Thyroid Deck 2

Question 1

Methimazole 10 to 50

Answer 1

10-50 times more active than propylthiouracil

Question 2

Methimazole completely

Answer 2

Completely absorbed, but at variable rate

Question 3

Methimazole slower

Answer 3

Slower excretion: 60-75% in urine in 48h

Question 4

Methimazole half life

Answer 4

Half-life 6 hours

Question 5

Methimazole onset of effects

Answer 5

Onset of effects in 1 week, peak 4-10 weeks

Question 6

Methimazole crosses

Answer 6

Crosses placental barrier, caution in pregnancy

Question 7

Methimazole is not

Answer 7

protein-bound

Question 8

Propylthiouracil (PTU) rapidily

Answer 8

Rapidly absorbed, reaches peak after 1 hour

Question 9

Propylthiouracil (PTU) incomplete

Answer 9

Incomplete absorption

Question 10

Propylthiouracil (PTU) eliminated

Answer 10

Eliminated by kidney within 24 hours

Question 11

Propylthiouracil (PTU) onset

Answer 11

Onset of effects in 10-21d, peak in 6-10 weeks

Question 12

Propylthiouracil (PTU) crosses

Answer 12

Crosses placental barrier, but more highly protein-bound so crosses
less readily

Question 13

Propylthiouracil (PTU) not secreted

Answer 13

Not secreted in breast milk in sufficient quantities to preclude breast
feeding

Question 14

Adverse Effects of Thiourelynes or Thioamides

Answer 14

• Maculopapular pruritic rash
• Alopecia
• Drowsiness, headaches
• Fever, arthralgias
• Nausea and vomiting
• Nasal stuffiness
• Transient leukopenia
• Agranulocytosis (infrequent, but potentially fatal)
• Renal/hepatic failure

Question 15

Monitoring Thiourelynes or Thioamides

Answer 15

• Thyroid studies, complete blood count (CBC), liver/renal
panels before starting drug
• Recheck in 1 to 2 months after starting drug.

Question 16

Interactions Thiourelynes or Thioamides

Answer 16

• Don’t use with decongestants; vasopressor action not
well tolerated
• Lithium
• Warfarin
• Antidiarrheals: Kaolin action interferes with absorption

Question 17

Corticosteroids two types

Answer 17

Glucocorticoids and Mineralcorticoid

Question 18

Glucocorticoids role in

Answer 18

Adrenal cortex origin

Question 19

Glucocorticoids originate in

Answer 19

Adrenal cortex origin

Question 20

Glucocorticoids structure

Answer 20

Steroidal structure

Question 21

Glucocorticoids part of the body

Answer 21

Part of body’s FB loop to reduce
inflammation
• Anti-inflammatory
• Immunosuppressive
• Antiproliferative

Question 22

Glucocorticoids unique

Answer 22

receptors different from sex

steroids and mineralcorticoids

Question 23

Mineralcorticoid class of

Answer 23

Class of steroid hormones that cause

Na and H20 retention

Question 24

Mineralcorticoid primary example

Answer 24

Aldosterone comes from adrenal
cortex
• Essential to maintenance of
adequate fluid volume (CO/BP)

Question 25

Long acting glucocorticoid

Answer 25

Dexamethasone

Question 26

Glucocorticoid use in allergy and pulmonary

Answer 26

Asthma, allergic rhinitis, uricaria,anaphylaxis, food/drug | allergy

Question 27

Glucocorticoid use in skin

Answer 27

Acute severe dermatitis

Question 28

Glucocorticoid use in endocrinology

Answer 28

Adrenal disorders

Question 29

Glucocorticoid use in GI

Answer 29

IBD: Crohn’s Disease; ulcerative colitis

Question 30

Glucocorticoid use in hematology

Answer 30

Leukemia, lymphoma

Question 31

Glucocorticoid use in ophthalmology

Answer 31

Uveitis

Question 32

Glucocorticoid use in rheumatology

Answer 32

RA, SLE, vasculitis

Question 33

Glucocorticoid other use

Answer 33

MS, organ transplant, nephrotic syndrome, cerebral | edema

Question 34

crushing's syndrome S/S

Answer 34

``` C – Cataracts U – Ulcers S – Striae, Skin thinning H – Hypertension, Hirsutism I – Immunosuppression, Infections N – Necrosis of femoral heads G – Glucose elevation O – Osteoporosis, Obesity I – Impaired wound healing D – Depression/mood changes ```

Question 35

Addison's disease is an

Answer 35

Impaired adrenocortical hormone synthesis • Primary: adrenal steroidogenesis impairment • Secondary: pituitary adrenocorticotropic hormone deficit • Tertiary: hypothalamic corticotropin-releasing hormone deficit

Question 36

Symptoms of Addisons Disease

Answer 36

Low BP, HypoNa, HyperK+, Hypoglycemia, fatigue, anorexia, weight loss, hyperpigmentation

Question 37

Initial testing for adisons diseas

Answer 37

AM cortisol, Low DHEA-S for age and sex, ACTH test, BUN, CBC, Electrolytes plasma aldosterone (renin)

Question 38

Treatment for Addisons disease

Answer 38

Treatment –Glucocorticoid replacement; Individualize! • Challenges • Inability to replicate circadian cortisol rhythm • Uncertainties in dose adjustment and treatment monitoring • Side effects of inadequate replacement; reduced QOL

Question 39

Tapering Corticosteroids there is no

Answer 39

standard taper

Question 40

Tapering Corticosteroids required if

Answer 40

Required if more than 2 weeks continuous | glucocorticosteroids

Question 41

Tapering Corticosteroids longer taper for

Answer 41

Longer taper for higher doses and longer-acting systemic glucocorticoids • Weeks to months to allow recovery of H-P-A axis