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Endocrine Pharmacology

Endocrine. Endocrine Pharmacology. Primary goal is to return the patient to a EUTHYROID state. Thyroid. Hypothyroidism is treated by replacing the deficient T3 and T4 hormones. Thyroxine is one of the two primary hormones, (T4), it is partially metabolized (T3)

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Endocrine Pharmacology

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  1. Endocrine Endocrine Pharmacology

  2. Primary goal is to return the patient to a EUTHYROID state. Thyroid

  3. Hypothyroidism is treated by replacing the deficient T3 and T4 hormones. Thyroxine is one of the two primary hormones, (T4), it is partially metabolized (T3) Synthetic LEVOTHYROXINE (Synthroid, Levoxyl) is considered the drug of choice. Thyroid Replacement Hormones

  4. Increase metabolic rate • Cardiac output • Body temp • Growth • Enzyme activity • Check B/P, pulse, weight, TSH Thyroid Hormones

  5. Contraindications • Adrenal insufficiency • MI • thyrotoxicosis • Side effects/adverse reactions • Insomnia( take in am) • Tremors • Palpitations, angina, dysrhythmias • Weight loss • Changes in appetite • Thyroid storm Thyroid Hormones

  6. Hair loss that occurs in children is temporary Report excitability, heat intolerance, cardiac deviations Do not switch brands Treatment is not to loss weight Avoid iodine ThYROID HORMONES

  7. Levthyroxine T4Liothyronie T3LiotrixThyroid USP (Natural sheep, cow, pig)

  8. Iodine 131 • Radio active isotope of iodine • It is absorbed in the thyriod gland in high concentrations and destroys the hyperactive thyroid tissue • Used for poor surgical risks, patients beyond childbearing years, and people with severe complicating diseases • May take 3 to 6 months to fully asses benefits Antithyroid Medications

  9. Administered in water • DANGEROUS, radioactive, wear gloves • Present in patient’s excreta • Avoid spills • Side effects • Tenderness in thyroid gland • Rebound hyperthyroidism • Hypothyroidism • Interacts with Lithium Carbonate Antithyroid Medications

  10. Propacil, propythiouracil • Tapazole, methimazole • Actions • Block the synthesis of T3 and T4, may take 3 weeks • Used for longterm hyperthyroidism and short term prior to thyroidectomy Antithyroid Medications

  11. Side effects • Purpuric Maculopapular rash, (most common) • Headaches, Salivary gland and Lymph node enlargement, Loss of taste • Bone marrow suppression, stress the importance of returning lab for lab work • Hepatotoxicity • Nephrotoxicity Antithyroid Medications

  12. Drug Interactions • Warfarin, reduce dosage • Digoxin , may require increased dosage Antithyroid Medications

  13. Secreted by the adrenal cortex of the adrenal gland • 2 Categories: • Mineralcorticoids • Fludrocortisone, aldosterone • Maintain fluid and electrolyte balance used to treat adrenal insufficiency caused by hypopituitarism or Addison’s Corticosteroids

  14. Glucocorticoids • Cortisone, hydrocortisone, prednisone, + • Regulate carbohydrate, fat and protien • Antiinflammatory, antiallergenic and immunosuppressant Corticosteroids

  15. Through assessment must be completed before initial dose • Lab test: prone to electrolyte imbalances (hypernatremia, hypokalemia) • Hyperglycemia • Infectious disease testing should be test prior to first dose • Do not tolerate stress well • Weight gain can be significant Corticosteroids

  16. IMPORTANT: Steroid therapy must be gradually discontinued in small increments to ensure the patient’s adrenal glands are able to start secreting steroids appropriately as the drug dosage is reduced. Should carry identification Avoid infections Corticosteroids

  17. Respriatory

  18. Steroids

  19. Adrenal cortex: Cortisol Widely used because of their anti inflammatory properties Do not cure, but relieve symptoms Question about infections May cause psychotic behaviors Delayed wound healing, dehiscence Glucocorticoids

  20. Cortisol Feedback

  21. Estrogens • Development of sex organs • Capillary dilatation, fluid retention, protein metabolism • Used for contraception, treatment of osteoporosis, severe acne in females, advanced prostate cancer Gonadal Hormones

  22. Estrogen • Weight gain, edema, breast tenderness, nausea • Hypertension, hyperglycemia, thrombophlebitis, • Break through bleeding Gonadal Hormones

  23. Progestins • Inhibits ovulation • Uses • Contraception • Relief of symptoms of endometriosis • Hormonal balance to relieve abnormal bleeding Gonadal Hormones

  24. Progestins • Side effects to expect: • Weight gain, edema, nausea, vomiting, diarrhea • Side effects to report: • Breakthrough bleeding, amenorrhea, continuing headache, jaundice, mental depression Gonadal Hormones

  25. Testosterone • Restoration of hormonal balance in androgen deficiency • Reduce discomfort associated with breast cancer • Side effects to expect: • Gastric irritation • Side effects to report: • Electrolyte imbalance, edema, masculinzation, hypercalcemia, hepatotoxicity Androgens

  26. DDAVP is a potent antidiuretic which, when administered, may lead to water intoxication and/or hyponatremia. Unless properly diagnosed and treated hyponatremia can be fatal. Therefore, fluid restriction is recommended and should be discussed with the patient and/or guardian. Careful medical supervision is required. Desmopressin D davp

  27. Fludrocortisone is in a class of drugs called steroids. Fludrocortisone prevents the release of substances in the body that cause inflammation. Fludrocortisone is used to treat conditions in which the body does not produce enough of its own steroids, such as Addison's disease, and salt-losing adrenogenital syndrome. fLORINEF

  28. Bone: Calcitonin suppresses resorption of bone by inhibiting the activity of osteoclasts, a cell type that "digests" bone matrix, releasing calcium and phosphorus into blood. Kidney: Calcium and phosphorus are prevented from being lost in urine by reabsorption in the kidney tubules. Calcitonin inhibits tubular reabsorption of these two ions, leading to increased rates of their loss in urine. Calcitonin

  29. Aldosterone is a hormone that increases the reabsorption of sodium and water and the release (secretion) of potassium in the kidneys. This increases the volume of fluid in the body, and drives blood pressure up. Many drugs, such as spironolactone, lower blood pressure by blocking the aldosterone receptor. Aldosterone is part of the renin-angiotensin system. effect of aldosterone is to increase reabsorption of ions and water in the kidney. ADH Aldosterone

  30. Aldosterone is a steroid hormone (mineralocorticoid family) produced by the outer-section (zona glomerulosa) of the adrenal cortex in the adrenal gland, and acts on the distal tubules and collecting ducts of the kidney to cause the conservation of sodium, secretion of potassium, increased water retention, and increased blood pressure. The effect of aldosterone is to increase reabsorption of ions and water in the kidney. Its activity is reduced in Addison's disease ADH

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