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Pharmacology-Exam #1 (Summer) > Thyroid/Parathyroid > Flashcards

Thyroid/Parathyroid Flashcards

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1
Q

Define thyroglobulin

A

Protein synthesized in the thyroid gland

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2
Q

Define Thyroxine-binding globulin (TBG)

A

Protein synthesized in the liver

Transports thyroid hormones in the blood

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3
Q

What is another name for TSH?

A

Thyrotropin

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4
Q

Lab findings in primary hypothyroidism

A 
Elevated TSH (>4.5 mIU/L)
Decreased serum free T4
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5
Q

Subclinical hypothyroidism lab values

A 
Elevated TSH (>4.5 mIU/L)
Normal serum free T4
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6
Q

When should Subclinical hypothyroidism be treated?

A

Iron deficiency anemia AND in patients with TSH >10

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7
Q

What is the most sensitive test for primary hypothyroidism and hyperthyroidism?

A

Serum TSH

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8
Q

Drugs that increase TSH

A
  1. Phenytoin
  2. Amiodarone
  3. Dopamine antagonist
  4. Excess estrogen or androgen
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9
Q

Disorders that may alter thyroid hormone lab values

A
  1. Pregnancy
  2. Chronic protein malnutrition
  3. Hepatic failure
  4. Nephrotic syndrome
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10
Q

What is the dose of a white tablet Levothyroxine

(Synthoid)?

A

50 mcg

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11
Q

What is the dosing of Levothyroxine? Half life?

A

Daily dosing

Half life= 7 days

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12
Q

When you change a dose of levothyroxine, when do you recheck a TSH and why?

A

Recheck TSH @ 6 weeks

Reaches steady state after 4-5 half lives

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13
Q

What can impair/reduce Levoythyroxine (T4) absorption?

A
  1. Food (take on empty stomach)
  2. H2 blockers and PPI’s
  3. Mucosal dz’s
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14
Q

Drugs that increase non-deiodinative T4 clearance

A
  1. Rifampin
  2. Carbamazepine
  3. Phenytoin
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15
Q

List the Synthetic T3 drug

A

Liothyronine

Cytomel

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16
Q

What is unique/disadvantage about Synthetic T3?

A

Rapid onset= Burst of energy
Short half life
Some is delivered too much to tissue than what is appropriate

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17
Q

List Synthetic T4:T3 (4:1) ratio drug

A

Liotrix

Throlar

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18
Q

Why does Synthetic T4:T3 LACK therapeutic rationale?

A

T4 is converted to T3 peripherally

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19
Q

What dose in the treatment of hypothyroidism do most patients require once they have reached steady state?

A

1.7 mcg/kg/day

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20
Q

What weight gives you a better estimate of a patient’s dose requirement?

A

Ideal Body Weight (IBW)

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21
Q

What it is the initial dose of Levothyroxine in young pt’s with long-standing dz and pt’s >45 WITHOUT known cardiac dz? When is it increased? Amount?

A

Initial dose= 50 mcg daily

Increased to 100 mcg after ONE month

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22
Q

What is the recommended initial daily dose for older patients OR those with known cardiac disease. When is is titrated up? Amount?

A

25 mcg per day

Titrated upward in increments of 25 mcg at monthly intervals

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23
Q

What percentage of pregnant women does the thyroxine dose requirement increase?Why?

Study These Flashcards
A

75%

Fetus is very reliant on T4 during the 1st trimester

24
Q

What can excessive doses of thyroid hormone lead to?

Study These Flashcards
A
  1. Heart failure
  2. Angina pectoris
  3. MI
25
What levothyroxine tablet is the least allergenic?
0.05 mg (50 mcg)= White tablet | Dye FREE
26
Result of hyperthyroidism in bones?
Hyperremodeling of cortical and trabecular bone= Reduced bone density=Increased risk of fx
27
TSH-Suppressive Levothyroxine Therapy Indications
1. Nodular thyroid dz and diffuse goiter: Suppress TSH to low-normal levels (0.5-1) 2. Hx of thyroid irradiation 3. Thyroid CA: Higher risk pt's (TSH <0.1), Lower-risk pt's (0.1-0.5)
28
What drugs can hypothyroidism effect the distribution?
1. Digoxin-Higher serum values | 2. Warfarin: Decreases sensitivity d/t lower metabolism of Vitamin K
29
What are the cardinal si/sx's in HYPERthyroidism?
1. Weight loss | 2. Increased appetite
30
What si/sx's are specific to Grave's disease (Hypothyroidism)?
1. Exopthalmos | 2. Pretibial Myxedema
31
What is first-line hyperthyroidism treatment in children, adolescents, and in pregnancy?
Antithyroid drugs: - Propothyrouracil (PTU) - Methimazole (MMI)*
32
Propothyrouracil (PTU) and Methimazole (MMI) MOA
Inhibit coupling of monoiodotyrosine and diiodotyrosine to form T4 and T3
33
How many weeks does it take for sx's to diminish and circulating thyroid hormone levels return to normal?
4-8 weeks
34
When should changes in PTU and MMI doses for each drug be made?
Monthly
35
What is the MC ADE of PTU and MMI?
Hepatoxicity
36
Other PTU and MMI. ADE's?
1. Rash 2. Leukopenia (benign) 3. Agranulocytosis 4. Arthralgias and a lupus-like syndrome
37
When is the ONLY time that PTU is considered a first-line drug treatment? Why?
Frist Trimester of pregnancy | MMI teratogenic effects outweighs that of PTU-associated hepatoxicity
38
When should Potassium iodide be administered?
7-14 days preoperatively (general surgery)
39
As an adjunct to radioactive iodine, when should saturated solution potassium iodide (SSKI) be administered? Why?
3-7 days AFTER RAI treatment | Allow that radioactive iodide to concentrate in the thyroid
40
Iodide ADE's
1. Salivary gland swelling | 2. "Iodism": Metallic taste, burning mouth/sore throat,, sore teeth/gums; gynecomastia
41
What can you prescribe for symptom relief in hyperthyroidism?
Propranolol
42
What is the advantage of radioactive iodine? When is this the best treatment option?
Hyperthyroidism cure | Best treatment for toxic nodules and toxic multinodular goiter
43
What are the disadvantage of radioactive iodine?
1. Permanent hypothyroidism almost inevitable | 2. Pregnancy must be deferred for 6–12 months; no breast-feeding
44
When is surgery for hyperthyroidism the best option?
- In pregnancy if major S/E from antithyroid drugs | - Coexisting suspicious nodule present
45
Lab findings in hypoparathyroidism
HYPOcalcemia HYPERphosphatemia HYPERcalciruia
46
What is crucial for PTH secretion and activation of the PTH receptor?
Magnesium
47
hypoparathyroidism treatment
1. Oral calcium carbonate 2. Calcitrol (Vitamin D 1,25) 3. Phosphate binders: If high calcium-phosphate
48
Define primary hyperparathyroidism
Intrinsic parathyroid gland dysfunction resulting in excessive secretions of PTH with a lack of response to feedback inhibition by elevated calcium
49
Define secondary hyperparathyroidism
Excessive secretion of PTH in response to hypocalcemia
50
Causes for secondary hyperparathyroidism?
1. Vitamin D deficiency | 2. Renal failure
51
What PTH level suggest primary hyperparathyroidism?
High PTH (>3.0 pmol/L)
52
What PTH level suggest non-PTH-mediated hypercalcemia?
Low PTH (<3.0 pmol/L)
53
What is the curative treatment for primary hyperparathyroidism?
Surgery
54
Secondary hyperparathyroidism treatment
1. Calcium replacement 2. Vitamin D analogues: paricalcitol and calcitriol 3. Phosphorus-binding agents: sevelamer 4. Calcimimetic: cinacalcet)
55
What are the advantages of Antithyroid drugs?
1. Noninvasive* | 2. Low risk of permanent hypothyroidism
56
What are the disadvantages of Antithyroid drugs?
Low cure rate (Avg=40-50%)

Pharmacology-Exam #1 (Summer) (6 decks)

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