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PHARMACOLOGY

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Identify uses and varying actions of these drugs. ... with type II diabetes if diet and exercise can't control blood glucose levels. ... – PowerPoint PPT presentation

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Title: PHARMACOLOGY


1
PHARMACOLOGY
  • Endocrine drugs

2
OBJECTIVES
  • Identify the classes of drugs that effect the
    endocrine system.
  • Identify uses and varying actions of these drugs.
  • Identify how these drugs are absorbed,
    distributed, metabolized, and excreted.
  • Identify drug interactions and adverse reactions
    to these drugs.

3
DRUGS AND THE ENDOCRINE SYSTEM
  • Consists of glands and hormones.
  • Regulates and integrates the body's metabolic
    activities and maintains homeostasis.
  • Include the following drugs natural and
    synthetic hormones, hormonelike substances, and
    drugs that stimulate or suppress hormone
    secretion.

4
DRUGS AND THE ENDOCRINE SYSTEM
  • The following are categories of endocrine drugs
  • Antidiabetic drugs and glucagon
  • Thyroid and antithyroid drugs
  • Pituitary drugs
  • Estrogens

5
ANTIDIABETIC DRUGS AND GLUCAGON
  • Hypoglycemic drugs - lower blood glucose levels
    (insulin and oral antidiabetics).
  • Hyperglycemic drugs - raise blood glucose levels
    (glucagon).
  • Used to treat type I and type II diabetes
    mellitus.

6
INSULIN
  • Used for patients that need an external source of
    insulin to control blood glucose levels.
  • Pharmacokinetics
  • Administered subcutaneously (or IV) absorption
    depends on injection site distributed throughout
    the body metabolized primarily in the liver
    excreted in the feces and urine.

7
INSULIN
  • Pharmacodynamics
  • An anabolic hormone that promotes
  • Storage of glucose as glycogen.
  • Increase in protein and fat synthesis.
  • Slowing of the breakdown of glycogen, protein,
    and fat.
  • Balancing of fluids and electrolytes.

8
INSULIN
  • Also can correct polyuria and polydipsia and
    facilitates the movement of potassium from the
    extracellular fluid into the cell.
  • Pharmacotherapeutics
  • Used to treat type I diabetes and type II
    diabetes when other methods have failed when
    blood glucose levels are elevated during periods
    of stress when oral agents are contraindicated.

9
INSULIN
  • Also used to treat diabetic ketoacidosis and
    hyperosmolar hyperglycemic nonketotic syndrome.
  • Drug interactions
  • Some drugs interact with insulin and other drugs
    directly affect blood glucose levels.
  • Adverse reactions
  • hypoglycemia

10
ORAL ANTIDIABETIC DRUGS
  • Types of oral antidiabetic drugs available
    include
  • first generation sulfonylureas (clorpropamide -
    Diabenase)
  • second generation sulfonylureas (glipizide -
    Glucotrol)
  • nonsulfonylureas and thiazolidinedione
    antidiabetic drugs (pioglitazone - Actos)

11
ORAL ANTIDIABETIC DRUGS
  • a biguanide drug - metformin (Glucophage)
  • an alpha-glucosidase inhibitor - acarbose
    (Precose)
  • Pharmacokinetics
  • Absorbed well from the GI tract distributed via
    the bloodstream throughout the body metabolized
    primarily in the liver excreted mostly in the
    urine.

12
ORAL ANTIDIABETIC DRUGS
  • Pharmacodynamics
  • Probably stimulate the pancreatic beta cells to
    release insulin in a patient with a minimally
    functioning pancreas.Within a few weeks to a few
    months, pancreatic insulin drops to pretreatment
    levels but the blood glucose levels remain
    normal. This is most likely due to its actions
    outside of the pancreas.

13
ORAL ANTIDIABETIC DRUGS
  • PHARMACOTHERAPEUTICS
  • Indicated for patients with type II diabetes if
    diet and exercise can't control blood glucose
    levels.
  • May be used in combination with insulin for
    patients who don't respond to either drug alone.

14
ORAL ANTIDIABETIC DRUGS
  • Drug interactions
  • hypo and hyperglycemia are the main risks when
    oral antidiabetic drugs interact with other
    drugs.
  • Adverse reactions
  • hypoglycemia

15
GLUCAGON
  • A hyperglycemic drug that raised blood glucose
    levels.
  • Normally produced by the alpha cells of the
    islets of Langerhans in the pancreas.

16
GLUCAGON
  • Pharmacokinetics
  • Administered parenterally absorbed rapidly
    distributed throughout the body effects occur
    primarily in the liver metabolized by the liver,
    kidneys, and plasma excreted by the liver and
    kidneys.

17
GLUCAGON
  • Pharmacodynamics
  • Regulates the rate of glucose production through
    glycogenolysis (glycogen to glucose),
    gluconeogenesis (free fatty acids protein to
    glucose), and lipolysis (adipose tissue fatty
    acids to glucose).
  • Pharmacotherapeutics
  • Used for the emergency treatment of severe
    hypoglycemia.

18
GLUCAGON
  • Drug interactions
  • interacts adversely only with oral anticoagulants
    increasing the tendency to bleed.
  • Adverse reactions
  • rare

19
THYROID AND ANTITHYROID DRUGS
  • Function to correct thyroid hormone deficiency
    (hypothyroidism) and thyroid hormone excess
    (hyperthyroidism).
  • Natural or synthetic and may contain
    triiodothyronine (T3) and/or thyroxine (T4).
  • Natural - animal - thyroid and thyroglobulin
  • Synthetic - sodium salts of L-isomers of the
    hormones - levothyroxine (Synthroid Levoxyl),
    liothyronine sodium, and liotrix.

20
THYROID AND ANTITHYROID DRUGS
  • Pharmacokinetics
  • Absorbed from the GI tract distributed in the
    plasma bound to serum proteins metabolized in
    the liver excreted unchanged in the feces.
  • Pharmacodynamics
  • The principal effect is an increased metabolic
    rate in body tissues.

21
THYROID AND ANTITHYROID DRUGS
  • Pharmacotherapeutics
  • Act as replacement or substitute hormones in the
    following situations to treat hypothyroidism
    with antithyroid drugs to prevent goiter
    formation and hypothyroidism to differentiate
    between primary and secondary hypothyroidism
    during diagnostic testing to treat papillary or
    follicular thyroid carcinoma.

22
THYROID AND ANTITHYROID DRUGS
  • Levothyroxine is the drug of choice for thyroid
    hormone replacement and thyroid-stimulating
    hormone suppression therapy.
  • Drug interactions
  • Interact with several common medications.
  • Adverse reactions
  • Result from toxicity.

23
ANTITHYROID DRUGS
  • Also called thyroid antagonists.
  • Used for patients with hyperthyroidism.
  • Include the following drugs
  • thionamides - propylthiouracil (Propyl-Thyracil)
    and methimazole (Tapazole)
  • iodides - stable iodine and radioactive iodine

24
ANTITHYROID DRUGS
  • Pharmacokinetics
  • Absorbed through the GI tract concentrated in
    the thyroid metabolized by conjugation
    (interchange of nuclear material) excreted in
    the urine.
  • Pharmacodynamics
  • Thionamides block iodines ability to combine
    with tyrosine preventing thyroid hormone
    synthesis.

25
ANTITHYROID DRUGS
  • The excess of stable iodine inhibits hormone
    synthesis through decreasing the formation and
    release of thyroid hormone.
  • Radioactive iodine reduces hormone secretion by
    destroying thyroid tissue through acute radiation
    thyroiditis and chronic gradual thyroid atrophy.

26
ANTITHYROID DRUGS
  • Pharmacotherapeutics
  • Used to treat hyperthyroidism especially in the
    form of Graves disease (autoimmune).
  • Stable iodine is used to prepare the thyroid
    gland for surgical removal. Also used after
    radioactive iodine therapy.
  • Propylthiouracil is usually used for rapid
    improvement of severe hyperthyroidism.

27
ANTITHYROID DRUGS
  • Methimazole is used for mild to moderate
    hyperthyroidism (administered once a day).
  • Drug interactions
  • May react synergistically with lithium causing
    hypothyroidism.
  • Adverse reactions
  • Granulocytopenia

28
PITUITARY DRUGS
  • Natural or synthetic hormones that mimic hormones
    produced by the pituitary gland.
  • Consist of two groups
  • Anterior pituitary drugs - control the function
    of other endocrine glands (thyroid, adrenals,
    ovaries, testes).
  • Posterior pituitary drugs - used to regulate
    fluid volume and stimulate smooth muscle
    contraction in selected clinical situations.

29
ANTERIOR PITUITARY DRUGS
  • The hormones produced by the anterior pituitary
    gland regulate growth, development, and sexual
    characteristics by stimulating the actions of
    other endocrine glands.
  • These drugs include adrenocorticotropics
    (corticotropin cosyntropin), somatrem (a growth
    hormone), gonadotropics, and thyrotropics.

30
ANTERIOR PITUITARY DRUGS
  • Pharmacokinetics
  • Administered mostly by injection absorbed,
    distributed, and metabolized rapidly metabolized
    by the liver and kidneys excreted in the urine.
  • Pharmacodynamics
  • Exert a profound effect on the bodys growth and
    development.

31
ANTERIOR PITUITARY DRUGS
  • Pharmacotherapeutics
  • Corticotropin (ACTH) and cosyntropin (Cortrosyn)
    are used diagnostically to differentiate between
    primary and secondary failure of the adrenal
    cortex.
  • Corticotropin is also used to treat adrenal
    insufficiency.
  • Somatrem (Protropin) is used to treat pituitary
    dwarfism.

32
ANTERIOR PITUITARY DRUGS
  • Drug interactions
  • When corticotropins are taken with diuretics, an
    increased potassium loss may occur.
  • Adverse reactions
  • hypersensitivity
  • Long term use can cause Cushings syndrome.

33
POSTERIOR PITUITARY DRUGS
  • These hormones are synthesized in the
    hypothalamus, stored in the posterior pituitary,
    and secreted into the blood.
  • These drugs include
  • Antidiuretic hormone (ADH) - vasopressin
    (Pitressin), desmopressin, and lypressin
  • Oxytocic drugs - oxytocin (Pitocin)

34
POSTERIOR PITUITARY DRUGS
  • Pharmacokinetics
  • Administered intranasally or parenterally
    absorbed, distributed, and metabolized rapidly.
  • Pharmacodynamics
  • Posterior pituitary hormones affect
  • Smooth muscle contraction in the uterus, bladder,
    and GI tract.

35
POSTERIOR PITUITARY DRUGS
  • Fluid balance through kidney reabsorption of
    water.
  • Blood pressure through stimulation of the
    arterial wall muscles.
  • ADH promotes the kidneys reabsorption of water
    increases blood pressure.
  • Oxytocin stimulates uterine contractions and
    lactation.

36
POSTERIOR PITUITARY DRUGS
  • Pharmacotherapeutics
  • ADH is prescribed for hormone replacement therapy
    in patients with neurogenic diabetes insipidus.
  • Desmopressin and lypressin are the drugs of
    choice for chronic ADH deficiency and are
    administered intranasally.
  • Vasopressin elevates blood pressure for
    short-term.

37
POSTERIOR PITUITARY DRUGS
  • Oxytocics are used to induce labor, treat
    preeclampsia and eclampsia, control uterine
    bleeding, contract the uterus, and stimulate
    lactation.
  • Drug interactions
  • Can occur with various drugs.
  • Adverse reactions
  • Hypersensitivity

38
ESTROGENS
  • Mimic the physiologic effects of naturally
    occurring female sex hormones.
  • Used to correct estrogen-deficient states and
    prevent pregnancy.
  • Estrogens that treat endocrine disorders include
  • Natural - estradiol and estrone
  • Synthetic - diethylstilbestrol and quinestrol

39
ESTROGENS
  • Pharmacokinetics
  • Absorbed well and distributed throughout the
    body metabolized in the liver excreted by the
    kidneys.
  • Pharmacodynamics
  • Believed to increase the synthesis of DNA, RNA,
    and protein in estrogen-responsive tissues in the
    female breast, urinary tract, and genital organs.

40
ESTROGENS
  • Pharmacotherapeutics
  • Prescribed in the following situations hormone
    replacement therapy in post-menopausal women and
    in women with primary ovarian failure
    palliatively to treat advanced inoperable breast
    cancer in post-menopausal women and prostate
    cancer in men.

41
ESTROGENS
  • Drug interactions
  • Few drug interactions.
  • May decrease the effects of anticoagulants.
  • Interfere with absorption of folic acid.
  • Adverse reactions
  • hypertension, thromboembolism, and
    thrombophlebitis
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