sessh Flashcards
(156 cards)
enzymes for iodide uptake
other important enzymes
NIS(na I, brings into thymocyte)
pendrin(chloride iodide exchanger, transports across the cell) to arrive in the follicular lumen
this is the first step of making iodide hormone
once in the lumen TPO-thyroidal peroxidase turns iodide to iodine via oxidization…. once in this form iodide can ionize tyrosine molecule (organifying them) making MIT and DIT. MIT and Dit couple up which is catalyzed by TPO
megalin
member of the LDL family that helps endocytize the iodine rich colloid. proteolysis is the final enzyme to make T4
5′ deiodinase
turns t4 to t3
then t3 can enter the nucleus to bind to thyroid receptor
Radioiodine uptake is usually markedly elevated
hyperthyroidism
inhibiting the peroxidase, thus blocking iodine organification, and coupling of the iodotyrosines.also blocks peripheral deiodination
thiamines
-does not block the uptake of iodide into the gland just stops the production. causes delayed effect because the thyroid will use up all its stores first.
DOC for Graves’ disease.
methimazole
_______preferred in severe hyperthyroid states or thyroid storm because_______
Propylthiouracil PTU
because blocks t4 to t3
pregnancy considerations with hyperthyroidism
1st trimester give PTU after give Methimazole
never give radioactive iodide
thiamin AE
pruritic rash, agranulocytosis, severe hepatitis*
PTU spa associated with liver failure
used prior to surgery to decrease vascularity of the thyroid gland and used in….
iodide
also used in a cytokine storm of cytotoxicosis
iodide AE
swelling of the neck and mouth, metallic taste in mouth, mouth ulcers
therapeutic effect is due to emission of β rays
radioactive iodine
contraindicated in pregnancy
amiodarone therapy can induce
either hyper or hypothyroidism
hypo esp in pts with AI thyroiditis(can add levothyroxine if meds cant be stopped)
hyper1. iodine in the amiodarone causes inc production of hormone esp if preexisting goiter(thioamine)
hyper2. destructive thyroid in previously normal pt causes inc in hormone release(glucocorticoids)
the obvious and not obvious side effects of glucocorticoids
metabolic effect(fat deposition), immunosupressive, anti-inflammatory
behavioural(insomnia, depression), pseudotumor cerebri(inc intracranial pressure), development of peptic ulcers(provokes H pylori and inc, stimulated fetal surfactant production, inc platelets and RBC
Weakness, fatigue, weight loss, hypotension, hyperpigmentation and
inability to maintain the blood glucose level during fasting.
tx
chronic adrenal insufficiency, Addisons
Daily hydrocortisone (with higher doses during periods of stress)
* Must be supplemented with fludrocortisone
antagonist at glucocorticoid & progesterone receptors
use?
MIFEPRISTONE
-Inoperable patients with Cushing’s syndrome due to ectopic ACTH production or adrenal carcinoma who failed to respond to other therapeutic manipulations
competes with aldosterone for its receptor
use?
spironolactone
Aldosteronism (diagnosis & treatment), hirsutism in women (acts as androgen antagonist), K+ sparing diuretic
spironolactone AE
Hyperkalemia, cardiac arrhythmia, impotence, menstrual abnormalities, gynecomastia,
potent & non-selective inhibitor of adrenal & gonadal steroid synthesis
use?
KETOCONAZOLE
-cushings syndrom
-prostate cancer
KETOCONAZOLE AE
hepatotoxicity
irregular menses, decreased libido, impotence, gynecomastia
blocks conversion of cholesterol to pregnenolone which leads to reduced synthesis of all hormonally active steroids
use?
AE?
AMINOGLUTETHIMIDE
Cushing syndrome due to adrenal cancer
lethargy, skin rash
relatively selective inhibitor of steroid 11-hydroxylation (interferes with cortisol & corticosterone synthesis)
use?
METYRAPONE
to test adrenal function
Tx for pregnant women with Cushing syndrome
METYRAPONE AE
hirsutism, salt and water retention
DKA management
replace fluid loss with saline, Insulin IV, possassium support, bicarb supp