Transcript Drug List - Grand Saline ISD

Chapter 14
Hormones
Chapter 14 Topics
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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
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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
Adrenal Sex Hormones
• Androgens are produced by:
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The testes
The ovaries
Adrenals
Peripheral fat tissue
• Most important male hormone is
testosterone which is produced by the testes
Responsibilities of Testosterone
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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
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Virilization
Hirsutism
Acne
Hepatoxicity
High levels of erythrocytes
Oily skin
Gynecomastia
Priapism
Male Impotence
• Failure to initiate or maintain an erection
until ejaculation
• Causes:
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Testosterone deficiency
Alcoholism
Cigarette smoking
Psychological factors
Medications
Drugs That May Cause Impotence
• Alcohol (most
significant)
• Amphetamines
• Antihypertensives
• Corticosteroids
• Estrogens
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H2 blockers
haloperidol
lithium
Opiates
Some antidepressants
Drug List
Agents for Male
Impotence
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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:
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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
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Nausea
Vomiting
Bloating
Weight gain
Breast tenderness
Breakthrough bleeding
Glucose intolerance
HRT
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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:
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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
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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
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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
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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:
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• 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
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Gender
Race
Heredity
Low calcium intake
Cigarette smoking
Alcohol abuse
Lack of weight-bearing exercise
Osteoporosis
• Weight bearing exercise can help strengthen
bones
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Walking
Jogging
Weight lifting
Dancing
• HRT can also be used to reduce the rate of
bone loss
Drug List
Agents for Bone Diseases
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alendronate (Fosamax)
calcitonin-salmon (Miacalcin)
calcium (Caltrate, Os-Cal, Tums, Viactiv)
etidronate (Didronel)
raloxifene (Evista)
Drug List
Agents for Bone Diseases
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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:
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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
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acyclovir (Zovirax)
azithromycin (Zithromax)
ceftriaxone (Rocephin)
clotrimazole (GyneLotrimin, Mycelex)
doxycycline (Doryx, Vibramycin)
Drug List
Agents for STDs
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erythromycin
fluconazole (Diflucan)
ketoconazole (Nizoral)
metronidazole (Flagyl)
miconazole (Monistat)
Drug List
Agents for STDs
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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:
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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:
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Hematologic
Allergic
Inflammatory
Neoplastic
Autoimmune
Addison’s Disease
• Life-threatening deficiency of
glucocorticoids and mineralocorticoids
• Treated with daily corticosteroids
Symptoms of Addison’s Disease
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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
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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
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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
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