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GK P2E3 > Thyroid/Parathyroid 2 > Flashcards

Thyroid/Parathyroid 2 Flashcards

1
Q

increases in doses made on monthly basis

greater hepaotoxicity than MMI

which drug?

A

propothyrouracil (PTU)

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2
Q

possible teratogenic effects

more potent than PTU

changes in dose made on monthly basis

which drug?

A

Methimazole (MMI)

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3
Q

PK of PTU and MMI

A

peak serum concentration is 1 hr after digestion (well absorbed in GI tract)

minimal urinary excretion (less for MMI)

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4
Q

how long does it take sxs of PTU and MMI to diminish & thyroid hormone levels to return to normal?

A

4-8 wks

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5
Q

ADEs of what?

pruiritic maculopapular rash

benign transient leukopenia

agranulocytosis

hepatotoxicity

arthralgias & lupus-like syndrome

A

PTU & MMI

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6
Q

What drug do you give to pregnant pts w/hyperthyroidism and why?

A

PTU in 1st trimester: use lowest dose to maintain maternal T4 levels in high-normal range

teratogenic effects of MMI outweigh hepatotoxic effects of PTU

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7
Q

dosage unikely to produce fetal goiter

A

PTU <200mg

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8
Q

best tx for toxic nodules and toxic multinodular goiter

A

radioactive iodine (RAI)

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9
Q

RAI pros

A

cure hyperthyroidism

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10
Q

RAI cons

A
  1. permanent hypothyporidism (inevitable)
  2. defer pregnancy 6-12 months: no breast feeding
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11
Q

What would you use as an adjunct to RAI?

A

Potassium iodide (SSKI) should be added 3-7 days after RAI tx so radioactive thyroid can concentrate in the thyroid

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12
Q

When should Potassium iodide (SSKI) be administered in regards to surgery?

A

give 7-14 days before surgery

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13
Q

what medication is given for sx relief?

A

adrenergic blockers: propanolol

alt: clonidine, diltiazem

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14
Q

how does propanolol help hyperthyroidism?

A

decreases palpitations, anxiety, tremor, and heat intolerance

Used as adjunct to antithyroid

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15
Q

primary tx for thyrotoxicosis a/w thyroiditis

A

propanolol

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16
Q

CI of propanolol

A

dont use in pts with decompensated HF

sinus bradycardia

pts on MAOI or TCAs

spontaneous hypoglycemia

17
Q

ADEs of Propanolol

A

N/V

anxiety

insomnia

18
Q

Iodide MOA

A

graves: blocks thyroid hoemone release

inhibits biosynthesis: interferes w/intrathyroidal iodide utilization

decreased size/vascularity of gland

19
Q

how long does it take for sx improvement when using iodides?

A

2-7 days

20
Q

Concerning Iodides:

T/F: Even though there is a decrease in T4/T3 release, hormone synthesis continues at an accelerated rate, resulting in a gland rich in stored hormones.

A

True

21
Q

T/F: normal and hyperfunctioning thyroid escapes inhibitory effect in 1-2 weeks.

A

True

22
Q

ADEs of Iodides

A

salivary gland swelling

“iodism” –>burning mouth/throat, sore teeth & gums

gynecomastia

23
Q

what is thyroid storm

A

thyrotoxicosis so severe it causes decompensation

24
Q

what meds do you use for thyroid storm

A
  1. PTU or MMI
  2. sodium iodide
  3. lugols solution
  4. propanolol
  5. corticosteroids: dexamethasone, prednisone, methylprednisone or hydrocortisone
25
Q

sx of hypoparathyroidism

A

usually asx

acute: tetany

chronic: lethargy, anxiety/depression, cataracts, coarse skin

systems affected: endocrine/metabolic, MSK, CNS, opthomalogic, renal

26
Q

what does disrupted PTH action result in

A

hypocalcemia

hyperphosphatemia

hypercalciuria

27
Q

what is crucial for PTH secretion and activation of PTH receptor

A

magnesium

28
Q

Tx for hypoparathyroidism

A

maintain serum Ca 8-8.5

oral Ca carbonate (ca salts) 1-3g a day

calcitriol

maintain serum Mg

Phosphate binders

thiazide diuretics + low salt diet

29
Q

what should you use instead for geriatric pts w/ hypoparathyroidism on a PPI or those who have constipation on oral calcium carbonate (calcium salts)?

A

calcium citrate

30
Q

what does the use of thiazide + low-salt diet prevent?

A

hypercalciuria

nephrocalcinosis

nephrolithiasis

31
Q

monitoring goals for hypoparathyroidism

A

Ca 8-8.5 (if Ca< 8, tx if asx)

24 hr urine Ca <300mg

Ca-phosphate <55mg

Measure Ca, Phosphate, Mg, Cr weekly-monlthy during initial management

32
Q

Lab results for primary HPT

A

PTH > 3 (high)

33
Q

lab results for non-PTH-mediatedhypercalcemia

A

PTH < 3.0 (low)

34
Q

Tx of Primary HPT

A

operative management is curative

35
Q

tx of pts with primary HPT awaiting surgery

A

bisphosphonates (alendronate) **avoid in kidney dz**

SERM (raloxifene)

36
Q

secondary HPT tx

A

replace Ca

vit D analogs (paricalcitol & calcitriol)

phosphorous binding agents (sevelamer)

calcimimetic (cinacalcet)

37
Q
A

GK P2E3 (7 decks)

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