Exam 2: Endocrine Pharmacology

Question 1

Name the 3 thyroid diseases

Answer 1

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

Question 2

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

Answer 2

L-tyrosine

Question 3

Which chemical is required for synthesis of thyroid hormones?

Answer 3

Iodine

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

Question 4

2 synthetic thyroid preparations are made by industry:

Answer 4

1. Sodium levothyroxine (T4 = Synthroid, Levoxyl)

2. Sodium liothyronine (T3 = Cytomel)

Question 5

What is the preferred drug for most cases of hypothyroidism?

Answer 5

Sodium levothyroxine (Synthroid, Levoxyl)

Question 6

Use for Sodium levothyroxine (T4 = Synthroid)

Answer 6

replacement or supplement therapy in hypothyroidism

Question 7

Mechanism of action for Sodium levothyroxine

Answer 7

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

Question 8

Important adverse effects of Sodium levothyroxine

Answer 8

Overdose…

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

Question 9

Name the drugs used to treat Hyperthyroidism

Answer 9

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

Question 10

Use of Propylthiouracil (PTU)

Answer 10

treatment of hyperthyroidism in preparation for surgery or radioactive iodine therapy

Question 11

Mechanism of Propylthiouracil (PTU)

Answer 11

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

Question 12

Side effects of PTU

Answer 12

skin rash
nausea
agranulocytosis

Question 13

What are Iodides

Answer 13

saturated solution of potassium iodide

Question 14

Mechanism of action of Iodides

Answer 14

Not clear…

Probably reduces secretion of thyroid hormone

Question 15

Use of Iodides

Answer 15

Used in conjunction with propylthiouracil to prepare patients for surgery

Question 16

Use of Methimazole (Tapazole)

Answer 16

Hyperthyroidism

Return patient to a normal metabolic state prior to thyroidectomy

Question 17

Mechanism of action of methimazole (Tapazole)

Answer 17

Blocks iodination reaction in thyroid gland

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

Question 18

Which of the hypertensive drugs is considered undesirable

Answer 18

methimazole (Tapazole)

- expensive, inconvenient, adverse effects

Question 19

Oral side effects of methimazole (Tapazole)

Answer 19

Taste alteration

Salivary gland swelling

Question 20

How does Radioactive iodide I 131 work?

Answer 20

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

Question 21

Dental considerations of patients with hypothyroidism

Answer 21

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

Question 22

Dental considerations of patients with hyperthyroidism

Answer 22

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

Question 23

Type I diabetes results from what?

Answer 23

autoimmune destruction of the pancreatic beta cells.

Question 24

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

Answer 24

Insulin

Question 25

Structure of Insulin

Answer 25

2 chains connected via disulfide bridges

Question 26

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

Answer 26

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

Question 27

How is insulin administered?

Answer 27

All insulins are injected subcutaneously (SC)

Question 28

Insulin is classified in what 3 ways?

Answer 28

1. Onset 2. Peak 3. Durations of action

Question 29

Name the short-acting insulin preparations

Answer 29

Insulin Regular (HumuLIN R)

Question 30

Name the rapid-acting insulin preparations

Answer 30

``` Insulin Aspart (NovoLOG) Insulin Glulisine (Apidra, Apidra Solostar) Insulin Lispro (HumaLOG) ```

Question 31

Name the intermediate acting insulin preparations

Answer 31

Insulin NPH (HumuLIN, NovoLIN N)

Question 32

Name the intermediate to long-acting insulin preparations

Answer 32

Insulin Detemir (Levemir)

Question 33

Name the long-acting insulin preparations

Answer 33

Insulin Glargine (Lantus, Lantus Solostar)

Question 34

Use of Lantus Solostar (insulin glargine)

Answer 34

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

Question 35

Oral complications of Lantus Solostar

Answer 35

Numbness of mouth

Question 36

General idea behind drugs that work to fix Type 2 diabetes

Answer 36

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

Question 37

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

Answer 37

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

Question 38

Risk of Oral Drug Therapy for Type 2 diabetes

Answer 38

hypoglycemia

Question 39

Name the Primary drugs for Type 2 diabetes

Answer 39

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

Question 40

Name the 1st generation Sulfonylureas

Answer 40

1. tolbutamide (Orinase) | others not in bold...

Question 41

Name the 2nd generation Sulfonylureas

Answer 41

1. glipizide (Glucotrol) | one more but not in bold

Question 42

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

Answer 42

Potency | -2nd generation are more potent but not more effective

Question 43

3 warnings with Sulfonylureas

Answer 43

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

Question 44

Describe a very serious drug interaction with Sulfonylureas

Answer 44

Aspirin | - simultaneous administration may enhance the hypoglycemic response to the sulfonylurea

Question 45

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

Answer 45

hypoglycemia