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Chapter 20: Other Hormones Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

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1 Chapter 20: Other Hormones Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

2 2 Chapter 20 Outline  Other hormones  Pituitary hormones  Thyroid hormones  Pancreatic hormones  Female sex hormones  Male sex hormones  Other agents that affect sex hormone systems

3 3Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Other Hormones  Haveles (p. 249)  Hormones are secreted by endocrine glands and transported by blood to target tissues, where they are biologically active  Endocrine glands include the pituitary, thyroid, parathyroids, pancreas, adrenals, gonads, and placenta  Help maintain homeostasis by regulating body functions and are controlled themselves by feedback systems cont’d…

4 4Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Other Hormones  In most systems, the hormone released has a negative feedback effect on the secretion of the hormone-stimulating substance  Drugs that affect the endocrine system include the hormones secreted by the endocrine glands, synthetic hormone agonists and antagonists, and substances that influence the synthesis and secretion of hormones  Used in replacement therapy such as treatment of diabetes mellitus (insulin) and hypothyroidism (levothyroxine)

5 5Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Pituitary Hormones  Haveles (pp )  Anterior pituitary  Posterior pituitary cont’d…

6 6Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Pituitary Hormones  Haveles (p. 249)  The pituitary gland (master gland) is located at the base of the brain; “master gland” due to its regulatory effect on other endocrine glands and organs of the body  Secretes peptide hormones that regulate the thyroid, adrenal, and sex glands; the kidney and the uterus; and growth  Also has a trophic effect; without gonadotropins, the entire reproductive system fails; without growth hormone and thyrotropin, normal growth and development are impossible cont’d…

7 7Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Pituitary Hormones  Haveles (pp )  Pituitary deficiency can produce loss of secondary sex characteristics, decreased metabolism, dwarfism, diabetes insipidus, hypothyroidism, Addison disease, loss of pigmentation, thinning and softening of the skin, decreased libido, and retarded dental development  Hypersecretion of pituitary hormones can produce sexual precocity, goiter, Cushing disease, acromegaly, and giantism  The two parts to the pituitary gland are the anterior lobe (adenohypophysis) and the posterior lobe (neurohypophysis)

8 8Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Anterior Pituitary  Haveles (pp ) (Fig. 20-2)  Secrets growth hormone (somatotropin), luteinizing hormone (LH); follicle-stimulating hormone (FSH); thyroid-stimulating hormone (TSH) or thyrotropin, adrenocorticotropic hormone (ACTH) or corticotropin, and prolactin  β-Lipotropin is a precursor to β-endorphin cont’d…

9 9Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Anterior Pituitary  Human growth hormone is used medically to treat children who lack it  Pharmaceutical gonadotropin-releasing hormone (GnRH) is a synthetic analogue  Leuprolide stimulates pituitary function and is used to treat infertility  GnRH agonists are used to treat prostate cancer and endometriosis

10 10Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Bromocriptine  Haveles (p. 251)  Inhibits pituitary function  Not a hormone; it is a dopamine agonist that suppresses prolactin levels  Used to treat prolactin-secreting adenomas, acromegaly, and Parkinson disease

11 11Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Posterior Pituitary  Haveles (p. 251)  Secretes vasopressin (antidiuretic hormone [ADH]) and oxytocin  vasopressin (Pitressin) has vasopressor and antidiuretic hormone activity and is used to treat transient diabetes insipidus Synthetic vasopressin analogues (desmopressin [DDAVP, Stimate] and lypressin [Diapid]) are used for chronic treatment of pituitary diabetes insipidus and for certain clotting disorders (hemophilia A and von Willebrand disease) Synthetic vasopressin analogues (desmopressin [DDAVP, Stimate] and lypressin [Diapid]) are used for chronic treatment of pituitary diabetes insipidus and for certain clotting disorders (hemophilia A and von Willebrand disease)  oxytocin (Pitocin, Suntocinon) is used to induce labor, control postpartum hemorrhage, and induce postpartum lactation

12 12Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Thyroid Hormones  Haveles (pp )  Iodine  Hypothyroidism  Hyperthyroidism cont’d…

13 13Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Thyroid Hormones  Haveles (p. 251)  The thyroid gland secretes two iodine- containing thyroid hormones—triiodothyronine (T 3 ) and tetraiodothyronine (thyroxine [T 4 ]); in addition, calcitonin regulates calcium metabolism  Thyroid hormones are important for energy metabolism, growth, and development  Thyroid hormones are synthesized from iodine and tyrosine and stored as complex protein until TSH stimulates their release

14 14Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Iodine  Haveles (p. 251)  The thyroid gland requires intake of adequate iodine; if iodine intake is deficient, normal amounts of thyroid hormones cannot be made  TSH is secreted in excess, and the thyroid hypertrophies (simple or nontoxic goiter)  Marine life is the only common food that is naturally rich in iodine; iodized salt has decreased the incidence of simple goiter

15 15Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hypothyroidism  Haveles (p. 251) (Box 20-1)  In the small child, hypothyroidism is called cretinism; in an adult, it is called myxedema or simple hypothyroidism  Patients are usually drowsy, weak, and listless and exhibit an expressionless, puffy face with edematous tongue and lips  Thyroid hypofunction is treated with exogenous thyroid hormones  The most common is levothyroxine cont’d…

16 16Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hyperthyroidism  Haveles (pp )  Two forms of thyroid hyperfunction  Diffuse toxic goiter (Graves disease) is characterized by a diffusely enlarged, highly vascular thyroid gland Common in young adults and considered a disorder of the immune response Common in young adults and considered a disorder of the immune response  Toxic nodular goiter (Plummer disease) is characterized by nodules that secrete excessive hormone while the rest of the glandular tissue is atrophied Occurs primarily in older patients Occurs primarily in older patientscont’d…

17 17Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hyperthyroidism  Excess levels of circulating thyroid hormone produce thyrotoxicosis  Adverse effects include excess production of heat, increased sympathetic activity, increased neuromuscular activity, increased sensitivity to pain, ophthalmopathy, exophthalmos, and anxiety  Oral manifestations include accelerated tooth eruption, marked loss of alveolar process, diffuse demineralization of jawbone, and rapidly progressive periodontitis  Direct inotropic effect in cardiovascular system cont’d…

18 18Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hyperthyroidism  Haveles (p. 252) (Box 20-2)  Treatment: the two most common treatments are radioactive iodine ( 131 I) and thyroidectomy  Either treatment usually results in hypothyroidism

19 19Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Antithyroid Agents  Haveles (p. 252)  Antithyroid drugs such as propylthiouracil (PTU) and methimazole (Tapazole) are used in patients who cannot tolerate surgery or treatment with 131 I  These drugs interfere directly with the synthesis of thyroid hormones by inhibiting the iodination of tyrosine moieties and the coupling of iodotyrosines

20 20Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Pancreatic Hormones  Haveles (pp )  Diabetes mellitus (DM)  Types of diabetes  Complications of diabetes  Dental issues  Cautions and contraindications  Systemic complications of diabetes  Effect of drugs on complications of diabetes  Evaluation of the dental patient with diabetes  Treatment of hypoglycemia  Drugs used to manage diabetes cont’d…

21 21Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Pancreatic Hormones  Haveles (p. 252)  Two primary hormones secreted by islets of Langerhans of the pancreas are insulin and glucagon  Insulin promotes fuel storage (glucose out of blood)  Glucagon promotes fuel mobilization (glucose into the blood)

22 22Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Diabetes Mellitus  Haveles (pp ) (Fig. 2-3; Table 20-1)  A group of metabolic disorders characterized by persistent hyperglycemia  Type I (insulin-dependent DM [IDDM])  Type II (non–insulin-dependent DM [NIDDM])  Symptoms and complications result, usually from inadequate or poorly timed secretion of insulin from the pancreas and/or insulin resistance of the cells

23 23Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Types of Diabetes  Haveles (pp )  Type I: usually develops in persons younger than age 30 years and results from autoimmune destruction of pancreatic beta cells  Associated with a complete lack of insulin secretion, increased glucagon secretion, rapid onset of disease, ketosis, and severe symptoms  Without insulin, type I DM is fatal  Must be treated with injections of insulin cont’d…

24 24Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Types of Diabetes  Haveles (pp ) (Box 20-3)  Type II: usually develops in persons older than age 40 years, but more and more cases are being reported in persons younger than age 20 years; attributed to lack of exercise  The pancreas can secrete enough insulin to prevent ketoacidosis but not enough to normalize plasma glucose Insulin secreted does not reduce glucose levels in serum to normal levels Insulin secreted does not reduce glucose levels in serum to normal levels  Insulin resistance develops and the pancreas gives out

25 25Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Complications of Diabetes  Haveles (p. 254)  Xerostomia: pronounced susceptibility to caries; the xerostomia is secondary to an increase in urination  Dry, cracking oral mucosa with presence of mucositis, ulcers, infections, and an inflamed painful tongue  Periodontal disease: patients with uncontrolled or undiagnosed diabetes are more prone to periodontal disease  Advanced glycation end-products (AGEs): collagen becomes cross-linked; thickening of blood vessels is associated with elevated AGEs

26 26Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Dental Issues  Haveles (p. 254)  Dental appointments should not interfere with meals and should involve minimal stress  Patients with diabetes have fragile blood vessels, delayed wound healing, and a tendency to develop infections  Surgical therapy should be approached with caution

27 27Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Cautions and Contraindications  Haveles (p. 254)  Drugs that may decrease insulin release or increase insulin requirements, such as epinephrine, glucocorticoids, or opioid analgesics, should be used with caution in patients with diabetes

28 28Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Systemic Complications of Diabetes  Haveles (pp )  Cardiovascular system: incidence of problems is higher in patients with diabetes  Retinopathy: microvascular disease affects the blood supply to the retina  Neuropathy: leads to reduced and sometimes absent feelings, especially in the lower extremities  Infections: gangrene can occur in the peripheral extremities due to depressed immunity, less effective white blood cells, microvascular changes, and neuropathy  Healing: slower healing

29 29Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Effect of Drugs on Complications of Diabetes  Haveles (pp )  Intensive treatment of patients with IDDM can substantially reduce the onset and progression of diabetic retinopathy, nephropathy, and neuropathy  The risk of hypoglycemia is increased three times, and the increase in weight gain tends to be greater

30 30Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Evaluation of the Dental Patient With Diabetes  Haveles (p. 256)  Two laboratory tests useful in evaluating a patient’s glucose control are serum glucose and glycosylated hemoglobin  Serum glucose is a measure of the patient’s glucose control at the time that the blood is sampled  Glycosylated hemoglobin (HbA 1C ) reflects glucose control over a 2- to 3-month period

31 31Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Treatment of Hypoglycemia  Haveles (p. 256)  When patient is conscious, treatment consists of any source of sugar: fruit juice, cake icing, glucose gel, or soluble carbohydrate  If the patient is unconscious and lacks a swallowing reflex, treatment consists of intravenous dextrose (50%)

32 32Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Drugs Used to Manage Diabetes  Haveles (pp )  Insulins  Oral antidiabetic agents  Other new drugs  Glucagon cont’d…

33 33Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Drugs Used to Manage Diabetes  Haveles (pp ) (Fig. 20-4; Table 20-4)  Insulins  Usually administered by subcutaneous injection, large molecular size prevents it from being absorbed from the gastrointestinal tract  Differ in onset and duration of action  Human insulin is prepared by recombinant DNA synthesis and by modifying porcine insulin cont’d…

34 34Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Drugs Used to Manage Diabetes  Insulins  Recently, an inhaled dose form was approved to treat both type 1 and type 2 diabetes  Can be used in place of short-acting injectable insulin that is used at mealtime for patients with type 1 diabetes  It is added to regimens that also include long- acting insulin

35 35Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Selected Insulin Preparations  Haveles (p. 256) (Table 20-4)  Rapid acting  insulin aspart (Novolog)  insulin lispro (Humalog)  insulin gallisin (Apidra)  Short acting  insulin regular (Novolin R, Humulin R) cont’d…

36 36Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Selected Insulin Preparations  Haveles (p. 256) (Table 20-4)  Intermediate acting  insulin NPH (Humulin N, Novolin N)  Humulin L Lente  Long acting  insulin detemir (Levimir)  insulin glargine (Lantus)

37 37Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Drugs Used to Manage Diabetes  Haveles (pp. 257) (Box 20-4)  Hypoglycemia is the most common adverse reaction to insulin  May be caused by unintentional overdose (insulin shock), failure to eat, or increased exercise or stress  Symptoms are explained by increased release of epinephrine from the adrenals, include sweating, weakness, nausea, and tachycardia  Symptoms from glucose deprivation of the brain include headache, blurred vision, mental confusion, incoherent speech, and eventually coma, convulsions, and death

38 38Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Oral Antidiabetic Agents  Haveles (pp , ) (Table 20-6)  Currently four groups of oral agents  The oldest is sulfonylureas; oral hypoglycemic agents  Antihyperglycemic agents: lower elevated blood sugar but do not produce hypoglycemia Biguanides Biguanides Nonsulfonurea secretagogues Nonsulfonurea secretagogues α-Glucosidase inhibitors α-Glucosidase inhibitors Thiazolidinediones Thiazolidinedionescont’d…

39 39Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Oral Antidiabetic Agents  Haveles (p. 257)  Biguanides: metformin (Glucophage) increases hepatic and peripheral insulin sensitivity cont’d…

40 40Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Oral Antidiabetic Agents  Haveles (pp ) (Fig. 20-6)  Sulfonylureas: the only orally active agents used to manage diabetes for many years  Mechanism of action includes stimulation of release of insulin from the beta cells of the pancreas, reduction of glucose from the liver, reduction in serum glucagon levels, and increase in sensitivity of target tissues to insulin  Indicated for patients with NIDDM who cannot be treated with diet and exercise alone

41 41Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Oral Diabetic Agents  Haveles (p. 259)  Nonsulfonylurea secretagogues  α-Glucosidase inhibitors: acarbose (Precose) slows down the breakdown of ingested fat, thus postprandial hyperglycemia is reduced  Thiazolidinediones: increase insulin sensitivity of adipose tissue, skeletal muscle, and the liver

42 42Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Other New Drugs  Haveles (p. 259)  exenatide (Byetta): an incretin mimetic that has an amino acid sequence similar to human glucagon-like peptide-1 (GLP-1) and in the presence of glucose acts to stimulate insulin secretion  pramlintide (Symlin): an amylinomimetic agent responsible for modulation of gastric emptying, prevention of postprandial rise in plasma glucagon, and satiety, which leads to decreased caloric intake and potential weight loss cont’d…

43 43Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Other New Drugs  Haveles (p. 262)  Colesevelam: a bile-acid sequestrant used to lower low-density lipoprotein (LDL) cholesterol  Dipeptidyl-peptidase-4 inhibitors: sitagliptin (Januvia) is an oral medication approved for use in the treatment of type II diabetes as monotherapy or in combination with metformin, a sulfonylurea, or a thiazolidinedione

44 44Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Glucagon  Haveles (p. 262)  A polypeptide hormone produced by α cells of the pancreas  Increases liver glycogenolysis by stimulating cyclic adenosine monophosphate (cAMP) synthesis and increasing phosphorylase kinase activity  An antagonist to insulin  May be used parenterally for emergency treatment of hypoglycemia, glucose is usually preferred

45 45Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Female Sex Hormones  Haveles (pp )  Estrogens  Progestins  Hormonal contraceptives cont’d…

46 46Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Female Sex Hormones  Haveles (pp )  There are both male and female sex hormones  Most sex hormones occur in both sexes but in different proportions  The two major female sex hormones are estrogens and progestins  The are secreted primarily by the ovaries but also by the testes and placenta  They are largely responsible for producing female sex characteristics, developing the reproductive system, and preparing the reproductive system for conception cont’d…

47 47Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Female Sex Hormones  Estrogen and progesterone levels vary daily  Changes are dependent on the pituitary gonadotropic hormones FHS and LH  On day 1 of an average 28-day cycle, secretions of FSH and LH begin to increase  This release is caused by a reduction in the blood levels of estrogen and progesterone, which normally inhibit their release cont’d…

48 48Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Female Sex Hormones  An ovarian egg matures in response to increased FSH  The follicle in which it is contained grows in size and begins to secrete estrogen  On approximately day 12, the rate of secretion of FSH and LH increases markedly to cause a rapid swelling of the follicle  This culminates in ovulation on day 14 cont’d…

49 49Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Female Sex Hormones  Haveles (p. 263) (Fig. 20-7)  After ovulation, LH causes secretory cells of the follicle to develop into a corpus luteum that secretes large quantities of estrogen and progesterone  This causes a feedback decrease in the secretion of both FSH and LH cont’d…

50 50Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Female Sex Hormones  The corpus luteum completely degenerates on approximately day 26  The decrease in estrogen and progesterone leads to menstruation and increased release of FSH and LH  The FSH initiates growth of new follicles to begin a new cycle

51 51Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Estrogens  Haveles (pp ) (Table 20-8)  Overview  Estrogens are largely responsible for the changes that take place during puberty  Synthetic estrogens can be used for therapy and conception  The most common side effects of estrogen therapy are nausea and vomiting Other side effects include uterine bleeding, vaginal discharge, edema, thrombophlebitis, weight gain, and hypertension Other side effects include uterine bleeding, vaginal discharge, edema, thrombophlebitis, weight gain, and hypertensioncont’d…

52 52Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Estrogens  Haveles (pp )  Estrogen therapy may also promote endometrial carcinoma in postmenopausal women  This risk may be cancelled out by administration of a progestin cont’d…

53 53Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Estrogens  Haveles (p. 264)  Effect on oral tissues  Changes in sex hormone levels are related to  Gingivitis at puberty  During pregnancy  After menopause  The increase in gingival inflammation may occur even with a decrease in the amount of plaque

54 54Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Progestins  Haveles (p. 264)  The corpus luteum is the primary source of progesterone during the normal female sexual cycle  Progesterone promotes secretory changes in the endometrium and prepares the uterus for implantation of the fertilized ovum If implantation does not occur, progesterone secretion declines and menstruation occurs If implantation does not occur, progesterone secretion declines and menstruation occurs If implantation takes place, the trophoblast secretes chorionic gonadotropin, which sustains the corpus luteum, maintaining progesterone and estrogen levels and preventing menstruation If implantation takes place, the trophoblast secretes chorionic gonadotropin, which sustains the corpus luteum, maintaining progesterone and estrogen levels and preventing menstruationcont’d…

55 55Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Progestins  Haveles (p. 264)  Progestins are used in a variety of dose forms  Parenteral medroxyprogesterone (Depo-Provera) is administered every 3 months as a contraceptive  Progestin-only “minipills” are used orally  A progestational agent can be administered as an intrauterine device (IUD) or implant under the skin of the arm

56 56Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hormonal Contraceptives  Haveles (pp ) (Box 20-5)  Oral contraceptives are the most common dose forms of hormonal contraceptives and consist of estrogens and progestins in various combinations  These are the most common birth control pills and are more than 99% effective  The combination type of oral contraceptive is taken for 21 days of each month  The seven pills in the fourth week contain no active ingredient cont’d…

57 57Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hormonal Contraceptives  Haveles (p. 265)  Seasonale is the newest in combination oral contraceptives  An extended cycle contraceptive  The contraceptive vaginal ring is a new dose form that introduces hormonal contraception into the body  An injectable contraceptive is also available cont’d… cont’d…

58 58Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hormonal Contraceptives  Haveles (p. 265)  Hormonal contraceptives are associated with a significant increase in the frequency of dry sockets after extractions  Contraindications for use of oral contraceptives include thromboembolitic disorders, significant dysfunction of the liver, known or suspected carcinoma of the breast or other estrogen- dependent neoplasm, and undiagnosed genital bleeding cont’d…

59 59Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Hormonal Contraceptives  Haveles (p. 265) (Table 20-9)  Certain antibiotics have been said to reduce the effectiveness of hormonal contraceptives  They are thought to do so by indirectly suppressing the intestinal flora and thus diminishing the availability of hydrolytic enzymes to regenerate the parent steroid molecule  Consequently, plasma concentrations of steroids are said to be abnormally low, and the steroid is cleared more rapidly from the body than under normal circumstances

60 60Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Male Sex Hormones  Haveles (p. 266) (Box 20-6; Table 20-10)  Androgens  Testosterone, the main androgen, has both androgenic and anabolic effects  Androgens are responsible for the development of secondary male sex characteristics cont’d…

61 61Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Male Sex Hormones  Haveles (p. 266)  Androgens are used illicitly for muscle mass gain  Androgenic steroids are schedule III controlled substances because of their abuse  Side effects of androgenic steroids include nausea, cholestatic jaundice, hepatocellular neoplasms, increased serum cholesterol, habituation, and depression and excitation cont’d…

62 62Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved. Other Agents that Affect Sex Hormone Systems  Haveles (pp ) (Table 20-11)  Clomiphene has the ability to induce ovulation in some anovulatory women  Leuprolide is used in the management of endometriosis and to treat infertility  Tamoxifen is indicated in the palliative treatment of breast cancer in postmenopausal women  Danazol is used to treat endometriosis and fibrocystic disease in women  Aromatase inhibitors reduce almost the entire amount of estrogen made in the bodies of postmenopausal women


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