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Human Diseases > Antidiabetic Drugs, Anti-thyroid Drugs and Oral Contraceptives > Flashcards

Antidiabetic Drugs, Anti-thyroid Drugs and Oral Contraceptives Flashcards

1
Q

Where are the hormones thyroxine/levothyroxine (T4) and tri-iodothyronine (T3) made from?

(Both under the control of TSH)

A

Thyroid gland

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2
Q

What hormone is produced by C (parafollicular) cells of thyroid gland?

A

Calcitonin

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3
Q

Hypothalamus -> Anterior Pituitary -> Thyroid Gland
State the hormones released at each structure.

A

TRH -> TSH -> T4 and T3

TRH = thyrotropin releasing hormone; TSH = thyroid stimulating hormone

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4
Q

What ions are thyroid hormone production dependent upon?

A

Iodide

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5
Q

What are thyroid hormones stored as?

A

Thyroglobulin

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6
Q

Thyroglobulin undergoes _________ to release hormones

A

Proteolysis

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7
Q

Which is more potent - T3 or T4?

A

T3

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8
Q

What does T4 become after undergoing transformation in the tissues?

A

T3

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9
Q

What do the T3 and T4 hormones influence?

A

DNA transcription and thus protein synthesis

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10
Q

What do thyroid hormones do?

A

Regulate growth: brain development
Calorigenic effects: increase O2 consumption (effect on BMR)
Metabolic effects: transform cholesterol to bile salts; increase lipolysis; increase blood glucose; increase metabolic rate
Cardiovascular effects: direct; indirect (increase sensitivity to catecholamines via beta receptor expression)

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11
Q

What are the causes of hypothyroidism in children?

A

Congenital hypothyroidism (causing cretinism)
Hashimoto’s thyroiditis (acquired autoimmune disease; usually affect teens; most common cause of hypothyroidism)

Cretinism: intellectual disability,small stature,thick facial features

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12
Q

What are the causes of thyroid hypofunction in adults?

A

Autoimmune destruction
Post surgery

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13
Q

What are the clinical features of myxoedema which is caused by thyroid hypofunction?

A

Puffiness of skin
Exopthalmous (deposition of protein and mucopolysaccharides leading to abnormal protrusion of eyeballs)

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14
Q

What does thyroid hypofunction cause?

A

Impaired immune response

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15
Q

What is the second most common endocrine disorder after diabetes mellitus?

A

Thyroid disease

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16
Q

What is the treatment of thyroid hypofunction?

A

Levothyroxine sodium (orally) for maintenance

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17
Q

What autoimmune disease can be acquired and cause hyperthyroidism?

A

Graves’ disease (diffuse goitre)

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18
Q

What clinical features will be present in patients with thyroid hyperfunction?

A

Anxiety
Tremor
Increase heart rate
Muscle weakness
Insomnia

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19
Q

What are the 3 methods of treating hyperthyroidism?

A

Antithyroid drugs eg carbimazole and propylthiouracil
Potassium iodide
Radioactive iodine

Control the production of T3 and T4

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20
Q

What are the 2 antithyroid drugs?

A

Carbimazole
Propylthiouracil

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21
Q

How do carbimazole and propylthiouracil work?

A

The ‘thionamides’ or ‘thiourylenes’ prevent incorporation of iodine into T3 and T4.
Propylthiouracil also stops conversion of T4 to T3.

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22
Q

What is the most commonly used drug to treat hyperthyroidism in the UK?

A

Carbimazole

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23
Q

When is propylthiouracil used instead of carbimazole?

A

If intolerant or sensitive to carbimazole
In 1st trimester of pregnancy

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24
Q

When is iodine given as treatment for thyroid hyperfunction?

A

Short term only prior to partial thyroidectomy

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25
Q

What are some unwanted side effects of antithyroid medications?

A

Thionamides: agranulocytosis, urticarial rash, hepatitis, arthralgia
Iodine-containing preps: hypersensitivity reactions (angioedema)
Radioactive iodine: hypothyroidism

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26
Q

What influences calcium and phosphate metabolism?

A

Calcitonin

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27
Q

What hormone does calcitonin oppose?

A

Parathyroid hormone (PTH)

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28
Q

What does calcitonin produce?

A

Hypocalcaemia
Hypophosphataemia

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29
Q

How does calcitonin work?

A

Inhibition of osteoclasts

Osteoclasts break down bone and release calcium into bloodstream

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30
Q

What is calcitonin used to treat?

A

Hypercalcaemia
Paget’s

31
Q

What are the different types of calcitonin and how to administer calcitonin?

A

Salmon, eel, pig or synthetic human calcitonin
SC or IM injection

32
Q

What needs to be avoided in uncontrolled hyperthyroidism?

A

Adrenaline

33
Q

What could Candidiasis be a possible indication of?

A

Reduced immune response in hypothyroidism

34
Q

What medications may taste disturbance be caused by?

A

Calcitonin
Carbimazole
Propylthiouracil

35
Q

What can cause damage to salivary glands?

A

Radioactive iodine

36
Q

What is type 1 diabetes mellitus due to?

A

Deficiency of insulin

37
Q

What is type 2 diabetes mellitus due to?

A

Decreased insulin secretion or resistance to insulin action

38
Q

How to treat diabetes?

A

Supply insulin
Increase insulin intake
Decrease glucose intake
Decrease glucose uptake

39
Q

What can inactivate insulin?

A

Gut enzymes

therefore cannot be taken intraorally

40
Q

Insulin can be administered parenterally. For maintenance, __________ injection. For emergency, ___________ injection.

A

Subcutaneous, intravenous

41
Q

What is the insulin adminestered through inhalation called?

A

Afrezza

Not currently available on NHS

42
Q

What type of insulins are there?

A

Animal insulin
Human insulin eg Humulin
Human analogue insulin (subgroup of human insulin) eg rapid acting, long acting, intermediate acting

43
Q

What are some examples of insulin regimens?

A

Once-daily insulin regimen
Twice daily insulin regimen or Biphasic
Basal-bolus regimen / multiple daily injection therapy
Continuous subcutaneous insulin infusion (CSII) / insulin pump therapy

44
Q

Once-daily insulin regimen:
Type _ diabetes supplemental to ______ __________

A

2, oral hypoglycaemics

45
Q

Twice daily insulin regimen or Biphasic:
Mix of short and _______ acting insulin

A

Intermediate

46
Q

Basal-bolus regimen / multiple daily injection therapy:
Type _ commonly
More flexible and tailorable to meal
Use of basal intermediate or long acting and separate short or rapid acting insulin

A

1

47
Q

CSII / insulin pump therapy:
Type _
Rapid insulin continuously
Adjustable

A

1

48
Q

Soluble insulin may cause ____ and _____ of the salivary glands

A

Pain, swelling

49
Q

What may inhaled insulin cause?

A

Dry mouth

50
Q

If GA involved dental procedure, usually involves checking __________.

A

HbA1c

51
Q

Which drug class can produce hypoglycaemia?

And should be used with caution?

A

NSAIDs

52
Q

What drug class can antagonise the hypoglycaemic effect of insulin?

A

Systemic steroids

53
Q

When should oral hypoglycaemics be used?

A

Only after >3 months of diet and exercise to try and control T2 diabetes and afterwards as a supplement to lifestyle factors

54
Q

What are some classes of oral hypoglycaemics?

A

Sulphonylureas
Biguanides
Thiazolidinediones (glitazones)
Alpha-glucosidase inhibitors

55
Q

Sulphonylureas are used to _________ insulin secretion, but must have functional beta cells. They are for those who are not _________ or those who cannot take ________. Examples of sulphonylureas include _______, _______ and tolbutamide. Sulphonylureas can be used in combination with other oral hypoglycaemic drugs.

A

Augment, overweight, metformin, gliclazide, glipizide

56
Q

Sulphonylureas are used to _________ insulin secretion, but patients must have functional beta cells. They are for those who are not _________ or those who cannot take ________. Examples of sulphonylureas include _______, _______ and tolbutamide. Sulphonylureas can be used in combination with other oral hypoglycaemic drugs.

A

Augment, overweight, metformin, gliclazide, glipizide

57
Q

Biguanides can only act in the presence of ______ so it will only work in patients with functional beta cells. Biguanides decrease ____________ and increase peripheral utilisation of __________. They are first choice of drug for _______ patients. An example of biguanide is metformin.

A

Insulin, gluconeogenesis, glucose, overweight

58
Q

Other oral hypoglycaemic drugs:
_________ inhibits intestinal α-glucosidases delays the digestion and absorption of starch and sucrose
‘________’ (pioglitazone) reduce peripheral insulin resistance, leading to a reduction of blood-glucose concentration
‘Gliptins’ (Alogliptin, linagliptin, saxagliptin) inhibit dipeptidylpeptidase-4 to increase insulin secretion and lower glucagon secretion
‘______’ (Exenatide, albiglutide, dulaglutide) bind to, and activate, the GLP-1 (glucagon-like peptide-1) receptor to increase insulin secretion, suppress glucagon secretion, and slow gastric emptying
‘______’ (Canagliflozin, dapagliflozin, empagliflozin) reversibly inhibit sodium-glucose co-transporter 2 (SGLT2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion

A

Acarbose
Glitazones
Gliptins
Tides
Gliflozin

59
Q

What oral hypoglycaemic drug may cause lichenoid eruptions, erythema multiforme and oral neuropathy?

A

Sulphonylureas

60
Q

What oral hypoglycaemic drug can produce taste disorders?

A

Metformin

61
Q

How to treat patients who are having hypoglycaemic episodes?

A

Oral glucose 10-20g (3 sugar lumps/2 teaspoon of sugar/100ml sugary drink/Glucogel)
If unconscious: 1mg IM or SC glucagon; less commonly available IV glucose 20-50ml of a 50% dextrose solution

62
Q

Combined oral contraceptive: ________ and ________. __ days active, __ days inactive.

A

Oestrogen and progesterone. 21, 7.

63
Q

____________-only oral contraceptive: continuous use. ‘mini pill’. Used when oestrogens contra-indicated eg predisposition to venous thrombosis.

A

Progesterone

64
Q

For patients who do not want to take progesterone-only oral contraceptive tablet everyday, what can they opt for?

A

Progesterone-only depot injection or implant

65
Q

What is in ‘morning after’ pill?

A

Oestrogen only

66
Q

How does oestrogen work?

A

Inhibits ovulation by inhibition of FSH

67
Q

How does progesterone work?

A

Inhibits release of LH, changes the endometrium to discourage implantation and thickens cervical mucus (prevents sperm from entering uterus)

68
Q

What effects do oral contraceptives cause that are related to dentistry?

A

Increase plaque-induced inflammation
Increase gingival crevicular fluid
Gingival pigmentation
Appear to increase the incidence of dry socket
Improves severity of oral aphthous ulceration related to menstruation
May increase post-operative pain

69
Q

Anticonvulsants eg __________ (enzyme-inducing) can stop oral contraceptives from working.

A

Carbamazepine

70
Q

What type of antibiotics will cause a problem when taking together with oral contraceptives? Give an example.

A

Enzyme-inducer eg rifampicin

71
Q

Are routine dental antibiotics enzyme-inducers?

A

No

72
Q

What should be recommended to patients who are taking enzyme-inducing antibiotics while using hormonal contraception?

A

Additional contraceptive methods such as condoms or IUD

73
Q

If antibiotics other than rifampicin and rifabutin are taken, additional contraception is not usually needed. However, concerns arise when symptoms such as _________ or _________ come up. The effect of the antibiotics on gut flora and enterohepatic cycling can affect the absorption of the oestrogen pills.

A

Diarrhoea, vomiting.

74
Q

What are the two drugs we need to be concerned about interacting with oral contraceptives?

A

Enzyme-inducing anticonvulsants eg carbamazepine
Antibiotics (enzyme-inducing eg rifampicin; non-enzyme-inducing but cause diarrhoea or vomiting)

Human Diseases (24 decks)

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