Unit XI
Drugs used for hormonal disorders & Supplementation, Contraception and
Medical Termination of Pregnancy
QUESTION 1: Classify Insulins. Write the mechanism of action of Insulin.
Insulin is a polypeptide hormone synthesized and secreted from the β-cells of
Langerhans of pancreas and regulates the metabolism of carbohydrates, proteins and
lipids in the body.
CLASSIFICATION OF INSULIN PREPARATIONS:
Based on the duration of action Insulin preparations can be classified as follows
I.
RAPID ACTING INSULIN: Insulin lispro, Insulin Aspart, Insulin Glulisine
II.
SHORT ACTING INSULIN: Regular insulin
III.
MEDIUM ACTING INSULIN: Intermediate acting
 Insulin zinc suspension (Lente)
 Neutral protamine hagedorn
IV.
LONG ACTING INSULIN:
 Protamine zinc insulin
 Insulin glargine
Mechanism of action: Insulin reduces blood glucose concentration by stimulating its
utilization by peripheral cells, stimulating glycogenesis and also by inhibiting
gluconeogenesis and glycogenolysis. It acts as follows
 Increases utilization of glucose: Insulin stimulates transportation of glucose
into the tissues such as adipose tissue, skeletal muscle and liver and increases the
utilization of glucose and reduces blood glucose level.
 Stimulates glycogenesis: Insulin stimulates conversion of Glucose to Glycogen
which is deposited in liver and adipose tissue and lowers blood glucose.
Dr. Ramesh C, Professor & HOD, EWCP
 Inhibits glycogenolysis: Insulin inhibits the breakdown of glycogen to glucose
in liver and adipose tissue and reduces blood glucose.
 Inhibits gluconeogenesis: Insulin inhibits the synthesis of glucose from noncarbohydrate substances and hence reduces concentration of glucose in glucose.
 Synthesis of proteins: Insulin promotes the synthesis of proteins from amino
acid and involved in anabolic process.
 Synthesis of Triglycerides: Insulin stimulates the synthesis of triglycerides from
serum free fatty acids and deposit in adipose tissue.
Therapeutic uses
 Insulin dependent diabetes mellitus (IDDM/Type I)
 Diabetic ketoacidosis
Adverse effects
 Hypoglycemia
 Weight gain
 Lactic acidosis
QUESTION 2: Classify oral hypoglycemic agents. Write the actions and side effects
of Metformin.
The drugs which are used in the treatment of non-insulin dependent diabetes mellitus
(Type-2/NIDDM) are known as oral hypoglycemic agents.
I.
INSULIN RELEASING AGENTS:
a. Sulfonylureas: Glipizide, Glimepiride, Glibenclamide
b. Phenyl alanine analogues: Nateglinide
II.
INSULIN SENSITIZERS:
a. Biguanides: Metformin
b. Thiazolidinediones: Pioglitazone, Rosiglitazone
III.
Α-GLUCOSIDASE INHIBITORS: Acarbose, Voglibose
Dr. Ramesh C, Professor & HOD, EWCP
METFORMIN
The metformin known as insulin sensitizers and stimulates the action of
insulin and reduces blood glucose level as follows.
 Increases utilization of glucose: Insulin stimulates transportation of glucose
into the tissues such as adipose tissue, skeletal muscle and liver and increases the
utilization of glucose and reduces blood glucose level.
 Stimulates glycogenesis: Insulin stimulates conversion of Glucose to Glycogen
which is deposited in liver and adipose tissue and lowers blood glucose.
 Inhibits glycogenolysis: Insulin inhibits the breakdown of glycogen to glucose
in liver and adipose tissue and reduces blood glucose.
 Inhibits gluconeogenesis: Insulin inhibits the synthesis of glucose from noncarbohydrate substances and hence reduces concentration of glucose in glucose.
 Synthesis of proteins: Insulin promotes the synthesis of proteins from amino
acid and involved in anabolic process.
 Synthesis of Triglycerides: Insulin stimulates the synthesis of triglycerides from
serum free fatty acids and deposit in adipose tissue.
Therapeutic uses
 Non-Insulin dependent diabetes mellitus (NIDDM/Type II)
 Diabetic ketoacidosis
Adverse effects
 Abdominal pain,
 Anorexia,
 Metallic taste
 Diarrhea
 Tiredness
 Hypoglycemia
Dr. Ramesh C, Professor & HOD, EWCP
 Weight gain
 Lactic acidosis
QUESTION 3. Name any thyroid supplement and thyroid suppressants. Write
the side effects of anti-thyroid drugs.
Thyroid supplement:
These are also known as thyroids and are used for the treatment of hypothyroidism
(Decreased activity of thyroid gland).
Examples: Thyroxine (T4), Tri-ido-tyronine (T3),
Thyroid suppressants:
These are also known as anti-thyroid agents which are used to treat hyperthyroidism
(Increased activity of thyroid gland).
Examples: Propyl-thiouracil, Carbimazole, Methimazole.
Adverse effects of Anti-thyroids:
 GIT Intolerance: Nausea, Vomiting, Abdominal pain.
 Hair loss
 Loss of taste
 Liver damage
 Hypothyroidism and goiter ( on overdose)
QUESTION 4: Name any TWO steroidal preparations. Write the side effects of
steroidal administration.
Steroidal drugs are substances secreted from adrenal cortex and produce various
biological actions in the body. Types of steroids are
 Gluco-corticosteroids: Cortisone, Hydrocortisone, Prednisolone,
Betamethasone
Dr. Ramesh C, Professor & HOD, EWCP
 Mineralo-corticosteroids: Aldosterone
 Sex-corticosteroids: Estrogen, Progesterone and testosterone.
Side effects of steroids
 Suppression of immunity
 Sodium and water retention
 Hypertension and Edema
 Hyperglycemia
 Muscle weakness
 Peptic ulcer
 Osteoporosis
 Glaucoma
 Growth retardation
QUESTION 5: What are pharmacological effects and side effects of anabolic
steroids.
The anabolic steroids are class of testosterone hormones which stimulates the synthesis
of proteins and increases anabolism and hence used to gain weight.
Examples: Nandrolone, Oxymetholone
Pharmacological actions of anabolic steroids
 Stimulates the synthesis of proteins and increases muscle growth
 Development of male sexual organs
 Stimulates the synthesis of sperm.
 Synthesis of RBC.
Therapeutic uses of anabolic steroids
 Catabolic state
 Osteoporosis
 Suboptimal growth in boys
Dr. Ramesh C, Professor & HOD, EWCP
 To enhance physical ability in athletes
 Hemolytic anemia
Side effects of anabolic steroids
 Complete amenorrhoea
 Acne, hirsutism,
 Decreased breast size,
 Deepening of voice,
 Edema
 Weight gain.
 Loss of libido in men,
 Hot flashes in women and night sweats,
 Muscle cramps,
 GIT upset,
QUESTION 6: Name two uterine stimulants. Write their uses and side effects.
Uterine stimulants are the drugs/agents which are used to produce the contraction of
uterine smooth muscle. These are also known as oxytocic agents.
Examples:
 Posterior pituitary hormones: Oxytocin
 Ergot alkaloids: Ergotamine, Ergometrine,
 Prostaglandins: PGF2α
Therapeutic uses of uterine stimulants
 Induction of labour
 To induce abortion
 Uterine inertia
 Postpartum hemorrhage
 Breast engorgement
Dr. Ramesh C, Professor & HOD, EWCP
Side effects of uterine stimulants
 Uterine cramps and severe pain
 Complete dilation of the birth canal
 Fetal tissue injury
 Uterine tissue damage
 Anti-diuretic action
QUESTION 7: Write uses and side effects of uterine relaxants.
Uterine relaxants are the drugs/agents which cause relaxation of uterine smooth
muscle. These are also known as Tocolytic agents.
Examples: Ritodrine, Isoxsuprine, Magnesium sulfate, Nifedipine
Therapeutic uses of uterine relaxants
 To prevent threatened abortion
 To avoid premature labour
 To prolong the labour
 Acute fetal distress
 To treat uterine cramps
Side effects of uterine relaxants
 CVS Complications: Hypotension, Tachycardia, Cardiac arrhythmia,
pulmonary edema
 Metabolic Complications: Hyperglycaemia,, hyperinsulinaemia, hypokalaemia.
 CNS complications: Anxiety, Restlessness, Headache
 May cause maternal morbidity
Dr. Ramesh C, Professor & HOD, EWCP
QUESTION 8: What are types of oral contraceptive preparations. Explain the
actions of Progesterone.
The oral contraceptives are the preparations consisting of progesterone and/or
estrogen which are used to prevent pregnancy.
Types of oral contraceptives
I.
II.
Combined pill: Consists of both progesterone and estrogen.
Progesterone only pill: Consists of only progesterone and also known as mini
pill.
III.
Post coital pill: There are three preparations available as follows
 Levonorgestrel 0.5 mg + ethinylestradiol 0.1mg
 Levonorgestrel alone 0.75 mg
 Mifepristone 600 mg single dose
Actions of progesterone
 Uterus: Regulates secretory changes in the uterus and maintain pregnancy.
 Vagina: Progesterone induces pregnancy like changes in the vaginal mucosa
 Breast: Progesterone causes proliferation of acini in the mammary glands
 CNS: Produces sedation
 Body temperature: Progesterone slightly increases body temperature.
 Respiration: Progesterone stimulates respiration in higher doses.
 Regulation of ovulation,
 Regulation of menstrual cycle
 Implantation of ovum in uterus
 Development of pregnancy
Therapeutic use of progesterone
 As contraceptive
 Hormone replacement therapy
 Dysfunctional uterine bleeding
Dr. Ramesh C, Professor & HOD, EWCP
 Endometriosis
 Premenstrual syndrome/tension
 Threatened/habitual abortion
 Endometrial carcinoma
Side effects of progesterone
 Breast engorgement,
 Headache,
 Rise in body temperature,
 Edema,
 Esophageal reflux,
 Acne
 Mood swings
 Irregular bleeding or amenorrhoea
 Hyperglycemia
 Congenital abnormalities
QUESTION 9: What are the regulators of Calcium in the body? Name any two
calcium preparations with side effects.
These are the drugs which increases or decreases the calcium level in the bod are
known as calcium regulators. They are as follows.
a) Drugs increase calcium in the body: Calcitriol (Vitamin D), Calcitonin
b) Drugs decrease calcium in the body: Parathorome
List of calcium salts
 Calcium gluconate
 Calcium chloride
 Calcium carbonate
Dr. Ramesh C, Professor & HOD, EWCP
Side effects of calcium salts
 Anorexia.
 Constipation.
 Flatulence.
 Dizziness.
 Flushing.
 Abnormal heartbeats
 Nausea.
 Vomiting.
Dr. Ramesh C, Professor & HOD, EWCP