1. 25
Drugs Used to Treat Endocrine Conditions

2. Endocrine System
Secretes hormones that control body by maintaining internal environment (homeostasis)

3. Endocrine System Some examples of hormones:
Corticotropin-releasing hormone (CRH)
Growth hormone-releasing hormone (GHRH)
Gonadotropin-release hormone (GnRH)
Thyrotropin-releasing hormone (TRH)
Anterior pituitary hormones

4. Figure 25-1 Primary glands of the endocrine system.

5. Table 25-1 Endocrine Glands and Their functions

6. Table 25-1 (continue) Endocrine Glands and Their functions

7. Figure 25-2 Pituitary hormones and their target cells, tissues, and organs.

8. Growth Hormone GH (somatotropin)
Causes increase in weight and length of body
Irregularities: gigantism or acromegaly

9. Thyroid-Stimulating Hormone
TSH
Controls secretion of thyroid hormone
Important for growth and function of thyroid gland
Stimulates uptake of iodine and increases synthesis and release of thyroid hormones
Abnormalities: hypothyroidism or hyperthyroidism (Graves’ disease)

10. Adrenocorticotropic Hormone
ACTH
Released by anterior lobe of pituitary gland
Stimulates growth of adrenal gland cortex and secretion of corticosteroids
Hypersecretion: Cushing’s syndrome

11. Gonadotropic Hormones
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)
Produced by pituitary gland
Affect gonadal tissue in men and women
In men: spermatogenesis
In women: gametogenesis and follicular development

12. Prolactin P
With estrogens, progesterone, hydrocortisone, and insulin, stimulates breast development
Stimulates milk secretion by mammary glands
Increases testicular steroidogenesis and development of male accessory sex organs

13. Vasopressin Antidiuretic hormone (ADH)
Stimulates water reabsorption from nephrons
Lack of ADH causes diabetes insipidus

14. Oxytocin Stimulates contraction of smooth muscle in the: Uterus
Alveoli of lactating breast

15. Table 25-2 Relationships Among Hypothalamic, Anterior Pituitary, and Target Organ Hormones

16. Thyroid Hormones Thyroxine (T4) Triiodothyronine (T3)
Calcitonin: calcium homeostasis

17. Myxedema Coma Associated with severe hypothyroidism
Medical emergency manifested by diminished level of consciousness
Symptoms: hypothermia, hypoventilation, hypotension, hypoglycemia

18. Congenital Hypothyroidism
Congenital hypothyroidism is absence of thyroid tissue during fetal development.
Absence of thyroid occurs more often in female infants.

19. Congenital Hypothyroidism
Thyroid hormone is essential for embryonic growth, particularly of brain tissue; infant will be mentally retarded if no thyroxine is available during fetal life.

20. Table 25-3 Common Thyroid and Antithyroid Agents

21. Potassium Iodide
Uses: hyperthyroidism; with other drugs for thyrotoxic crisis
Adverse effects: possible irregular heartbeat, mental confusion, pulmonary edema
Contraindications: hypothyroidism, hyperkalemia, acute bronchitis

22. Potassium Iodide
Patient information: iodine is present in shellfish, iodized salt and some OTC cough preparations

23. Methimazole Uses: hyperthyroidism
Adverse effects: hypothyroidism, pancytopenia, aplastic anemia, arthralgia, peripheral neuropathy
Contraindications: pregnancy and lactation
Patient Information: take before breakfast

24. Propylthiouracil Uses: hyperthyroidism, iodine-induced thyrotoxicosis
Adverse effects: agranulocytosis, hypothyroidism, bradycardia
Contraindications: last trimester of pregnancy and during lactation

25. Propylthiouracil
Patient information: instruct patients to report agranulocytosis symptoms, avoid foods that inhibit thyroid secretion, and take early in day

26. Levothyroxine Uses: hypothyroidism
Adverse effects: hyperthyroidism (high levels), chest pain, rapid or irregular heartbeat
Contraindications: allergies to povidone-iodine or tartrazine
Many interactions with other drugs

27. Levothyroxine
Patient information: instruct patients to get frequent blood tests, take on empty stomach, and immediately report chest pain or irregular heartbeat

28. Parathyroid Hormone (PTH)
Acts to restore calcium concentration
Hypoparathyroidism: rare disorder in which body produces little or no parathyroid hormone, resulting in hypocalcemia

29. Pancreatic Hormones
Glucagon: secreted by islets of Langerhans in pancreas when blood glucose levels are low
Functions to maintain adequate levels of glucose in blood
Insulin: secreted by pancreatic beta cells
Promotes use of glucose in cells

30. Diabetes Mellitus Serious endocrine disorder Hyperglycemia
Results from deficient insulin secretion or decreased sensitivity of insulin receptors on target cells
Affects 17 million Americans
Type 1: 10% of cases; caused by lack of insulin secretion by pancreas
Type 2: 90% of cases; caused by resistance of insulin receptors to insulin

31. Figure 25-3A Diabetes mellitus can be caused by dysregulation of beta-cell function.

32. Figure 25-3B Interaction of blood glucose levels, insulin, and glucagon.

33. Diabetes in Children
Chronic pathological conditions resulting from diabetes mellitus in children include:
Diabetic neuropathy
Retinopathy
Nephropathy
Stroke
Coronary artery disease
Infection

34. Diabetes and Obesity Obesity: major cause of type 2 diabetes
Type 2 diabetes usually affects people older than age 40.
African-Americans have highest rates of obesity and diabetes compared to other racial/ethnic groups.
30 minutes of moderate physical activity most days are recommended to treat obesity.

35. Table 25-4 Classifications of Insulin

36. Table 25-4 (continued) Classifications of Insulin

37. Insulin Therapy Insulin controls the level of blood glucose.
It does not cure diabetes.
Insulin therapy is required long term.

38. Rapid-acting Insulin Uses: treatment of type 2 diabetes
Adverse effects: hypoglycemia
Contraindications: cautious use in hyperthyroidism and hypothyroidism, renal or hepatic impairment, lactation and pregnancy, and older adults
Patient information: instruct patients in proper diet and symptoms of hypoglycemia

39. Short-acting Insulins
Uses: emergency treatment of diabetic ketoacidosis or coma, to initiate therapy in type 1 diabetes, and in combination with other insulins
Adverse effects: hypoglycemic reactions
Contraindications: cautious use in pregnancy and lactation, in patients with kidney or liver impairment

40. Intermediate-acting Insulins
Uses: to control hyperglycemia
Adverse effects: rare
Contraindications: during hypoglycemia; cautious in insulin-resistant patients, hyperthyroidism or hypothyroidism, renal or hepatic impairment, pregnancy or lactation, older adults, children younger than 3 years

41. Intermediate-acting Insulins
Patient information: teach patients to check blood glucose levels and maintain well-balanced diet

42. Long-acting Insulin Uses: type 1 and 2 diabetes
Adverse effects: hypoglycemia and hypokalemia
Contraindications: cautious use in patient with renal or hepatic impairment, during pregnancy or lactation, and in children younger than 6 years

43. Long-acting Insulin
Patient information: advise patients to carry source of glucose

44. Insulin in Zinc Suspension
Uses: type 1 diabetes
Adverse effects: similar to those of rapid-acting
Contraindications: hypoglycemia
Patient information: instruct patients about hypoglycemic symptoms and to use orange juice and sugar-containing foods to treat hypoglycemic reactions

45. Table 25-5 Common Oral Antidiabetic Drugs

46. Table 25-5 (continued) Common Oral Antidiabetic Drugs

47. Sulfonylureas Uses: treatment of mild to moderate type 2 diabetes
Adverse effects: hypoglycemia, fainting, confusion, blurred vision, bone-marrow depression
Contraindications: severe infections; acidosis; severe renal, hepatic, or thyroid dysfunction

48. Sulfonylureas
Patient information: teach patients to avoid alcohol

49. Biguanides
Uses: type 2 diabetes when no response to sulfonylureas occurs
Adverse effects: anorexia, GI upset, lactic acidosis
Contraindications: renal disease, alcoholism, hepatic disease, chronic cardiopulmonary dysfunction

50. Thiazolidinediones Uses: adjuncts to treatment of type 2 diabetes
Adverse effects: edema, anemia, headache, back pain, fatigue, weight gain, hypoglycemia
Contraindications: active liver impairment, pregnancy, lactation, in children younger than 18 years

51. Thiazolidinediones
Patient information: advise patients to report symptoms of hepatic dysfunction

52. Alpha-glucosidase Inhibitors
Uses: monotherapy or combination therapy for type 2 diabetes
Adverse effects: GI effects, hypoglycemia
Contraindications: inflammatory bowel disease or other GI conditions, renal impairment

53. Alpha-glucosidase Inhibitors
Patient information: instruct patients that insulin may be needed in times of infection, stress, or surgery

54. Table 25-6 Adrenocortical Hormones and Their Effects

55. Table 25-7 Major Adrenal Corticosteroids (Glucocorticoids)

56. Glucocorticoids
Uses: replacement therapy in adrenal insufficiency; rheumatic, inflammatory, allergic, neoplastic, and other disorders
Adverse effects: insomnia, behavioral changes, acute peptic ulcer disease

57. Glucocorticoids
Contraindications: peptic ulcer, heart disease, hypertension infectious illnesses, psychoses, diabetes, osteoporosis, glaucoma
Patient information: advise patients not to stop abruptly, to not have immunizations, and to take drugs with food

58. Mineralocorticoids
Uses: primary and secondary adrenocortical deficiency
Adverse effects: edema, hypertension, heart failure, hypokalemia, muscular weakness, headache
Contraindications: patients with systemic fungal infections; cautious use in Addison’s disease, pregnancy, and lactation

59. Mineralocorticoids
Patient information: advise patients to maintain a low-sodium, high-potassium diet, and to recognize symptoms of edema, hypertension, and heart failure