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Focus on
PHARMACOLOGY
ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
25
Drugs Used to
Treat Endocrine
Conditions
Endocrine System
• Secretes hormones that control body
by maintaining internal environment
(homeostasis)
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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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Figure 25-1
Primary glands of the endocrine system.
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Table 25-1
Endocrine Glands and Their functions
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Table 25-1 (continue)
Endocrine Glands and Their functions
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Figure 25-2
Pituitary hormones and their target cells, tissues, and organs.
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Growth Hormone
• GH (somatotropin)
• Causes increase in weight and length of
body
• Irregularities: gigantism or acromegaly
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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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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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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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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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Vasopressin
• Antidiuretic hormone (ADH)
• Stimulates water reabsorption from
nephrons
• Lack of ADH causes diabetes insipidus
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Oxytocin
• Stimulates contraction of smooth
muscle in the:
– Uterus
– Alveoli of lactating breast
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Table 25-2
Relationships Among Hypothalamic, Anterior Pituitary, and Target Organ
Hormones
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Thyroid Hormones
• Thyroxine (T4)
• Triiodothyronine (T3)
• Calcitonin: calcium homeostasis
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Myxedema Coma
• Associated with severe hypothyroidism
• Medical emergency manifested by
diminished level of consciousness
• Symptoms: hypothermia,
hypoventilation, hypotension,
hypoglycemia
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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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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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Table 25-3
Common Thyroid and Antithyroid Agents
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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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Potassium Iodide
• Patient information: iodine is present in
shellfish, iodized salt and some OTC
cough preparations
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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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Propylthiouracil
• Uses: hyperthyroidism, iodine-induced
thyrotoxicosis
• Adverse effects: agranulocytosis,
hypothyroidism, bradycardia
• Contraindications: last trimester of
pregnancy and during lactation
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Propylthiouracil
• Patient information: instruct patients to
report agranulocytosis symptoms,
avoid foods that inhibit thyroid
secretion, and take early in day
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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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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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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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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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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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Figure 25-3A
Diabetes mellitus can be caused by dysregulation of beta-cell function.
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Figure 25-3B
Interaction of blood glucose levels, insulin, and glucagon.
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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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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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Table 25-4
Classifications of Insulin
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Table 25-4 (continued) Classifications of Insulin
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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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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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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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Intermediate-acting Insulins
• Uses: to control hyperglycemia
• Adverse effects: rare
• Contraindications: during
hypoglycemia; cautious in insulinresistant patients, hyperthyroidism or
hypothyroidism, renal or hepatic
impairment, pregnancy or lactation,
older adults, children younger than 3
years
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Intermediate-acting Insulins
• Patient information: teach patients to
check blood glucose levels and
maintain well-balanced diet
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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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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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Table 25-5
Common Oral Antidiabetic Drugs
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Table 25-5 (continued) Common Oral Antidiabetic Drugs
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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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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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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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Thiazolidinediones
• Patient information: advise patients to
report symptoms of hepatic dysfunction
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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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Alpha-glucosidase Inhibitors
• Patient information: instruct patients
that insulin may be needed in times of
infection, stress, or surgery
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Table 25-6
Adrenocortical Hormones and Their Effects
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Table 25-7
Major Adrenal Corticosteroids (Glucocorticoids)
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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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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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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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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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