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Chapter 14

Chapter 14. Hormones. Chapter 14 Topics. 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

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Chapter 14

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  1. Chapter 14 Hormones

  2. Chapter 14 Topics • The Endocrine System • Male Impotence • Female Hormones • Bone Disease • Sexually Transmitted Disease • Corticosteroids • Diabetes - Hypoglycemic Agents

  3. 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

  4. 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

  5. Learning Objectives • Understand diabetes and the proper treatment and care of patients • Know the applications for growth hormone

  6. The Endocrine System • Consists of glands and other structures that produce hormones which are released into the circulatory system

  7. 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

  8. Regulation • Homeostatsis is achieved through feedback mechanisms • Negative feedback – negates change to bring levels back to normal

  9. Pituitary Gland • Regulates other endocrine glands as well as other body activities

  10. 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

  11. Thyroid Hormone Feedback Loop • Thyroid hormones build up in the blood • Signals are sent to the hypothalamic-pituitary axis that adequate levels have been met • TSH levels decrease

  12. 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

  13. Apathy Constipation Decreased heart rate Depression Dry skin, nails, and scalp Easy fatiguing Enlarged thyroid Lowered voice pitch Myxedema Puffy face Reduced mental acuity Swelling of eyelids Tongue enlarged and thickened Weight gain Hypothyroidism Symptoms

  14. Causes of Hypothyroidism • Autoimmune destruction of the gland • Radioactive iodine therapy • Surgical removal of the gland

  15. Treatment for Hypothyroidism • Thyroid replacement therapy • Should not be used to treat obesity

  16. Drug List Agents for Hypothyroidism • levothyroxine, T4 (Levothroid, Levoxyl, Synthroid) • liothyronine, T3 (Cytomel) • liotrix (Thyrolar) • thyroid (Armour Thyroid)

  17. levothyroxine, T4 (Levothroid, Levoxyl, Synthroid) • Used for chronic therapy • Can be cardiotoxic • Alters protein binding of other drugs • Should not switch brands once stabilized

  18. levothyroxine Dispensing Issues • Can be cardiotoxic; report any of the following: • Chest pain, increased pulse, palpitations, heat intolerance, excessive sweating Warning!

  19. levothyroxine Dispensing Issues • Look-alike and Sound-alike Drugs: • levothyroxine (thyroid replacement) • levofloxacin (antibiotic) Warning!

  20. 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

  21. Symptoms of Hypterthyroidism • Decreased menses • Diarrhea • Exophthalmos • Flushing of the skin • Heat intolerance • Nervousness • Perspiration • Tachycardia • Weight loss

  22. Drug List Agents for Hyperthyroidism • methimazole (Tapazole) • propylthiouracil, PTU • radioactive iodine, 131I

  23. Discussion What are the treatment options for hyperthyroidism?

  24. Discussion What are the treatment options for hyperthyroidism? Answer: in children: surgery and hormone replacement; adults: surgery or medications

  25. Adrenal Sex Hormones • Androgens are produced by: • The testes • The ovaries • Adrenals • Peripheral fat tissue • Most important male hormone is testosterone which is produced by the testes

  26. Responsibilities of Testosterone • Initiating sperm production • Behavioral characteristics • Libido • Sexual potency • Muscle mass and strength • Fat distribution • Bone mass • Erythropoiesis • Prevention of baldness

  27. 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

  28. Androgen’s Side Effects • Virilization • Hirsutism • Acne • Hepatoxicity • High levels of erythrocytes • Oily skin • Gynecomastia • Priapism

  29. Male Impotence • Failure to initiate or maintain an erection until ejaculation • Causes: • Testosterone deficiency • Alcoholism • Cigarette smoking • Psychological factors • Medications

  30. Alcohol (most significant) Amphetamines Antihypertensives Corticosteroids Estrogens H2 blockers haloperidol lithium Opiates Some antidepressants Drugs That May Cause Impotence

  31. Drug List Agents for Male Impotence • alprostadil (Caverject, Edex, Muse) • danazol (Danocrine) • methyltestosterone (Android, Testred) • oxymetholone (Anadrol) • papaverine • testosterone (Androderm, AndroGel, Striant, Testoderm)

  32. Drug List Agents for Male Impotence – Phosphodiesterase Inhibitors • sildenafil (Viagra) • tadalafil (Cialis) • vardenafil (Levitra)

  33. sildenafil (Viagra) • 1st oral therapy for impotence • Allows an erection to occur naturally • Take at least 1 hour before activity

  34. sildenafil Dispensing Issues • Potentially lethal interaction with nitrates Warning!

  35. tadalafil (Cialis) • Duration of action is 36 hours • Faster onset and longer duration than others in this class

  36. tadalafil Dispensing Issues • Potentially lethal interaction with nitrates Warning!

  37. Female Hormones • Can prevent conception, ease symptoms of menopause, and help prevent osteoporosis • 2 main female hormones: • Estrogen • Progesterone

  38. Estrogen • Formed in the ovaries when FSH is released • Responsible for: • Endometrial growth • Increased cervical mucus • Cornification of vaginal mucosa • Growth of breast tissue • Increased epiphyseal closure • Sodium retention • Carbohydrate metabolism • Calcium utilization

  39. 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

  40. Menopause • As women reach menopause estrogen production decreases • HRT can be used to supplement estrogen levels

  41. estrogens Dispensing Issues • Patients should not smoke during therapy, whether birth control or HRT Warning!

  42. Estrogen’s Side Effects • Nausea • Vomiting • Bloating • Weight gain • Breast tenderness • Breakthrough bleeding • Glucose intolerance

  43. HRT • Reduces symptoms of menopause • Decreases bone loss • Lowers risk of cardiovascular disease • Small risk of breast cancer

  44. 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)

  45. Drug List Estrogens • estradiol-levonorgestrel (Climara Pro) • estradiol-norethindrone (Activella, CombiPatch) • estradiol-norgestimate (Ortho-Prefest)

  46. Drug List Estrogens • estropipate (Ogen) • ethinyl estradiol (Estinyl) • ethinyl estradiol-norethindrone (Femhrt)

  47. estrogen-medroxyprogesterone (Premphase, Prempro) • Provides estrogen and progesterone replacement • Prevents uterine cancer

  48. Progestins • Used primarily in birth control and to prevent uterine cancer • Also used for menstrual dysfunction

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