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Chapter 14 Hormones Chapter 14 Topics • • • • • • • The Endocrine System Male Impotence Female Hormones Bone Disease Sexually Transmitted Disease Corticosteroids Diabetes - Hypoglycemic Agents Learning Objectives • Explain the concept of hormones and how they regulate the body • Discuss thyroid replacement therapy • Discuss adrenal sex hormones and male dysfunction • Understand the concept of hormone replacement therapy Learning Objectives • Understand the formulation of oral contraceptives • Recognize the urgent need for the drugs used at delivery • Describe the diseases of the genital systems and how to avoid them • Discuss corticosteroids Learning Objectives • Understand diabetes and the proper treatment and care of patients • Know the applications for growth hormone The Endocrine System • Consists of glands and other structures that produce hormones which are released into the circulatory system The Endocrine System • Consists of glands and other structures that produce hormones which are released into the circulatory system • Regulation is established through hormones affecting target tissue Regulation • Homeostatsis is achieved through feedback mechanisms • Negative feedback – negates change to bring levels back to normal Pituitary Gland • Regulates other endocrine glands as well as other body activities Thyroid Gland • Produces hormones (T3 and T4) that stimulate metabolic activity of body tissues • Hypothalamus and pituitary glands work together to release TSH • TSH stimulates T3 and T4 release Thyroid Hormone Feedback Loop • Thyroid hormones build up in the blood • Signals are sent to the hypothalamicpituitary axis that adequate levels have been met • TSH levels decrease Hypothyroidism • Production of thyroid hormones is below normal • Cretinism occurs in children at birth due to inadequate maternal iodine intake – Can cause mental retardation, thick tongue, lethargy, lack of response, short stature – can be corrected if treated Hypothyroidism Symptoms • • • • • Apathy Constipation Decreased heart rate Depression Dry skin, nails, and scalp • Easy fatiguing • Enlarged thyroid • • • • • • Lowered voice pitch Myxedema Puffy face Reduced mental acuity Swelling of eyelids Tongue enlarged and thickened • Weight gain Causes of Hypothyroidism • Autoimmune destruction of the gland • Radioactive iodine therapy • Surgical removal of the gland Treatment for Hypothyroidism • Thyroid replacement therapy – Should not be used to treat obesity Drug List Agents for Hypothyroidism • levothyroxine, T4 (Levothroid, Levoxyl, Synthroid) • liothyronine, T3 (Cytomel) • liotrix (Thyrolar) • thyroid (Armour Thyroid) levothyroxine, T4 (Levothroid, Levoxyl, Synthroid) • Used for chronic therapy • Can be cardiotoxic • Alters protein binding of other drugs • Should not switch brands once stabilized levothyroxine Dispensing Issues Warning! • Can be cardiotoxic; report any of the following: – Chest pain, increased pulse, palpitations, heat intolerance, excessive sweating levothyroxine Dispensing Issues Warning! • Look-alike and Sound-alike Drugs: – levothyroxine (thyroid replacement) – levofloxacin (antibiotic) Hyperthyroidism • Excessive thyroid hormone • Most common cause is Grave’s disease • Other causes: – Excessive exogenous iodine – Thyroid nodules – Tumor in the pituitary causing overproduction of TSH Symptoms of Hypterthyroidism • • • • • • • • • Decreased menses Diarrhea Exophthalmos Flushing of the skin Heat intolerance Nervousness Perspiration Tachycardia Weight loss Drug List Agents for Hyperthyroidism • methimazole (Tapazole) • propylthiouracil, PTU • radioactive iodine, 131I Discussion What are the treatment options for hyperthyroidism? Discussion What are the treatment options for hyperthyroidism? Answer: in children: surgery and hormone replacement; adults: surgery or medications Adrenal Sex Hormones • Androgens are produced by: – – – – The testes The ovaries Adrenals Peripheral fat tissue • Most important male hormone is testosterone which is produced by the testes Responsibilities of Testosterone • • • • • • • • • Initiating sperm production Behavioral characteristics Libido Sexual potency Muscle mass and strength Fat distribution Bone mass Erythropoiesis Prevention of baldness Hypogonadism • Deficient hormone production and secretion • Androgens must be replaced by medications – May cause virilization, muscle building, and hematologic stimulation of erythropoiesis – Can be used to treat anemia, breast cancer, or endometriosis Androgen’s Side Effects • • • • • • • • Virilization Hirsutism Acne Hepatoxicity High levels of erythrocytes Oily skin Gynecomastia Priapism Male Impotence • Failure to initiate or maintain an erection until ejaculation • Causes: – – – – – Testosterone deficiency Alcoholism Cigarette smoking Psychological factors Medications Drugs That May Cause Impotence • Alcohol (most significant) • Amphetamines • Antihypertensives • Corticosteroids • Estrogens • • • • • H2 blockers haloperidol lithium Opiates Some antidepressants Drug List Agents for Male Impotence • • • • • • alprostadil (Caverject, Edex, Muse) danazol (Danocrine) methyltestosterone (Android, Testred) oxymetholone (Anadrol) papaverine testosterone (Androderm, AndroGel, Striant, Testoderm) Drug List Agents for Male Impotence – Phosphodiesterase Inhibitors • sildenafil (Viagra) • tadalafil (Cialis) • vardenafil (Levitra) sildenafil (Viagra) • 1st oral therapy for impotence • Allows an erection to occur naturally • Take at least 1 hour before activity sildenafil Dispensing Issues Warning! • Potentially lethal interaction with nitrates tadalafil (Cialis) • Duration of action is 36 hours • Faster onset and longer duration than others in this class tadalafil Dispensing Issues Warning! • Potentially lethal interaction with nitrates Female Hormones • Can prevent conception, ease symptoms of menopause, and help prevent osteoporosis • 2 main female hormones: – Estrogen – Progesterone Estrogen • Formed in the ovaries when FSH is released • Responsible for: – – – – – – – – Endometrial growth Increased cervical mucus Cornification of vaginal mucosa Growth of breast tissue Increased epiphyseal closure Sodium retention Carbohydrate metabolism Calcium utilization Estrogen Deficiency Symptoms • Irregular bleeding and cycles • “hot flashes” that start in the face and move down through the body • Atrophic vulvovaginitis, excessive dryness • Dyspareunia • Frequent infections Menopause • As women reach menopause estrogen production decreases • HRT can be used to supplement estrogen levels estrogens Dispensing Issues Warning! • Patients should not smoke during therapy, whether birth control or HRT Estrogen’s Side Effects • • • • • • • Nausea Vomiting Bloating Weight gain Breast tenderness Breakthrough bleeding Glucose intolerance HRT • • • • Reduces symptoms of menopause Decreases bone loss Lowers risk of cardiovascular disease Small risk of breast cancer Drug List Estrogens • conjugated estrogen (Enjuvia,Premarin) • conjugated estrogen-medroxyprogesterone (Premphase, Prempro) • estradiol (Alora, Climara, Esclim, Estrace, Estraderm, Estrasorb, Estring, Femring, Menostar, Vivelle, Vivelle Dot) Drug List Estrogens • estradiol-levonorgestrel (Climara Pro) • estradiol-norethindrone (Activella, CombiPatch) • estradiol-norgestimate (Ortho-Prefest) Drug List Estrogens • estropipate (Ogen) • ethinyl estradiol (Estinyl) • ethinyl estradiol-norethindrone (Femhrt) estrogen-medroxyprogesterone (Premphase, Prempro) • Provides estrogen and progesterone replacement • Prevents uterine cancer Progestins • Used primarily in birth control and to prevent uterine cancer • Also used for menstrual dysfunction Progestin’s Side Effects Similar to pregnancy: • • • • • Weight gain Depression Fatigue Acne Hirsutism Drug List • levonorgestrel (Norplant II) • medroxyprogesterone (Depo-Provera, Provera) • norethindrone (Micronor) Contraceptives • Most OCs are combinations of estrogen and progestin • Interfere with hormones responsible for regulation of the menstrual cycle • Change the consistency of cervical mucus • Alter the endometrial lining Benefits of OCs • • • • • Prevention of pregnancy Regulates menstrual cycle Reduces menstrual flow Lessens severe menstrual cramps and pain Protects against ovarian and endometrial cancer, benign breast disease, ectopic pregnancy, fibroadenomas, and ovarian cysts Oral Contraceptives • There are different combinations of estrogen and progestin as well as differing strengths • Tricycling – taking meds for 3 - 21 day cycles without a pill-free interval Drug List Contraceptive Agents • estradiol cypionate-medroxyprogesterone (Lunelle) • ethinyl estradiol-desogestrel (Cyclessa, Desogen, Kariva, Mircette, Ortho-Cept) • ethinyl estradiol-drospirenone (Yasmin) Drug List Contraceptive Agents • ethinyl estradiol-ethynodiol diacetate (Demulen) • ethinyl estradiol-etonogestrel (NuvaRing) • ethinyl estradiol-levonorgestrel (Levlen, Nordette, Seasonale, Tri-Levlen, Triphasil, Trivora-28) Drug List Contraceptive Agents • ethinyl estradiol-norelgestromin (Ortho Evra) • ethinyl estradiol-norethindrone (Estrostep Fe, Femhrt, Loestrin Fe, Ovcon) • ethinyl estradiol-norgestimate (Ortho TriCyclen, Ortho Tri-Cylcen Lo) Drug List Contraceptive Agents • ethinyl estradiol-norgestrel (Lo/Ovral, LowOgestrel, Ovral) ethinyl estradiol-desogestrel (Cyclessa, Desogen, Kariva, Mircette, Ortho-Cept) • Inhibits ovulation • Includes 2 days of placebo followed by 5 days of low-dose estrogen • May be safer for smokers ethinyl estradiol-levonorgestrel (Seasonale) • Taken for 3 months at a time • Patient only has 4 menses per year • Prevents egg release from the ovaries, increases mucus thickness, and thickness of the endometrial lining ethinyl estradiol-dropirenone (Yasmin) • Drospirenone is related to spironolactone (a diuretic) • Causes less bloating and less weight gain • May cause weight loss due to excess water loss ethinyl estradiol-norelgestromin (Ortho-Evra) • Transdermal contraceptive • Suppresses gonadotropins • A new patch is applied every 7 days for 3 weeks then the 4th week is patch free Some Oral Contraceptive Interactions • • • • • • • • Antibiotics Anticonvulsants Antifungals Benzodiazepines Bronchodilators Corticosteroids Lipid-lowering agents TCAs Emergency Contraception • In great demand • Patients want them to be available OTC Discussion What is one of the arguments for emergency contraceptives being OTC? Discussion What is one of the arguments for emergency contraceptives being OTC? Answer: After making a doctor’s appointment and then going to the get the prescription, sometimes it is too late to take the medication Drug List Contraceptive Agents Emergency Contraceptives • levonorgestrel (Plan B) • norgestrel (Ovrette) Home Pregnancy Tests • Critical organ systems develop in the first month which is affected by – – – – Mother’s diet Environment (smoking) Medications Consumption of alcoholic beverages Home Pregnancy Tests • Based on detecting human chorionic gonadotropin (HCG) • Levels can be measured as early as 6-8 days after conception • Results are given within 1-5 minutes • Tests are better than 95% accurate Drugs Used at Birth • Often no drugs are necessary for delivery, but in some cases they are • To restart labor • To decrease uncontrolled bleeding Drug List Drugs Used at Birth • methylergonovine (Methergine) • oxytocin (Pitocin) oxytocin (Pitocin) • Natural hormone that stimulates uterine contractions • Drug should be used as a last resort oxytocin’s Side Effects For the woman: For the child: • • • • • Bradycardia • Arrhythmias • Jaundice Vomiting Irregular heart rate Tachycardia Postpartum bleeding Bone Disease • Osteoclasts resorb bone • Osteoblasts form bone • In healthy bones, there is a balance between the two • As age progresses, osteoclasts become more active than osteoblasts and bones are weakened Osteoporosis • Weakening of the bone mass • Occurs faster in women over 50 than in men • Women with less estrogen production or intake may be at higher risk Risk Factors for Osteoporosis • • • • • • • Gender Race Heredity Low calcium intake Cigarette smoking Alcohol abuse Lack of weight-bearing exercise Osteoporosis • Weight bearing exercise can help strengthen bones – – – – Walking Jogging Weight lifting Dancing • HRT can also be used to reduce the rate of bone loss Drug List Agents for Bone Diseases • • • • • alendronate (Fosamax) calcitonin-salmon (Miacalcin) calcium (Caltrate, Os-Cal, Tums, Viactiv) etidronate (Didronel) raloxifene (Evista) Drug List Agents for Bone Diseases • • • • risedronate (Actonel) teriparatide (Forteo) tiludronate (Skelid) zoledronic acid (Zometa) alendronate (Fosamax) • Inhibits bone resorption from osteoclasts • Can partially reverse bone loss in postmenopausal women alendronate Dispensing Issues Warning! • Must be taken at least 30 mins prior to first food, beverage, or medication • Take with 6-8 oz of plain water only • Avoid laying down for at least 30 mins after taking medication risedronate (Actonel) • Inhibits bone resorption through action on osteoclasts or osteoclast precursors • Used only for Paget’s disease • Once a week dosing calcitonin-salmon (Miacalcin) • Available in nasal spray • Should only be given to patients who cannot tolerate HRT or when HRT is contraindicated raloxifene (Evista) • Prevents bone loss in the same manner as estrogen • Alternative for women who cannot take HRT • Patients should also take calcium and vitamin D supplements Discussion What definite instructions should this patient be given? Discussion What definite instructions should this patient be given? Answer: Take the medication with a full glass of water 30 minutes before any other food or drink and do not lay down for 30 minutes after taking Sexually Transmitted Disease • Refer to Figure 14.7 for the structural anatomy of the male and female genital systems Gonorrhea • Most commonly reported STD • Caused by Neisseria gonorrhoeae that attaches to mucosal cells in: – – – – – Oropharyngeal area Eye Joints Rectum Male and female genitalia Gonorrhea • If untreated, it can cause systemic infection including – The heart, meninges, eyes, pharynx, and joints • Eye infections occur most often in newborns and can cause blindness Syphilis • Caused by Treponema pallidum • Incubation averages three weeks • Infection develops in 3 stages: – Primary stage – Secondary stage – Tertiary stage Primary-Stage Infection • Small, hard-based sore develops at site of infection • May be painless and patient may be unaware • Fluid in the sores is highly infectious • Bacteria enters the bloodstream and lymphatic system Secondary-Stage Infection • Produces skin rashes, patchy hair loss, malaise, and mild fever • Symptoms subside after a few weeks and disease becomes latent • After 2-4 years of latency, the disease is usually no longer infectious Tertiary-Stage Infection • Occurs after an interval of at least 10 years • Lesions appear as a rubbery mass in many organs and sometimes the skin • May cause extensive damage Congenital Syphilis • Crosses the placenta into the fetus • Results in neurologic damage if pregnancy occurs during the tertiary stage • Pregnancy during primary or secondary stage is likely to produce a stillborn child Genital Herpes • Caused by herpes simplex virus • Lesions appear after 1 week of incubation • Infectious vesicles appear and heal within 2 weeks • Virus becomes latent until reactivated Candidiasis • Caused by Candida albicans • Yeast-like fungal infection that can cause infection in genital area of men and women and the mouth (thrush) • Can cause itching and a thick, yellow, cheesy discharge Vaginitis • Caused by Gardnerella vaginitis • Results from interaction between this organism and anaerobic bacterium in the vagina • Symptoms: frothy discharge with fishy odor and vaginal pH of 5 to 6 Vaginitis • May also be caused by Trichomonas vaginalis • Normally found in both sexes, but causes infection if vaginal pH changes • Causes profuse yellowish or cream-colored discharge with a disagreeable odor, irritation, and itching Drug List Agents for STDs • • • • • acyclovir (Zovirax) azithromycin (Zithromax) ceftriaxone (Rocephin) clotrimazole (GyneLotrimin, Mycelex) doxycycline (Doryx, Vibramycin) Drug List Agents for STDs • • • • • erythromycin fluconazole (Diflucan) ketoconazole (Nizoral) metronidazole (Flagyl) miconazole (Monistat) Drug List Agents for STDs • • • • • penicillin G benzathine (Bicillin L-A) spectinomycin (Trobicin) tetracycline (Sumycin) tioconazole (Vagistat-1) valacyclovir (Valtrex) azithromycin (Zithromax) • One-time dose to treat: – Chancroid in men – Chlamydia in women – Gonococcal infections in both sexes acyclovir (Zovirax) and valacyclovir (Valtrex) • Used to treat genital herpes • Interfere with DNA synthesis of the virus • Lessen severity, shorten healing time, and reduce frequency of attacks Corticosteroids • Adrenal glands produce glucocorticoids and mineralocorticoids Corticosteroids • Adrenal glands produce glucocorticoids and mineralocorticoids • Glucocorticoids: – Involved in cholesterol, fat, and protein metabolism Corticosteroids • Adrenal glands produce glucocorticoids and mineralocorticoids • Glucocorticoids: – Involved in cholesterol, fat, and protein metabolism • Mineralocorticoids: – Involved in regulating electrolyte and water balance Cortisol • Principal adrenal steroid hormone • Responsible for: – – – – – Gluconeogenesis Protein catabolism Anti-inflammatory reactions Stimulation of fat deposition Sodium and water retention Corticosteroids • Adrenal hormones excluding sex hormones • Steroid production follows a circadian rhythm Corticosteroids • Act as anti-inflammatory and immunosuppressive agents in treating diseases of different origins: – – – – – Hematologic Allergic Inflammatory Neoplastic Autoimmune Addison’s Disease • Life-threatening deficiency of glucocorticoids and mineralocorticoids • Treated with daily corticosteroids Symptoms of Addison’s Disease • • • • • • Debilitating weakness Hyperkalemia Hyperpigmentation of skin Low levels of serum sodium and glucose Reduced blood pressure Weight loss Cushing’s Disease • Caused by an overproduction of steroids or excessive administration of corticosteroids • Symptoms: – Protruding abdomen; round, puffy face; fat over the shoulder blades Reasons for Using Corticosteroids • Inhibit inflammation • Useful in treating asthma, rashes, and skin disorders • Available in many different dosage forms Problems with Corticosteroids • Lessen the ability of leukocytes to destroy infection which decreases fever, redness, and swelling • Also may cause infection to spread Corticosteroid Dispensing Issues Warning! • Take caution in patients with diabetes, uncontrolled hypertension, CHF, severe infection or altered immunity, or peptic ulcer disease with active GI bleeding Corticosteroids • Usage must be tapered off, not abruptly stopped • May cause withdrawal symptoms – Anorexia, nausea, vomiting, myalgia, arthralgia, lethargy, headache, sluggishness, weight loss, postural hypotension, fever and depression • Doses should be given in the morning Adverse Effects of Glucocorticoids • • • • • • • • Cardiovascular effects Dermatologic effects Gastrointestinal effects Immune system effects Metabolic effects Musculoskeletal effects Neuropsychiatric effects Ophthalmic effects Diabetes/Hypoglycemic Agents • In the islets of Langerhans, in the pancreas, there are two primary specialized cells • Alpha Cells • Beta Cells Hypoglycemic Agents • In the islets of Langerhans, in the pancreas, there are two primary specialized cells • Alpha Cells – Produce glucagon and raise blood glucose levels • Beta Cells Hypoglycemic Agents • In the islets of Langerhans, in the pancreas, there are two primary specialized cells • Alpha Cells – Produce glucagon and raise blood glucose levels • Beta Cells – Produce insulin and lower blood glucose levels Insulin • Helps cells burn glucose for energy • Works with receptors for glucose uptake • Enhances transport and incorporation of amino acids into protein • Increases ion transport into tissues • Inhibits fat breakdown Diabetes • Caused by inadequate secretion or utilization of insulin • Leads to excessive blood glucose levels • Normal: 100 mg/dL Type I Diabetes • Occurs most commonly in children and young adults • Average age of diagnosis is 11 or 12 • Patients are insulin dependent and have no ability to produce insulin on their own • May be due to an autoimmune response • Type I accounts for 5-10% of diabetic population Type II Diabetes • Affect 80-90% of diabetics • Most patients are over 40 and more women than men are affected • Could be caused by insulin deficiency or insulin receptor resistance • Many of these patients are overweight and can treat their diabetes with weight loss Gestational Diabetes • • • • Occurs during pregnancy Increases risk of fetal morbidity and death Onset is during the 2nd and 3rd trimesters Can be treated with diet, exercise, and insulin • 30-40% of women with gestational diabetes will develop type II in 5-10 years Secondary Diabetes • Caused by medications – – – – – – Oral contraceptives Beta blockers Diuretics Calcium channel blockers Glucocorticoids phenytoin • May return to normal when drug is stopped Symptoms of Diabetes • • • • • • • • • • Frequent infections Glycosuria Hunger Increased urination and nocturia Numbness and tingling Slow wound healing Thirst Visual changes Vomiting Weight loss, easy fatigability, irritability, ketoacidosis Complications of Diabetes • Retinopathy leading to blindness • Neuropathy • Vascular problems can lead to inadequate healing which could lead to amputation • Dermatologic involvement • Nephropathy is the primary cause of endstage renal disease Lack of Insulin Activity • Diabetics cannot use glucose therefore their bodies metabolize fat • Gluconeogenesis is the formation of glucose from protein and fatty acids • Fatty acid is oxidized into ketones Ketones • Strong acids • Cause the body pH to drop • Excreted in the urine or eliminated through respiration • Causes a fruity acetone smell on the breath that can be mistaken for alcohol Treating Diabetes • Treatment consists of diet, exercise, and medications • Blood glucose monitoring must be done regularly throughout the day • Type II diabetics may be able to control the disease through diet and exercise alone Treatment for Type II 1. 2. 3. 4. 5. Lifestyle changes Oral monotherapy Combination oral therapy Oral drug plus insulin Insulin only General Treatment Guidelines • Attention to diet • Blood pressure control • Compliance with medications • Control of hyperlipidemia • Daily foot inspections • Increased physical activity • Recognizing hypoglycemia • Blood glucose testing • Monitoring in the Dr’s office • Patient education • Prompt treatment of infections • Setting goals Drug List Drug for Lower Extremity Diabetic Ulcers • becaplermin gel (Regranex) Insulin • Administered subcutaneously due to degradation in the GI tract • Different types of insulin have different onset of action times and duration of action times Insulin Duration of Action Type Duration of Action Humalog, Novolog Regular 1 hr (works in 15 mins and gone in about an hour) 5-6 hours (onset – 30 mins) NPH 10-16 hours Lente 12-18 hours Lantus 24 hours mixed Quick onset, longer duration Insulin Dispensing Issues Warning! • It is very easy to grab the wrong insulin in the refrigerator • Always double-check yourself • They look exactly alike Insulin administration sites should be rotated Hypoglycemia • Blood glucose levels of <70 mg/dL • Can be caused by – – – – Skipping meals Too much exercise Poor medication regimen Certain drugs Signs & Symptoms of Hypoglycemia • • • • • Confusion Double vision Headache Hunger Numbness and tingling in mouth and lips • • • • • • Nervousness Palpitations Sweating Thirst Visual disturbances Weakness Drug List Human Insulins • • • • • NPH isophane insulin (Humulin N) insulin aspart (NovoLog) insulin glargine (Lantus) insulin lispro (Humalog) regular insulin (Humulin R) insulin lispro (Humalog) • Rapid-onset insulin • Can be injected immediately before or after meals • May be used with a pump insulin aspart (NovoLog) • Rapid-acting insulin analog • Each dose should be administered before meals • May be used with a pump insulin glargine (Lantus) • Synthetic long-acting insulin • Absorbed slowly and works over a 24-hour time period • Works similarly to physiologic insulin release Drug List Human Insulins Mixtures • insulin aspart w/ protamine-insulin aspart (NovoLog Mix 70/30) • insulin lispro w/ protamine-insulin lispro (Humalog Mix 75/25) • insulin with zinc (lente) (Humulin L) • NPH-regular insulin (Humulin 70/30) Drug List Oral Hypoglycemic Agents First- Generation Sulfonylureas • chlorpropamide (Diabinese) • tolbutamide Drug List Oral Hypoglycemic Agents Second-Generation Sulfonylureas • glimepiride (Amaryl) • glipizide (Glucotrol, Glucotrol XL) • glyburide (DiaBeta, Glynase, Micronase) glipizide (Glucotrol, Glucotrol XL) • Taken with breakfast • Promotes insulin release from beta cells • Increases insulin sensitivity glipizide Dispensing Issues Warning! • Look-Alike and Sound-Alike Drugs – Glucotrol – Glucotrol XL glipizide Dispensing Issues Warning! • Look-Alike and Sound-Alike Drugs – glipizide (Glucotrol, Glucotrol XL) – glyburide (DiaBeta, Glynase, Micronase) Drug List Oral Hypoglycemic Agents Enzyme inhibitors: • acarbose (Precose) • miglitol (Glyset) Biguanide: • metformin (Glucophage, Riomet) metformin (Glucophage, Riomet) • Decreases intestinal absorption of glucose and improves insulin sensitivity • Has an effect on serum lipid levels • Best candidates are overweight diabetics with high lipid profile Drug List Oral Hypoglycemic Agents Glitazones/Thiazolidinediones • pioglitazone (Actos) • rosiglitazone (Avandia) pioglitazone (Actos) • Depends on the presence of insulin • Liver enzymes should be carefully monitored • May be taken without regard to food rosiglitazone (Avandia) • Increases insulin sensitivity in muscle and adipose tissue • Can be taken without regard to food Drug List Oral Hypoglycemic Agents Meglitinides • nateglinide (Starlix) • repaglinide (Prandin) Drug List Oral Hypoglycemic Agents Combinations • glipizide-metformin (Metaglip) • glyburide-metformin (Glucovance) • rosiglitazone-metformin (Avandamet) Discussion What does a diabetic have to be concerned with in relation to diet? Discussion What does a diabetic have to be concerned with in relation to diet? Answer: Eating at the same time everyday; to limit sugar intake by reading package labels Growth Hormone • Deficiency of endogenous growth hormone causes growth retardation • Growth delay may be caused by – Family growth patterns, genetic disorders, malnutrition, systemic or chronic illness, psychosocial stress, or a combination of these – Endocrine deficiency, or problems with thyroxine, cortisol, insulin, or GH Growth Hormone • Non-endocrine related disorders can also cause growth delay: – Intrauterine growth retardation, chromosomal defects, abnormal growth of cartilage or bone, poor nutrition, variety of systemic diseases Growth Hormone • Release of GH is stimulated by the release of GHRF secreted by the hypothalamus • GH is inhibited by – – – – – – Glucocorticoids Obesity Depression Progesterone Hypokalemia Altered thyroid function Drug List Synthetic Human Growth Hormones • somatrem (Protropin) • somatropin (Humatrope) Growth Hormone • The younger the patient at time of treatment the greater the height that may be achieved • Little response is seen after age 15-16 in boys and 14-15 in girls