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Pharmacology - Exam 3 > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

What can occur if there is suboptimal thyroid functioning during growth & development?

A
  • mental retardation

- dwarfism

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2
Q

How is most T3/T4 circulated?

A
  • highly protein bound
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3
Q

When is T3/T4 physiologically active?

A
  • only when it is free
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4
Q

What drugs decrease TSH secretion?

A
  • DA
  • glucocorticoids
  • octreotide
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5
Q

What drugs decrease T3/T4 secretion?

A
  • Li
  • I
  • radiocontrast dyes
  • amiodarone (can also increase T3/T4)
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6
Q

What are the hyperthyroid disorders?

A
  • Graves
  • multi-nodulare toxic goiter
  • thyrotoxicosis
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7
Q

What are the types of hypothyroid disorders?

A
  • primary

- secondary

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8
Q

What are the types of primary hypothyroid disorders?

A
  • Hashimoto’s

- iatrogenic

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9
Q

What are the types of secondary hypothyroid disorders?

A
  • pituitary dz

- hypothalmamic dz

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10
Q

What is the hallmark sign of hyperthyroidism?

A
  • wt loss w/ increased appetite

- exopthalmos/proptosis

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11
Q

What are the levels of TSH and T3/T4 in hyperthyroidism?

A
  • decreased TSH

- increased T3/T4

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12
Q

What are the tx options for hyperthyroidism?

A
  • anti-thyroid drugs (ATD)
  • radioactive iodine (RAI)
  • lithium
  • potassium iodide
  • surgery
  • symptomatic tx (i.e. beta blockers)
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13
Q

What is the preferred ATD class for hyperthyroidism?

A
  • thioamides
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14
Q

What are the drugs of the thioamides?

A
  • methimazole

- PTU

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15
Q

Define euthyroid

A
  • normal thyroid levels

- asymptomatic

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16
Q

What is the MOA of thioamides?

A
  • inhibit T3/T4 synthesis
  • depletes stored hormone
  • PTU only: inhibits peripheral conversion of T4 to T3 w/in hrs of dose
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17
Q

Why don’t pregnant women take methimazole?

A
  • crosses placenta

- increases TSH and decreases T4 in fetus

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18
Q

What and when is the medication changed for preggers?

A
  • PTU in 1st trimester –> switched to methimazole in 2nd
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19
Q

Discuss PTU v. methimazole for breastfeeding

A
  • PTU OK but methimazole preferred
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20
Q

What are common ADEs for thioamides?

A
  • GI upset
  • arthralgia
  • rash, urticaria, pruritis (more in methimazole than PTU)
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21
Q

What are the serious ADEs of thioamides?

A
  • agranylocytosis

- hepatotoxicity

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22
Q

What is the monitoring schedule of free T4 for thioamides?

A
  • 4w s/p initiating tx
  • q 4-8w until euthyroid then q 2-3m
  • once in remission, q 6-12m x 12-18m
23
Q

What is the monitoring schedule of WBC for thioamides?

A
  • onset of febrile illness of pharyngitis
24
Q

What is the monitoring schedule of LFTs for thioamides?

A
  • pts on pTU w/ S&S of hepatotoxicity
25
Q

What is the MOA of iodides?

A
  • inhibits prestored T3/T4 release
  • decrease T3/T4 synthesis
  • decrease thyroid gland vascularity
26
Q

When are iodides used?

A
  • thyrotoxicosis
27
Q

What are the iodide products?

A
  • potassium iodide (KI)

i. e. saturated sol (SSKI) & lugols

28
Q

What are the ADEs of iodides?

A
  • rash
  • GI upset
  • paresthesia
  • immune hypersensitivity reaction
  • salivary gland swelling
  • iodism (iodine overdose)
29
Q

When is lithium indicated?

A
  • psych patients
  • as an adjunct to thioamides
  • not recommended in the guidelines
30
Q

What is the MOA of Li?

A
  • blocks T3/T4 relase
31
Q

What is the dose of Li?

A
  • 300mg q8h
32
Q

What are the ADEs of Li?

A
  • tremor
  • polyuria
  • renal failure
  • seizure
  • arrhythmia
  • bradycardia
  • suicide
  • toxicity
33
Q

When are beta blockers used in thyroid dzs?

A
  • symptomatic tx of palpations, tachycardia, tremor, heat intolerance
34
Q

What is the MOA of beta blockers?

A
  • blocks b-adrenergic receptors to mitigate adrenergic symptoms
35
Q

What are the ADEs of beta blockers?

A
  • fluid retention
  • bradycardia/heart block
  • hypotension
  • fatigue
36
Q

What is an example of RAI?

A
  • I131 (sodium iodide 131)
37
Q

What is the MOA of RAI?

A
  • taken up by thyroid via TSH receptor
  • incorporated into stored hormone
  • emits beta particles which irreversibly damage thyrocytes ==> hypothyroidism
38
Q

What are the ADEs of RAI?

A
  • dysphagia

- thyroid tenderness

39
Q

Discuss T3/T4 monitoring on RAIs

A
  • 2-4w s/p tx
40
Q

When does hypothyroidism present on RAIs?

A
  • 4-8w s/p tx
41
Q

What will labs look like for subclinical hyperthyroidism?

A
  • low TSH

- T3/T4 WNL

42
Q

What is the tx for amiodarone induced thyroiditis Type I? Type II?

A
  • type I: thiamides

- type II: glucocorticoids

43
Q

What will labs look like for subclinical hypothyroidism?

A
  • elevated TSH

- T3/T4 WNL

44
Q

What will labs look like for hypothyroidism?

A
  • increased TSH

- decreased T3/T4

45
Q

What is the 1st line tx for hypothyroidism?

A
  • synthetic levothyroxine
46
Q

What is the MOA of L-thyroxine?

A
  • increases T3/T4 levels
47
Q

What is the dosing of L-thyroxine?

A
  • initial = 1.6 mcg/kg/d

- adjustments = 12.5-25mcg/d

48
Q

How is levothyroxine serum levels decreased?

A
  • drugs that decrease absorption
  • drugs that increase elimination
  • age
  • extreme obesity
  • GI disorders
49
Q

When are patients monitored who are on levothyroxine?

A
  • 4-6w s/p intial tx

- once normalized, q 6-12m

50
Q

What are the ADEs of synthetic thyroids?

A
  • allergic reactions
  • arrhythmia
  • acute MI
  • infertility
  • wt loss
  • heat intolerance
  • increased fx risk
51
Q

What are the synthetic thyroid hormones?

A
  • levothyroxine
  • liothyronine
  • liotrix
52
Q

What are the natural thyroid hormones?

A
  • thyroid USP

- thyroglobulin USP

53
Q

When are pregnant women being txed for hypothyroidism tested?

A
  • q 4w during 1st half of pregnancy
54
Q

What is a major concern of drug-drug interactions for pts on thyroid replacement therapy?

A
  • warfarin

Pharmacology - Exam 3 (4 decks)

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