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Pharmacology II > Exam 2: Endocrine Pharmacology > Flashcards

Exam 2: Endocrine Pharmacology Flashcards

1
Q

Name the 3 thyroid diseases

A
  1. Lack of iodine in diet
    • excessive secretion of TSH, resulting in thyroid hypertrophy (Goiter)
  2. Primary hypo/hyperthyroidism = disease of thyroid gland
  3. Secondary hypo/hyperthyroidism = disease of pituitary or hypothalamus gland
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2
Q

What is the precursor to making synthetic thyroid hormones T4 and T3?

A

L-tyrosine

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3
Q

Which chemical is required for synthesis of thyroid hormones?

A

Iodine

  • without iodine, build-up of TH precursor, resulting in goiter
  • americans obtain iodine from iodized salt
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4
Q

2 synthetic thyroid preparations are made by industry:

A
  1. Sodium levothyroxine (T4 = Synthroid, Levoxyl)

2. Sodium liothyronine (T3 = Cytomel)

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5
Q

What is the preferred drug for most cases of hypothyroidism?

A

Sodium levothyroxine (Synthroid, Levoxyl)

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6
Q

Use for Sodium levothyroxine (T4 = Synthroid)

A

replacement or supplement therapy in hypothyroidism

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7
Q

Mechanism of action for Sodium levothyroxine

A
  • Affects DNA transcription and stimulates protein synthesis
  • Promotes gluconeogenesis
  • Mobilizes glycogen stores
  • **Increases basal metabolic rate
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8
Q

Important adverse effects of Sodium levothyroxine

A

Overdose…

  1. Palpitations, tachycardia
  2. Nervousness, sweating
  3. Increased appetite
  4. Weight loss
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9
Q

Name the drugs used to treat Hyperthyroidism

A
  1. Propylthiouracil
  2. Iodides
  3. methimazole (Tapazole)
  4. Radioactive Iodide I 131
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10
Q

Use of Propylthiouracil (PTU)

A

treatment of hyperthyroidism in preparation for surgery or radioactive iodine therapy

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11
Q

Mechanism of Propylthiouracil (PTU)

A

Blocks iodination reaction in thyroid gland; blocks synthesis of T4 and T3

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12
Q

Side effects of PTU

A

skin rash
nausea
agranulocytosis

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13
Q

What are Iodides

A

saturated solution of potassium iodide

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14
Q

Mechanism of action of Iodides

A

Not clear…

Probably reduces secretion of thyroid hormone

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15
Q

Use of Iodides

A

Used in conjunction with propylthiouracil to prepare patients for surgery

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16
Q

Use of Methimazole (Tapazole)

A

Hyperthyroidism

Return patient to a normal metabolic state prior to thyroidectomy

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17
Q

Mechanism of action of methimazole (Tapazole)

A

Blocks iodination reaction in thyroid gland

Blocks iodine’s ability to combine with tyrosine to form T3 and T4

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18
Q

Which of the hypertensive drugs is considered undesirable

A

methimazole (Tapazole)

- expensive, inconvenient, adverse effects

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19
Q

Oral side effects of methimazole (Tapazole)

A

Taste alteration

Salivary gland swelling

20
Q

How does Radioactive iodide I 131 work?

A

Patient swallows iodine tagged with radioactive nucleotide = drug binds to iodine receptors and slowly irradiates and destroys thyroid gland (

21
Q

Dental considerations of patients with hypothyroidism

A
  1. Easier from management perspective
  2. Cold, tired/fatigued
  3. MORE sensitive to CNS depressants
    • lower dose
22
Q

Dental considerations of patients with hyperthyroidism

A
  1. Nervous; may have increased blood pressure
  2. May be sensitive to epinephrine
    • if active disease, ABSOLUTE contraindication to epinephrine
  3. Palpitations and tachycardia
  4. May perceive more pain
  5. Less sensitive to CNS depressants
23
Q

Type I diabetes results from what?

A

autoimmune destruction of the pancreatic beta cells.

24
Q

What is the only effective drug in treating Type 1 diabetes?

A

Insulin

25
Q

Structure of Insulin

A

2 chains connected via disulfide bridges

26
Q

T or F, Insulin preparations currently used are from animal sources

A

False, no longer used. Current insulin is available as human-type insulin

27
Q

How is insulin administered?

A

All insulins are injected subcutaneously (SC)

28
Q

Insulin is classified in what 3 ways?

A
  1. Onset
  2. Peak
  3. Durations of action
29
Q

Name the short-acting insulin preparations

A

Insulin Regular (HumuLIN R)

30
Q

Name the rapid-acting insulin preparations

A 
Insulin Aspart (NovoLOG)
Insulin Glulisine (Apidra, Apidra Solostar)
Insulin Lispro (HumaLOG)
31
Q

Name the intermediate acting insulin preparations

A

Insulin NPH (HumuLIN, NovoLIN N)

32
Q

Name the intermediate to long-acting insulin preparations

A

Insulin Detemir (Levemir)

33
Q

Name the long-acting insulin preparations

A

Insulin Glargine (Lantus, Lantus Solostar)

34
Q

Use of Lantus Solostar (insulin glargine)

A

Treatment of type 1 diabetes and type 2 diabetes to improve glycemic control.

35
Q

Oral complications of Lantus Solostar

A

Numbness of mouth

36
Q

General idea behind drugs that work to fix Type 2 diabetes

A

Target cells become insensitive to insulin. So, more insulin is needed to elicit response in resistant cells.

37
Q

Name the goals of oral drug therapy for management of Type 2 Diabetes

A
  1. Increase insulin secretion in glucose-dependent manner
  2. Suppress hepatic gluconeogenesis
  3. Improve insulin sensitivity
38
Q

Risk of Oral Drug Therapy for Type 2 diabetes

A

hypoglycemia

39
Q

Name the Primary drugs for Type 2 diabetes

A
  1. sulfonylureas (traditional oral hypoglycemias)
  2. Biguanides (Metformin)
  3. Alpha-glucosidase inhibitors
  4. Thiazolidinediones (TZDs)
  5. Incretins - GLP-1 agonists, DD-4 inhibitors
40
Q

Name the 1st generation Sulfonylureas

A
  1. tolbutamide (Orinase)

others not in bold…

41
Q

Name the 2nd generation Sulfonylureas

A
  1. glipizide (Glucotrol)

one more but not in bold

42
Q

What is the major distinction between 1st and 2nd generations of Sulfonylureas

A

Potency

-2nd generation are more potent but not more effective

43
Q

3 warnings with Sulfonylureas

A
  1. Increased cardiovascular mortality
  2. Sulfonamide allergy
  3. Caution with use if severe hepatic disease
44
Q

Describe a very serious drug interaction with Sulfonylureas

A

Aspirin

- simultaneous administration may enhance the hypoglycemic response to the sulfonylurea

45
Q

What is the result of a drug interaction between aspirin and sulfonylurea?

A

hypoglycemia

Pharmacology II (24 decks)

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