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Pharmacology > (2) Endocrine and Diabetes > Flashcards

(2) Endocrine and Diabetes Flashcards

1
Q

Which hormones are secreted by the posterior pituitary

A 
Antidiuretic hormone (ADH)
Oxytocin
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2
Q

Where does ADH act

A

kidney tubules

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3
Q

where does oxytocin act

A

uterine smooth muscle and mammary glands

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4
Q

What is T4

A

Thyroxine (the less active thyroid hormone, longer half life)

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5
Q

What is T3

A

Triodothyronine (more active thyroid hormone, shorter half life)

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6
Q

What is used by the thyroid to make T3 and T4

A

iodine and tyrosine

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7
Q

What causes goiter formation

A

Most commonly caused by lack of dietary iodine

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8
Q

What is primary hypothyroidism

A

when the thyroid gland doesn’t produce enough thyroid hormone

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9
Q

What does Hashimotos disease cause

A

auto-immune disease that attacks the thyroid causing hypothyroidism

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10
Q

What is secondary hypothyroidism

A

when the pituitary isn’t secreting enough TSH, often caused by a tumor

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11
Q

What are the functions of the thyroid hormones

A
  1. regulate gene expression to increase metabolism
  2. increase BMR
  3. Stimulate carbohydrate metabolism and lipolysis
  4. affect protein synthesis
  5. increase sensitivity to catecholamines
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12
Q

What will an insufficient diet of iodine cause

A

hypothyroidism

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13
Q

What are the clinical signs of hypothyroidism

A 
weight gain
constipation
fatigue
irregular menstrual cycle
edema
(retardation if untreated from  a young age)
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14
Q

What is the method of treatment for hypothyroidism

A 
hormone replacement therapy
Levothyroxine (synthetic T4)
Levothyronine (synthetic T3)
Liotrix (both T3 and T4)
natural thyroid hormones (porcine or bovine T3 and T4)
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15
Q

What is the difference between T3 and T4

A

T3 is the more active form
T4 has a longer half life, has higher plasma concentration and is converted into T3 by Tissue Deiodinase
(T4 has 4 iodine molecules, T3 has 3)

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16
Q

What is the Synthetic T4 hormone replacement drug

A

levothyroxine

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17
Q

what is the synthetic T3 drug

A

levothyronine

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18
Q

what is liotrix

A

synthetic T3 and T4

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19
Q

What is armour thyroid

A

porcine T3 and T4 used to treat hypothyroidism

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20
Q

What is caused by thyroid hormone replacement overdose

A
  • nervousness
  • Tachycardia (risk of angina and complications with epi
  • nausea and diarrhea
  • tremors
  • weight loss
  • heat intolerance
    (all symptoms of hyperthyroidism)
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21
Q

What are the symptoms of hyperthyroidism

A
  • Fatigue
  • Weight loss
  • tachycardia
  • anxiety
  • swollen eyes (exopthalmus)
  • heat intolerance
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22
Q

What are the different causes of primary hyperthyroidism

A

Graves disease
thyroid tumors
thyroiditis

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23
Q

What is graves disease

A

an autoimmune disorder with antibodies that serve as agonist to thyroid receptors, causing activation of thyroid

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24
Q

what does a tumor of the thyroid cause

A

uncontrolled synthesis and secretion of thyroid hormones

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25
Q

what is thyroiditis

A

inflammation of the thyroid caused by infection or stress

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26
Q

what is a thyroid storm

A

sudden onset of hyperthyroidism

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27
Q

how is hyperthyroidism treated

A
  1. Anti-thyroid drugs (thioamides)
  2. Radioactive Iodine
  3. Thyroidectomy
  4. B-Blockers (thyroiditis)
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28
Q

How do Anti-thyroid (thioamides) drugs work

A

by inhibiting thyroid hormone synthesis

they irreversibly bind to thyroid peroxidase (which breaks down iodine and attaches it to tyrosine)

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29
Q

What are the names of common anti-thyroid drugs (thioamides)

A

propylthiouracil

methimazole

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30
Q

What are the adverse affects of anti-thyroid drugs

A

rash
nausea
agranulocytosis

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31
Q

how does radioactive iodine work for hyperthyroidism

A

it can be used in imaging purposes to visualize where iodine is being taken up
it also can be used to destroy thyroid cells or cancer cells in the thyroid that are causing hyperthyroidism

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32
Q

should the taking of thyroid drugs be abruptly stopped

A

no

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33
Q

What are the hormones produced by the adrenal gland

A 
Medulla = epi and norepi
cortex
= mineralcorticoids (aldosterone)
= glucocorticoids (cortisol)
= androgens (testosterone)
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34
Q

What is adrenocorticotropin (ACTH) and what does it do

A

the anterior pituitary hormone that stimulates the production of cortisol from the adrenal cortex

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35
Q

how is ACTH used as a diagnostic tool

A

it is given then the amount of cortisol produced is evaluated. it indicates the capacity of the adrenal cortex to produce cortisol

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36
Q

What are the two main diseases associated with the adrenal cortex

A

addisons disease and cushings disease

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37
Q

what is addisons disease

A

adrenal insufficiency = lack of all adrenal hormones

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38
Q

what is cushings disease

A

hypercortisolism

39
Q

What is the cause of addisons disease

A

usually autoimmune destruction of the adrenal glands

40
Q

what is the method of treatment for addisons disease

A

hormone replacement therapy
1 - cortisone/hydrocortisone = glucocorticoid
2 - fludrocortisone = mineralocorticoid

41
Q

What are glucocorticoids used for

A 
1 - asthma
2 - anti-inflammation
3- collagen/connective tissue diseases
4 - rheumatic diseases
5 - some lymphomas and leukemias
6 - cerebral edema
7 - acute MS attacks
42
Q

How can glucocorticoids be administered

A

topically, eye drops, nasal spray, tablet, liquid, IV, inhalation

43
Q

what are the adverse affects of glucocorticoids

A
  • insomnia
  • infections
  • skin and muscle atrophy
  • hypertension, atherosclerosis
  • osteoporosis
  • weight gain
  • hyperglycemia
  • cataracts and glaucoma
    (cushings syndrome in cases of overdose)
44
Q

Why are topical/nasal spray/inhaled glucocorticoids used before oral and IV

A

because they are lower doses and less likely to have adverse effects

45
Q

What are the actions of glucocorticoids

A
  1. raise plasma glucose

2. anti-inflammatory

46
Q

how do glucocorticoids raise plasma glucose

A
  1. decrease glucose uptake
  2. stimulate gluconeogenesis
  3. stimulate lipolysis
47
Q

how do glucocorticoids act as anti-inflammatory

A

inhibit NF-KB, macrophages, and phospholipase A2

48
Q

What is the suffix for corticoids (gluco- and mineralo-)

A

isone

olone

49
Q

When are corticosteroids used in dentistry

A

when patients suffer from immune based oral pathology (erosive lichen planus, pemphigus, etc)
or in cases of acute allergic reactions

50
Q

What are the things to remember when prescribing glucocorticoids

A
  1. topical is preferred over systemic
  2. if using systemic use short term high dose instead of long term low dose
  3. take in the AM to mimic natural cycle
  4. take on alternate days if possible
  5. gradually increase and decrease dose
51
Q

What is the most common reason for estrogen use as a medication

A

in post-menopausal women as hormone replacement

52
Q

what are common estrogens/progestins

A
  1. estradiol (Estrace)
  2. conjugated estrogens (premarin)
  3. estropipate (Ogen)
53
Q

What makes up oral contraceptives

A

a combination of estrogen and progestin

54
Q

what is the oral contraceptive “minipill”

A

progestin only

55
Q

what is the emergency contraceptive or Plan B

A

Levnorgestrel

56
Q

What is the primary side effect of oral contraceptives

A

increased risk of thromboembolism

57
Q

What are metandren and halotestin

A

methyltestosterone = metandren
fluoxymesterone = halotestin
testosterone replacement drugs

58
Q

what is sildenafil

A

viagra

59
Q

What is the primary source of energy for a cell in the body

A

glucose

60
Q

where is excess glucose stored, and what is it stored as

A

in the liver as glycogen

61
Q

what does glucagon do

A

starts the process of glycogenolysis

62
Q

what causes glucagon to be secreted

A

low blood glucose levels

63
Q

where is glucagon released from

A

alpha cells in the pancreas

64
Q

what is insulin

A

the hormone that causes the uptake of glucose into cells (including storage into fat cells) and causes glycogenesis in the liver

65
Q

where causes the secretion of insulin

A

high blood glucose levels

66
Q

where is insulin secreted from

A

beta cells in the pancreas

67
Q

What is normal blood glucose levels

A

80-100 mg/dl

68
Q

What is the diagnostic level for diabetes

A

FASTING blood glucose of 126 mg/dl or higher

69
Q

What is diabetes mellitus

A

chronic hyperglycemia

70
Q

what are the base causes of diabetes mellitus

A
  1. inadequate insulin secretion
  2. abnormal insulin target responsiveness
  3. both
71
Q

What is type 1 diabetes mellitus

A

autoimmune destruction of pancreatic beta cells = inadequate or no insulin secretion
often childhood onset

72
Q

what are the clinical manifestations of type 1 diabetes

A
  1. polyuria
  2. polydipsia
  3. polyphagia
  4. weight loss
  5. fatigue
  6. glucosuria
  7. vaginal yeast infection
73
Q

What is the treatment for type 1 diabetes

A

insulin therapy

74
Q

What are the different insulin preparations

A

Rapid acting - Aspart (novolog) Lispro (humalog)
short acting - Novolog Mix, Humulin R
intermediate - Novolin NPH, Humulin N
Prolonged - Humulin U, Glargine, Detemir

75
Q

What is the most difficult problem for type 1 diabetics

A

knowing the right dose and the right time to take the dose

76
Q

what is the effect of incretins on insulin

A

stimulates insulin secretion

77
Q

when and from where are incretins secreted

A

from the small intestine when food is being absorbed

78
Q

What are the functions of insulin

A
  1. increase glucose uptake by most insulin sensitive cells
  2. enhance glucose usage and storage in cells
  3. enhance amino acid utilization
  4. promote fat synthesis
79
Q

What is diabetic ketoacidosis

A

when the body can’t utilize glucose due to insufficient insulin it breaks down ketones for fuel. if untreated it can lower blood ph which can lead to coma and death

80
Q

what is the characteristic sign of ketoacidosis

A

fruity breath smell (from acetone)

81
Q

What is happens on an insulin overdose

A

hypoglycemia (can lead to shock and even death)

82
Q

What is the diagnostic level for hypoglycemia

A

below 50mg/dl

83
Q

What are the signs and symptoms of hypoglycemia

A

Shakiness, dizziness, sweating, hunger, headache, pale skin, sudden moodiness, confusion, tingling sensation around the mouth

84
Q

what to do for hypoglycemia

A

give sugar, juice, glucagon

85
Q

What is type II diabetes

A

when a patient has normal plasma insulin levels (or slightly high) but has high blood glucose levels (>126 mg/dl). blood glucose levels stay high longer than normal. suggesting that insulin function is decreased

86
Q

What is an A1c test

A

a test used to monitor glucose control of diabetes over time (gives an average of blood glucose over a 4 month period)

87
Q

what is a healthy A1c score

A

4-5.9

blood glucose would be 60 - 100

88
Q

What are the different drug classes used in type II diabetes

A

insulin secretagogues (increase insulin output)
Biguanides (decrease glucose production in liver)
Thiazolidinediones (decrease insulin resistance)
a-Glucosidase inhibitor (delays carb absorption)
GLP-1 receptor agonists (sitmulate insulin secretion)

89
Q

Along with medications what is done to treat type II diabetes

A

diet, exercise, smoking cessation, monitoring of blood glucose levels

90
Q

What are the insulin secretagogues (increase insulin output) drugs

A 
glimiperide
glipizide
glyburide
repaglinide
nateglinide
91
Q

what are the Biguanides drugs and what do they do

A

metformin

decrease glucose production in liver

92
Q

What are the Thiazolidinediones and what do they do

A

rosiglitasone
poiglitasone
(decrease insulin resistance)

93
Q

What are the a-Glucosidase inhibitor drugs and what do they do

A

acarbose
miglitol
(delays carb absorption)

94
Q

what are the GLP-1 receptor agonists and what do they do

A

Exenatide
liraglutide
Incretin mimics (stimulate insulin secretion from pancreas)

Pharmacology (8 decks)

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