Pharmacology

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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Endocrine System Animation

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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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Diabetes Video

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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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Insulin Video

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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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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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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