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Pharm Part II > E2: Endocrine Pt 1: Thyroid & Diabetes > Flashcards

E2: Endocrine Pt 1: Thyroid & Diabetes Flashcards

1
Q

LACK of iodine in diet leads to excessive secretion of ____, resulting in thyroid hypertrophy aka a _______.

A

TSH… goiter

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2
Q

_______ hypo/hyperthyroidism = disease of THYROID gland

A

PRIMARY

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3
Q

________ hypo/hyperthyroidism = disease of pituitary or HYPOTHALAMUS gland

A

SECONDARY

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4
Q

WHAT is the precursor to making thyroid hormones T4 and T3??… T4 and T3 are IODINATED derivatives of this…

A

L-tyrosine

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5
Q

WITHOUT iodine, build-up of TH precursor, resulting in a ______

A

goiter

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6
Q

Syn and storing Thyroid hormone: Occurs as part of the synthesis of ________, a large glycoprotein….This form is NEVER secreted into the bloodstream

A

thyroglobulin

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7
Q

Getting T3 and T4 made! Lysosomes fuse with vesicles resulting in ________ of thyroglobulin and release of iodinated amino acids (T3 and T4).

A

proteolysis

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8
Q

YAY recycling! ____________ and ___________ undergo deiodination, allowing for recirculation of iodine

A

Diiodotyrosine and moniodotyrosine

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9
Q

What are the TWO synthetic thyroid preparations made by industry?

A

1.Sodium Levo-thy-rox-ine (T4=Synthroid/Levoxyl) 2.Sodium Lio-thy-RO-NINE (T3 = Cytomel) where the f did this name come from?

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10
Q

What is the PREFERRED DRUG for most cases of HYPOthyroidism?

A

Sodium Levo-thy-rox-ine (Synthroid, Levoxyl)

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11
Q

What is the most widely sold brand name for Sodium Levo-thyroxine?

A

Synthroid

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12
Q

Sodium levothyroxine (T4 = Synthroid)-Use: replacement or supplement therapy in __________

A

HYPOthyroidism

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13
Q

Sodium levothyroxine (T4 = Synthroid)-MECH: Affects DNA transcription and stimulates ________… Promotes ___________….Mobilizes ______ stores **Increases __________!

A

protein synthesis… gluconeogenesis…. glycogen…..basal metabolic rate

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14
Q

What are 4 signs of overdose of Sodium Levothyroxine??? (hyperthyroid)

A

1.tachycardia/palpations 2.Nervousness/sweating 3.increased appetite 4.wight loss (WOMEN abuse this)

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15
Q

What do we use to treat HYPERthyroidism??? Lets start with the Canadian drug, eh? How does it work??

A

PTU (Put Thyroid Under) i mean PropylThioUracil…Blocks iodination reaction (blocks oxidation of iodine) in thyroid gland; blocks synthesis of T4 and T3

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16
Q

What are three side effects of Propylthiouracil?

A

Skin rash, nausea, aGRANuloCYtosis

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17
Q

Lets get broad: what are the 4 drugs for HYPERthyroidism?

A

1.PTU (PropylThioUracil) (Canadian) 2.Iodides 3. THE BIG ONE: METHimAZole (TapaZOLE) 4.Radioactive Iodide 131

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18
Q

What drug am I? Mechanism of action is not clear: probably reduces secretion of thyroid hormone Use: used in conjunction with propylthiouracil to prepare patients for surgery

A

Potassium Iodide

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19
Q

What drug am I? Use: palliative treatment of hyperthyroidism, return the patient to a normal metabolic state prior to thyroidectomy; control thyrotoxic crisis that may accompany thyroidectomy

A

METH-im-AZ-ole (Tapazole)

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20
Q

Gotta LOVE those Mechanisms!!! What drug AND fill in the BLANK: Blocks iodination reaction (blocks _______ of iodine) in thyroid gland; blocks iodine’s ability to combine with ______ to form T3 and T4

A

METH-im-AZ-ole….oxidation…tyrosine

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21
Q

Why is METH-im-AZole SO UNDESIREABLE??? Undesirable drug: ________, inconvenient (requires monitoring; compliance), adverse effects (eg: ________ disorders, fever, rash, vasculitis, arthralgia)

A

expensive……hematologic

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22
Q

WHEELHOUSE: What are the 2 ORAL side effects of good ole METH-im-AZole?

A

Oral side effects: taste alteration, salivary gland swelling

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23
Q

SOO cool! Radioactive Iodide Tx: _____ ray emission (15-30 millicuries) destroy thyroid tissue.. How lone does this take?

A

Beta ray emission (15-30 millicuries) destroy thyroid tissue..takes about 3 months

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24
Q

WHEELHOUSE: Dental Considerations for Hypothyroid Pts….They are usually cold and _____ and are more sensitive to _______ so give them a lower dose..

A

fatigue…CNS depressants=lower dose of sedatives, opiods

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25
Q

HOLY CRAP: which active condition is an ABSOLUTE CONTRAINDICATION TO EPINEPHRINE????

A

HyperThyroid

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26
Q

Unlike the hypothyroid pt, the hyperthyroid pt is _____ sensitive to CNS depressants so they require a ____ dose!

A

less. higher

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27
Q

What are the two likely outcomes of giving a Hyperthyroid Pt epinephrine?

A

1.Palpitations 2.Tachycardia

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28
Q

What is the most important/first intervention that a dental professional can do with a diabetes patient while they are in the chair?

A

tell them to test their blood sugar regularly!

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29
Q

Simple mech: Type 1 diabetes…Whats the CAUSE?

A

Beta cells are not producing insulin correctly…autoimmune destruction of pancreatic beta cells

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30
Q

Simple Mech: Type 2 diabetes

A

Insulin RECEPTORS become blocked/INSENSATIVE

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31
Q

What is the ONLY effective drug in the Tx of Type 1 Diabetes?

A

INSULIN!!

32
Q

What % of diabetics are Type I?

A

10% and it significantly decreases life expectancy (10 years!)

33
Q

Structure of Insulin : 2 chains connected via _________

A

disulfide bridges

34
Q

Insulin stimulates ________ processes in muscle, liver and fat cells….Binds to ________ receptor to initiate signal propagation within the cell

A

anabolic… cell-surface

35
Q

What are the three ways Insulin is classified?

A

1.Onset 2.Peak 3.Duration of Action

36
Q

What is the most popular Type 1 diabetes drug? What else can it treat? WHEELHOUSE-What are the oral complications?

A

Lantus SoloStar…can also treat Type 2! ORAL: NUMBNESS of the MOUTH!!

37
Q

How many types of Type 1 diabetes drugs are there? What are the 5 categories?

A

7 total…1.Short Acting 2.Rapid acting 3.intermediate 4.intermediate to long 5. long

38
Q

Type 2 diabetes usually develops after ____ years of age (now occurring at younger ages)…Significant blood levels of ______ present

A

35…. insulin

39
Q

INTERESTING! Type 2 DM: _______ is needed to elicit response in RESISTANT cells..

A

More insulin…its like heroine i guess.

40
Q

What is the typical result of untreated Type 2 DM?

A

hyperglycemia

41
Q

For Type 2 diabetes: ________ are oftentimes used as supplementation with oral medications, especially if patient is poorly controlled

A

Insulin injections

42
Q

What are the 3 main goals of drugs for Type 2 DM? What is the risk with these Tx’s?

A

1.Increase insulin secretion in glucose-dependent manner 2.Suppress hepatic GlucoNeoGenesis 3.Improve insulin sensitivity…Risk: hypOglycemia

43
Q

THE O.G.> SulFonylUreas: Promote insulin release from _________

A

Pancreatic BETA cells

44
Q

THE O.G.> SulFonylUreas: Newer drugs (2nd generation) are more _______ but not more effective

A

POTENT

45
Q

THE O.G.> SulFonylUreas: WHAT IS THE BOARD FAVORITE? The one that “everyone should know”

A

TOL-BUT-AMIDE (ORINASE)

46
Q

What do all of the O.G.-SulFonylUreas end in?

A

“-amide”

47
Q

2nd Gen SulFonylUreas: What is the main one “everyone should know”?

A

Glip-iz-ide (GlucoTrol)… i like that one! (control glucose!)

48
Q

2nd Gen SulFonylUreas: these are __ to ____ times more _____ than 1st generation

A

10 to 100…POTENT!!! WOAH

49
Q

2nd Gen SulFonylUreas: What do these bad boys end in?

A

“-ide”

50
Q

DANGER WILL ROBINSON: SulfonylUreas are linked to Increased _________ mortality

A

cardiovascular

51
Q

DANGER WILL ROBINSON: SulfonylUreas….allergy = contraindicated in patients who are allergic to ________

A

Sulfonamide

52
Q

DANGER WILL ROBINSON: SulfonylUreas….Caution with use if severe _______ disease

A

hepatic

53
Q

DANGER WILL ROBINSON: SulfonylUreas….Simultaneous administration of _______ and sulfonylureas may enhance the hypoglycemic response to the sulfonylurea…WHAT is the result of this interaction????

A

ASPIRIN…The aspirin appears to displace the sulfonylurea from plasma proteins causing increased blood levels of the sulfonylurea drug….RESULTS in HYPOGLYCEMIA

54
Q

DANGER WILL ROBINSON: SulfonylUreas….the interaction with ASPIRIN is ALSO said to be salicylate inhibition of ________ synthesis, a.t.STILL resulting in _______

A

prostaglandin E….Hypoglycemia

55
Q

What is the MOST POPULAR class of Type II DM drug? What is the specific drug name and its brand name?

A

BIG-U-anides….metformin (GlucoPhage)

56
Q

What are the 4 MAGICAL mechanisms for the BIGuANIDES-metformin (Glucophage)?

A

1.inhibits absorption of glucose from the gut 2.decreases hepatic glucose production 3.increases insulin sensitivity 4.increase peripheral glucose uptake and utilization

57
Q

What are just 3 of the 7 freaking advantages/benefits of metformin as your most popular Type II DM drug?

A

1.More EFFECTIVE at reducing glycemic level 2.Reduces CARDIOVASCULAR mortality 3.Reduces rates of CANCER!

58
Q

What is a BIG risk for Metformin users that have RENAL impairment?

A

Lactic Acidosis

59
Q

Which Type II DM drug is it REALLY recommended to AVOID EtOH?

A

Metformin

60
Q

What are the 4 organs Metformin can have a big impact on?

A

1.kidney 2.liver 3.heart 4. G.I.

61
Q

What are the 2 Alpha-GlucoSidase Inhibitors for the Tx of Type II DM?

A

1.Acarbose 2.Miglitol

62
Q

Type II DM-Alpha-GlucoSidase Inhibitors: Inhibits the enzyme (alpha- glucosidase) responsible for degrading __________ in gut…What is the result?

A

complex carbohydrates…no monosaccharides avail to absorb!

63
Q

Type II DM-Alpha-GlucoSidase Inhibitors: Did you know?? There is ______ in blood glucose concentrations after a meal when taking these drugs

A

DELAY…just a delay councilor, just a delay

64
Q

Which Type II DM drug “resets” insulin receptors = reduces insulin resistance

A

THI-AZOL-I-DI-NED-I-ONES

65
Q

Thiazolidinediones–Activity depends on the presence of ______ for activity

A

insulin

66
Q

Thiazolidinediones–Decreases _____ glucose output….Increases insulin-stimulated glucose uptake in ________….Decreases _______ in adipocytes

A

hepatic…skeletal muscle….lipolysis

67
Q

What are the two Thiazolidinediones?

A

1.PioGlitAZone 2. RosiGlitAZone

68
Q

Which Type II DM drug is associated with MORE THAN 30 FREAKING LIVER FAILURE DEATHS!??!? (classic BOARDS question)

A

THI-AZO-LID-IN-ED-IONES

69
Q

Thiazolidinediones ask have an Increased risk of ________ so it is *contraindicated in these pt’s

A

heart failure

70
Q

What do the Thiazolidinediones end in?

A

“-zone” GET IN THE ZONE!

71
Q

What Type II DM drugs Mimic hormones produced by the body to stimulate the release of insulin?

A

Incretins!

72
Q

What are the two types of incretins?

A

1.GLP-1 receptor agonists (GlucagonLike Peptide-1) 2.DPP-4 Inhibitiors (DiPeptidyl Peptidase-4)

73
Q

What do all of the incretin DPP-4 inhibitors end in?

A

“liptin”

74
Q

DANGER WILL ROBINSON: INCRETINS—New concerns that these drugs cause inflammation and possible pre-cancerous changes of _______

A

pancreas…NO FREAKING BUENO

75
Q

What is the GOLD STANDARD for measuring diabetes? Whats a Normal value? What is the goal for diabetics?

A

the GLYCATED HEMOGLOBIN (HbA1c) Test…less than 6% is normal…goal for diabetics is under 7% (you are diagnosed at 6.5%)

76
Q

What are the 3 steps for Tx of DM?

A

1.Lifestyle modifications 2. metformin 3.add a second drug if persists

Pharm Part II (28 decks)

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