Thyroid_Drugs_Merged.docx

Thyroid Drugs \#\#\# \*\*Slide 1: Overview of Thyroid Hormones\*\* 1\. \*\*Which of the following thyroid hormones is more biologically active but less abundant in the bloodstream?\*\* \- A. T4 \- B. T3 \- C. Reverse T3 (rT3) \- D. Thyroglobulin \*\*Answer:\*\* B. T3【137†source】 2\. \*\*Wh...

Thyroid Drugs \#\#\# \*\*Slide 1: Overview of Thyroid Hormones\*\* 1\. \*\*Which of the following thyroid hormones is more biologically active but less abundant in the bloodstream?\*\* \- A. T4 \- B. T3 \- C. Reverse T3 (rT3) \- D. Thyroglobulin \*\*Answer:\*\* B. T3【137†source】 2\. \*\*What percentage of T4 is converted to T3 in peripheral tissues?\*\* \- A. 10% \- B. 20% \- C. 50% \- D. 80% \*\*Answer:\*\* D. 80%【137†source】 3\. \*\*Which enzyme is required for the conversion of T4 to T3 in peripheral tissues?\*\* \- A. Thyroid peroxidase \- B. Deiodinase \- C. Lipase \- D. Amylase \*\*Answer:\*\* B. Deiodinase【137†source】 \-\-- \#\#\# \*\*Slide 2: Thyroid Hormone Synthesis\*\* 1\. \*\*Thyroid hormone production begins with the uptake of which substance by the thyroid gland?\*\* \- A. Iodide \- B. Sodium \- C. Calcium \- D. Glucose \*\*Answer:\*\* A. Iodide【137†source】 2\. \*\*Which enzyme in the thyroid gland is responsible for converting iodide to iodine and facilitating hormone production?\*\* \- A. Deiodinase \- B. Thyroid peroxidase (TPO) \- C. Glutathione peroxidase \- D. Monoamine oxidase \*\*Answer:\*\* B. Thyroid peroxidase (TPO)【137†source】 3\. \*\*What thyroid hormone is formed by the combination of two diiodotyrosine (DIT) molecules?\*\* \- A. T3 \- B. T4 \- C. Reverse T3 \- D. Thyroglobulin \*\*Answer:\*\* B. T4【137†source】 \-\-- \#\#\# \*\*Slide 3: Thyroid Hormone Metabolism\*\* 1\. \*\*Most physiologically active thyroid hormone is derived from which hormone in the peripheral tissues?\*\* \- A. T4 \- B. T3 \- C. Reverse T3 \- D. TSH \*\*Answer:\*\* A. T4【137†source】 2\. \*\*Which of the following factors can affect thyroid hormone-binding proteins, reducing the availability of free T4 and T3?\*\* \- A. High stress \- B. Low calcium intake \- C. Decreased liver enzymes \- D. High sodium intake \*\*Answer:\*\* A. High stress【137†source】 3\. \*\*What percentage of T4 is bound to thyroid-binding globulin (TBG)?\*\* \- A. 30% \- B. 50% \- C. 70% \- D. 90% \*\*Answer:\*\* C. 70%【137†source】 \-\-- \#\#\# \*\*Slide 4: Hypothyroidism - Causes and Symptoms\*\* 1\. \*\*Which autoimmune disorder is a common cause of hypothyroidism?\*\* \- A. Graves\' disease \- B. Hashimoto\'s thyroiditis \- C. Addison\'s disease \- D. Cushing\'s syndrome \*\*Answer:\*\* B. Hashimoto\'s thyroiditis【137†source】 2\. \*\*Which of the following symptoms is commonly associated with hypothyroidism?\*\* \- A. Weight loss \- B. Heat intolerance \- C. Constipation \- D. Tachycardia \*\*Answer:\*\* C. Constipation【137†source】 3\. \*\*What is the most common cause of hypothyroidism worldwide?\*\* \- A. Iodine deficiency \- B. Radiation therapy \- C. Pituitary tumor \- D. Viral infection \*\*Answer:\*\* A. Iodine deficiency【137†source】 \-\-- \#\#\# \*\*Slide 5: Thyroid Function Tests\*\* 1\. \*\*Which of the following thyroid function tests is used as the primary screening tool for thyroid disorders?\*\* \- A. Free T4 \- B. TSH \- C. Free T3 \- D. Thyroglobulin antibodies \*\*Answer:\*\* B. TSH【137†source】 2\. \*\*In patients with primary hypothyroidism, what would you expect the TSH levels to be?\*\* \- A. Low \- B. Normal \- C. High \- D. Suppressed \*\*Answer:\*\* C. High【137†source】 3\. \*\*Which of the following tests can help diagnose autoimmune thyroid disorders like Hashimoto's thyroiditis?\*\* \- A. TSH receptor antibodies \- B. Anti-thyroglobulin and thyroid peroxidase (TPO) antibodies \- C. Free T3 \- D. Reverse T3 \*\*Answer:\*\* B. Anti-thyroglobulin and thyroid peroxidase (TPO) antibodies【137†source】 \-\-- \#\#\# \*\*Slide 6: Thyroid Hormones - Intracellular Action\*\* 1\. \*\*Which inflammatory markers can impair intracellular T3 production?\*\* \- A. CRP and ESR \- B. Platelet count and hemoglobin \- C. White blood cells and neutrophils \- D. Calcium and potassium \*\*Answer:\*\* A. CRP and ESR【137†source】 2\. \*\*Which enzyme plays a major role in converting T4 to T3 within peripheral tissues?\*\* \- A. D2 (Type 2 deiodinase) \- B. TPO \- C. Amylase \- D. Alkaline phosphatase \*\*Answer:\*\* A. D2 (Type 2 deiodinase)【137†source】 3\. \*\*In states of illness or inflammation, the body preferentially converts T4 into which inactive thyroid hormone?\*\* \- A. T3 \- B. Reverse T3 (rT3) \- C. Thyroglobulin \- D. TSH \*\*Answer:\*\* B. Reverse T3 (rT3)【137†source】 \#\#\# \*\*Slide 7: Levothyroxine (T4)\*\* 1\. \*\*Levothyroxine is the treatment of choice for which condition?\*\* \- A. Hyperthyroidism \- B. Hypothyroidism \- C. Thyroid storm \- D. Goiter \*\*Answer:\*\* B. Hypothyroidism 2\. \*\*What is the primary reason levothyroxine should be taken on an empty stomach?\*\* \- A. To enhance its metabolism \- B. To prevent gastrointestinal side effects \- C. To optimize its absorption \- D. To increase its half-life \*\*Answer:\*\* C. To optimize its absorption 3\. \*\*Which of the following is a boxed warning associated with levothyroxine?\*\* \- A. Risk of thyroid storm \- B. Increased risk of osteoporosis \- C. Not for use in the treatment of obesity or weight loss \- D. Risk of severe liver injury \*\*Answer:\*\* C. Not for use in the treatment of obesity or weight loss \-\-- \#\#\# \*\*Slide 8: Monitoring Levothyroxine Therapy\*\* 1\. \*\*When should a full thyroid panel be repeated after starting or changing the dose of levothyroxine?\*\* \- A. After 2 weeks \- B. After 4-6 weeks \- C. After 6-8 weeks \- D. After 3 months \*\*Answer:\*\* C. After 6-8 weeks 2\. \*\*Which laboratory test is considered the most sensitive for monitoring levothyroxine therapy in hypothyroid patients?\*\* \- A. Free T3 \- B. Total T4 \- C. TSH (Thyroid Stimulating Hormone) \- D. Reverse T3 \*\*Answer:\*\* C. TSH 3\. \*\*Levothyroxine dosing for adults is typically initiated at:\*\* \- A. 1.6 mcg/kg/day \- B. 0.8 mcg/kg/day \- C. 2.5 mcg/kg/day \- D. 0.5 mcg/kg/day \*\*Answer:\*\* A. 1.6 mcg/kg/day \-\-- \#\#\# \*\*Slide 9: Thyroid Function Tests\*\* 1\. \*\*Which thyroid function test helps assess the brain's perception of thyroid hormone status?\*\* \- A. Free T3 \- B. Free T4 \- C. TSH \- D. Reverse T3 \*\*Answer:\*\* C. TSH 2\. \*\*What role does reverse T3 (rT3) play in thyroid hormone metabolism?\*\* \- A. It is the biologically active form of T3 \- B. It is an inactive form of T3 produced during illness or stress \- C. It enhances the action of T4 \- D. It stimulates thyroid hormone production \*\*Answer:\*\* B. It is an inactive form of T3 produced during illness or stress 3\. \*\*Which of the following can promote the conversion of T4 to rT3?\*\* \- A. Chronic inflammation \- B. Hypercalcemia \- C. High serum sodium levels \- D. Low cholesterol \*\*Answer:\*\* A. Chronic inflammation \-\-- \#\#\# \*\*Slide 10: Intracellular Action of Thyroid Hormones\*\* 1\. \*\*Which enzyme is responsible for converting T4 to the active form T3 within cells?\*\* \- A. Thyroid peroxidase \- B. D1 and D2 deiodinases \- C. Amylase \- D. Lipase \*\*Answer:\*\* B. D1 and D2 deiodinases 2\. \*\*What happens to T3 production during periods of acute illness or inflammation?\*\* \- A. It increases dramatically \- B. It remains unchanged \- C. It decreases due to increased rT3 production \- D. It is enhanced by increased D2 enzyme activity \*\*Answer:\*\* C. It decreases due to increased rT3 production 3\. \*\*Why can T3 production not always be assessed using standard lab tests during illness?\*\* \- A. T3 production is primarily extracellular \- B. Intracellular T3 production is impaired but not extracellular T3 \- C. Labs only measure the inactive form rT3 \- D. The body stops producing T3 entirely \*\*Answer:\*\* B. Intracellular T3 production is impaired but not extracellular T3 \-\-- \#\#\# \*\*Slide 11: Goals of Hypothyroidism Therapy\*\* 1\. \*\*What is the primary goal of levothyroxine therapy in hypothyroidism?\*\* \- A. Reduce thyroid gland size \- B. Normalize TSH secretion \- C. Increase T3 levels \- D. Prevent goiter formation \*\*Answer:\*\* B. Normalize TSH secretion 2\. \*\*In patients with goiter, levothyroxine therapy aims to:\*\* \- A. Increase T4 synthesis \- B. Reduce the size of the goiter \- C. Stimulate TSH release \- D. Increase iodine uptake \*\*Answer:\*\* B. Reduce the size of the goiter 3\. \*\*What is the recommended target range for TSH in patients receiving levothyroxine replacement therapy?\*\* \- A. 0.1-0.5 µU/ml \- B. 0.5-2.5 µU/ml \- C. 2.5-5.0 µU/ml \- D. 3.0-6.0 µU/ml \*\*Answer:\*\* B. 0.5-2.5 µU/ml \-\-- \#\#\# \*\*Slide 12: Hypothyroid Therapy in Special Populations\*\* 1\. \*\*Which population requires a lower initial dose of levothyroxine to avoid overtreatment?\*\* \- A. Pregnant women \- B. Children \- C. Elderly patients with cardiovascular disease \- D. Athletes \*\*Answer:\*\* C. Elderly patients with cardiovascular disease 2\. \*\*Why should pregnant women with hypothyroidism be monitored more frequently during treatment?\*\* \- A. To avoid excessive T3 production \- B. Because thyroid hormone demands increase during pregnancy \- C. To ensure the baby is not affected by high T4 levels \- D. Due to the risk of hyperglycemia \*\*Answer:\*\* B. Because thyroid hormone demands increase during pregnancy 3\. \*\*Which of the following is a common risk of undertreating hypothyroidism during pregnancy?\*\* \- A. Premature labor \- B. Fetal hyperthyroidism \- C. Gestational diabetes \- D. Fetal developmental delays \*\*Answer:\*\* D. Fetal developmental delays Slide 13: Levothyroxine Dosage and Dosing Considerations What is the recommended starting dose of levothyroxine for a patient over 50 years old with no known cardiac disease? A. 100 mcg/day B. 25 mcg/day C. 50 mcg/day D. 75 mcg/day\ Answer: C. 50 mcg/day is a more conservative levothyroxine dosing approach recommended for older patients with cardiac disease?\*\* A. To prevent osteoporosis B. To reduce the risk of atrial fibrillation, angina, or myocardial infarction C. To increase the half-life of the drug D. To prevent drug interactions\ Answer: B. To reduce the risk of atrial fibrillation, angina, or myocardial infarction Hor initiating levothyroxine therapy should a full thyroid panel be rechecked? A. 2-4 weeks B. 4-6 weeks C. 6-8 weeks D. 10-12 weeks\ Answer: C. 6-8 weeks Slide roxine Tablet Strengths and Adverse Effects Which of the following adverse effects is most likely due to excessive levothyroxine dosing? A. Hair loss B. Diarrhea and weight loss C. Hypertension D. Hypoglycemia\ Answer: B. Diarrhea and weight loss Which of the followingnormalities can result from over-replacement with levothyroxine? A. Bradycardia B. Arrhythmias and myocardial infarction C. Coronary artery disease D. Deep vein thrombosis\ Answer: B. Arrhythmias and myocardial infarction Which supplements should be sepalevothyroxine administration by at least 4 hours to avoid decreased absorption? A. Calcium and iron supplements B. Folic acid and vitamin B12 C. Vitamin D and potassium D. Magnesium and zinc\ Answer: A. Calcium and iron supplements \*\*Slide 15: Levothyroxine Drug Interac Which medications can increase the metabolism of levothyroxine, necessitating a higher dose? A. Proton pump inhibitors B. Cytochrome P450 inducers such as phenytoin and carbamazepine C. Antacids D. Calcium supplements\ Answer: B. Cytochrome P450 inducers such as phenytoin and carbamazepine How long should a patient wait to take calcium or irnts after taking levothyroxine? A. 2 hours B. 3 hours C. 4 hours D. 5 hours\ Answer: C. 4 hours Which of the following drugs can decrease levothyroxine absorpen concurrently? A. Multivitamins containing zinc B. Corticosteroids C. ACE inhibitors D. Beta-blockers\ Answer: A. Multivitamins containing zinc \#\#\# \*\*Slide 16: Levothyroxine - Adverse Effects\*\* 1\. \*\*Which of the following is a common adverse effect of excessive levothyroxine dosing?\*\* \- A. Hypothyroidism \- B. Hyperthyroidism \- C. Weight gain \- D. Bradycardia \*\*Answer:\*\* B. Hyperthyroidism【150:16†source】 2\. \*\*Patients on long-term levothyroxine therapy are at an increased risk for which of the following?\*\* \- A. Osteoporosis \- B. Hepatotoxicity \- C. Renal failure \- D. Hyperkalemia \*\*Answer:\*\* A. Osteoporosis【150:16†source】 3\. \*\*Which cardiac abnormality may occur with excessive levothyroxine therapy?\*\* \- A. Arrhythmias \- B. Heart block \- C. Cardiomyopathy \- D. Pericarditis \*\*Answer:\*\* A. Arrhythmias【150:16†source】 \-\-- \#\#\# \*\*Slide 17: Levothyroxine - Drug Interactions\*\* 1\. \*\*Which of the following supplements can interfere with levothyroxine absorption?\*\* \- A. Vitamin D \- B. Iron supplements \- C. Magnesium \- D. Potassium chloride \*\*Answer:\*\* B. Iron supplements【150:16†source】 2\. \*\*How should patients separate the administration of levothyroxine and calcium supplements?\*\* \- A. 1 hour \- B. 2 hours \- C. 4 hours \- D. 6 hours \*\*Answer:\*\* C. 4 hours【150:16†source】 3\. \*\*Which class of drugs increases the metabolism of levothyroxine, potentially lowering its effectiveness?\*\* \- A. Calcium channel blockers \- B. Anti-epileptic drugs like phenytoin \- C. Beta blockers \- D. Antidepressants \*\*Answer:\*\* B. Anti-epileptic drugs like phenytoin【150:16†source】 \-\-- \#\#\# \*\*Slide 18: Levothyroxine - Monitoring\*\* 1\. \*\*When should levothyroxine dosage be re-evaluated after starting or adjusting therapy?\*\* \- A. 2-4 weeks \- B. 4-6 weeks \- C. 6-8 weeks \- D. 8-12 weeks \*\*Answer:\*\* C. 6-8 weeks【150:16†source】 2\. \*\*Which of the following lab tests is primarily used to monitor the efficacy of levothyroxine therapy?\*\* \- A. Free T3 \- B. Total T4 \- C. TSH (Thyroid-Stimulating Hormone) \- D. Reverse T3 \*\*Answer:\*\* C. TSH (Thyroid-Stimulating Hormone)【150:16†source】 3\. \*\*What is the recommended frequency for monitoring thyroid function in a stable patient on levothyroxine?\*\* \- A. Every 3 months \- B. Every 6 months \- C. Every 12 months \- D. Every 2 years \*\*Answer:\*\* C. Every 12 months【150:16†source】 \#\#\# \*\*Slide 19: Hyperthyroidism - Overview\*\* 1\. \*\*Which of the following is the most common cause of hyperthyroidism?\*\* \- A. Thyroid cancer \- B. Graves\' disease \- C. Toxic multinodular goiter \- D. Drug-induced thyroiditis \*\*Answer:\*\* B. Graves\' disease 2\. \*\*Which lab finding is typical in hyperthyroidism?\*\* \- A. Elevated TSH \- B. Suppressed TSH, elevated T3 and T4 \- C. Decreased T3 and T4 levels \- D. Elevated reverse T3 \*\*Answer:\*\* B. Suppressed TSH, elevated T3 and T4 3\. \*\*Which symptom is characteristic of hyperthyroidism?\*\* \- A. Cold intolerance \- B. Bradycardia \- C. Heat intolerance \- D. Weight gain \*\*Answer:\*\* C. Heat intolerance \-\-- \#\#\# \*\*Slide 20: Graves\' Disease\*\* 1\. \*\*What is the primary immunologic feature of Graves\' disease?\*\* \- A. Production of thyroid-stimulating antibodies (TSI) \- B. Production of anti-thyroid peroxidase antibodies \- C. Decreased iodine uptake \- D. Destruction of thyroid follicular cells \*\*Answer:\*\* A. Production of thyroid-stimulating antibodies (TSI) 2\. \*\*Which eye-related condition is associated with Graves\' disease?\*\* \- A. Ptosis \- B. Orbital myositis \- C. Exophthalmos \- D. Optic neuritis \*\*Answer:\*\* C. Exophthalmos 3\. \*\*Which test can be used to confirm the diagnosis of Graves\' disease?\*\* \- A. Anti-thyroid peroxidase antibodies \- B. Radioactive iodine uptake (RAIU) test \- C. Serum cortisol levels \- D. Thyroid ultrasound \*\*Answer:\*\* B. Radioactive iodine uptake (RAIU) test \-\-- \#\#\# \*\*Slide 21: Treatment of Hyperthyroidism\*\* 1\. \*\*Which of the following is a first-line treatment for hyperthyroidism?\*\* \- A. Methimazole \- B. Propylthiouracil (PTU) \- C. Levothyroxine \- D. Liothyronine \*\*Answer:\*\* A. Methimazole 2\. \*\*Which of the following hyperthyroid treatments is contraindicated in the first trimester of pregnancy?\*\* \- A. Radioactive iodine \- B. Methimazole \- C. Propylthiouracil (PTU) \- D. Beta-blockers \*\*Answer:\*\* B. Methimazole 3\. \*\*What is the primary action of thioamide drugs (e.g., methimazole, PTU) in treating hyperthyroidism?\*\* \- A. Block thyroid hormone release \- B. Inhibit thyroid hormone synthesis \- C. Increase iodine uptake by the thyroid \- D. Decrease peripheral conversion of T4 to T3 \*\*Answer:\*\* B. Inhibit thyroid hormone synthesis \-\-- \#\#\# \*\*Slide 22: Methimazole and Propylthiouracil (PTU)\*\* 1\. \*\*Methimazole is preferred over PTU due to which of the following advantages?\*\* \- A. Lower incidence of side effects \- B. Safer for use during pregnancy \- C. Longer half-life and once-daily dosing \- D. Better efficacy for treating thyroid cancer \*\*Answer:\*\* C. Longer half-life and once-daily dosing 2\. \*\*Which of the following is a serious side effect of PTU?\*\* \- A. Hepatotoxicity \- B. Hyperkalemia \- C. Osteoporosis \- D. Nephrotoxicity \*\*Answer:\*\* A. Hepatotoxicity 3\. \*\*In what situation is PTU preferred over methimazole?\*\* \- A. During the first trimester of pregnancy \- B. In patients with liver disease \- C. In patients with renal failure \- D. For long-term therapy in children \*\*Answer:\*\* A. During the first trimester of pregnancy \-\-- \#\#\# \*\*Slide 23: Radioactive Iodine Therapy\*\* 1\. \*\*Which of the following is a common side effect of radioactive iodine therapy for hyperthyroidism?\*\* \- A. Hypothyroidism \- B. Hypercalcemia \- C. Weight gain \- D. Hyperkalemia \*\*Answer:\*\* A. Hypothyroidism 2\. \*\*Which patient population should avoid radioactive iodine therapy?\*\* \- A. Men with prostate cancer \- B. Women who are pregnant or breastfeeding \- C. Children under 18 years of age \- D. Patients with autoimmune disorders \*\*Answer:\*\* B. Women who are pregnant or breastfeeding 3\. \*\*How long should a patient wait to conceive after receiving radioactive iodine therapy?\*\* \- A. 1 month \- B. 3 months \- C. 6 months \- D. 12 months \*\*Answer:\*\* C. 6 months \-\-- \#\#\# \*\*Slide 24: Beta-blockers in Hyperthyroidism\*\* 1\. \*\*What is the primary use of beta-blockers in the treatment of hyperthyroidism?\*\* \- A. Reduce thyroid hormone production \- B. Alleviate symptoms such as tachycardia and tremors \- C. Block iodine uptake \- D. Inhibit thyroid-stimulating antibodies \*\*Answer:\*\* B. Alleviate symptoms such as tachycardia and tremors 2\. \*\*Which beta-blocker is most commonly used in the management of hyperthyroid symptoms?\*\* \- A. Propranolol \- B. Metoprolol \- C. Atenolol \- D. Labetalol \*\*Answer:\*\* A. Propranolol 3\. \*\*In addition to reducing heart rate, how do beta-blockers assist in hyperthyroidism management?\*\* \- A. Increase T4 production \- B. Decrease TSH secretion \- C. Block peripheral conversion of T4 to T3 \- D. Increase iodine uptake \*\*Answer:\*\* C. Block peripheral conversion of T4 to T3 Slide 25: Hyperthyroidism - Causes Which of the following is the most common cause of hyperthyroidism? A. Graves' disease B. Toxic multinodular goiter C. Thyroid cancer D. Thyroiditis\ Answer: A. Graves' disease Which symptom is typically associated with hyperthyroidism? A. Cold intolerance B. Weight gain C. Palpitations D. Constipation\ Answer: C. Palpitations Which laboratory finding is expected in hyperthyroidism? A. Elevated TSH and low T3/T4 B. Low TSH and high T3/T4 C. Normal TSH with low T3/T4 D. Elevated TSH and elevated reverse T3\ Answer: B. Low TSH and high T3/T4 Slide 26: Thioamides - Mechanism of Action Which of the following is the mechanism of action of Methimazole? A. Inhibition of iodine organification B. Inhibition of TSH release C. Enhancement of T4 synthesis D. Stimulation of iodine uptake\ Answer: A. Inhibition of iodine organification Which drug also inhibits the conversion of T4 to T3 in peripheral tissues? A. Methimazole B. Propylthiouracil (PTU) C. Levothyroxine D. Liothyronine\ Answer: B. Propylthiouracil (PTU) In what situation is Propylthiouracil (PTU) preferred over Methimazole? A. During the second trimester of pregnancy B. In cases of thyroid storm C. In patients allergic to levothyroxine D. For long-term hyperthyroidism treatment\ Answer: B. In cases of thyroid storm Slide 27: Methimazole What is the typical maintenance dose of Methimazole for treating hyperthyroidism? A. 50-100 mg daily B. 5-15 mg daily C. 30-60 mg daily D. 100-200 mg daily\ Answer: B. 5-15 mg daily Why is Methimazole contraindicated in the first trimester of pregnancy? A. Risk of fetal hypothyroidism and birth defects B. Risk of maternal hypercalcemia C. Increased risk of preeclampsia D. Decreased efficacy in pregnant patients\ Answer: A. Risk of fetal hypothyroidism and birth defects How long does it typically take for T4 and T3 levels to drop after starting Methimazole therapy? A. 1-2 days B. 2-3 weeks C. 4-6 weeks D. 3 months\ Answer: B. 2-3 weeks \#\#\# \*\*Slide 28: Thioamides - Mechanism of Action\*\* 1\. \*\*What is the mechanism of action of methimazole in the treatment of hyperthyroidism?\*\* \- A. Inhibits the synthesis of thyroid hormones by blocking the iodination of tyrosine \- B. Stimulates thyroid hormone secretion \- C. Increases the conversion of T4 to T3 \- D. Blocks thyroid hormone release \*\*Answer:\*\* A. Inhibits the synthesis of thyroid hormones by blocking the iodination of tyrosine 2\. \*\*Which thioamide also inhibits the peripheral conversion of T4 to T3?\*\* \- A. Methimazole \- B. Propylthiouracil (PTU) \- C. Levothyroxine \- D. Liothyronine \*\*Answer:\*\* B. Propylthiouracil (PTU) 3\. \*\*What is an advantage of using PTU over methimazole in thyroid storm?\*\* \- A. PTU inhibits both thyroid hormone synthesis and peripheral conversion of T4 to T3 \- B. PTU has a longer half-life than methimazole \- C. PTU has fewer adverse effects \- D. PTU is safer for long-term use \*\*Answer:\*\* A. PTU inhibits both thyroid hormone synthesis and peripheral conversion of T4 to T3 \-\-- \#\#\# \*\*Slide 29: Methimazole (Tapazole®)\*\* 1\. \*\*Why is methimazole preferred over PTU in most cases of hyperthyroidism?\*\* \- A. Methimazole has fewer side effects \- B. Methimazole is more potent and requires less frequent dosing \- C. PTU is associated with a higher risk of agranulocytosis \- D. Methimazole is safer for use in pregnancy \*\*Answer:\*\* B. Methimazole is more potent and requires less frequent dosing 2\. \*\*What is a contraindication for the use of methimazole in pregnant women?\*\* \- A. Methimazole increases the risk of congenital defects in the first trimester \- B. Methimazole is associated with low birth weight in the third trimester \- C. Methimazole causes preterm labor in the second trimester \- D. Methimazole is linked to maternal hypothyroidism during pregnancy \*\*Answer:\*\* A. Methimazole increases the risk of congenital defects in the first trimester 3\. \*\*How long does it typically take to see symptom improvement after starting methimazole?\*\* \- A. 1-2 weeks \- B. 2-3 weeks \- C. 4-6 weeks \- D. 6-8 weeks \*\*Answer:\*\* B. 2-3 weeks \-\-- \#\#\# \*\*Slide 30: Propylthiouracil (PTU)\*\* 1\. \*\*What is the primary reason PTU is reserved for use in the first trimester of pregnancy?\*\* \- A. PTU is less potent than methimazole \- B. PTU is associated with lower rates of congenital abnormalities in early pregnancy \- C. PTU has a longer half-life \- D. PTU is less likely to cross the placenta \*\*Answer:\*\* B. PTU is associated with lower rates of congenital abnormalities in early pregnancy 2\. \*\*Which serious adverse effect is associated with the use of PTU?\*\* \- A. Renal failure \- B. Severe liver injury and acute liver failure \- C. Hypoglycemia \- D. Thrombocytopenia \*\*Answer:\*\* B. Severe liver injury and acute liver failure 3\. \*\*What laboratory test should be monitored regularly when starting PTU therapy?\*\* \- A. Serum calcium levels \- B. Liver function tests (LFTs) \- C. Renal function tests \- D. Blood glucose levels \*\*Answer:\*\* B. Liver function tests (LFTs) \#\#\# \*\*Slide 31: Thioamides - Adverse Effects\*\* 1\. \*\*What is the most serious adverse effect associated with methimazole and PTU?\*\* \- A. Hepatotoxicity \- B. Agranulocytosis \- C. Hypoglycemia \- D. Hypercalcemia \*\*Answer:\*\* B. Agranulocytosis 2\. \*\*Which symptom should prompt urgent medical evaluation in a patient taking methimazole or PTU?\*\* \- A. Diarrhea \- B. Sore throat and fever \- C. Weight gain \- D. Hair loss \*\*Answer:\*\* B. Sore throat and fever 3\. \*\*Which liver condition is associated with propylthiouracil (PTU)?\*\* \- A. Cholestatic liver dysfunction \- B. Allergic hepatitis \- C. Fatty liver disease \- D. Cirrhosis \*\*Answer:\*\* B. Allergic hepatitis \-\-- \#\#\# \*\*Slide 32: Thioamides - Monitoring and Lab Testing\*\* 1\. \*\*What baseline lab test should be performed before starting thioamide therapy?\*\* \- A. Serum creatinine \- B. TSH and Free T4 \- C. Serum glucose \- D. Serum calcium \*\*Answer:\*\* B. TSH and Free T4 2\. \*\*When should a CBC with differential be checked in patients taking thioamides?\*\* \- A. At baseline and anytime symptoms of agranulocytosis appear \- B. Only when symptoms of liver dysfunction occur \- C. Once every 6 months \- D. After 3 months of therapy \*\*Answer:\*\* A. At baseline and anytime symptoms of agranulocytosis appear 3\. \*\*What should be monitored regularly in patients on thioamide therapy to assess for liver injury?\*\* \- A. Serum potassium \- B. Liver enzymes (LFTs) \- C. Blood urea nitrogen (BUN) \- D. Urine output \*\*Answer:\*\* B. Liver enzymes (LFTs) \-\-- \#\#\# \*\*Slide 33: Iodides - Clinical Uses\*\* 1\. \*\*Which of the following is an indication for iodide use in thyroid disease management?\*\* \- A. To reduce the size and vascularity of the thyroid gland before surgery \- B. To increase thyroid hormone production in hypothyroidism \- C. As monotherapy for long-term control of hyperthyroidism \- D. To prevent thyroid hormone release during radioactive iodine therapy \*\*Answer:\*\* A. To reduce the size and vascularity of the thyroid gland before surgery 2\. \*\*How do large doses of iodide inhibit thyroid hormone release?\*\* \- A. By increasing thyroglobulin synthesis \- B. By inhibiting organification and blocking thyroid hormone synthesis \- C. By stimulating TSH release from the pituitary gland \- D. By increasing iodine uptake by the thyroid \*\*Answer:\*\* B. By inhibiting organification and blocking thyroid hormone synthesis 3\. \*\*Which condition is a contraindication for iodide use in thyroid disease?\*\* \- A. Pregnancy \- B. Hyperthyroidism \- C. Graves' disease \- D. Diabetes mellitus \*\*Answer:\*\* A. Pregnancy \-\-- \#\#\# \*\*Slide 34: Iodides - Adverse Effects\*\* 1\. \*\*Which of the following is a disadvantage of iodide use in thyroid storm management?\*\* \- A. Short duration of effect \- B. Delayed onset of symptom improvement \- C. Risk of hyperkalemia \- D. Inability to combine with thioamides \*\*Answer:\*\* B. Delayed onset of symptom improvement 2\. \*\*What is the typical duration of iodide's effect on thyroid hormone synthesis?\*\* \- A. 2 weeks \- B. 4 weeks \- C. 8 weeks \- D. 12 weeks \*\*Answer:\*\* A. 2 weeks 3\. \*\*Why should iodides not be used alone for long-term hyperthyroidism management?\*\* \- A. Because they can cause hypothyroidism \- B. Because their effect on thyroid hormone release lasts only a few weeks \- C. Because they cause irreversible thyroid damage \- D. Because they increase the risk of thyroid storm \*\*Answer:\*\* B. Because their effect on thyroid hormone release lasts only a few weeks \-\-- \#\#\# \*\*Slide 35: Beta-blockers in Hyperthyroidism\*\* 1\. \*\*What is the primary use of beta-blockers in the management of hyperthyroidism?\*\* \- A. To inhibit thyroid hormone synthesis \- B. To manage symptoms like tachycardia and anxiety \- C. To block iodine uptake in the thyroid \- D. To prevent agranulocytosis \*\*Answer:\*\* B. To manage symptoms like tachycardia and anxiety 2\. \*\*Which beta-blocker is most commonly used in the management of hyperthyroid symptoms?\*\* \- A. Atenolol \- B. Metoprolol \- C. Propranolol \- D. Carvedilol \*\*Answer:\*\* C. Propranolol 3\. \*\*At what dose of propranolol does it start inhibiting the peripheral conversion of T4 to T3?\*\* \- A. 80 mg/day \- B. 100 mg/day \- C. 160 mg/day \- D. 240 mg/day \*\*Answer:\*\* C. 160 mg/day Slide 36: Iodides - Clinical Uses and Mechanism of Action Which of the following describes the mechanism of action of iodides in thyroid storm management? A. Increase the conversion of T4 to T3 B. Inhibit the release of thyroid hormones by blocking organification C. Stimulate thyroid hormone synthesis D. Block iodine uptake by the thyroid gland\ Answer: B. Inhibit the release of thyroid hormones by blocking organification What is a clinical use of potassium iodide in thyroid disease? A. To treat hypothyroidism B. To reduce the size and vascularity of the thyroid before surgery C. As a long-term therapy for hyperthyroidism D. To increase TSH secretion\ Answer: B. To reduce the size and vascularity of the thyroid before surgery Why should iodide use be avoided in pregnancy? A. It can cause hyperthyroidism in the fetus B. It increases the risk of iodine-induced hypothyroidism C. It can cause goiter and hypothyroidism in the fetus D. It leads to a higher risk of miscarriage\ Answer: C. It can cause goiter and hypothyroidism in the fetus Slide 37: Beta-Blockers in Hyperthyroidism Which of the following is a key benefit of beta-blocker therapy in hyperthyroidism? A. They inhibit TSH secretion B. They block thyroid hormone synthesis C. They provide symptomatic relief by controlling tachycardia and anxiety D. They promote the conversion of T4 to T3\ Answer: C. They provide symptomatic relief by controlling tachycardia and anxiety Which beta-blocker is commonly used in the management of hyperthyroid symptoms? A. Metoprolol B. Atenolol C. Propranolol D. Carvedilol\ Answer: C. Propranolol At high doses, propranolol can have what additional effect in hyperthyroidism management? A. Increase TSH secretion B. Inhibit the peripheral conversion of T4 to T3 C. Increase T4 secretion from the thyroid D. Stimulate beta-adrenergic receptors\ Answer: B. Inhibit the peripheral conversion of T4 to T3 \#\#\# \*\*Slide 37: Alpha-Glucosidase Inhibitors - Mechanism of Action\*\* 1\. \*\*What is the primary mechanism of action of alpha-glucosidase inhibitors like acarbose and miglitol?\*\* \- A. Inhibits glucose reabsorption in the kidneys \- B. Delays the breakdown and absorption of complex carbohydrates in the intestines \- C. Stimulates insulin secretion from beta cells \- D. Enhances insulin sensitivity in peripheral tissues \*\*Answer:\*\* B. Delays the breakdown and absorption of complex carbohydrates in the intestines【176:0†source】 2\. \*\*Which of the following is a benefit of using alpha-glucosidase inhibitors for managing type 2 diabetes?\*\* \- A. They do not cause hypoglycemia when used as monotherapy \- B. They increase insulin sensitivity \- C. They directly stimulate beta-cell insulin secretion \- D. They promote weight loss \*\*Answer:\*\* A. They do not cause hypoglycemia when used as monotherapy【176:0†source】 3\. \*\*Alpha-glucosidase inhibitors primarily affect which phase of glucose regulation?\*\* \- A. Fasting blood glucose \- B. Postprandial glucose \- C. Basal glucose levels \- D. Nocturnal glucose levels \*\*Answer:\*\* B. Postprandial glucose【176:0†source】 \-\-- \#\#\# \*\*Slide 38: Alpha-Glucosidase Inhibitors - Adverse Effects\*\* 1\. \*\*Which of the following is a common gastrointestinal side effect of alpha-glucosidase inhibitors?\*\* \- A. Diarrhea and abdominal cramping \- B. Nausea and vomiting \- C. Constipation \- D. Gastrointestinal bleeding \*\*Answer:\*\* A. Diarrhea and abdominal cramping【176:0†source】 2\. \*\*Alpha-glucosidase inhibitors are contraindicated in patients with which condition?\*\* \- A. Chronic kidney disease \- B. Cirrhosis \- C. Heart failure \- D. Hypertension \*\*Answer:\*\* B. Cirrhosis【176:0†source】 3\. \*\*Why are alpha-glucosidase inhibitors contraindicated in patients with inflammatory bowel disease (IBD)?\*\* \- A. They increase absorption of fats, worsening IBD \- B. They increase gas production, which may exacerbate symptoms of IBD \- C. They decrease nutrient absorption, worsening malabsorption in IBD \- D. They promote intestinal bleeding \*\*Answer:\*\* B. They increase gas production, which may exacerbate symptoms of IBD【176:0†source】 \-\-- \#\#\# \*\*Slide 39: Alpha-Glucosidase Inhibitors - Clinical Pearls\*\* 1\. \*\*When should alpha-glucosidase inhibitors be administered to achieve optimal glucose control?\*\* \- A. 30 minutes before meals \- B. With the first bite of a meal \- C. One hour after meals \- D. At bedtime \*\*Answer:\*\* B. With the first bite of a meal【176:0†source】 2\. \*\*How much can alpha-glucosidase inhibitors reduce A1c levels in patients with type 2 diabetes?\*\* \- A. 0.1-0.2% \- B. 0.5-0.6% \- C. 0.7-0.8% \- D. 1.0-1.2% \*\*Answer:\*\* C. 0.7-0.8%【176:0†source】 3\. \*\*Which of the following is important when treating hypoglycemia in patients on alpha-glucosidase inhibitors?\*\* \- A. Use sucrose-based sources like fruit juices \- B. Use glucose tablets or gels \- C. Increase carbohydrate intake with complex carbs \- D. Administer insulin \*\*Answer:\*\* B. Use glucose tablets or gels【176:0†source】 \-\-- \#\#\# \*\*Slide 40: Alpha-Glucosidase Inhibitors - Monitoring\*\* 1\. \*\*Which of the following should be monitored regularly in patients taking alpha-glucosidase inhibitors?\*\* \- A. Liver function tests (LFTs) \- B. Blood urea nitrogen (BUN) \- C. White blood cell count (WBC) \- D. Serum calcium \*\*Answer:\*\* A. Liver function tests (LFTs)【176:0†source】 2\. \*\*Why might post-meal self-monitoring of blood glucose (SMBG) be considered for select patients taking alpha-glucosidase inhibitors?\*\* \- A. To adjust insulin doses \- B. To monitor the effectiveness in controlling postprandial glucose \- C. To assess for nocturnal hypoglycemia \- D. To check fasting blood glucose levels \*\*Answer:\*\* B. To monitor the effectiveness in controlling postprandial glucose【176:0†source】 3\. \*\*Alpha-glucosidase inhibitors should be avoided in patients with a serum creatinine level greater than:\*\* \- A. 1.5 mg/dL \- B. 2 mg/dL \- C. 2.5 mg/dL \- D. 3 mg/dL \*\*Answer:\*\* B. 2 mg/dL【176:0†source】 \-\-- \#\#\# \*\*Slide 41: DPP-4 Inhibitors - Mechanism of Action\*\* 1\. \*\*What is the primary action of DPP-4 inhibitors in patients with type 2 diabetes?\*\* \- A. Stimulates insulin secretion and inhibits glucagon secretion \- B. Increases insulin sensitivity in peripheral tissues \- C. Enhances glucose reabsorption in the kidneys \- D. Slows glucose absorption in the intestines \*\*Answer:\*\* A. Stimulates insulin secretion and inhibits glucagon secretion【176:0†source】 2\. \*\*DPP-4 inhibitors increase levels of which two incretin hormones?\*\* \- A. GIP and GLP-1 \- B. Insulin and glucagon \- C. Ghrelin and leptin \- D. Amylin and somatostatin \*\*Answer:\*\* A. GIP and GLP-1【176:0†source】 3\. \*\*Which of the following is a key benefit of DPP-4 inhibitors?\*\* \- A. Weight loss \- B. Reduction in postprandial glucose levels \- C. Decreased absorption of carbohydrates \- D. Increased glycogen synthesis \*\*Answer:\*\* B. Reduction in postprandial glucose levels【176:0†source】 \-\-- \#\#\# \*\*Slide 42: DPP-4 Inhibitors - Mechanism of Action\*\* 1\. \*\*What is the primary action of DPP-4 inhibitors in managing type 2 diabetes?\*\* \- A. Stimulate insulin secretion in response to elevated blood glucose \- B. Increase glucose absorption in the intestines \- C. Inhibit insulin release from beta cells \- D. Promote glucose reabsorption in the kidneys \*\*Answer:\*\* A. Stimulate insulin secretion in response to elevated blood glucose【180:0†source】 2\. \*\*Which two incretin hormones are primarily affected by DPP-4 inhibitors?\*\* \- A. GLP-1 and GIP \- B. Insulin and glucagon \- C. Amylin and somatostatin \- D. Ghrelin and leptin \*\*Answer:\*\* A. GLP-1 and GIP【180:0†source】 3\. \*\*DPP-4 inhibitors reduce blood glucose by increasing which of the following?\*\* \- A. Gastric emptying time \- B. Insulin secretion and inhibiting glucagon secretion \- C. Lipolysis in adipose tissue \- D. Fatty acid oxidation \*\*Answer:\*\* B. Insulin secretion and inhibiting glucagon secretion【180:0†source】 \-\-- \#\#\# \*\*Slide 43: DPP-4 Inhibitors - Adverse Effects\*\* 1\. \*\*Which of the following adverse effects is associated with DPP-4 inhibitors?\*\* \- A. Acute pancreatitis \- B. Hypotension \- C. Hyperkalemia \- D. Weight gain \*\*Answer:\*\* A. Acute pancreatitis【180:0†source】 2\. \*\*What is a potential cardiovascular concern when using DPP-4 inhibitors?\*\* \- A. Increased risk of heart failure \- B. Increased risk of myocardial infarction \- C. Increased risk of stroke \- D. Hypertension \*\*Answer:\*\* A. Increased risk of heart failure【180:0†source】 3\. \*\*Which of the following best describes the hypoglycemic risk when using DPP-4 inhibitors as monotherapy?\*\* \- A. High risk of hypoglycemia \- B. Moderate risk of hypoglycemia \- C. Low risk of severe hypoglycemia \- D. No risk of hypoglycemia \*\*Answer:\*\* C. Low risk of severe hypoglycemia【180:0†source】 \-\-- \#\#\# \*\*Slide 44: DPP-4 Inhibitors - Clinical Pearls\*\* 1\. \*\*What is a key benefit of DPP-4 inhibitors in terms of weight management for type 2 diabetes patients?\*\* \- A. They promote weight loss \- B. They are weight neutral \- C. They cause weight gain \- D. They reduce body fat \*\*Answer:\*\* B. They are weight neutral【180:0†source】 2\. \*\*By how much can DPP-4 inhibitors reduce hemoglobin A1c levels?\*\* \- A. 0.1-0.3% \- B. 0.4-0.5% \- C. 0.5-0.7% \- D. 0.8-1.0% \*\*Answer:\*\* C. 0.5-0.7%【180:0†source】 3\. \*\*Which of the following clinical applications is appropriate for DPP-4 inhibitors?\*\* \- A. Used as monotherapy in type 1 diabetes \- B. Used in combination with GLP-1 agonists \- C. Can be used in combination with metformin \- D. Used primarily for patients with ketoacidosis \*\*Answer:\*\* C. Can be used in combination with metformin【180:0†source】 \-\-- \#\#\# \*\*Slide 45: DPP-4 Inhibitors - Monitoring\*\* 1\. \*\*Which of the following parameters should be regularly monitored in patients on DPP-4 inhibitors?\*\* \- A. Hepatic function \- B. Renal function \- C. Serum potassium \- D. Blood pressure \*\*Answer:\*\* B. Renal function【180:0†source】 2\. \*\*Why is it important to monitor for signs of pancreatitis in patients taking DPP-4 inhibitors?\*\* \- A. DPP-4 inhibitors can increase the risk of acute pancreatitis \- B. Pancreatitis is a sign of DPP-4 inhibitor overdose \- C. DPP-4 inhibitors improve pancreatic function \- D. Pancreatitis is a contraindication for all diabetes medications \*\*Answer:\*\* A. DPP-4 inhibitors can increase the risk of acute pancreatitis【180:0†source】 3\. \*\*What is the potential risk of DPP-4 inhibitors in patients with a predisposition to cancer?\*\* \- A. Increased risk of colorectal cancer \- B. Potential promotion of cellular invasion in some cancers \- C. Decreased risk of melanoma \- D. No cancer risk associated with DPP-4 inhibitors \*\*Answer:\*\* B. Potential promotion of cellular invasion in some cancers【180:0†source】 \-\-- \#\#\# \*\*Slide 46: Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors - Mechanism of Action\*\* 1\. \*\*What is the primary mechanism of action of SGLT2 inhibitors in the treatment of type 2 diabetes?\*\* \- A. Blocking glucose absorption in the intestines \- B. Blocking glucose reabsorption in the kidneys \- C. Increasing insulin production by beta cells \- D. Enhancing peripheral glucose uptake \*\*Answer:\*\* B. Blocking glucose reabsorption in the kidneys【180:0†source】 2\. \*\*Which of the following effects does SGLT2 inhibition have on glucose excretion?\*\* \- A. Decreases glucose excretion in the urine \- B. Increases glucose excretion in the urine \- C. Promotes insulin sensitivity in the kidneys \- D. Reduces insulin requirements for glucose excretion \*\*Answer:\*\* B. Increases glucose excretion in the urine【180:0†source】 3\. \*\*SGLT2 inhibitors are most beneficial for patients with which of the following comorbid conditions?\*\* \- A. Chronic kidney disease (CKD) and heart failure \- B. Hypertension and obesity \- C. Liver cirrhosis and hypertension \- D. COPD and heart failure \*\*Answer:\*\* A. Chronic kidney disease (CKD) and heart failure【180:0†source】