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1. Drugs used in Endocrine Disorders By Raheem khan DION-DUHS Raheem khan

2. A. Antidiabetic Drugs Raheem khan

3. Lecture Outline By the completion of this section the learners will be able to: 1. Review disease process of Diabetes mellitus. 2. Discuss the role of Insulin in metabolic process. 3. Discuss different types of anti-diabetic agents with their mode of action, side effects and care. 4. List the principles of therapy for all anti-diabetic agents. 5. State reasons for combinations of insulin and oral hypoglycemic agents. Raheem khan

4. DIABETES MELLITUS Disorder of carbohydrate, fat and protein metabolism caused by lack or inefficient use of insulin in the body. Diabetes is classified as:  Type –I (IDDM)  Type – II (NIDDM) Raheem khan

5. Disease process of Diabetes mellitus Raheem khan

6. Mechanism of Insulin Release Mechanism of insulin release in normal pancreatic beta cells Insulin production is more or less constant within the beta cells Its release is triggered by food, chiefly food containing absorbable glucose Raheem khan

7. The actions of insulin (indirect and direct) on cells include: Increased glycogen synthesis – insulin forces storage of glucose in liver (and muscle) cells in the form of glycogen; lowered levels of insulin cause liver cells to convert glycogen to glucose and excrete it into the blood. This is the clinical action of insulin, which is directly useful in reducing high blood glucose levels as in diabetes. Raheem khan

8. Increased lipid synthesis – insulin forces fat cells to take in blood lipids, which are converted to triglycerides; lack of insulin causes the reverse. Raheem khan

9. Management Management is with, Diet Exercise, and Use of appropriate medications (insulin in the case of type 1 diabetes, oral medications as well as possibly insulin in type 2 diabetes) Raheem khan

10. INSULIN Sources of insulin: Bovine insulin (CATTLE) Porcine insulin (PIG) Human insulin (Human insulin is laboratory created by growing insulin proteins within E-coli bacteria) Uses Pharmacokinetics:  Injected as SC, IM, IV  Peak plasma concentration attain in 60-90min. Raheem khan

11. Insulin preparations Insulin preparations differ with respect to their:  Source  Strength  Formulation Dose: 0.3units/kg (16 – 20units daily) Adverse effects of insulin:  Hypoglycemia  Lipodystrophy  Allergic reactions Raheem khan

12. ORAL HYPOGLYCEMIC AGENTS: Sulphonylureas : Example: Glibenclamide Gliclazide Glipizide Glimepride 2. Biguanide : Example: Metformin Raheem khan

13. ORAL HYPOGLYCEMIC AGENTS: Thiazolidinediones : Example: Pioglitazone Rosiglitazone Meglitinide : Example: Repaglinide Netaglinide Alpha- glucidose inhibitors: Example: Acarbose Raheem khan

14. B. Corticosteroids Raheem khan

15. Objectives By the completion of this section the learners will be able to: 1. Review the Anatomy & Physiology of adrenal glands. 2. Discuss the action, indication, side effects and contraindication of exogenous corticosteroids. 3. List few commonly used corticosteroids. Raheem khan

16. 4. Differentiate between short term and long-term corticosteroid therapy. 5. Discuss the action, indication, side effects and contraindication of exogenous androgen therapy. 6. Discuss the consequences of abusing anabolic steroids. Raheem khan

17. 7. Identify few names of anabolic steroids. 8. Apply nursing process for the clients using corticosteroids / androgens therapy. Raheem khan

18. Anatomy of Adrenal Gland The adrenal glands (also known as suprarenal glands) are endocrine glands that sit at the top of the kidneys. Raheem khan

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20. Physiology of Corticosteroids Corticosteroids are a group of chemicals secreted by the adrenal gland medulla (inner zone) produces epinephrine and norepinephrine cortex (outer zone) produces corticosteroids a. glucocorticoids (e.g. Cortisol ) allow the body to respond to stress b. mineralocorticoids (e.g. ALDOSTERONE) control fluid and electrolyte balance c. sex hormones (e.g. ANDROGENS & ESTROGENS) Raheem khan

21. Corticosteroids Agents Systemic (oral and IV) Prednisone Methylprednisolone (Solu-medrol) Cortisone Hydrocortisone Raheem khan

22. Corticosteroids Available for Inhalation   Beclomethasone dipropionate (Beclovent ) Triamcinolone acetonide (Azmacort) Budesonide (Pulmicort) Raheem khan

23. Mode of Action Inhibit many of the cells involved in airway inflammation Reduce the number of mast cells in the airways Inhibit plasma exudation Inhibit mucus secretion Raheem khan

24. Reduces the accumulation of neutrophils at inflammatory sites and increases the number in circulation Reduces the number of monocytes, basophils and eosinophils. Constrict the microvasculature to reduce leakage of cells and fluids into inflammatory sites Raheem khan

25. Restore responsiveness to ß-adrenergic stimulation Increase the affinity of the receptors for ß-agonists Effect is seen 1-4 hours after IV administration IV bolus is given in status asthmatics for this effect Raheem khan

26. Hazards and Side Effects of Steroids Insomnia Mood changes Manic-depression Schizophrenia Raheem khan

27. Cataract formation Myopathy of skeletal muscle Osteoporosis Peptic ulcer Fluid retention Hypertension Increased WBC count Raheem khan

28. Clinical Application of Aerosol Steroids Use in Asthma Use in Chronic Obstructive Pulmonary Disease (COPD) Raheem khan

29. Androgenic (Anabolic) Corticosteroids Endogenous sex hormone secreted by adrenal cortex in both men and women (less in women) produces secondary male sexual characteristics, including increase in muscle mass (anabolic effects). Derivatives have been developed which minimize masculinizing effects and maximize anabolic effects   Raheem khan

30. Medical Uses Treatment of anemia increases RBC production hypogonadism stimulates sexual development   Raheem khan

31. Use by Athletes controversial due to many side effects increase body weight and mass increase performance, endurance and strength Raheem khan

32. C. Thyroid and Antithyroid Drugs Raheem khan

33. Objectives By the completion of this section the learners will be able to: 1. Review the physiologic effects of thyroid hormone. 2. Identify effects of hypo and hyper secretions of thyroid hormone. 3. Discuss actions, indications, side effects and contraindications of thyroid and anti-thyroid drugs. Raheem khan

34. 4. Integrate the influence of thyroid and anti-thyroid drugs on the metabolism of other drugs. 5. Teach clients self-care activities related to the use of thyroid and anti-thyroid drugs. Raheem khan

35. THYROID GLAND Butterfly-shaped gland present behind the larynx. Thyroid hormone is produced by thyroid gland. Thyroid hormone exist in two major forms: Levothyroxine (T4) Triiodothyronine (T3) Raheem khan

36. Physiologic effects of Thyroid Hormone (It is likely that all cells in the body are targets for thyroid hormone). Metabolism: Stimulate diverse metabolic activities such as: Lipid metabolism Carbohydrate metabolism Growth & Development: Growth retardation observed in thyroid deficiency. Other effects: Documented effects include: Cardiovascular system Central nervous system Reproductive system Raheem khan

37. Thyroid Disease States Hypothyroidism: Non-goitrous Goitrous Hyperthyroidism: Grave’s diseases system Thyroid storm Drug-induced Raheem khan

38. Drugs used to treat hypothyroidism Category Preparation Dosage Thyroid hormone products Thyroid USP 16-195mg daily Thyroglobulin 16-160mg daily Levothyroxine sodium 0.0125-0.2mg daily Liothyronine sodium 5-100mcg daily Liotrix Based upon need Raheem khan

39. Drugs used to treat hyperthyroidism Category Drug Dosage Thionamides Methimazole 5-20mg PO q 8hrsinitially and then 5-15mg daily. Carbimazole 40mg/day PO for 3-4wks then titrate by decrements initially 10mg q 4-6wks to a maintenance dose of 5-10mg daily Propylthiouracil 300-900 PO daily in divided doses into 3 doses given at 8hr intervals, then maintain at 100- 150mg daily. Iodine Potassium iodide , Sodium iodide PO prn 250mg tid Strong iodine solution 0.3ml PO tid Sodium iodide 131 Dose depends on use Raheem khan

40. Nursing priorities and considerations (Indications, Adverse effects and Contra indications of Thyroid drugs Main indication of levothyroxine is thyroid deficiency. Adverse effects of thyroid hormones parallel the increase in metabolic rate. In pregnancy a hypothyroid patient should be carefully assessed. Raheem khan

41. Nursing priorities and considerations (Indications, Adverse effects and Contra indications of Anti -thyroid drugs Thionamides are used as principal therapy in hyperthyroidism and are liable to cause minor and major adverse effects. Iodide is used for thyroid storm , also used as antiseptic and produces symptoms of iodism . Radioiodine is used in thyroid carcinoma along with surgery and is contraindicated in children, pregnant or breast-feeding women, Raheem khan

42. Nursing process Assessment, Potential nursing diagnosis Planning Implementation Evaluation Raheem khan

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