Thyroid and calcium homeostasis Flashcards by Melissa Ring

What medications can you prescribe for hypothyroidism

Levothyroxine (T4)
Liothyrine (T3)
Liotrix (T3+T4)

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What are the goals of treating hypothyroidism

provide resolution in patients symptoms

Achieve normalization of serum thyrotropin (TSH) w/ improvement in thyroid hormone concentrations

avoid over treatment - especially in elderly

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What may decrease absorption of T4

Aluminum and magnesium containing antacids

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What is the PK of T4

Metabolized in the liver
eliminated in bile
half life 7 days
deiodinated in patients tissue

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What is the PK of T3

Oral
short half life
metabolized by liver
eliminated in bile

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What is important to teach patients when prescribing T4

Needs to be on an empty stomach

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What are some adverse effects of T3

Increased risk of cariotoxicity
transient hyperthyroidism

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When is T3 alone typically prescribed

When patient comes in and has myxedema coma

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What are some medications for hyperthyroidism

methimazole
propylthiouracil
propranolol
iodine + potassium iodine

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What drugs are Thiomides

Propylthiouracil (PTU)
Methimazole

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What are the MOA of PTU and methimazole

Inhibit thyroid hormone synthesis and thyroperoxidase

PTU also inhibits D1

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What is the DOC for thyroid storms

PTU

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Which thioamide is preferred in early pregnancy

PTU

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Which thioamide is preferred in 2nd and 3rd trimester

methimazole

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What are the side effects for thioamides

Teratogenic
Hepatotoxicity
BM suppression (Agranulocytosis)

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What is the advantage of methimazole over PTU

Methimazole has clinical advantages and is less toxic

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What is the MOA of propranolol

Non-selective beta blocker
Inhibits deiodination of T4
reduces circulating T3

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What is the PK of propranolol

IV in emergent settings

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What are the adverse effects of propranolol

Decrease CO

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What is the MOA of iodine and KI

Inhibition of biosynthesis (iodination of tyrosine)

inhibition of secretion of T3/T4

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When are the effects of iodine at their max

10 days post admin

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What are the adverse effects of iodine

exacerbation of hyperthyroidism
mucosal injury

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What are the indications for potassium iodide

Preoperative preparation for thyroidectomy in Graves disease to decrease gland vascularity

thyroid storm

combo treatment to improve short term control of graves

S/P admin of radioiodine in Graves disease

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When is potassium iodine used most commonly

used to treat severe hyperthyroidism and to protect the thyroid gland when using radiopharmaceuticals

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What is the PK of radioactive iodine

orally admin. as sodium iodide rapidly absorbed into thyroid causing local destruction

How long does it take to inactivate the thyroid after taking radioactive iodine

6-18weeks

What are the indications for radioactive iodine

Graves Toxic adenoma multi nodular goiter

What are clinical presentations of hypercalcemia

Shortened QT wave ST depression AV blocks

What are some common causes of hypercalcemia

hyperparathyroidism malignancy thiazides lithium pancreatitis granulomatous disease

What are some options for treating hypercalcemia

IV hydration calcitonin bisphosphonates loop diuretis glucocorticoids denosumab dialysis

What is the treatment for low to moderate hypercalcemia

hydration and fix underlying causes

How do you treat severe hypercalcemia

Calcitonin Zoledronic acid Denosumab

What is the job of calcitonin

Stimulates Ca2+ deposites in bones and decrease uptake in the kidney

What is the job of vitamin D

Increase intestinal and renal uptake of Ca2+ and stimulates release from bones to stimulate bone mineralization

What does estrogen do

Inhibits apoptosis in osteoblasts Induces apoptosis in osteoclasts estrogen deficiency leads to excess remodeling and bone resorption = osteoporosis

A low or intermittent levels of PTH, what effect does it have

anabolic effects of osteoblasts

If there is Hugh PTH levels, what is the cause

catabolic effects of osteoblasts

What is the MOA of bisphosphonates

Inhibits osteoclast activity which reduces bone resorption and turnover

What are medications that are bisphosphonates

Alendronate Risendronate Zoledronic acid Ibandronate

What is the indication for alendronate

Osteoporosis pagets Osteopenia in non-ambulatory pts

What is the indication for risedronate

Osteoporosis pagets

What is the indication for ibandronate

Osteoporosis

What is the indication for Zoledronic acid

osteoporosis malignant hypercalcemia bone metastesis multiple myeloma

What are the side effects of bisphosphonates

Bone/joint/muscle pain Nausea, heartburn, diarrhea Upper GI irritation (Alendronate) Headache Atypical femur fractures osteonecrosis of jaw Hypcalcemia

What are contraindications for bisphosphonates

Esophageal disorders renal insufficiency hypocalcemia Taking with food (30-60 min before food)

What is the MOA of calcitonin

Antagonizes effects of PTH inhibits osteoclast activity promotes renal secretion of Ca2+

What are the indications for calcitonin

Hypercalcemia pagets disease Post menopausal osteoporosis pain from osteoporotic fx

What are adverse effects of calcitonin

Rhinitis epistaxis back pain N/V bronchospasm hypocalcemia anaphylaxis

What is the MOA of vitamin D

Cholecalciferol is a provitamin. The active metabolites 1,25-dihydroxyvitamin D which stimulates Ca2+ absorption from the small intestine to promote bone mineralization

What are the indications for vitamin D

Deficiency Osteoporosis Hypoparathyroidism

What are the adverse effects of vitamin D

Well tolerated

What are contraindications for Vitamin D

Hypercalcemia Primary hyperparathyroidism Sarcoidosis

What is the MOA of Calcitriol

Vit. D analog that stimulates intestinal Ca2+ absorption which decreases PTH synthesis and stimulate bone mineralization

What are the indications for Calcitriol

Renal failure Hypoparathyroidism rickets hypophosphatemia

What are the adverse effects of Calcitriol

Hypercalcemia hyperphosphatemia N/V

What are the contraindications for calcitriol

Pancreatitis soft tissue calcification arrhythmias

What is the MOA of denosumab

Recombinant antibody that inhibits RANK-L to bind to RANK (antiresorptive)

What are the indications for Denosumab

Osteoporosis Unable to tolerate/unresponsive to bisphosphonates renal impairment

What are the side effects of denosumab

Osteonecrosis of jaw atypical subtrochanteric fracture bone pain

What are the contraindications of denosumab

Hypocalcemia

What is the MOA of Teriparatide (Recombinate PTH)

Anabolic affect on bone metabolism by stimulating bone formation and activating bone remodeling treatment <2yrs / lifetime

What are the indications for teriparatide

Osteoporosis

What are the side effects of teriparatide

Generally well tolerates hypercalcemia/hypercalciuria orthostatic hypertension

What is the BBW for teriparatide

Osteosarcoma

What are the contraindications for teriparatide

Hypercalcemia severe renal impairment

What is the MOA for Raloxifene

Selective estrogen receptor modifier (SERM) acts like estrogen adonis in the bone, decreasing bone resorption and overall bone turnover = increase in bone density

What are the indications of Raloxifene

postmenopausal Osteoporosis

What are adverse effects of Raloxifene

Hot flashes leg cramps peripheral edema DVT/PE

What are the contraindications for Raloxifene

History of DVT/PE pregnancy

How do Thiazides effect calcium levels

Decrease urinary excretion Ca2+ inhibits secretion of calcium sometimes leading to hypercalcemia

How to loop diuretics effect calcium levels

Increases urinary calcium concentration useful with hypercalcemia because it stimulates Ca2+ excretion

What therapeutic effects do the fluoride ions have on the body

Increases osteoblast activity increase bone density *fx risk NOT reduced

What are the toxic effects of the fluoride ion

GI effects (N/V & Diarrhea) Renal/cardiac dysfunction

Thyroid and calcium homeostasis Flashcards

(73 cards)