40 = 40 units/mL U-100 = 100 units/mL ```

Question 62

Why is insulin crystalized?

Answer 62

zinc helps crystallization???

Question 63

What insulin has a double peak in dogs? What hours does it happen?

Answer 63

porcine insulin zinc suspension - 4 and 11 hours

Question 64

What are the 2 long acting insulins?

Answer 64

protamine zinc insulin | Glargine/Lantus

Question 65

What are the 2 intermediate acting insulins?

Answer 65

``` isophane insulin(NPH insulin) porcine insulin zinc suspension ```

Question 66

In what 3 ways can effectiveness of DM management be assesed?

Answer 66

Glycosylated hemoglobin - not really used Fructosamines - shows past 2-4 weeks Glucose curve

Question 67

What is it called when dose of insulin that is too high (rebound hyperglycemia)?

Answer 67

somogyi effect - detected by glucose curve

Question 68

What type of glucose decrease will give "central" neural signs of hypoglycemia?

Answer 68

slow decrease

Question 69

What is the MOA of sulfonylureas?

Answer 69

stimulate release of insulin from B cells

Question 70

What is an example of a sulfonylurea? how is it administered?

Answer 70

Glupizide, Glimepiride - oral BID

Question 71

What is the source of biguanide drugs?

Answer 71

Galega officinalis (Goats rue)

Question 72

What is an example of a biguanide?

Answer 72

metformin - decrease GI uptake of glucose

Question 73

What type of drug is acarbose? why isnt it used as much in humans?

Answer 73

alpha-glucosidase inhibitor - many GIT SE

Question 74

What are incretins secreted from? What stimulates their secretion?

Answer 74

Secreted from GIT, stimulated by food

Question 75

What are 2 major incretins?

Answer 75

GLP-1 - increase insulin, decrease glucagon | GIP - increase insulin release

Question 76

Exenatide is derived from what?

Answer 76

gila monster saliva

Question 77

How is DPP-4 related to GLP-1?

Answer 77

DDP-4 =degrades incretins

Question 78

What is an amylin agonist analogue example?

Answer 78

pramlintide

Question 79

What 3 things does pramlintide do in humans?

Answer 79

slows gastric emptying, prevents rise in glucagon, satiety