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69 Cards in this Set

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What is the mechanism steroid drugs?
- Steroid enters cell
- Binds to receptor
- Enters nucleus
- 2 receptors combine (act as a transcription factor)
- Alters expression of a panel of genes
What are thyroid hormones do?
What is their MOA?
T3 and T4
Regulate metabolism, tissue growth and development
What regulates Thyroid Hormones?
- Thyroid stim H (TRH) (pituitary) -->
regulated by thyroid release H (TSH) (hypothalamus)

- High T3/T4: negative feedback on TSH/TRH release
What are T3 and T4 made from?
What the heck are the numbers?
Which is more potent?
Tyrosine
Inorganic iodine – thyroid traps iodine

# of iodines

T3 3-4 X greater than T4
(responsible for most ADR's)
What are the functions of T3 and T4?
- Increased metabolic rate
- CV Increase blood flow and sensitivity to catecholamines =
(increases CO)
- Fine muscle tremor
- Lipid mobilization/breakdown
What causes hypothyroidism?
What are its symptoms?
Decreased T3/T4

lethargy, fatigue, flaky skin
What is the treatment of Hypothyroidism?
Dessicated thyroid extract (Thyroid USP)
Liotrix (mixture of T3 and T4)
Levothyroxine (T4)
What is Dessicated thyroid extract?
Ground up bovine thyroid
Cheap but activity varies
Why is Liotrix not necessarily the best choice to treat hypothyroidism?
But T3 not needed and just increases ADRs
What is the drug of choice to treat hypothyroidism?
Levothyroxine (T4)
What must you monitor in the treatment of hypothyroidism?
How long will it take to see the full effects of the treatment?
What are the ADR's of treatment?
T4 and TSH levels

A few weeks

Hyperthyroidism
What are the symptoms of Hyperthyroidism?
nervousness
irritability
weight loss
increased appetite
palpitations and tachycardia
ptosis
periorbital edema
What is the term for an acute and potentially life-threatening hyperthyroidism?
Thyroid Storm
What are the treatment of hyperthyroidism?
Beta Blockers
Thioamides
Radioactive Iodine
Iodine
What are the Beta blocker agents of hyperthyroidism?
Propranolol (heart blockers)
What are the agents of thioamides?
What do they do?
Which is more active?
Which is used in pregnancy?
propylthiouracil (PTU) and methimazole

blocks synthesis of T3 and T4

Methimazole
Propylthiouracil (PTU)
How is radioactive iodine used?
Taken into thyroid and destroys cells
100% cure rate - may take few doses
Not in pregnancy
How is iodine used?
High doses - Blocks synthesis of T3/T4 and T3/T4 release

Works pretty quick (days)
What are other ways to say corticosteroids?
Glucocorticoids
Adrenocorticoids
Adrenal corticoids
What is the Hypothalamo-pituitary-adrenal axis (HPA)
>/ TSH --> >/ ACTH --> >/ Cortisol or hydrocortisone
What is an endogenous corticosteroid?
Cortisol (Hydrocortisone)
What occurs due to higher levels of corticosteroids?
Negative feedback of CRH in hypothalamus and ACTH in the pituitary
What are the anti-inflammatory effects of Corticosteroids?
- /> release of pro-inflammatory cytokines from immune cells
- High dose kill off immune cells (T cells>Bcells)
What is the function of Corticosteroids on glucose?
Increase in formation and storage of glucose - hyperglycemia
How does corticosteroids effect lipids in the body?
- Increased lipid breakdown
- Redistribution of fat
--> legs and arms to back of neck and face
What are the adverse effects of using corticosteroids?
- Adrenal suppression
- High lvls cause neg feedback on CRH and ACTH
- Increased infection
- Muscle breakdown (decreased immune cell) Esp. in elderly
- CNS effects(Aggression, psychosis)
- Cushing effects
What are the Cushing affects of corticosteroids?
Hyperglycemia
Moon face, buffalo hump
What are the uses of corticosteroids?
Replacement therapy
Allergies
Cancer (T cell effects)
Arthritis
Eye diseases (May mask infection)
GI inflammation
General immunosuppression
Skin diseases
What is a gonadal hormone that is an endogenous estrogen?
Where is it made?
Estradiol
Ovaries due to FSH
What is a gonadal hormone that is an endogenous progestin?
Where is it made?
Progesterone
Ovaries due to LH
What is a gonadal hormone which is a major Androgen?
Where is it made?
Testosterone, dihydrotesterone
Testes due to LH
What are the effects of Estradiol?
- Normal maturation of female
- Development of endometrial lining during cycle
- Increased bone mass
- Increased clotting proteins
What are the effects of Progesterone?
- Development of secretory endometrium during cycle
- Maintenance of pregnancy
Who generally receive hormone replacement therapy?
What are the benefits?
Post menopause and No uterus

Maintenance of bone mass
Can help vasomotor symptoms (hot flashes)
What are the risks for using hormone replacement therapy?
- Cancer - progestin protects endometrium
- CV issues - clotting w/ estrogens
What are typical oral contraceptives?
Why?
Estrogen/Progestrone Combo
Progestin alone = high failure rate
What is the MOA of Oral Contraceptives?
Negative feedback on FSH/LH -> inhibit ovulation
With the use of oral contraceptives..
_____ may increase metabolism
_____ may alter absorption
smoking
Broad spectrum antibiotics
What are the adverse reactions to using oral contraceptives?
N&V,diarrhea
Breakthrough bleeding
Increased cancer
What are the actions of the Androgens?
Maturation of men
Anabolic effects
What are the Adverse effects of using Androgens?
- Masculinization/feminization
- Aggressiveness
- Hepatotoxicity – with orally active 17-substituted agents
What disease has a common characteristic of hyperglycemia?
Diabetes
Where does damage from hyperglycemia occur?
BV's in eyes
kidneys
heart
extremities
wounds
What is a 51 amino acid peptide produced in pancreas?
Insulin
What are the effects of Insulin on the body?
Liver: >/ glucose storage, protein breakdown
Sk / M.: >/ glucose storage and uptake and protein synthesis
Fat: /> lipolysis
What are the rapid acting insulins?
How fast will they work?
Lispro, aspart, glulisine, inhaled

Act within minutes
Use before meals
What are the short acting insulins?
How fast will they work?
Regular insulin
W/in 2 hours
What are the intermediate acting insulins?
What are they good for?
NPH, lente
Good for overnight control
What are the long acting insulins?
What are they good for?
Glargine, detemir
Day-long control
What are the types of insulin delivery systems?
Pens - fast
Pumps - constant delivery
What are the adverse reactions to using insulin drugs?
Hypoglycemia: carry glucose to protect the brain
What are drugs that close K+ channels on beta cells -> increase insulin release
Insulin Secretegogues (non-insulin drugs)
What are the Insulin Secretegogues?
- Sulfonylureas – glyburide, glipizide, glimeperide
- Newer – repaglinide, nateglinide
What are the adverse reactions to using Insulin Secretegogues?
Hypoglycemia – older agents especially
Weight gain
Can worsen type 2 diabetes
What is the MOA of Metformin (non-insulin diabetic drugs)
- Blocks gluconeogenesis
- AMP kinase agonist
AMPK- metabolic master switch
Activation causes
-->Decreased glucose synthesis
-->Decreased resistance to insulin
What are the adverse effects of using Metformin?
GI upset
What is the MOA of the Thiazolidinediones (non-insulin diabetic drugs)?
- PPAR gamma activator
PPAR gamma – transcription factor that involves many genes involved in metabolism
What does activation of the PPAR gamma do?
- Decreased gluconeogenesis
- Decreased fasting and postprandial hyperglycemia
What are the adverse reactions to using thiazolidinediones?
Increased MI risk
- Why other agent rosiglitazone pulled from market
What are the alpha glucosidase inhibitors (non-insulin diabetic drugs)?
What do they do?
Acarbose
Mioglitol

Converts food starches to glucose
What are the adverse reactions associated with Alpha glucosidase inhibitors?
GI Distress
What are GLP-1 drugs and what are their agents?
Incretin Peptides

Exanatide – GLP-1 analog
Sitagliptin, vildagliptin, saxagliptin – DPP-4 inhibitors
What does incretin peptide do?
- Released in response to food
- Stimulates insulin release
- Delays gastric emptying
What is DPP-4?
Enzyme that breaks down GLP-1
What are the adverse effects for using GLP-1 drugs?
Exanatide – GI upset
DPP-4 inhibitors cause HA
Thyroid disease can lead to _____ problems, _____.
gum
loose teeth
Corticosteroids:
Can be used to decrease _____
Can predispose to infection and poor healing of _____
inflammation
tooth extractions
Estrogens affect bone _____
Estrogens affect _____ proteins
_____ can affect oral contraceptives
density
clotting
Antibiotics
What are two factors to be aware of with diabetes that affects dentistry?
Healing affected
Hypoglycemia