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Pharmacology: Exam 3 > Thyroid, Parathyroid, and Steroids > Flashcards

Thyroid, Parathyroid, and Steroids Flashcards

1
Q

TRH

A

Thyrotropin Releasing Hormone

-stimulates anterior pituitary to secrete TSH

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2
Q

TSH

A

Thyroid Stimulating Hormone

-stimulate thyroid to secrete T3 and T4

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3
Q

T3

A

Tri iodo thyronine

  • Active
  • 10% of secreted thyroid hormone
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4
Q

T4

A
  • Converted to T3 in the liver

- 90% of secreted thyroid hormone

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5
Q

Hypothyroidism

A

Decreased secretion of thyroid hormones

  • Primary causes: Hashimoto’s, removal of thyroid, thyroid gland ablation, drug induced
  • Secondary causes: pituitary issue
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6
Q

Signs and Symptoms of Hypothyroidism

A
  • Bradycardia
  • Feeling cold
  • Decreased appetite
  • Weight gain
  • Constipation
  • Fatigue
  • Dry Skin
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7
Q

Levothyroxine

A

Synthetic T4 that must be converted to active form in periphery

  • Monitor TSH
  • Can cause nausea, vomiting, diarrhea, and insomnia
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8
Q

Levothyroxine DDIs

A
  • Phenytoin, Carbamazepine
  • Warfarin
  • Fiber, Cholestyramine
  • Sucralfate
  • Rifampin
  • Calcium, antacids
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9
Q

Administer Levothyroxine

A

Give 30-60 minutes prior to any meal or other medications

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10
Q

Liothyronine

A

Synthetic T3

-Does not need to be converted but not as reliable or efficacious & short half life

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11
Q

Liothyronine ADRs

A

Severe cardiac effects: tachycardia, arrhythmia, MI, hypotension

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12
Q

Desiccated Thyroid

A

Mix of T3 and T4 from ground up pig thyroid

-monitor TSH frequently because of issues with consistency

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13
Q

Hyperthyroidism

A

Increased thyroid hormone activity
-causes: graves’ disease, Plummer’s disease, Iodine induced, Excessive Pituitary TSH, Excessive ingestion of thyroid hormone, Thyroiditis, Lithium

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14
Q

Signs and symptoms of Hyperthyroidism

A 
Palpitations/Tachycardia
Irritability
Nervousness/tremor
Increased bowel movements
Goiter
Hunger
Heat intolerance
Weight loss
Insomnia
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15
Q

Thioamides MOA

A

STOP synthesis of thyroid hormones via inhibition of thyroid peroxidase (for Hyperthyroidism)

  • drug is iodinated instead of iodide
  • no effect on circulating T3 or T4
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16
Q

Thioamides Drugs

A

Methimazole (Preferred)

Propylthiourazil (frequent 3x dosing and expensive)

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17
Q

Thioamides ADRs

A 
Edema
Alopecia
Possible Agranulocytosis
Liver Damage
Vasculitis with Propylthiouracil
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18
Q

Sodium Iodide (Radioactive I)

A

Used for Hyperthyroidism; mimics iodide and is taken up by thyroid

  • destroys gland cells, shrinks size of thyroid
  • Used in thyroid cancer treatment
  • Watch for hypothyroidism
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19
Q

Potassium Iodide

A

STOP release of thyroid hormones and hormone synthesis

  • use with thioamides
  • used in hyperthyroidism thyroid storm
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20
Q

Parathyroid Hormone (PTH)

A

Released from the parathyroid gland in response to decreased calcium levels
-PTH receptor on osteoclasts that moves calcium from bone into bloodstream

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21
Q

Osteoclasts

A

Bone Resorption

-used in bone removal; releases calcium and phosphorus

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22
Q

Osteoblasts

A
  • Bone Formation

- used in bone building; fill in empty spaces of bone with collagen and calcium/phosphate crystals

23
Q

Cinacalcet MOA

A

Used in hyperparathyroidism; increased sensitivity of calcium sensing receptor; decreases PTH, calcium and phosphorous which prevents progressive bone disease

24
Q

What is Cinacalcet approved for?

A
  • Hypercalcemia (Primary hyperparathyroidism and parathyroid carcinoma)
  • Chronic Kidney Disease (secondary hyperparathyroidism)
  • NO in hypocalcemia
25
Osteoporosis/Osteopenia
Decreased bone strength, quality, and mineral density (increased fracture risk)
26
Osteoporosis/osteopenia risk factors
- Elderly (more resorption than formation after age 30) - post menopausal women (estrogen) - medications - low dietary calcium
27
Calcium and Vitamin D
Vitamin D increases calcium absorption in the intestines and reabsorption in the kidneys
28
Vitamin D supplements
Cholecalciferol (D3): more potent, longer acting Ergocalciferol (D2) Calcitriol- synthetic analog Doxecalciferol- metabolized in liver, can use in kidney dysfunction
29
Bisphosphonates
GOLD STANDARD for osteoporosis treatment - Decreases rate of bone resorption via inhibition of osteoclasts and osteoclast precursors (osteoclast apoptosis) - Long half life: infrequent dosing
30
Bisphosphonate drugs
Alendronate Ibandronate Risendronate Zoledronic Acid
31
Bisphosphonates ADRs
``` Hypocalcemia Hypophosphatemia Myalgia Osteonecrosis of the jaw* Erosive Esophagitis* ```
32
Calcitonin
Used for pain relief associated with osteoporotic vertebral fractures - PTH antagonism, inhibiting bone resorption (activation of calcitonin receptors on osteoclasts inhibits osteoclast activity - IV or intranasal administration
33
Teraparatide and Abaloparatide
For Moderate to Severe Osteoporosis (daily SC injection) | -Recombinant formulation of endogenous PTH: stimulates OSTEOBLAST function for new bone formation
34
Teraparatide and Abaloparatide ADR
BBW: osteosarcoma - Mild hypercalcemia - Orthostatic hypotension
35
Denosumab
``` SC Injection (every 6 mo) -Monoclonal antibody; RANKL inhibitor used to reduce bone resorption via blocking osteoclast activity ```
36
Denosumab ADR
Injection site reaction | possible increased risk of infection
37
Estrogen
Reduces osteoclast activity (does't reverse loss) | -decreased vasomotor symptoms
38
Raloxifene
Selective Estrogen Receptor Modulator (SERM) | -estrogen agonist in the bone to prevent bone loss- decrease bone resorption
39
Raloxifene ADR
Vasomotor symptoms (hot flashes)
40
Cushing Syndrome
Increased ACTH production, leading to high circulating cortisol levels -tumor on pituitary gland or excessive glucocorticoid administration (use surgery or stop medication)
41
Hyperaldosteronism
- adrenal gland produce too much aldosterone | - treat with aldosterone antagonist
42
Addison's disease (primary adrenal insufficiency)
- An autoimmune disorder where not enough corticosteroids produced endogenously - Treated with glucocorticoids and mineralocorticoid replacement
43
Secondary Adrenal Insufficiency
- Pituitary gland cannot produce enough ACTH | - Tumor: surgical removal
44
Cortisol
- Regulates metabolism, cardiovascular function, growth, inflammation, and immunity - Negative feedback system - Activates glucocorticoid receptors - Glucocorticoids mimic the actions of cortisol
45
Glucocorticoids Therapeutic Use
- Inflammation - Immunosuppression - Replacement in adrenal insufficiency
46
Glucocorticoid Receptor Agonists
``` Betamethasone Budesonide Clobetasol Cortisone Dexamethasone Fluticasone Hydrocortisone Methylprednisone Mometasone Prednisolone Prednisone Triamcinolone ```
47
HPA Axis Suppression
- After ~1 week of glucocorticoid use, cortisol production is suppressed via negative feedback - Abrupt cessation can lead to acute adrenal insufficiency for 2-3 days - TAPER so body can readjust HPA axis
48
Glucocorticoids ADE
``` Hyperglycemia Immunosuppression Insomnia Psychological effects Osteoporosis Lipolysis Hormonal changes Hypertension Slowed growth in children Muscle issues Ocular issues ```
49
Avoiding glucocorticoid ADRs
- Use small dose in short duration | - local administration
50
Mineralocorticoids
Predominantly activated by endogenous aldosterone
51
Fludrocortisone
Mineralocorticoid receptor agonist - similar to aldosterone: increased reabsorption of sodium and loss of potassium - ADR: Dose dependent hypertension
52
Aldosterone Antagonists
- Used in primary aldosteronism - Competes with aldosterone receptors in distal tubules, increasing sodium and water excretion while preserving potassium - Used in CHF, resistant hypertension, cystic acne
53
Aldosterone Antagonist drugs
Spironolactone | Eplernone
54
Aldosterone Antagonist ADRs
Hyperkalemia Gynecomastia Impotence

Pharmacology: Exam 3 (5 decks)

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