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Pharmacology > Endocrine > Flashcards

Endocrine Flashcards

1
Q

what causes diabetes

A
  • decrease in insulin secretion with or without a reduction in insulin action -> elevated levels of blood glucose
  • insulin does not function properly or not produced in efficient amounts -> not take up the glucose into the cells -> glucose remains in the blood -> hyperglycaemia
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2
Q

what are normal blood sugar levels when a patient is fasting

A
  • between 4.0 and 6.0 mol/L
  • 2 hours post meals 5.0-8.0 mmol/L
  • normal HbA1C is <6.0%
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3
Q

where is insulin made and secreted

A
  • by the beta cells of the islets of langerhans in the pancreas
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4
Q

what is type 1 diabetes and what are its s&s

A
  • absolute insulin deficiency as a result of destruction of pancreatic islet beta cells
  • autoimmune process whereby insulin antibodies in the body are involved in pancreatic cell destruction
  • characterized by drowsiness, nausea, sweating, tachycardia and coma
  • onset of symptoms quick
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5
Q

what is type 2 diabetes

A
  • insulin resistance
  • adequate, near adequate or perhaps even excessive amounts of insulin
  • genetic disposition (heredity) plays a major role in development
  • usually obese and symptoms are gradual
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6
Q

what are complications of diabetes

A
  • microvascular: eye (retinopathy), gingiva, kidney, nerves (Neuropathy) and extremities
  • macrovascular: Coronary Artery Disease (major cause of death in diabetics), Congestive Heart Disease, peripheral vascular disease, hyperlipidemia, hypertension
  • periodontal disease
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7
Q

what is HbA1c

A
  • measures the percentage of hemoglobin in the red blood cells that is bound to glucose
  • reflect mean blood glucose concentrations over the preceding 2-3 months
  • the goal is to have a HbA1c of 7% or lower in diabetics, and 6% in non diabetics
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8
Q

how do we diagnose and treat diabetes

A
  • random blood glucose between 4 and 6, after meals 5-8
  • fasting blood glucose and glucose tolerance testing
  • HbA1c
  • exercise and diet modification
  • smoking cessation
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9
Q

what are antidiabetic agents

A
  • oral
  • injectable insulin
  • drug used based on whether absolute insulin deficiency (type 1) or a defect in insulin action and secretion (type 2)
  • type 1 diabetes: insulin is essential because there is no insulin being produced in the beta cells`
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10
Q

what are some dental considerations when a Pte is using insulin

A
  • epi: caused hyperglycaemia – decreases the effectiveness of insulin, caution when using a local anesthetic containing EPI
  • hypoglycaemia: monitor dental patient, make sure patient took insulin as prescribed and has eaten before the dental appt
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11
Q

what are some oral diabetic agents and what is their mechanism of action

A
  • glyburide (diabeta)
  • metformin
  • glipizide
  • rosiglitazone
  • all act by either:
  • stimulating release of insulin from islet cells
  • increasing the sensitivity of insulin receptors on target cells
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12
Q

what are some oral manifestations of diabetes

A
  • xerostomia
  • burning tongue/mouth
  • candida (fungal) infections
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13
Q

patients with diabetes should do what before tx

A
  • eat!!!! also take their meds
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14
Q

what is thyroxine

A
  • major hormone secreted by thyroid gland, requires iodine for synthesis
  • used for therapeutic purposes because more constant blood levels
  • max absorption on empty stomach
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15
Q

how do we test for thyroid disease

A
  • blood test is taken that measures unbound T4 and TSH levels
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16
Q

what are s&s of hyperthyroidism

A
  • sweating, weight loss, nervousness, oversensitive to heat, fatigue, moist skin, tachycardia (in graves disease, there is bulging of the eyes)
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17
Q

what are s&s of hypothyroidism

A
  • cold intolerance, weakness, tiredness, fatigue, hoarseness, constipation, aches, pains
  • myxedema (severe hypothyroidism)
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18
Q

what are drugs for hyperthyroidism

A
  • thioamide drugs:
  • propylthiouracil
  • methimazole
  • inhibit thyroid hormone production by interfering within the incorporation of iodine
  • radioactive iodine, or iodine
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19
Q

what are thyroid replacement drugs

A
  • for hypothyroidism
  • thyroid USP
  • levothyroxine
  • L-triiodothyronine
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20
Q

what are adverse events regarding thyroid replacement drugs

A
  • excessive doses of thyroxine can lead to heart disorders, including congestive heart failure and MI
  • thyroid USP may cause allergic run since it is derived from animal sources
21
Q

what is contraindicated in ptes with thyroid storm

A
  • epi
22
Q

what are 3 types of corticosteroid (think 3 Ss)

A
  • mineralocorticoids (aldosterone - salt)
  • glucocorticoids (cortisol - sugar)
  • gonadocorticoids (sex hormones)
23
Q

how does glucose affect metabolism (glucocorticosteroids)

A
  • can affect glucose metabolism
  • naturally occurring steroids cause proteins and lipids to be broken down and converted into glucose
  • cause carbs stored in the form of glycogen to be converted back to glucose and deposited into the blood
24
Q

what do glucocovrticosteroids do

A
  • suppress the inflammatory process within the body, ie bee sting, arthritis
  • no use naturally occurring steroids but have been replaced by others that can be produced more economically
  • products: systemic, injectable, topical
25
Q

what are indications for use of glucocorticosteroids

A
  • Addisons disease
  • systemic lupus erythematosus
  • control inflammation (asthma, skin, IBS) –unclear mechanism of action; stabilize individual cells and their internal structures so that they do not release the substances (eg histamine) that initiate the irritation, pain and inflammation
  • dental related ulcerative inflammatory lesions such as lichen plants, burning tongue, and aphthous stomatitis (canker sores)
  • bulls disorders (eg pemphigus vulgaris and erythema multiforme)
  • suppress the immune system: allergies, seasonal rhinitis
  • leukemias, lymphomas
  • ulcerative colitis, crohns disease
26
Q

how do we classify glucocorticosteroids

A
  • according the duration of action: short-acting, intermediate-acting, long-acting
  • according the anti-inflammatory potency: hydrocortisone – least anti-inflammatory; betamethasone and dexamethasone – most potent anti-inflammatory
27
Q

what are some side effect too glucocorticosteroids

A
  • muscle weakness
  • hyperglycemia
  • intraoral candidiasis
  • immune suppression
  • ulcers
  • poor wound healing
  • diabetes (increase glucose secretion)
  • less calcium absorption and increase calcium excretion via kidneys (removes calcium from bones – osteoporosis)
  • shutdown of adrenal glands: life threatening, see after long-term use or after discontinuing the steroid, glands unable to immediately start normal levels of production, reversible with time, important to monitor dosage and response
28
Q

how do we dose glucocorticosteroids

A
  • alternate-day dosing should be use in long-term therapy
  • doubling the dosage an administering the drug every other day in the morning mimics the endogenous (own body) corticosteroid circadian rhythm)
  • goal is to maintain the lowest dose possible while obtaining a desired clinical response
29
Q

what are some contraindications/precautions for using glucocorticosteroids

A
  • herpes simplex
  • glaucoma
  • diabetes mellitus
  • peptic ulcer disease
  • osteoporosis
  • congestive heart failure
  • hypertension
  • infections (fungal, bacterial, etc)
  • psychiatric disorders
30
Q

what is withdrawal from corticosteroids like

A
  • ‘tapering’ period
  • that that patients do not experience withdrawal syndrome – allows the body to recover the norma secretion of endogenous corticosteroids. in most ptes, the dosage is tapered over 2 months or more
  • symptoms of rapid withdrawal: headache, fatigue, joint pain, nausea, vomiting, weight loss, fever, peeling of skin
31
Q

when would drug interactions with corticosteroids require steroid levels be decreased

A
  • carbamazepine
  • phenobarbitals
  • phenytoin
  • rifampin
32
Q

what are topical glucocorticosteroids classified by

A
  • according to potency

- hydrocortisone is the least potent and best to use in infants and children because of minimal systemic absorption

33
Q

when is an increase in dose of corticosteroids necessary

A
  • for ptes undergoing stressful dental procedures like extractions, periodontal surgery and implant surgery
34
Q

what are sex hormones and what are they produced by

A
  • steroids produced from cholesterol
35
Q

what are female sex hormones

A
  • estrogens and progestins, including progesterone
  • estradiol = main estrogen secreted by ovary
  • estrone
  • estriol
36
Q

what is the major male sex hormone

A
  • androgens, which includes testosterone
37
Q

what are indications for the use of estrogens

A
  • hormone replacement therapy to reduce the symptoms of menopause
  • oral contraceptives in combination with progestins
  • treatment of uterine bleeding due to hormone imbalance
  • amenorrhea (lack of menstruation)
  • certain carcinomas
  • vulvar and vaginal atrophy
  • prevention and tx of osteoporosis
  • treatment of skin lesions (ie acne)
38
Q

when is estrogen contraindicated

A
  • in ptes with:
  • breast cancer (uterus, cervix and vaginal cancer)
  • pregnancy
  • liver disease
  • vascular thromboembolic (blood clot) condition – increased risk to blood clots if Pte smokes and takes the pill
  • increased risk especially if used long term of cerebral vascular accident (stroke, particularly in smokers
39
Q

what are some adverse effects of estrogen

A
  • endometrial hyperplasia
  • gallbladder disease
  • increased incidence of breast cancer in ptes taking estrogen on a long term basis is controversial
  • additionally, estrogen cause neasue and vomiting, headache, dizziness and breast tenderness
40
Q

what are the main female sex hormones used in bc

A
  • estrogen and progestins
41
Q

what does bc do

A
  • prevent ovulation

- stop secretion of FSH and LH

42
Q

what are the 3 basic formulations of BC: estrogen and progestin

A
  • monophonic: provides a constant amount of estrogen and progestin throughout the menstrual cycle
  • biphasic: estrogen level stays the same, progestin level increases toward end of cycle
  • triphasic: amount of estrogen and progestin vary in 3 phases during 28 day cycles
43
Q

what is the progestin only bc and when is it used

A
  • ‘minipill’
  • less effective than estrogen and progestin oc
  • for patients at high risk for side effects from estrogen
44
Q

what are some drug interactions with bc

A
  • antibiotics
  • warfarin
  • phenytoin
45
Q

what does plan B do

A
  • each tablet contains .75 mg of levonorgestrel
  • 2 pills you take together
  • temporarily stops the release of an egg from the ovary
  • prevents fertilization
  • prevents a fertilized egg from attaching to the uterus
  • not an abortion pill – will not terminate pregnancy
  • SE: vomiting, nausea, spotting
46
Q

what is mifepristone

A
  • called the ‘morning after’

pill, which is used to abort a fetus

47
Q

what is testosterone used to treat

A
  • hypogonadism (diminished function of the testes)
  • most testosterone products undergo extensive first pass metabolism in the liver, reducing the oral bioavailability. thus, most products are given parentally (IM), buccally, or transdermally (through the skin)
48
Q

what are anabolic steroids

A
  • testosterone-like compounds with hormonal activity

- used inappropriately by athletes to increase muscle mass and strength

Pharmacology (21 decks)

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