Download Pituitary Agents. Thyroid and Antithyroid Agents. Antidiabe

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
Different hormones, different
signals
Negative
feedback
-
Anterior
pituitary
Thyroid
hormones
TSH
Thyroid
gland
Negative
feedback
-
Negative
feedback
+
ADH
Water
absorption
Negative
feedback
Insulin
Liver, fat
& muscle
osmolality
+
Pancreas
Glucose
-
Hypothalamus
-
+
Parathyroids
calcium
PTH
Bone, GIT
& Kidney
+
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
• 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
• Release of GH is stimulated by the release of
GHRF secreted by the hypothalamus
• GH is inhibited by
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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
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
Feedback
Negative
feedback
-
Anterior
pituitary
Thyroid
hormones
TSH
Thyroid
gland
+
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
Primary and secondary disorders
Primary
Thyroid
disease
Secondary
Thyroid
disease
Hypothyroidism Symptoms
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Apathy
Constipation
Decreased heart rate
Depression
Dry skin, nails, and
scalp
• Easy fatiguing
• Enlarged thyroid
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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
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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
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
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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
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Oral contraceptives
Beta blockers
Diuretics
Calcium channel blockers
Glucocorticoids
phenytoin
• May return to normal when drug is stopped
Symptoms of Diabetes
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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
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Skipping meals
Too much exercise
Poor medication regimen
Certain drugs
Signs & Symptoms of
Hypoglycemia
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Confusion
Double vision
Headache
Hunger
Numbness and
tingling in mouth and
lips
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Nervousness
Palpitations
Sweating
Thirst
Visual disturbances
Weakness
Drug List
Human Insulins
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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