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thyroid and pituitary Flashcards

1
Q

thyroid makes more t3 or t4?

A

t4

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2
Q

t3 or t4 bioactive?

A

t3

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3
Q

TSH level in hyperthyroidism

A

low

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4
Q

what vitamin interferes w/ thyroid testing?

A

biotin

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5
Q

1 cause of correctable intellectual disability

A

iodine deficiency

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6
Q

amiodarone, lithium,, tyrosine kinase inhibitors (sunitinib, sorafenib; 50%) can all cause ____

A

hypothyroidism

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7
Q

1st line for hypothyroidism

A

levothyroxine

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8
Q

counseing for levothyroxine

A

Take on empty stomach w/ water only
* 30min-1 hour before breakfast
* Take at night
* Careful w/ soy products – can decrease absorption of levothyroxine

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9
Q

DI: Aluminum containing antacids
o PPIs
o Bile acid sequestrants
o Iron supplements
o Calcium supplements
o Ciprofloxacin
o Estrogens (OCPs)
o Grapefruit

A

Drugs impairing levothyroxine absorption, separate administrations times by 4 hrs

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10
Q

how long to monitor TSH after initial dose or dose change of levothyroxine

A

6 wks. then 6-12 months

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11
Q

levothyroxine dosing for in pregnancy / OCPs

A

dose needs to be higher. separate prenatal vitamin by 3 hrs

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12
Q

dosing of levothyroxine

A

1.6mcg/kg

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13
Q

AEs of excessive dosing: Cardiac: heart failure, angina, MI, tachycardia, palpitations, Afib
§ Skeletal: reduced bone density
* Increased risk of fracture; similar profile to osteoporosis
§ GI disturbances: abdominal cramps, diarrhea

A

levothyroxine

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14
Q

indication: thioureas / thioamides

A

hyperthyroidism

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15
Q

class: Propylthiouracil (PTU), Methimazole (Tapazole)

A

thioureas / thioamides

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16
Q

MOA: inhibit enzyme thyroid peroxidase
* Prevents conversion of iodide to iodine à functional T4/T3 cannot be made

A

thioureas

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17
Q

thiourea that blocks conversion of t4/t3 in periphery

A

PTU

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18
Q

thiourea used in 1st trimester of pregnancy

A

PTU

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19
Q

AEs: Higher risk of teratogenicity; aplasia cutis

A

methimazole

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20
Q

AEs: Arthralgias, lupus-like symptoms
* Fever
* Rash
* Transient leukopenia
* Agranulocytosis (rare, but serious)
* Hepatotoxicity w/ both, but more severe w/ PTU

A

thioureas

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21
Q

monitoring if on thioureas

A

baseline CBC, LFTs

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22
Q

add __ to thioureas

A

BB

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23
Q

1st line BB for hyperthyroidism

A

propranolol

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24
Q

MOA: block many hyperthyroidism manifestations mediated by B adrenergic receptors
* Some T4 to T3 conversion is blocked

25
CI for radiactive iodine
pregnancy / breastfeeding
26
counseling for radioactive iodine
maintain 6ft distance and avoid public transport for several days. don't get pregnant for 6 months. no intercourse for few days
27
class: SSKI – saturated solution of potassium iodide § Lugol’s solution – potassium iodine-iodide
iodide solutions
28
MOA: acutely block thyroid hormone release, inhibit thyroid biosynthesis, decreases size and vascularity of thyroid glands
iodide solutions
29
iodide solutions before or after radiactive iodine albation
after only
30
iodide solutions as monotherapy?
no
31
AEs: * Rash, metallic taste, mucous membranes ulcerations, fever
iodide solutions
32
1st line for thyroid storm
PTU (preferred) or methimazole
33
give ___ 2nd in thyroid storm
Iodide solution: SSKI or Lugol’s solution
34
Most abundant hormone produced by anterior pituitary lobe
GH
35
first test to do if suspected acromegaly
serum IGF-1. will be elevated
36
1st line treatment for acromegaly
surgery
37
1st line med for acromegaly
Somatostatin (GHIH) analogs – first line medication o Octreotide (sandostatin), Lanreotide, Pasireotide
38
MOA: mimic endogenous somatostatin and bind to somatostatin receptors in pituitary * Inhibits GH and subsequently IGF-1
Somatostatin (GHIH) analogs
39
best efficacy somatostatin
pasireotide
40
AEs: § GI disturbances § Biliary sludge § Asymptomatic gallstones § May alter balance of counterregulatory hormones (glucagon, insulin, GH) à hyper or hypoglycemia § Higher incidence of hyperglycemia w/ DM § May suppress pituitary release of TSH à hypothyroidism
somatostatin analogs
41
monitoring for somatostatin analogs
thyroid function and glucose
42
drug cautions w/ somatostatin analogs
Caution with insulin, oral hypoglycemic agents, BB, CCB à sinus bradycardia, conduction abnormalities, arrhythmias
43
class: Pegvisomant (Somavert)
GH receptor antagonist
44
Most effective agent in normalizing IFG-1 concentration in acromegaly
Pegvisomant (Somavert)
45
main AE of Pegvisomant (Somavert)
hepatoxicity
46
Pegvisomant (Somavert) is a great option for acromegaly pts w/ _____
DM
47
class: Cabergoline, Bromocriptine
dopamine agonists
48
monitoring while on dopamine agonists
echos
49
these meds can cause.... Somatostatin analogs, GnRH agonists (ex: octreotide), methoxamine, phentolamine, isoproterenol, glucocorticoids, methylphenidate, amphetamine derivatives
GH deficiency
50
main pharm tx for GH deficiency
Recombinant Human Growth Hormone (somatotropin)
51
time of day to administer Recombinant Human Growth Hormone (somatotropin)
evening
52
AEs: § Edema, arthralgia, myalgia, carpal tunnel syndrome, benign increases in ICP (HA, vision changes, AMS) * Adults > children
Recombinant Human Growth Hormone (somatotropin)
53
Recombinant Human Growth Hormone (somatotropin) CIs
Patients w/ active malignancy and obese/respiratory compromise in a child w/ Prader-Willi syndrome
54
prolactin is inhibited by ____
dopamine
55
most common endocrine disorder of hypothalamic-pituitary-axis
hyperprolactinemia
56
Any medications that antagonize dopamine or stimulate prolactin can induce hyperprolactinemia such as ______
o Risperidone (major!), metoclopramide, antidepressants, cimetidine, methyldopa, verapamil
57
1st line med for hyperprolactinemia
dopamine agonists (cabergoline)
58
Women who become pregnant while taking a dopamine agonist should _____
discontinue treatment to minimize fetal exposure

Pharm 2 (29 decks)

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