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69 Cards in this Set
- Front
- Back
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What is the mechanism steroid drugs?
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- Steroid enters cell
- Binds to receptor - Enters nucleus - 2 receptors combine (act as a transcription factor) - Alters expression of a panel of genes |
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What are thyroid hormones do?
What is their MOA? |
T3 and T4
Regulate metabolism, tissue growth and development |
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What regulates Thyroid Hormones?
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- Thyroid stim H (TRH) (pituitary) -->
regulated by thyroid release H (TSH) (hypothalamus) - High T3/T4: negative feedback on TSH/TRH release |
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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) |
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What are the functions of T3 and T4?
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- Increased metabolic rate
- CV Increase blood flow and sensitivity to catecholamines = (increases CO) - Fine muscle tremor - Lipid mobilization/breakdown |
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What causes hypothyroidism?
What are its symptoms? |
Decreased T3/T4
lethargy, fatigue, flaky skin |
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What is the treatment of Hypothyroidism?
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Dessicated thyroid extract (Thyroid USP)
Liotrix (mixture of T3 and T4) Levothyroxine (T4) |
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What is Dessicated thyroid extract?
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Ground up bovine thyroid
Cheap but activity varies |
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Why is Liotrix not necessarily the best choice to treat hypothyroidism?
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But T3 not needed and just increases ADRs
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What is the drug of choice to treat hypothyroidism?
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Levothyroxine (T4)
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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 |
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What are the symptoms of Hyperthyroidism?
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nervousness
irritability weight loss increased appetite palpitations and tachycardia ptosis periorbital edema |
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What is the term for an acute and potentially life-threatening hyperthyroidism?
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Thyroid Storm
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What are the treatment of hyperthyroidism?
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Beta Blockers
Thioamides Radioactive Iodine Iodine |
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What are the Beta blocker agents of hyperthyroidism?
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Propranolol (heart blockers)
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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) |
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How is radioactive iodine used?
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Taken into thyroid and destroys cells
100% cure rate - may take few doses Not in pregnancy |
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How is iodine used?
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High doses - Blocks synthesis of T3/T4 and T3/T4 release
Works pretty quick (days) |
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What are other ways to say corticosteroids?
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Glucocorticoids
Adrenocorticoids Adrenal corticoids |
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What is the Hypothalamo-pituitary-adrenal axis (HPA)
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>/ TSH --> >/ ACTH --> >/ Cortisol or hydrocortisone
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What is an endogenous corticosteroid?
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Cortisol (Hydrocortisone)
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What occurs due to higher levels of corticosteroids?
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Negative feedback of CRH in hypothalamus and ACTH in the pituitary
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What are the anti-inflammatory effects of Corticosteroids?
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- /> release of pro-inflammatory cytokines from immune cells
- High dose kill off immune cells (T cells>Bcells) |
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What is the function of Corticosteroids on glucose?
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Increase in formation and storage of glucose - hyperglycemia
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How does corticosteroids effect lipids in the body?
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- Increased lipid breakdown
- Redistribution of fat --> legs and arms to back of neck and face |
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What are the adverse effects of using corticosteroids?
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- 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 |
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What are the Cushing affects of corticosteroids?
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Hyperglycemia
Moon face, buffalo hump |
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What are the uses of corticosteroids?
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Replacement therapy
Allergies Cancer (T cell effects) Arthritis Eye diseases (May mask infection) GI inflammation General immunosuppression Skin diseases |
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What is a gonadal hormone that is an endogenous estrogen?
Where is it made? |
Estradiol
Ovaries due to FSH |
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What is a gonadal hormone that is an endogenous progestin?
Where is it made? |
Progesterone
Ovaries due to LH |
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What is a gonadal hormone which is a major Androgen?
Where is it made? |
Testosterone, dihydrotesterone
Testes due to LH |
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What are the effects of Estradiol?
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- Normal maturation of female
- Development of endometrial lining during cycle - Increased bone mass - Increased clotting proteins |
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What are the effects of Progesterone?
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- Development of secretory endometrium during cycle
- Maintenance of pregnancy |
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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) |
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What are the risks for using hormone replacement therapy?
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- Cancer - progestin protects endometrium
- CV issues - clotting w/ estrogens |
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What are typical oral contraceptives?
Why? |
Estrogen/Progestrone Combo
Progestin alone = high failure rate |
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What is the MOA of Oral Contraceptives?
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Negative feedback on FSH/LH -> inhibit ovulation
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With the use of oral contraceptives..
_____ may increase metabolism _____ may alter absorption |
smoking
Broad spectrum antibiotics |
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What are the adverse reactions to using oral contraceptives?
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N&V,diarrhea
Breakthrough bleeding Increased cancer |
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What are the actions of the Androgens?
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Maturation of men
Anabolic effects |
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What are the Adverse effects of using Androgens?
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- Masculinization/feminization
- Aggressiveness - Hepatotoxicity – with orally active 17-substituted agents |
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What disease has a common characteristic of hyperglycemia?
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Diabetes
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Where does damage from hyperglycemia occur?
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BV's in eyes
kidneys heart extremities wounds |
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What is a 51 amino acid peptide produced in pancreas?
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Insulin
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What are the effects of Insulin on the body?
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Liver: >/ glucose storage, protein breakdown
Sk / M.: >/ glucose storage and uptake and protein synthesis Fat: /> lipolysis |
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What are the rapid acting insulins?
How fast will they work? |
Lispro, aspart, glulisine, inhaled
Act within minutes Use before meals |
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What are the short acting insulins?
How fast will they work? |
Regular insulin
W/in 2 hours |
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What are the intermediate acting insulins?
What are they good for? |
NPH, lente
Good for overnight control |
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What are the long acting insulins?
What are they good for? |
Glargine, detemir
Day-long control |
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What are the types of insulin delivery systems?
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Pens - fast
Pumps - constant delivery |
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What are the adverse reactions to using insulin drugs?
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Hypoglycemia: carry glucose to protect the brain
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What are drugs that close K+ channels on beta cells -> increase insulin release
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Insulin Secretegogues (non-insulin drugs)
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What are the Insulin Secretegogues?
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- Sulfonylureas – glyburide, glipizide, glimeperide
- Newer – repaglinide, nateglinide |
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What are the adverse reactions to using Insulin Secretegogues?
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Hypoglycemia – older agents especially
Weight gain Can worsen type 2 diabetes |
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What is the MOA of Metformin (non-insulin diabetic drugs)
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- Blocks gluconeogenesis
- AMP kinase agonist AMPK- metabolic master switch Activation causes -->Decreased glucose synthesis -->Decreased resistance to insulin |
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What are the adverse effects of using Metformin?
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GI upset
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What is the MOA of the Thiazolidinediones (non-insulin diabetic drugs)?
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- PPAR gamma activator
PPAR gamma – transcription factor that involves many genes involved in metabolism |
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What does activation of the PPAR gamma do?
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- Decreased gluconeogenesis
- Decreased fasting and postprandial hyperglycemia |
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What are the adverse reactions to using thiazolidinediones?
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Increased MI risk
- Why other agent rosiglitazone pulled from market |
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What are the alpha glucosidase inhibitors (non-insulin diabetic drugs)?
What do they do? |
Acarbose
Mioglitol Converts food starches to glucose |
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What are the adverse reactions associated with Alpha glucosidase inhibitors?
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GI Distress
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What are GLP-1 drugs and what are their agents?
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Incretin Peptides
Exanatide – GLP-1 analog Sitagliptin, vildagliptin, saxagliptin – DPP-4 inhibitors |
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What does incretin peptide do?
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- Released in response to food
- Stimulates insulin release - Delays gastric emptying |
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What is DPP-4?
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Enzyme that breaks down GLP-1
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What are the adverse effects for using GLP-1 drugs?
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Exanatide – GI upset
DPP-4 inhibitors cause HA |
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Thyroid disease can lead to _____ problems, _____.
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gum
loose teeth |
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Corticosteroids:
Can be used to decrease _____ Can predispose to infection and poor healing of _____ |
inflammation
tooth extractions |
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Estrogens affect bone _____
Estrogens affect _____ proteins _____ can affect oral contraceptives |
density
clotting Antibiotics |
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What are two factors to be aware of with diabetes that affects dentistry?
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Healing affected
Hypoglycemia |
