1. Drugs affecting the ENDOCRINE SYSTEM

2. How Metabolism is controlled and mediated by hormones
Many disorders are due to either over or under secretion of a hormones
Endocrinology
Can potentiate normal hormonal action
Inhibit hormonal action.

3. Drugs affecting THYROID gland
Thyroid gland produces hormones Thyroxine and triiodothyronine which influence growth, development and metabolism.
Production of these hormones depends on the thyroid gland receiving iodine from the body

4. HYPOTHYROIDISM Decrease in thyroid activity caused by :
1. Hashimotos thyroiditis (Auto immune disorder.)
2. Myxoedema If hypothyroidism not treated
3. Iodine deficiency.
4. Radioactive iodine ingestion.
5. Atrophy of thyroid gland.
6. Surgical removal of all or part of gland.

5. SIGNS AND SYMPTOMS Tiredness Lethargy Weight Gain Intolerance to heat
Dry skin
Bradycardia
Mental impairment

6. HYPOTHROIDISM NURSING IMPLICATIONS. Monitor symptoms related to BMR
Monitor heart rate, reporting tachycardia and palpitations.
Education re life long treatment of deficient hormones.
Diabetics need to monitor BSL as insulin or oral hypoglycaemics may need increasing.

7. HYPERTHROIDISM (Thyrotoxicosis)
Overproduction of thyroid hormone.
Graves Disease is an example of hyperthyroidism. More common in women than in men and occurs between years of age and often arises after emotional or physical stress or infection.

8. SIGNS AND SYMPTOMS Exophthalmos Tremor Nervousness Constant hunger
Weight loss
Fatigue
Heat tolerance
Palpitations

9. Drugs for ADRENAL CORTEX problems.
3 Naturally occurring Groups
Mineralocorticoids. Electrolyte and water balance. Natural occurring is aldosterone.
Glucocorticoids. Affect fat, protein and carbohydrate metabolism and also have an anti-inflammatory effect.
Gonadocorticoids, sex hormones.

10. Mineralocorticoids
These drugs primarily responsible for regulating sodium and potassium in the body.
Treat adrenocortical insufficiencies.
Potent immunosuppressants, prevent organ transplant rejection
Lung maturation in premature infants
Aldosterone, causes Sodium and Water retention increases blood volume and BP
Fludrocortisone (Florinef)

11. GLUCOCORTICOIDS Classified according to their duration of action
Increases blood glucose, mobilizes fats, stimulates protein catabolism, depresses immunity, and inflammatory responses.
Natural = Hydrocortisone
Synthetic = All others, prednisone

12. Examples Betamethasone Dexamethasone Prednisone Flixotide
Betnovate cream

13. Effects Euphoria, psychiatric problems
Fluid retention, electrolyte imbalance
Delayed wound healing, bruising, acne
Fungal infections exacerbated
Hyperglycaemia, insomnia
Increased appetite, obesity
Osteoporosis (long term effect)
Cushings syndrome (Metabolic disorder resulting from chronic and excessive production of cortisol by the adrenal cortex.

14. CUSHINGS SYNDROME SIGNS & SYMPTOMS 1. Moon Face 2. Buffalo hump
3. Depression
4. Anxiety
5. Menstrual irregularities
6. Acne

15. Nursing Implications Monitor BP Inhaled steroids, wash mouth IMI deep
Not withdrawn immediately, tapered over at least 2 weeks
BSL monitoring
Taken with food

16. Oestrogen only preparations
Gonadocorticoids
Oestrogen only preparations
Replacement (menopause)
Morning after pill
Induces uptake of Ca into bone, therapy for menopausal women with osteoporosis
S.E. = breast tenderness, Fluid retention, thrombosis

17. Progesterone only preparations
Gonadocorticoids
Progesterone only preparations
Suppress ovarian function
Mini pill
S.E. similar to Oestrogen only symptoms

18. Gonadocorticoids Oral contraceptives Combination
S.E. thromboembolism, heart disease, CVA, liver disease

19. Gonadocorticoids Androgens (testosterone), Treat deficiencies.
Nandrolone, a anabolic androgen, Produces masculinising effect

20. Drugs used in disorders of the PANCREAS
When the pancreas no longer secrete sufficient effective insulin the glucose cannot enter the cells.
NIDDM, IDDM, Glucogon.
Glucagon acts on the liver to increase blood glucose levels by stimulating the breakdown of glycogen into glucose, and amino acids and free fatty acids

22. INSULIN IVI, S/C, IMI (rare). Short medium or long acting.
Observe for Hypoglycemic episodes
Requirements may vary with pregnancy, infections, stress,
Never change type quickly.

23. Do you know the signs and symptoms of a “hypo” ?
HYPOGLCEMIA
Do you know the signs and symptoms of a “hypo” ?

24. Oral Hypoglycaemic agents 2 types
Sulfonylureas, (Daonil)
1: Stimulates insulin secretion
2: inhibits gluconeogenesis (forming glucose from amino acids and fatty acids)
3: increases the number of insulin receptors in the target cells
Biguanide, (Metformin) acts by promoting glucose uptake into cells .
Used in precaution with renal disorders

25. Nursing Implication Monitor BSL
Reduced tolerance to alcohol and need to restrict intake
Pt to carry medi alert tag
Educate family
Monitor liver enzymes

26. Drugs used on disorders of the PARATHYROID
Calcitonin (Decreases) (thyroid) and parathyroid (Increases) blood Calcium.
Calcitonin inhibits bone reabsorption
S/E dose related nausea and vomiting, local inflammation at inj site, alopecia, headache, Oesopageal pain,
Alendroate (Fosamax), increases Ca level. Avoid laying flat ½ hour after ingestion

28. Posterior Pituitary Hormones
Antidiuretic Hormone (ADH) Vasopressin
Cannot be administered orally.
Oxytocin, smooth muscle stimulant, used to initiate labour.
Oxytocin

29. Identification of Drugs
Daonil
Actrapid
Prednisilone
Metformin
Syntocinon
Thyroxin

30. Identification of Drugs
Tolbutamide
Gliclazide
Dexamethasone
Humalin 70:30
Pulmicourt