Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS
Focus on PHARMACOLOGY ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
Drugs Used to Treat Endocrine Conditions
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Multimedia Directory
Slide 5 Endocrine System Animation
Slide 35 Diabetes Video
Slide 40 Insulin Video
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Endocrine System
- Secretes hormones that control body by maintaining internal environment (homeostasis)
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Endocrine System
- Some examples of hormones:
Corticotropin-releasing hormone (CRH)
Growth hormone-releasing hormone (GHRH)
Gonadotropin-release hormone (GnRH)
Thyrotropin-releasing hormone (TRH)
Anterior pituitary hormones
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Endocrine System Animation
Click on the screenshot to view an animation showing the endocrine system. The animation may take a moment before playing.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Figure 25-1 Primary glands of the endocrine system.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-1 Endocrine Glands and Their functions
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-1 (continue) Endocrine Glands and Their functions
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Figure 25-2 Pituitary hormones and their target cells, tissues, and organs.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Growth Hormone
- GH (somatotropin)
- Causes increase in weight and length of body
- Irregularities: gigantism or acromegaly
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Thyroid-Stimulating Hormone
- TSH
- Controls secretion of thyroid hormone
- Important for growth and function of thyroid gland
- Stimulates uptake of iodine and increases synthesis and release of thyroid hormones
- Abnormalities: hypothyroidism or hyperthyroidism (Graves’ disease)
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Adrenocorticotropic Hormone
- ACTH
- Released by anterior lobe of pituitary gland
- Stimulates growth of adrenal gland cortex and secretion of corticosteroids
- Hypersecretion: Cushing’s syndrome
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Gonadotropic Hormones
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Produced by pituitary gland
- Affect gonadal tissue in men and women
In men: spermatogenesis
In women: gametogenesis and follicular development
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Prolactin
- P
- With estrogens, progesterone, hydrocortisone, and insulin, stimulates breast development
- Stimulates milk secretion by mammary glands
- Increases testicular steroidogenesis and development of male accessory sex organs
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Vasopressin
- Antidiuretic hormone (ADH)
- Stimulates water reabsorption from nephrons
- Lack of ADH causes diabetes insipidus
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Oxytocin
- Stimulates contraction of smooth muscle in the:
Uterus
Alveoli of lactating breast
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-2 Relationships Among Hypothalamic, Anterior Pituitary, and Target Organ Hormones
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Thyroid Hormones
- Thyroxine (T4)
- Triiodothyronine (T3)
- Calcitonin: calcium homeostasis
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Myxedema Coma
- Associated with severe hypothyroidism
- Medical emergency manifested by diminished level of consciousness
- Symptoms: hypothermia, hypoventilation, hypotension, hypoglycemia
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Congenital Hypothyroidism
- Congenital hypothyroidism is absence of thyroid tissue during fetal development.
- Absence of thyroid occurs more often in female infants.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Congenital Hypothyroidism
- Thyroid hormone is essential for embryonic growth, particularly of brain tissue; infant will be mentally retarded if no thyroxine is available during fetal life.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-3 Common Thyroid and Antithyroid Agents
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Potassium Iodide
- Uses: hyperthyroidism; with other drugs for thyrotoxic crisis
- Adverse effects: possible irregular heartbeat, mental confusion, pulmonary edema
- Contraindications: hypothyroidism, hyperkalemia, acute bronchitis
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Potassium Iodide
- Patient information: iodine is present in shellfish, iodized salt and some OTC cough preparations
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Methimazole
- Uses: hyperthyroidism
- Adverse effects: hypothyroidism, pancytopenia, aplastic anemia, arthralgia, peripheral neuropathy
- Contraindications: pregnancy and lactation
- Patient Information: take before breakfast
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Propylthiouracil
- Uses: hyperthyroidism, iodine-induced thyrotoxicosis
- Adverse effects: agranulocytosis, hypothyroidism, bradycardia
- Contraindications: last trimester of pregnancy and during lactation
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Propylthiouracil
- Patient information: instruct patients to report agranulocytosis symptoms, avoid foods that inhibit thyroid secretion, and take early in day
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Levothyroxine
- Uses: hypothyroidism
- Adverse effects: hyperthyroidism (high levels), chest pain, rapid or irregular heartbeat
- Contraindications: allergies to povidone-iodine or tartrazine
- Many interactions with other drugs
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Levothyroxine
- Patient information: instruct patients to get frequent blood tests, take on empty stomach, and immediately report chest pain or irregular heartbeat
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Parathyroid Hormone (PTH)
- Acts to restore calcium concentration
- Hypoparathyroidism: rare disorder in which body produces little or no parathyroid hormone, resulting in hypocalcemia
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Pancreatic Hormones
- Glucagon: secreted by islets of Langerhans in pancreas when blood glucose levels are low
Functions to maintain adequate levels of glucose in blood
- Insulin: secreted by pancreatic beta cells
Promotes use of glucose in cells
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Diabetes Mellitus
- Serious endocrine disorder
Hyperglycemia
Results from deficient insulin secretion or decreased sensitivity of insulin receptors on target cells
Affects 17 million Americans
Type 1: 10% of cases; caused by lack of insulin secretion by pancreas
Type 2: 90% of cases; caused by resistance of insulin receptors to insulin
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Figure 25-3A Diabetes mellitus can be caused by dysregulation of beta-cell function.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Figure 25-3B Interaction of blood glucose levels, insulin, and glucagon.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Diabetes Video
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Diabetes in Children
- Chronic pathological conditions resulting from diabetes mellitus in children include:
Diabetic neuropathy
Retinopathy
Nephropathy
Stroke
Coronary artery disease
Infection
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Diabetes and Obesity
- Obesity: major cause of type 2 diabetes
- Type 2 diabetes usually affects people older than age 40.
- African-Americans have highest rates of obesity and diabetes compared to other racial/ethnic groups.
- 30 minutes of moderate physical activity most days are recommended to treat obesity.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-4 Classifications of Insulin
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-4 (continued) Classifications of Insulin
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Insulin Video
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Insulin Therapy
- Insulin controls the level of blood glucose.
- It does not cure diabetes.
- Insulin therapy is required long term.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Rapid-acting Insulin
- Uses: treatment of type 2 diabetes
- Adverse effects: hypoglycemia
- Contraindications: cautious use in hyperthyroidism and hypothyroidism, renal or hepatic impairment, lactation and pregnancy, and older adults
- Patient information: instruct patients in proper diet and symptoms of hypoglycemia
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Short-acting Insulins
- Uses: emergency treatment of diabetic ketoacidosis or coma, to initiate therapy in type 1 diabetes, and in combination with other insulins
- Adverse effects: hypoglycemic reactions
- Contraindications: cautious use in pregnancy and lactation, in patients with kidney or liver impairment
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Intermediate-acting Insulins
- Uses: to control hyperglycemia
- Adverse effects: rare
- Contraindications: during hypoglycemia; cautious in insulin-resistant patients, hyperthyroidism or hypothyroidism, renal or hepatic impairment, pregnancy or lactation, older adults, children younger than 3 years
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Intermediate-acting Insulins
- Patient information: teach patients to check blood glucose levels and maintain well-balanced diet
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Long-acting Insulin
- Uses: type 1 and 2 diabetes
- Adverse effects: hypoglycemia and hypokalemia
- Contraindications: cautious use in patient with renal or hepatic impairment, during pregnancy or lactation, and in children younger than 6 years
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Long-acting Insulin
- Patient information: advise patients to carry source of glucose
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Insulin in Zinc Suspension
- Uses: type 1 diabetes
- Adverse effects: similar to those of rapid-acting
- Contraindications: hypoglycemia
- Patient information: instruct patients about hypoglycemic symptoms and to use orange juice and sugar-containing foods to treat hypoglycemic reactions
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-5 Common Oral Antidiabetic Drugs
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-5 (continued) Common Oral Antidiabetic Drugs
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Sulfonylureas
- Uses: treatment of mild to moderate type 2 diabetes
- Adverse effects: hypoglycemia, fainting, confusion, blurred vision, bone-marrow depression
- Contraindications: severe infections; acidosis; severe renal, hepatic, or thyroid dysfunction
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Sulfonylureas
- Patient information: teach patients to avoid alcohol
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Biguanides
- Uses: type 2 diabetes when no response to sulfonylureas occurs
- Adverse effects: anorexia, GI upset, lactic acidosis
- Contraindications: renal disease, alcoholism, hepatic disease, chronic cardiopulmonary dysfunction
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Thiazolidinediones
- Uses: adjuncts to treatment of type 2 diabetes
- Adverse effects: edema, anemia, headache, back pain, fatigue, weight gain, hypoglycemia
- Contraindications: active liver impairment, pregnancy, lactation, in children younger than 18 years
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Thiazolidinediones
- Patient information: advise patients to report symptoms of hepatic dysfunction
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Alpha-glucosidase Inhibitors
- Uses: monotherapy or combination therapy for type 2 diabetes
- Adverse effects: GI effects, hypoglycemia
- Contraindications: inflammatory bowel disease or other GI conditions, renal impairment
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Alpha-glucosidase Inhibitors
- Patient information: instruct patients that insulin may be needed in times of infection, stress, or surgery
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-6 Adrenocortical Hormones and Their Effects
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Table 25-7 Major Adrenal Corticosteroids (Glucocorticoids)
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Glucocorticoids
- Uses: replacement therapy in adrenal insufficiency; rheumatic, inflammatory, allergic, neoplastic, and other disorders
- Adverse effects: insomnia, behavioral changes, acute peptic ulcer disease
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Glucocorticoids
- Contraindications: peptic ulcer, heart disease, hypertension infectious illnesses, psychoses, diabetes, osteoporosis, glaucoma
- Patient information: advise patients not to stop abruptly, to not have immunizations, and to take drugs with food
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Mineralocorticoids
- Uses: primary and secondary adrenocortical deficiency
- Adverse effects: edema, hypertension, heart failure, hypokalemia, muscular weakness, headache
- Contraindications: patients with systemic fungal infections; cautious use in Addison’s disease, pregnancy, and lactation
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition Jahangir Moini
Mineralocorticoids
- Patient information: advise patients to maintain a low-sodium, high-potassium diet, and to recognize symptoms of edema, hypertension, and heart failure
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