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Endo week 1- thyroid/pituitary
Pharm
64
Medical
Graduate
11/03/2018

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Cards

Term
Which thyroid replacement medication has the highest risk of cardiotoxicity?
Definition
Liothyronine (T3)
Term
What drug classes are used to tx hyperthyroidism?
Definition
Thioamides
Iodides
Radioactive iodine
Term
What are examples of thioamides and which is the DOC?
Definition
*Methimazole
Propylthiouracil
Term
MOA of thioamides?
Definition
Inhibit thyroid peroxidase enzyme
Term
Black box warning of propylthiouracil?
Definition
Hepatitis
Term
Why is propylthiouracil preferred in the 1st trimester of pregnancy?
Definition
Mostly protein-bound- has difficulty crossing the placenta
Term
What is the pregnancy category of the thioamides?
Definition
D
Term
MOA of iodides?
Definition
Inhibit organification & hormone release by inhibition of thyroglobulin proteolysis
Term
MOA of radioactive iodine?
Definition
Destruction of thyroid parenchyma
Term
How does propranolol help treat thyrotoxicosis?
Definition
Can prevent peripheral conversion from T4-T3
Term
MC cause of hypothyroidism?
Definition
Hashimoto's thyroiditis
Term
What is myxedema coma?
Definition
Disease state of end stage untreated hypothyroidism- stupor, weakness, hypothermia, possibly death
Term
Pathophys of Graves' disease?
Definition
Immunologic disorder in which our T cells stimulate our B cells to synthesize antibodies against our thyroid antigens
Term
What drug may used to manage thyrotoxicosis in pts in whom B-blockers are contraindicated (e.g. asthma)?
Definition
Diltiazem
Term
Tx for "thyroid storm"?
Definition
B-blockers for cardiovascular symptoms
Propylthiouracil to inhibit hormone synthesis
Term
What is somatropin?
Definition
Recombinant GH
Acts thru GH receptors to increase IGF-1
Term
What is mecasermin?
Definition
Synthetic IGF-1
Term
What drugs are in the class of GH agonists?
Definition
Somatropin- recombinant GH
Mecasermin- synthetic IGF-1
Term
What is octreotide?
Definition
Synthetic somatostatin analog
Term
What is pegvisomant?
Definition
GH receptor antagonist
Term
Symptoms of ovarian hyperstimulation syndrome?
Definition
ovarian enlargement, ascites, hypovolemia, and possibly shock
Term
What is the indication for HCG?
Definition
Activate Luteinizing Hormone receptors
Term
How is HCG manufactured?
Definition
Recombinant or urine-derived
Term
What medications are recombinant FSH analogs?
Definition
Follitropins (alpha, beta, or urine derived)
Term
What are menotropins?
Definition
Urine-derived FSH and LH (from postmenopausal women)
Term
Leuprolide MOA?
Definition
Downregulates GnRH receptors, inhibiting gonadotropin release
Term
What drugs are used to suppress endogenous gonadotropin release in women undergoing ovarian stimulation?
Definition
Leuprolide and Ganirelix- downregulate GnRH receptors
Term
What drug class can help suppress hyperprolactinemia?
Definition
Dopamine D2 agonists- bromocriptine
Term
What drugs are ADH receptor antagonists?
Definition
The -vaptans
Term
Which ADH receptor antagonist is selective for V2 receptors?
Definition
Tolvaptan
Term
Normal recommended adult daily intake of iodide?
Definition
150mcg
Term
Recommended intake of iodide during pregnancy/lactation?
Definition
200mcg
Term
How much iodide does the thyroid take up daily for hormone synthesis?
Definition
75mcg
Term
What transporter takes iodide up into the thyroid gland and what chemicals inhibit this transporter?
Definition
Na-I cotransporter
Thiocyanate, perchlorate
Term
What is the function of the peroxidase enzyme?
Definition
Oxidizes iodide into active iodine
Term
What can inhibit the oxidation of iodide into active iodine?
Definition
Iodides, thioamides
Term
What function does proteolysis serve in the thyroid?
Definition
Cleaves T3, T4, MIT and DIT from thyroglobulin
Term
What protein reversibly binds to T3 and T4 in the blood?
Definition
TBG- thyroxine binding globulin
Term
How much of T4 is in its free form?
Definition
~0.04%
Term
How much of T3 is in its free form?
Definition
~0.4%
Term
What meds can inhibit peripheral conversion of T4 to T3?
Definition
radiocontrast media, beta blockers, corticosteroids, and amiodarone
Term
What effect does pregnancy, estrogen, and OCPs have on thyroid levels?
Definition
Increase TBG sites --> increased total and bound thyroid hormones, but free levels remain unchanged
Term
What effect do rifampin, carbamazepine, and phenobarbital have on thyroid metabolism?
Definition
Increase it --> may require dose increase
Term
Which has greater cardiotoxicity risk: synthroid or liothyronine?
Definition
Liothyronine (T3)
Term
What antithyroid med has a black box warning for severe hepatitis?
Definition
Propylthiouracil
Term
Why is propylthiouracil preferred in the first trimester of pregnancy?
Definition
More protein bound --> less crosses the placenta
Term
How long do we treat w/ propylthiouracil before remission of hyperthyroidism?
Definition
4 months
Term
Tx of choice for myxedema coma?
Definition
Loading dose of IV levothyroxine: 300–400 mcg initially, followed by 50–100 mcg daily
Term
Diplopia and pretibial dermopathy should make you think of what disorder?
Definition
Graves disease
Term
Cardiovascular management of thyroid storm?
Definition
Propranolol/esmolol
If B-blockers contraindicated, diltiazem
Term
What is the drug of choice for hyperthyroidism?
Definition
Methimazole
Term
What recombinant hormone is associated w/ slipped capital femoral epiphysis (SCFE) in children?
Definition
Somatropin
Term
Adverse fx of mecasermin?
Definition
Hypoglycemia, Intracranial hypertension, Increased liver enzymes
Term
Adverse fx of somatropin in children?
Definition
• Pseudotumor cerebri
• Slipped capital femoral
epiphysis
• Progression of scoliosis
• Edema
• Hyperglycemia
Term
Adverse fx of somatropin in adults?
Definition
Peripheral edema
• Myalgia
• Arthralgia
Term
Adverse fx of octreotide?
Definition
gastrointestinal disturbances, gallstones, bradycardia, and cardiac conduction abnormalities.
Term
Adverse fx of pegvisomant?
Definition
Increased liver enzymes
Term
What is ovarian hyperstimulation syndrome?
Definition
Includes ovarian enlargement, ascites, hypovolemia, and possibly shock
Term
Steps of ovulation induction?
Definition
1) inhibit endogenous gonadotropin secretion by administering GnRH agonist/antagonist
2) Stimulate follicle development via FSH analog
3) Stimulate oocyte maturation via LH analog
Term
HCG adverse fx?
Definition
ovarian hyperstimulation syndrome, multiple pregnancies in women, gynecomastia in men, headache, depression, and edema.
Term
Which is more likely to cause ovarian hyperstimulation syndrome: leuprolide or ganirelix?
Definition
Leuprolide
Term
Which has more specific V2 action: vasopressin or desmopressin?
Definition
Desmo
Term
Adverse fx of vasopressin?
Definition
Increased intestinal activity
• Nausea
• Cramps
• Ischemia
Term
Which ADH antagonist is hepatotoxic: conivaptan or tolvaptan?
Definition
Tolvaptan
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