Transcript 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
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Anterior
pituitary
Thyroid
hormones
TSH
Thyroid
gland
Negative
feedback
-
Negative
feedback
+
ADH
Water
absorption
Negative
feedback
Insulin
Liver, fat
& muscle
osmolality
+
Pancreas
Glucose
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Hypothalamus
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+
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
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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