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51 Cards in this Set

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Propylthiouracil
MOA:
uses:
toxicity:
MOA:
1) inh organification and coupling of thyroid hormone synthesis.
2) dec peripheral conversion of T4 to T3

uses: hyperthyroidism

toxicity: skin rash, agranulocytosis, aplastic anemia, autoimmune hemolytic anemia, oral ulcers
Methimazole
MOA:
uses:
toxicity:
CI:
MOA:
1) inh organification and coupling of thyroid hormone synthesis.

uses: hyperthyroidism

CI: pregnancy
toxicity: skin rash, agranulocytosis, aplastic anemia, scalp defects (abnl hair loss), cholestatic jaundice
GH can be used to treat...
1) GH deficiency
2) Turner's syndrome
Somatostatin (octreotide) can be used to treat...
1) Acromegaly (inh GH)
2) carcinoid (suppresses release of seritonin)
3) gastrinoma
4) glucagonoma
5) VIPoma (suppresses release of peptides)
6) esophageal varicies
Oxytocin can be used for...
1) stimulate labor
2) uterine contractions
3) milk let-down
4) CONTROLS UTERINE HEMORRHAGE
ADH/ DDAVP/ desmopressin can be used to treat...
central DI, vWdz, urinary incontinence
How do we treat nephrogenic DI?
1st line: HCTZ, Amiloride (might be better bc its K-sparing, pt wont get low K)
2nd line: Indomethecin, NSAIDS
What drugs have nephrogenic DI as a side effect?
Demicocycline, Li
What class of drugs is Demicocycline?
What does Demicocylcine treat?
Demicocycline side effects...
Tetracyclines
SIADH
S/E: Nephrogenic DI, photosensitivity, abnormalities of bone and teeth
Treatment for Conns syndrome
spirinolactone, adrenalectomy
Treatment for Addisson's dz
Hydrocortisone
Finasteride
MOA:
uses:
MOA: 5 alpha reductase inh

uses: BPH, male pattern baldness
Treatment for prostate cancer...
DOC: leuprilide (GnRH analogue the eventually desensitizes the receptor for GnRH on LH/FSH)
#2: flutamide (blocks DHT receptor)

***often used conjunctively, briefly... then flutamide is d/c'd
so both raloxifene and tamoxifene are agonist at bone and antagonists at breast. so whats the difference bw these 2?
tamoxifene is agonist at uterus. (inc risk for uterine cancer)

raloxifene is antagonist at uterus (dec risk for uterine cancer)
Treatment of SIADH
1) fluid restrict
2) Democycline or Li

*** if Na < 120, give 3% NS
Treatment of Conn's syndrome
1) ACE- I to raise K
(ACE-I blocks formation of aldosterone, which decreases K wasting)

2) Spirinolactone (blocks aldosterone rec)

3) Adrenalectomy
Addisson's
1) test
2) treatment
1) Corsyntropin (inject cortisol)
2) Hydrocortisone
Adissonian crisis treatment
Hydrocortisone
Pheo
1) test
2) treatment
3) Pre-op
4) Operative
5) CI
1) Phentolamine (short acting alpha nonspecific blocker)
2) Phenoxybenzamine (irriversible alpha nonspecific blocker)
3) pre-op: 14 days of Phenoxy, fluid load, high Na diet
4) Operative: Phentolamine--> Adrenalectomy
5) CI: Beta-blockers

***if there are complications in surgery, and NE/Epi spills, patient will go into hypertensive crisis.... Now you can give Beta-1 blockers
(leave Beta-2 receptors unblocked, so pt can maintain vasodilation)
you are now depending of IV fluids to maintain BP
Treatment for insulinoma
remove
Treatment for nessidioblastosis
nessidioblastosis= insulinoma in infant

Rx: subtotal pancreatectomy
HONK
1) serum Osm
2) treatment
1) serum Osm > 320
2) Rx: 10L NS, insulin drip, replace electrolytes and bicarb

***in this order
DKA treatment
1) Insulin drip (until ketones disappear, and to help put K in cell)
2) NS to dilute K (additive effort with #1)
3) KCl to maintain K levels when K falls to 4.5
4) D5 1/2 NS when glucose= 250 and ketones=0
Dawn phenomenon Rx
increase PM's NPH insulin or
move PM insulin closer to bedtime or
inc AM's regular insulin
Treatment of Somogyi effect
dec evening NPH
Erythrasma
s/s:
cause:
Rx:
s/s: diabetic with rash in skin folds that shines coral-red under Woods lamp
Cause: Corneybacterium minute
Rx: Erythromycin
Metabolic Syndrome
1) def
2) treatment
def: "FAT Body Habitus"
Fasting gluc > 100
Abd girth >35 (female), >40 (male)
TG > 150
BP > 130/80 (whether taking BP med or not)
HDL <50 (female), <40 (male)

2) Metformin
Glucagonoma
1) triad
2) treamtment
1) DM2, diarrhea, Necrolytic Migratory erythema
2) Octreotide
Waterhouse Freidrich syndrome
treatment
methylprednisone
Primary hyperparathyroid
causes
treatment
causes: adenoma
1) furosemide (loops loose Ca)
2) Calcitonin
3) Bisphosphinates
4) parathyroidectomy
Biphosphonates
MOA:
uses:
S/E:
ex:
MOA: inhibit osteoclasts
uses: primary hyperthyroidism, hypERcalcemia, 2nd line for osteoporosis phx (1st line is raloxafine)
S/E: low Ca, low Mg, osteonecrosis, ulcers, drug induced esophagitis (take while sitting upright, with full glass of water, stay sitting up for at least 30 min)
ex: -dronate, -dranate, -drenic acid
Which bisphosphonates are used for hyPERcalcemia?
Ibondronate, Zolendrinic acid
which bisphophonate has decreased incidence of hip fractures and mortality?
Zolendrinic acid
Secondary hyperparathyroid
causes:
treatment:
causes: renal failure
treatment: Ca supplements
Which 2 forms of hyperthyroid might we use I-131 ablation for?
1) Graves
-resistant to PTU &
methimazole
-elderly
2) Plummer's
-solitary toxic nodule- Definitely
-multinodule- maybe???
Treatment for graves
1st line: PTU or methimazole
2nd line: I-131
DeQuirvians thyroiditis
clue words:
Treatment
clue words: viral, SUBACUTE granulomatous, painful, lid-lag, transiently hyperthyroid, then hypothyroid

Rx: NSAIDS or corticosteroids for pain
hyperphase: propanalol with PTU or methimazole
hypOphase: T3 or T4
Silent thyroiditis
clue words:
treatment:
clue words: postpartum, SUBACUTE lymphocytic, painless, transiently hyperthyroid, then hypothyroid

Rx:
hyperphase: propanalol with PTU or methimazole
hypOphase: T3 or T4


***Hashimotos is CHRONIC lymphocytic
Treatment for thyroid storm
-propanolol with PTU or methamizole
-glucocorticoids
-Iodine (I) to inhibit thyroid hormone release (use Li if pt has Iodine allergy)
Treatment for Plummer's disease
-propanolol with PTU or methimazole
-if solitary nodule--> I-131
-if multinodular-????
Treatment for Hashimotos
Levothytoxine; aka thyroxine (T4)
Synthroid
-is one of many market drugs for...
-short-coming
-market drug for T4 (levothyroxine)
-short-coming: Ca and Fe inhibit absorption
Reidels struma
-what is it?
-clue
treatment
-fibrous thyroiditis
-Clues: firm thyroid, woody CT in neck, die of suffocation
-treatment: give T4 if hypothyroid,
may need surgery
Treatment of pituitary tumor
transphenoidectomy

EXCEPTIONS
1) prolactinoma: bromocriptine (DA agonist), Cabergoline (DA-2 agonist)
2) GH tumor: octreotide
Acromegaly treatment
1) octreotide (inh GH)
2) pituitary ablation
What 2 drugs could lead to "factitious hyperthyroidism"?
Will their T3-T4 levels be elevated?
What shows on iodine scan?
1) Amiodarone
2) IFN alpha

T3-T4 elevated, low TSh

low uptake on iodine scan
What is another name for factitious hyperthyroidism?
Jod- Basedow effect
S/E of antithyroid medication (methimazole or PTU)
Agranulocytosis (must continuously check WBC w differential)
name all the drugs that inhibit deiodination of T4 (converting T4 to T3)
1) PTU
2) propanalol
3) dexamethosone
I 131 ablation
CI:
S/E:
CI: preggo, severe eye dz
S/E: afib, hand tremor (2/2 dying thyroid cells leaking T3/T4)
agranulocytosis
s/s:
sign to stop drug causing it:
s/s: fever, sore throat
sign: WBC < 1,000