Quiz 6

Thyroid Hormones are the only compounds containing what?

What is the world's most preventable cause of mental retardation?

To avoid iodine deficiency in the US what is done?

Iodine and what are absorbed concurrently?

What drugs can inhibit the uptake of iodine?

How can calorgenesis and oxygen consumpution be measured? What will this tell us?

Hypothyroidism has a connection to what cardiovascular issue?

Lack of iodine in the body can cause what mood changes?

What is the mechanism of action of iodide in the body?

QSAR studies are underway for TRbeta1 selective ligands in the hope of discovering agents?

Bile acids induce energy expenditure by promoting?

Levels of thryoid hormones are controlled by what type of feedback?

What is TRH?

What is TRH produced by?

TRH travels to where after being produced by the hypothalamus?

A patient thyroid panel includes what?

TRH binds to receptors on the pituitary gland stimulating the release of what?

What are T3 levels capable of blocking?

Thyroid hormones are stored as amino acid residues of a protein called what?

What is resoponsible for the transport of thyroid hormones in the blood?

What type of hormone is metabolically active?

What is the percentage of free T4?

What is the percentage of free T3?

What is more active T3 or T4? How much more?

What are 3 thyroid issues that can occur?

What are goiters?

What are the five types of hypothroidism?

What is the treatment in all cases of hypothyroidism?

What is hyperthyroidism?

Exophthalmic goiter leads to?

What are some symptoms of hyperthyroidism?

What are some symptoms of Grave's disease?

Graves disease can be treated with what?

T4 is converted to what? How much of it is? By what enzyme?

The conversion of T4 is down regulated in what?

In what is T4 excreted?

How much enterohepatic recirculation is there in phenolic hydroxyl?

What is the major metabolic route in thyroid hormones?

What role does the liver play in metabolism of thyroid hormones?

Thyroid hormones increase what?

What drugs interfer with the deioniation reaction to T3?

What drugs interfer with T4 binding to plasma transport proteins?

In diabetic patients receiving thyroid replacement therapy you have to mointor what else?

Thyroid drug
Tablet and injection forms

Levothyroxine sodium

Liothyronine Sodium

Soft gel capsule that avoids heating during manufacturing to improve stability and reliable dosing 12.5 to 150 mg?

Liotrix-1-Thyrolar is a 4:1 ration of t4:t3 that is made of?

4:3 ratio of T4:T3
Made of Desiccated pig thyroid
Tablets

What time of day does Levothyroxine produce benefits?

What do iodine thyroid products do?

Iodine drug products?

5% iodine and 10% potassium iodine
OTC product
Oral solution of KI
approved by the FDA for radiological terrorist attack use

Indicated for adjunctive therapy in hyperthyroid patients taking an anti-thyroid drug, thryoid block in the case of radiation emergency

What are the two options for clincal treatment of hyperthyroidism?

Disadvantages of clinical approaches in hyperthyroid therapy?

Anti-thyroid drugs
directly prevent the overproduction of excess thyroid hormone or preventing release
Black box warning for severe liver injury for those who cannot tolerate other treatments
Indicated: Hyperthyroidism, preparation for thyroidectomy or radioiodine therapy or patients in which surgery is contraindicated
MOA: Inhibits iodine uptake and hormone biosynthetic iodination and T4 deionization enzyme 5'-deiodinase I, prevents coupling of two dilodetyrosines during synthesis May develop Agranulocytosis as a severe side effect (sore throat and fever)
Leading drug induced cause of liver transplation
Watch for unusal bleeding moitor prothrombin
Neuritis, depression, jaundice, N/V
Long term therapy may lead to disease remission

Anti-thyroid drugs
Directly prevent the overproduction of excess thyroid hormones or preventing release
Indications: Hyperthryroidism, preperation for thyroidectomy or radioiodine therapy or patients in which surgery is contraindicated
MOA: Inhibits iodide uptake and hormone biosynthectic iodination and T4 delodination enzyme 5'-deiodinase I
causes less hepatoxicity

Preferred for thyroid storm
Blocks T4 to T3 conversion peripherally
Prefered in pregnancy because doesn't cross placenta but not always true

Iodine product that has radioactivity
Indications: hyperthyroidism and cases of selected thyroid cancer
Beta and gamma emitter with a half-life of 8 days
Rapidly absorbed and concentrated in the thyroid, rapid excretion via the kidney
Contraindicated in pregnancy, preexisting N/V and diarrhea
May take up to 2 months for effects to become apparent due to signifcant reservoir in carrier proteins
Avoid any iodine containing product since it will decrease effectiveness of this agent

Gout Nodulosis presents with elevation levels of what?

Gout Nodulosis lacks what characteristic of other forms of gout?

Gout often precents where?

Gout should never be treated with what?

Deforming gout should be treated with what?

Acute attack of gout are?

Uric acid has how many ionized hydroxyl groups?

Uric acid is the end produc of the metabolism of?

Uric acid is higher is which sex?

Uricosuric agents are ANIONIC and weak acids
Indications: prolongation of beta-lactam plasma concentration, gout, gouty arthritis, hyperuricemia
MOA: Uriscouric activity prevents renal proximal tubular reabsorption of uric acid; penicillins and cephalosporins-prevents tubular excretion
Can prolong the effect of Tamifulu
Do not take asprin of salicylates because they will antagonize the effects of this drug, drink lots of water
Extensive hepatic metabolism followed by renal excretion
SHOULD NOT BE USED DURING GOUT ATTACK!
Use with cholchicine

Uricosuric agents are what?

Uricosuric agent
Indication: Gout, gouty arthritis, anti-platelet agent
MOA: prevents renal tubular reabsorption of uric acid, also a COX inhibitor, inhibits prostaglandins, decreased inflammatory effect
Drug interactions with salicylates, inhibits CYP3A4, warfarin, hypoglycemic agents, sulfonylureas
Not for uses during gouty attack
inhitis platelet aggregation, watch blood counts

Agents to treat gout
Natural produc isolated from flowering plant seeds and corm, from a member of the lily family
First used by the Arabs
Always use together with a uricosuric agent
ndications: Unique anti-inflammatory agent that is largely effective only in gout, can be used to relieve pain of an acute attack or prophylactically; also unlabled use for MS, cirrhosis and post heart surgery
MOA: decreases granulocyte phagocytosis and prevents leukocyte migration and lactage production, decreases inflammatory response to deposited crystals, an antimitotic agent, prevents spindle formation. Does not decrease plasma uric acid levels
Perform periodic blood counts to look for leukopenia, not an analgesic nor uricosuric agent
Discontinue use at first sign of N/V, diarrhea or stomach pain, causes malabsorption of vitamin B12

What are the absorption issues releated with Cholchicine?

Allopurionol is converted to what? By what?

Indications: Management of gout, malignancies, calcium oxalate calculi
MOA: Inhibits xanthine oxidase which is responsible for the synthesis of urate from xanthine and hypoxanthine
Has long half-life
Inhibits liver microsomal enzymes
Therapy started at low doese and titrated up
Drink a lot of water

Newest agent for gout in the last 40 years
For management of gout
MOA: selective inhibitor of xanthine oxidase which is responsible for the synthesis of urate from xanthine and hypoxanthine

Drug to be used with patients with gout who have kidney issues?

Gout agent that is injectable
recombinate DNA technology, biotechnology drug
For chronic gout in adult patinets refractory to conventional therapies
Not for asymptomatic hyperuricemia
Premedicate with corticosteroids and antihistamines, watch for infusion reactions and anaphylaxis
Admister with a pump over 120 minutes or more, no bolus
Contraindicated in glucose-6-phosphate dehydrogenase deficiency
gouty flare occur manage with colchincine and NSAIDS

What is the biggest improvement in respiratory drug therapy the last 10 years?

Indications: relief of reversible bronchospasm associated with acute and chronic bronchial asthma, exercise induced bronchspasm emphsema, and other COPD
Long term Beta2 agonist (Salmeterol) are used in conjunction with anti-inflmamatory agents for long-term control especially nocturnal symptoms
Short term beta2 agonist (Albuterol, bitolerol, pirbuterol, terbutaline) are the agents of choice for acute attacks and EIB--More than twice weekly also use an inhaled corticosteroid

MOA: relative sleactiviy of a particular agent for alpha, beta 1 and beta 2 adrenergic effects determines its usefulness clinicall and predicst and agents side effect that will be observed

Sympathetic Bronchodilator
Tablets, extended release, syrup aerosol, solution, capsules for inhalation
Racemic mixture
B1 activity<B2 acitivy PO onset 30 min duration 4-8 hours inhlation onset 5 minutes with duration of 3-6 hours used in ER

One enatiomer
sympathomimetric bronchodilator
solution for inhlation
Can be used in pediatrics
Has less B1 activity than B1 activity

Sympathomimetric Bronchodilator
Short acting agent
B1 activity <B2 activity tablets, aerosol, injections

Sympathomimetic Bronchodilator
B1<B2
onset 5 minutes duration 5 hours
Tied with bitolterol for the 5th most potent B2 agent

Prodrug
Sympathomimetic Bronchodilators
B1<B2
onset 2-4 minutes duration 5-8 Hours
Erosol and solutions for inhalation

Sympathomimetic Bronchodilators
Short acting agent B1<B2 onset 30 minutes duration 4 hours
tablets, syrup, solution for inhaltion, aerosol

Sympathomimetic Bronchodilator
Short acting agent B1=B2 activity, IV onset immediate with duration of 1 hour, inhalation onset 2-5 minutes with duration of 1-3 hours
2nd most potent B2 agonist abailable
inhlation, aerosol, injection

Sympathomimetic Bronchodilators
Short acting agent B1=B2=alpha
onset 1-5 minutes duration 1-3 hours subq slower
inhalation
aerosol
injection

Capsule
Injection
Sympathomimetic Bronchodilators
alpha-B1-B2
PO onset 15-60 minutes
capsules and injections
Natural product

Sympathomimetic Bronchodilator
Powder
combo with a corticosteroid fluticason
B1<B2, onset 20 minutes
BID

Long acting agents
Sympathomimetic bronchodilator
200x higher affinity for B2 receptors over B1 (S,S), 1000x less potent as B2 agonist than (R, R)
Also an inhbitior of mast cell mediators such as histamine and leukotrienes