IPS2: Pharmacology - Part 7.2 - Endocrine Drugs - Adrenocortical and Thyroid Hormones

Zones of of adrenal cortex:

Secrete mineralocorticoid.

a. Zona glomerulosa

b. Zona fasciculata

c. Zona reticularis

a. Zona glomerulosa

Zones of of adrenal cortex:

Secrete glucocorticosteroids.

a. Zona glomerulosa

b. Zona fasciculata

c. Zona reticularis

b. Zona fasciculata

Zones of of adrenal cortex:

Secrete sex hormones.

a. Zona glomerulosa

b. Zona fasciculata

c. Zona reticularis

c. Zona reticularis

Major mineralocorticoid in the body.

a. Aldosterone

b. Cortisol

c. Androgen

a. Aldosterone

Major glucocorticosteroid in the body.

a. Aldosterone

b. Cortisol

c. Androgen

b. Cortisol

Major sex hormones in the body.

a. Aldosterone

b. Cortisol

c. Androgen

c. Androgen

Adrenal Cortex produce:

a. Glucocorticosteroids

b. Mineralocorticosteroids

c. Adrenal sex steroids

d. a and b

e. b and c

f. All

f. All

Adrenal Cortex minimally produce:

a. Glucocorticosteroids

b. Mineralocorticosteroids

c. Adrenal sex steroids

d. a and b

e. b and c

f. All

c. Adrenal sex steroids

Glucocorticosteroids: Cortisol or Hydrocortisol physiologic effect.

a. Achieve at <10-20mg cosrtisol/day

b. Metabolism of CHO, CHON and Fats for generation of energy

c. Enhances the bronchial and vascular smooth muscle response to cathecholamines particularly adrenaline

d. a and b

e. b and c

f. All

f. All

Glucocorticosteroids: Cortisol or Hydrocortisol pharmacologic effect except:

a. Achieve at greater than or equal 10-20mg cosrtisol/day

b. Anti-inflammatory

c. Immunosuppression

d. Catabolism of CHON and bones

e. Inhibition of cell division

f. None

f. None

Glucocorticoids clinical uses except:

a. Inflammatory diseases: collagen vascular disease (RA, SLE etc.), BA, COPD

b. Transplant rejection inhibition

c. Inflammatory Bowel Disease

d. Dermatologic diseases

e. Cancer

f. None

f. None

Glucocorticoids adverse effects except:

a. Cushing's syndrome

b. Increased risk of infection

c. Hyperglycemia

d. Poor wound healing

e. Adrenal suppression

f. None

f. None

Glucocorticoids adverse effect:

Develops when there is prolonged use of GC beyond physiological dose.

a. Cushing's syndrome

b. Increased risk of infection

c. Hyperglycemia

d. Poor wound healing

e. Adrenal suppression

f. None

a. Cushing's syndrome

Glucocorticoids adverse effect:

Occurs when supraphysiological doses of GC are given for at least 10-14 days.

a. Cushing's syndrome

b. Increased risk of infection

c. Hyperglycemia

d. Poor wound healing

e. Adrenal suppression

f. None

e. Adrenal suppression

Cushing syndrome except:

a. Moon face

b. Buffalo hump

c. Truncal obesity

d. Thinning of skin

e. Easy bruising

f. None

f. None

Aldosterone

a. Endogenous mineralcorticosteroids

b. Physiologic effect is same with pharmacologic effect

c. Affect the water and electrolyte balance

d. a and b

e. b and c

f. All

f. All

Aldosterone causes reabsorption of the following in the blood except:

a. H2O

b. Na+

c. HCO3-

d. H+

e. None

d. H+ - this is secreted

Aldosterone causes secretion and urinary disposal of the following except

a. K+

b. Na+

c. Cl-

d. H+

e. None

b. Na+ - this is reabsorb.

Hyperaldosteronism except

a. More water and Na

b. HTN and hypervolemic

c. Metabolic alkalosis

d. Hypochloremia

e. Hyperkalemia

f. None

e. Hyperkalemia - this is effect of hypoaldosteronism

Hypoaldosteronism except

a. Hypovolemic

b. Hypotension

c. Metabolic acidosis

d. Hyperchloremia

e. Hyperkalemia

f. None

f. None

Biosynthesis of thyroid hormone

1- Release into the Systemic Circulation

2- Peripheral conversion of less active T4 to more active T3 via the enzyme deiodinase

3- Active uptake of Iodine via Sodium Iodide symporter

4- Exocytosis of thyroglobulin

5- Peroxidase catalase reactions

6- Proteolysis

a. 435621

b. 345621

c. 435612

d. 345612

d. 345612

Sites of thyroid hormone synthesis.

a. Thyroid follicular cell

b. Follicle colloid

c. Both

d. None

c. Both

Thyroglobulin is a specialized protein found in the thyroid follicular cell containing what amino acid residues?

a. Proline

b. Threonine

c. Glycine

d. Tyrosine

d. Tyrosine

Peroxidase catalase requiring reactions except:

a. Peroxidation of iodide to Iodine

b. Organification of Iodine

c. Coupling reaction

d. Proteolysis

e. None

d. Proteolysis

Aka Iodination which is addition of Iodine to tyrosine residues of the thyroglobulin.

a. Peroxidation of iodide to Iodine

b. Organification of Iodine

c. Coupling reaction

b. Organification of Iodine

1 Iodine + Tyrosine residues of the thyroglobulin

a. Monoiodothyronine (MIT)

b. Diiodothyronine (DIT)

c. T3

d. T4

a. Monoiodothyronine

2 Iodine + Tyrosine residues of the thyroglobulin

a. Monoiodothyronine (MIT)

b. Diiodothyronine (DIT)

c. T3

d. T4

b. Diiodothyronine

Iodination occurs in

a. Thyroid follicular cell

b. Follicle colloid

c. Endothelium

d. Blood

b. Follicle colloid

Iodinated tyrosine of thyroglobulin will get attached to each other.

a. Peroxidation of iodide to Iodine

b. Organification of Iodine

c. Coupling reaction

c. Coupling reaction

MIT + DIT

a. T3

b. T4

a. T3

DIT + DIT

a. T3

b. T4

b. T4

More active.

a. T3

b. T4

a. T3

Goal is to remove the protein portion, thyroglobulin, of the synthesized hormone.

a. Peroxidation of iodide to Iodine

b. Organification of Iodine

c. Coupling reaction

d. Proteolysis

d. Proteolysis

Proprotion of release in the systemic circulation of T4 and T3

a. 3:1

b. 2:1

c. 5:1

d. 4:1

c. 5:1 - 5T4 : 1T3

Responsible for peripheral conversion of less active T4 to more active T3.

a. Deiodinase

b. Peroxidase

c. Aromatase

d. Na/I symporter

a. Deiodinase

Hypothyroidism causes except

a. Iodine deficiency

b. Thyroidectomy

c. Autoimmune Hashimoto's disease

d. Amiodarone usage more than 2 weeks

e. Radioactive Iodine usage

f. None

d. Amiodarone usage more than 2 weeks - less than 2 weeks usage is what will cause hypothyroidism

Hypothyroidism signs and symptoms except:

a. Slow metabolism

b. Heat intolerance

c. Increased sleeping time

d. Decreased appetite but increased in body weight

e. Myxedema coma (severe)

f. None

b. Heat intolerance - this is for hyperthyroidism.

Thyroid gland defect.

a. Primary hypothyroidism

b. Secondary hypothyroidism

c. Tertiary hypothyroidism

a. Primary hypothyroidism

Anterior pituitary gland defect.

a. Primary hypothyroidism

b. Secondary hypothyroidism

c. Tertiary hypothyroidism

b. Secondary hypothyroidism

Hypothalamus defect.

a. Primary hypothyroidism

b. Secondary hypothyroidism

c. Tertiary hypothyroidism

c. Tertiary hypothyroidism

Decreased in primary hypothyroidism.

I. TRH

II. TSH

III. T4

IV. T3

a. I, II, III, IV

b. II, III, IV

c. III, IV

d. I, II

c. III, IV

Decreased in secondary hypothyroidism.

I. TRH

II. TSH

III. T4

IV. T3

a. I, II, III, IV

b. II, III, IV

c. III, IV

d. I, II

b. II, III, IV

Decreased in tertiary hypothyroidism.

I. TRH

II. TSH

III. T4

IV. T3

a. I, II, III, IV

b. II, III, IV

c. III, IV

d. I, II

a. I, II, III, IV

Drugs for hypothyroidism except:

a. Dextrothyroxine

b. Levothyroxine

c. Liothyronine

d. Methimazole

e. None

d. Methimazole - this is antithyroid.

Drugs for hypothyroidism:

Has approximately 4% of the biological activity of L-isomer.

a. Dextrothyroxine

b. Levothyroxine

c. Liothyronine

a. Dextrothyroxine

Drugs for hypothyroidism:

3-4x more potent than levothyroxine.

a. Dextrothyroxine

b. Levothyroxine

c. Liothyronine

c. Liothyronine (T3)

Drugs for hypothyroidism:

Preparation of choice for thyroid replacement and suppression therapy.

a. Dextrothyroxine

b. Levothyroxine

c. Liothyronine

b. Levothyroxine (T4)

Hyperthyroidism causes.

a. Grave's Disease

b. Solitary hyperfunctioning nodule

c. Amiodarone usage for more than 2 weeks

d. a and b

e. b and c

f. All

f. All

Grave's disease except:

a. Autoimmune disease more common to women

b. Hyperthyroid state

c. Ophthalmopathy

d. Dermopathy

e. None

e. None

Signs and symptoms of hyperthyroidism except:

a. Hypermetabolic

b. Hypersympathetic

c. Heat intolerance

d. Episodes of nervousness

e. None

e. None

Signs and symptoms of hyperthyroidism except:

a. Tachycardia, palpitations

b. Tremors: fine finger tremors

c. Increased sweating

d. Increased appetite but decrease in weight

e. Nose changes

f. None

e. Nose changes - Eye changes

Antithyroid agents except:

a. Thioamides

b. Inorganic Anions/Anion Inhibitors

c. Iodides

d. Radioactive iodine (RAI)

e. Beta Blockers

f. None

f. None

First line antithyroid agents.

a. Thioamides

b. Inorganic Anions/Anion Inhibitors

c. Iodides

d. Radioactive iodine (RAI)

e. Beta Blockers

a. Thioamides

Peroxidase inhibitors.

a. Thioamides

b. Inorganic Anions/Anion Inhibitors

c. Iodides

d. Radioactive iodine (RAI)

e. Beta Blockers

a. Thioamides

Thioamides.

a. Propylthiouracil (PTU)

b. Methimazole

c. Carbimazole

d. a and b

e. b and c

f. All

f. All

Thioamide with additional MOA of inhibiting peripheral deiodination of T4 to the more active T3.

a. Propylthiouracil (PTU)

b. Methimazole

c. Carbimazole

d. a and b

e. b and c

f. All

a. Propylthiouracil (PTU)

Prodrug of methimazole.

a. Propylthiouracil (PTU)

b. Methimazole

c. Carbimazole

d. a and b

e. b and c

f. All

c. Carbimazole

Faster onset of action but shorter duration thus useful in emergency states (thyroid storm or hyperthyroid crisis), in pregnancy and lactation.

a. Propylthiouracil (PTU)

b. Methimazole

a. Propylthiouracil (PTU)

Has the side effect of drug-induced hepatitis

a. Propylthiouracil (PTU)

b. Methimazole

a. Propylthiouracil (PTU)

Slower onset, longer duration.

a. Propylthiouracil (PTU)

b. Methimazole

b. Methimazole

10x more potent thus dose is divided by 10 (XDrug/10)

a. Propylthiouracil (PTU)

b. Methimazole

b. Methimazole - dose is PTUdose/10

Preferred for maintenance treatment of hyperthyroidism.

a. Propylthiouracil (PTU)

b. Methimazole

b. Methimazole

Not given during pregnancy and lactation becaue it has the teratogenic effect, Aplasia Cutis.

a. Propylthiouracil (PTU)

b. Methimazole

b. Methimazole

Side effect of obstructive jaundice.

a. Propylthiouracil (PTU)

b. Methimazole

b. Methimazole

Toxicities of thioamides

a. Agranulocytosis

b. Hypothyroidism

c. Both

d. None

c. Both

Blocks Active uptake of Iodine via Sodium Iodide symporter.

a. Thioamides

b. Inorganic Anions/Anion Inhibitors

c. Iodides

d. Radioactive iodine (RAI)

e. Beta Blockers

b. Inorganic Anions/Anion Inhibitors

Inorganic Anions/Anion Inhibitors.

a. Perchlorate

b. Pertechnetate

c. Thiocyanate

d. a and b

e. b and c

f. All

f. All

DOC in the management of amiodarone-induced hyperthyroidism.

a. Perchlorate

b. Pertechnetate

c. Thiocyanate

d. a and b

e. b and c

f. All

a. Perchlorate

Adverse effect of Inorganic Anions/Anion Inhibitors.

a. Agranulocytosis

b. Hypothyroidism

c. Aplastic anemia

d. a and b

e. b and c

f. All

c. Aplastic anemia

Iodides.

a. MOA is through Wolff-Chaikoff effect

b. Local control of thyroid gland

c. Only effective for <10-14 days (max 14 days)

d. a and b

e. b and c

f. All

f. All

Uses of iodides.

a. Initial management of iodine storm

b. Preoperative control of hyperthyroidism

c. Both

d. None

c. Both

Side effects and contraindication of iodides.

a. Iodism

b. Pregnancy

c. Radioactive iodine (RAI): I131

d. a and b

e. b and c

f. All

f. All

Iodism

a. Conjuctivitis

b. Rhinitis

c. Sialadenitis

d. a and b

e. b and c

f. All

f. All

Emits B-radiation that destroys follicular cells of thyroid gland (oxidative damage).

a. Thioamides

b. Inorganic Anions/Anion Inhibitors

c. Iodides

d. Radioactive iodine (RAI): I131

e. Beta Blockers

d. Radioactive iodine (RAI): I131

Preferred tx for most cases of hyperthyroidism except during pregnancy.

a. Thioamides

b. Inorganic Anions/Anion Inhibitors

c. Iodides

d. Radioactive iodine (RAI): I131

e. Beta Blockers

d. Radioactive iodine (RAI): I131

Cautions with RAI.

a. Not prepared in a pharmacy

b. Avoid contact with children, pregnant individuals within the 1st 2-3 days

c. Adverse effect is hypothyroidism

d. All

d. All

Beta blockers except:

a. Block the peripheral sympathetic effects of thyroid hormone.

b. Block the peripheral conversion of T4 to T3

c. Used as adjuncts in the management of thyrotoxicosis

d. Can cause clinical improvement of hyperthyroid symptoms by altering thyroid hormone levels

e. None

d. Can cause clinical improvement of hyperthyroid symptoms by altering thyroid hormone levels

It does not typically alter thyroid hormone levels.