Download pharmacy technician chapter twenty nine

PHARMACY TECHNICIAN
CHAPTER TWENTY NINE
1
The Endocrine System
• A “communication”
system for the body
• Major components
of the endocrine
system are:
– Hypothalamus
– Pituitary gland
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The Endocrine System (cont.)
• Secondary components of the endocrine system are:
–
–
–
–
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Thyroid
Parathyroid
Pancreas
Adrenal glands
Gonads
• The pituitary gland controls the secondary
components of the endocrine system
• During pregnancy, the placenta also acts as an
endocrine gland
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The Hypothalamus and Pituitary Gland
• Hypothalamus
– Part of the brainstem
– Controls the activity of the pituitary gland
• Pituitary gland
– About the size of a large pea
– Called the “master gland” because it controls many other
glands
– Composed of anterior and posterior lobes
– Each lobe contains a number of hormones
• Hormones—chemical substances that regulate
certain bodily functions
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Hormones
• Transfer information and instructions from one set of
cells to another
• Each hormone affects only the cells that are
genetically programmed to receive and respond to its
message
• Hormones are divided into two groups according to
their structure:
– Steroids—slow acting, long lasting, and usually end in the
suffix “-rone” (examples: testosterone, progesterone)
– Peptides and amines—made of proteins, fast acting, and
short lived (examples: insulin, ADH)
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Female Sex Hormones
• Estrogen—responsible for:
–
–
–
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Development of secondary sex characteristics
Formation of osteoblasts
Inhibition of osteoclasts
Bone loss
• Progesterone—prepares lining of uterus for
implantation of fertilized egg
• Replacement female hormones may be derived from
animal, plant, or lab-modified sources
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Male Sex Hormones
• Also called androgens or masculinizing hormones
• Primary male sex hormone is testosterone:
– Produced in the testes
– Stimulates the development of male sex organs
– Maintains secondary sex characteristics
• Progesterone—maintains healthy prostate
• Replacement male hormones are typically anabolic
steroids
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Glandular Disease States
• Some cancers (breast, uterus, prostate gland)
are dependent on sex hormones
• Use of opposite sex hormones appears to
antagonize or inhibit tumor growth
• Endocrine therapy is palliative only
8
Pituitary Gigantism
• Results from an excessive secretion of GH in
childhood
• Usually caused by a nonmalignant tumor of
the pituitary gland
• Causes the child to grow excessively and to be
bigger in all areas of the body
• Size and growth are proportionate
9
Pituitary Dwarfism
• Results from a lack of GH
• Person may be somewhat short at birth
• In most cases the child’s growth is normal
until 6 to 12 months of age
10
Acromegaly
• Excessive secretion of GH during the adult
years
• Characterized by enlarged bones of the cheek,
hands, feet, and jaws
• Prominent forehead and large nose
• Arms, legs, and hands are disproportionate,
excessively large
• Often the person will have slender arms,
sometimes with atrophied muscles
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Anabolic Steroid Use
• Excessive steroid use signals the pituitary gland to
stop producing gonadotropin
• Natural ability to produce testosterone may shut
down
– May lead to a permanent imbalance of the hormone
• In men and women, anabolic steroid use can lead to:
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Edema and weight gain due to sodium and water retention
Jaundice or hepatic carcinoma
High cholesterol and associated diseases
Increased or decreased libido
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Anabolic Steroid Use (cont.)
• Women may undergo masculinization, such as
growth of facial hair, permanent increases in
amount of body hair, and permanent
deepening of the voice
• Men may endure sterility, impotence,
priapism, and gynecomastia (enlarged breast
and nipple tenderness)
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PHARMACY TECHNICIAN
CHAPTER THIRTY
14
Figure 30.1
The female reproductive system.
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Female Reproductive System
• Composed of internal organs and external genitals
• Internal reproductive organs are:
–
–
–
–
Two ovaries
Two fallopian tubes
Uterus
Vagina
• External genitals are known together as the vulva.
The vulva consists of:
– Labia minora
– Labia majora
– Clitoris
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Male Reproductive System
• Composed of external genitals and gonads,
and internal organs
• External genitals and gonads are the penis and
testes
• Internal organ is the prostate
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Female Reproductive Function
• The function of the female reproductive system is to
conceive and bear children
• Governed by the menstrual cycle, which consists of
two stages:
– Ovulation—prepares an oocyte for fertilization
– Menstruation—dissolves the unfertilized oocyte and sheds
uterine lining
• Hormones that govern the female reproductive
system are the estrogenic hormones
– Estriol
- Estrone
- Estradiol
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Male Reproductive Function
• The function of the male reproductive system
is to deliver sex cells to the female
• Fertility in the male begins with the
production of gonadotropin releasing
hormone (GnRH) in the hypothalamus
• GnRH instructs the pituitary gland to
manufacture FSH and LH
• FSH causes sperm production
• LH stimulates production of testosterone
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Infertility
• Defined as the failure to conceive after one year of regular,
unprotected intercourse
• May be caused by either or both sex partners
• In women, can be treated with antiestrogenic drugs
– Stimulates pituitary production of FSH and LH
– Boosts follicle growth and the release of eggs
• In men, infertility can be treated with
– Antibiotics—if infertility is caused by infection
– Antihistamines—block mast cells that reduce sperm quality
– Anti-erectile dysfunction agents—may enhance fertility by
increasing sperm motion and capacitation
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Infertility (cont.)
• In men, infertility can be treated with
– Bromocriptine—used to reduce excess prolactin
manufactured by the pituitary
– Gonadotropin releasing hormone (GnRH)—
beneficial for men with gonadotropin deficiency
and hypogonadism; good for restoring sperm
production after chemotherapy
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Pelvic Inflammatory Disease (PID)
• The major cause of infertility worldwide
• Symptoms of the reproductive system include:
– Scarring
– Abscess formation
– Tubal damage
• Treatment is with anti-infectives
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Infertility From Sexually Transmitted
Diseases
• Affects both males and females
• Viral STDs (genital herpes, HIV)
– Symptoms managed with medication
– Cannot be cured
• Bacterial STDs (gonorrhea, chlamydia)
– Curable with antibiotics
• Fungal and parasitic diseases
– Curable with antifungal and anthelminthic agents,
respectively
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Erectile Dysfunction
• Inability to sustain an erection for penetration
• Many causes, including stress and poor health
• Treated with:
– Levitra® (vardenafil)
– Cialis® (tadalafil)
– Viagra® (sildenafil)
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Benign Orostatic Hyperplasia
• Noncancerous growth or enlargement of the
prostate gland
• Treated with alpha-adrenergic blockers and 5alpha reductase inhibitors
– Alpha-adrenergic blockers relax smooth muscle
tissue in the bladder neck and prostate, which
increases urinary flow
– 5-alpha reductase inhibitors prevent the
conversion of testosterone to the hormone
dihydrotestosterone (DHT
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PHARMACY TECHNICIAN
CHAPTER THIRTY ONE
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The Nervous System
• Divided into central nervous system (CNS) and
peripheral nervous system (PNS)
• Central nervous system
– Includes brain and spinal cord
– Controls all nervous system functions
– Control may be direct or indirect
• Peripheral nervous system
– Includes all other nerves and sensory organs
– Controlled by central nervous system
– Divided into somatic and autonomic nervous systems
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Functions of the Nervous System
• Sensory (afferent)
– Sends impulses from other parts of body toward the CNS
– Senses external changes or conditions in the environment,
such as cold or heat
– Senses internal changes in the body, such as decrease in
potassium or calcium
• Integrative
– Processes perceived information about the sensory
changes
– Interprets or explains changes in external/internal
environments
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Functions of the Nervous System
(cont.)
• Motor (efferent)
– Sends impulses away from the CNS to other parts
of the body
– Allows and controls body movement
– Causes glands to secrete hormones or other
chemicals into the bloodstream
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Sympathetic Nervous System
• Governed by the neurotransmitter
norepinephrine
• Prepares body for energetic tasks, stressful
situations, and the “fight or flight” response
• Stimulates heart, lungs, and blood vessels
• Decreases activity of gastrointestinal and
genitourinary functions
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Parasympathetic Nervous System
• Governed by the neurotransmitter
acetylcholine
• Activates body for sleep in nonstressful
periods
• Effects the “rest and relaxation” response
• Decreases activity of heart, lungs, and blood
vessels
• Increases activity of gastrointestinal and
genitourinary functions
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Neuron
• Smallest unit of the
nervous system
• Brain is composed
of approximately
100 billion neurons
• Highly
differentiated from
other cells
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Neuron (cont.)
• Has specialized projections called dendrites
and axons that communicate with the rest of
the body:
– Dendrites bring information to the cell body from
the central nervous system
– Axons take information away from the cell body to
the central nervous system
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Nervous System Communication
• Neurons communicate with each other through an
electrochemical process
• Can be compared to a computer sending electrical
signals over its wires
• Brain sends electrical signals through neurons
instead of wires
• Neurons produce electrochemical hormones called
neurotransmitters
• Neurotransmitters are stored in the ends of the
nerve cells
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Neurotransmitters
• Released at the end of the neuron
• Synapse is the space between two different
neurons
• Neurons transfer information by crossing
synapses
• Neurotransmitters travel across the synapse to
reach a receiving neuron
• Attach to special structures called receptors
• Communicate with and control glands, organs,
and muscles
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Blood-Brain Barrier (BBB)
• Semipermeable membrane that allows some substances to enter
brain, prevents others from entering
• Protects brain from substances in the blood that could injure the
brain and protects the brain from hormones and
neurotransmitters in the rest of the body
• Maintains a constant environment, or homeostasis, for the brain
• Water-soluble or low-lipid/low-fat-soluble molecules do not
penetrate and highly-lipid/fat-soluble molecules, such as
barbiturates, rapidly cross
• Large molecules do not easily pass through
• Highly electrically charged molecules are slowed down
36
Anxiety
• Uncomfortable emotional state characterized by
apprehension, worry, and fear
• Associated with the following risk factors:
– Genetics
– Brain chemistry
– Life events
– Personality
• Treated with benzodiazepines, antidepressants
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Depression
• Symptoms include feelings of despair, lack of
energy, inability to concentrate
• Related to decreases in concentration of the
neurotransmitters
• Treated with drugs that:
– Block the reuptake of neurotransmitters
– Interfere with the breakdown of the monoamines
within the synaptic cleft
38
Bipolar Disorder
• Characterized by severe emotional highs
(mania) and lows (depression)
• Episodes, referred to as mood swings, can last
hours, days, months, or years
• Treatment may include:
– Lithium—reduces hyperexcitability of the nerves
– Antidepressant drugs
39
Psychosis
• State in which a person is out of touch with
reality
• One cause may be an increase in dopamine
• Treated with antipsychotic drugs that attach to
the dopamine D2 receptor
40
Mental Disorders
• The following mental disorders may be treated
psychotherapeutically:
– Psychosis
– Depression
– Anxiety
– Obsessive-compulsive disorder
– Panic disorder
• Although there is no cure for mental illness, drugs will help
the patient to have a better experience in daily living and
function more effectively
41
Mental Disorders (cont.)
• The National Institutes of Mental Health
classifies the following four types of
psychotherapeutic agents:
– Antianxiety
– Antidepressant
– Antimanic
– Antipsychotic
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PHARMACY TECHNICIAN
CHAPTER THIRTY TWO
43
Age Categories
• Neonates are newborn babies, from birth to
one month of age
• Infants are between the ages of one month to
two years
• A child or “pediatric” patient is considered to
be between 2 years and 12 years of age
44
Pharmacokinetics
• Significant physiologic differences with pediatric patients
• Absorption, distribution, metabolism, and excretion occur
differently in children
– Organ systems are not fully developed
• Pediatric patients may not absorb a medication as quickly as
adults
• Children have more water and less fat in their bodies
– Water-soluble and fat-soluble drugs will not distribute in the same
manner
• Children may have slower or more rapid metabolism rates
• Children may have slower excretion rates than adults, leading
to toxicity risks
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Administering Medications
• Dosage adjustments must be considered to
compensate for physiological differences
• Route of administration and dosage forms
must also be considered
• Compliance in pediatric patients is an
important factor
– Liquids are the dosage form most commonly used,
because they can be colored and flavored to mask
bitter or other unpleasant tastes
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Determining Dose
• Several formulas are used, including those
based on:
– Weight
– Age
– Body surface area (BSA)
– Milligrams per body weight per day
• Body weight is most common and reliable
method used
• Age is considered the least reliable
47
Asthma
• Affects around 6 million children under the
age of 18 each year in the United States
• The most common chronic condition among
children
• Accounts for several million absences from
school each year
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Jaundice
• Affects as many as 50 percent of newborns in the
first two to four days postpartum
• Typically disappears by one to two weeks of life
• Causes skin and whites of the eyes to appear yellow
• Caused by excess buildup of bilirubin in the blood
• The infant’s liver cannot break down the bilirubin as
fast as the body makes it
• If left untreated, high levels can cause deafness,
cerebral palsy, and brain damage
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PHARMACY TECHNICIAN
CHAPTER THIRTY THREE
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Geriatric Patients
• Experience many physiological changes as aging occurs
• Cardiac output decreases significantly with age
– Affects the amount of blood that the kidneys and liver
receive
• By age 65, the liver and kidneys receive significantly less blood
flow than at age 40
– Metabolism and excretion processes are slowed
– Certain drugs stay in the body longer and may cause
increased side effects
• Organs decrease in size as patients age
– Further slows metabolism
– May enhance intensity of drug effects
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Polypharmacy
• Defined as “the administration of more
medications than are clinically necessary”
• Elderly patients often require complicated and
multiple drug regimens
• Elderly patients may combine prescription
medications with OTC medications
• Increased possibility of drug-drug and drugdisease interactions
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Drug Compliance
• Defined as following a prescribed medication
regimen
• Another primary factor in geriatric medication
• Noncompliance is very common in the elderly
• Occurs when the patient does not take medication as
prescribed:
– Dosing schedule may be confusing
– Patient has difficulty understanding or remembering what
the drug is
– Patient has difficulty understanding or remembering why
drug was prescribed
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Medicare Part D
• Became effective in January 1, 2006
• Provides prescription coverage to all patients eligible for
Medicare benefits
• Voluntary insurance program
• Provides some drug coverage for those who experience
hardships or who need high-cost medications
• Patients in the program are given a variety of drug coverage
plans to choose from:
– Yearly deductible (between $0 and $265)
– Monthly premium
– Different formulary and specific costs
• For patients on high-cost medications, the pharmacist may
provide and charge for medication management therapy
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PHARMACY TECHNICIAN
CHAPTER THIRTY FOUR
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Recombinant DNA Technology
• Recombinant therapeutic proteins are artificial forms
of recombinant DNA
• Created by combining or inserting one or more DNA
strands into a single molecule
• Examples include:
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Humulin insulin or rHI (recombinant human insulin)
Cerezyme® for Gaucher’s disease
Leukine® for neutropenia
Synvisc® and Hyalgan® for rheumatoid arthritis
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Biologics Made with Recombinant DNA Technology
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The Four Steps of Genetic Engineering
• Isolate the desirable gene (such as resistance to a
particular disease)
• Insert the gene into a vector
– Vector—any organism that does not itself cause disease
but spreads disease by distributing pathogens from one
host to another
• Use the vector to transform or genetically alter the
cells of another organism
• Ensure that only those organisms that have taken up
the vector survive
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FDA Approval for New
Biopharmaceuticals
• Preclinical phase—new drug is tested against a
targeted disease through laboratory and
animal studies
• Company files an Investigational New Drug
Application with the FDA
– Shows the results of previous studies and sets out
protocols for future clinical studies
– Includes chemical structure of compound and plans for
manufacture
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FDA Approval for New
Biopharmaceuticals (cont.)
• IND becomes effective if the FDA does not
disapprove it within 30 days
– Future clinical trials include volunteers in clinics
and hospitals under the care of a physician; may
take several years
• Following the successful completion of all
three phases, the company can then file a new
drug application
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Future Drugs
• Biopharmaceuticals are used to treat cancers,
diabetes, hepatitis, multiple sclerosis, and
other life-threatening conditions
• Genetic engineering and stem cell research
play very important roles in the discovery of
new products and the diseases they treat
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Future Drugs (cont.)
• Using stem cells, it may become possible to
generate healthy heart muscle cells in the
laboratory and then transplant those cells into
patients with chronic heart disease
• Genetically engineered drugs could be used to
repair damaged genes or replace missing
genes in people who have genetic disorders
such as cystic fibrosis
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