Drugs used in Endocrine Disorders.pdf rf

Drugs used inendocrine disorder. This is important topic of Pharmacology.

1. Drugs used in Endocrine
Disorders

2. ENDOCRINE SYSTEM
The endocrine system consist of many glands which produce and secret hormones.
These hormones helps in the regulation of all body activities:
•Metabolism of nutrients and water
•Reproduction
•Growth and development
The major elements of the endocrine system are:
•Hypothalamus and Pituitary gland
•Thyroid and parathyroid glands
•Pancreas
•Adrenal glands,
•Ovaries and testes

3. ENDOCRINE SYSTEM

4. •Theendocrinesystemregulatesandintegratesthebodymetabolicactivitiesand
maintainshomeostasis(thebody'sinternalequilibrium).
•Thedrugclassesthattreatendocrinesystemdisordersinclude:naturalhormones
andtheirsyntheticanaloguesubstancesdrugsthatstimulateOrsuppress
hormonelikenesecretion.
Endocrine Gland Hormone Effect
Adrenal (cortex) Aldosterone Increases blood Na+ levels
Adrenal (cortex) Cortisol Increases blood sugar levels
Adrenal (medulla) Epinephrine and norepinephrineStimulates fight-or-flight response
Pancreas Insulin Reduces blood glucose levels
Pancreas Glucagon Increases blood glucose levels
Thyroid
Thyroxine (T4) and
triiodothyronine (T3) Stimulates basal metabolic rate
Thyroid Calcitonin Reduces blood Ca+ levels

5. Pancreas
It consist of two major types of
secretary cells:
•Exocrine gland : Secret digestive
juice
•Endocrine gland : release endocrine
hormones
Endocrine contains four major cell
types:
•Alpha (A) Secrete glucagon
•Beta (B) cells Secrete insulin
•Delta (D) cells Secrete Somatostatin
•F secrete pancreatic polypeptide.

6. Glucose
•Primary source of energyfor cell in the body.
•Excessglucose is stored in the liver as glycogen.
•When circulating glucose is needed the glycogenstored in the liver
is broken down in a process called glycogenolysis.
•Glucagon starts this process.
•Glucagon is released by the alphacellsof the pancreas.
•In order for glucose to be used, it must enter the tissues with the
help of insulin.

7. The following lab tests can confirm the diagnosis of diabetes:
HbA1c ≥ 6.5 %
Fasting plasma glucose ≥ 126 mg/dL
Two-hour plasma glucose ≥ 200 mg/dL
Symptoms with a random plasma glucose ≥ 200 mg/dL

8. DIABETES MELLITUS
•Complex disorder of glucose metabolism
•Insulin production and/or utilization is impaired.
•Hyperglycemia develops, which requires treatment to control.
•Chronic disease that affects multiple organ systems
Pathophysiology
•Type 1: Pancreatic beta cells are no longer able to produce insulin.
•Type 2: Pancreas produces less insulin over time.
•Both types: Liver and muscles are unable to properly utilize glucose.

9. Comparison
Type I diabetes
•Onset is abrupt
•Mostly diagnosed in teenage
•Absent or minimal insulin
Production
•Causes: virus, toxin- autoimmune
condition
•Symptoms: Polyuria, polydipsia,
fatigue, weight loss
•Treatment: Insulin
•Complications: Eyes, kidney, MI,
Stroke, Nerve damage, neuropathy
Type II Diabetes
•Onset is gradual
•In Adulthood
•Insulin resistance develops
overtime and Prod decrease
•Genetic and environmental factors-
lifestyle, obesity, diet
•Same, sometimes recurrent
infections
•Oral hypoglycemics, lifestyle
changes and sometimees insulin
•Same complications

10. ClinicalManifestations: DM Type I
•Polyuria (excess urination)
•Polydipsia (excessive thirst)
•Polyphagia (excess appetite)
•Glucosuria (high blood glucose levels)
•Weight loss
•Fatigue
•Vaginal yeast infection (females)

11. Insulin typeInsulin NameOnse
t
(min)
Peak
(h)
Duration
(h)
Method
Rapid-actingLispro
Aspart
Glulisin
15 1.33.5 Used to cover extra carbohydrates
Dosage adjusted according to number of
carbohydrates ingested.
Best given 15 minutes before a meal.
Short ActingRegular
Humalin R
Novolin R
30-602-48-12 Best given 30 to 60 minutes before a meal.
* Only insulin that can be given intravenous in cases of
severe DKA.
Intermediate
Acting
NPH
Novalin
Lente
1-1.54-1212-18 Combination of long-acting 70% and rapid-acting 30%.
Effect is slower and more prolonged.
Long-Acting
Insulin
Lantus
Levemir
Insulin Glargin
1-3 Does
not
peak
24 Slow and steady release
Provide a baseline of insulin through out the day
Ultra-long
acting
Degludec
Ultralente
30-90
min
Does
not
peak
>=36 Provide a baseline of insulin for longer time
Combination
s
0.5-12-1010-18 Combination: 70/30 or 50/50
Each contains rapid-acting and slower-acting insulin.
(Different brands of insulin may vary in onset, peak time, and duration, even if they’re the same type.)

12. Mechanism of Action
•Promotes cellular update of glucose, converts glucose to
glycogen,
•It restores the ability to metabolize carbohydrates, fats and
protein; to store glucose in the liver, and covert glycogen to fat
stores.
•Site of injection: Upper arm, upper outer thighs, Abdomen,
buttocks
•Side Effects To much insulin can result in hypoglycemia
(generally below 50 mg/dL).
•Insulin overdose can result in shock and possible death.
•Lipohypertrophy
•The major challenge is to balance glucose and insulin levels in
the body.

13. Hypoglycemia symptoms: Shakiness, Dizziness, Sweating, Hunger, Headache,
Pale skin, Sudden moodiness or behavior changes, Confusion or difficulty paying
attention, Tingling sensation around the mouth

14. Contraindications
•Hypersensitivity to Beef, zinc, or potassium insulin
•Avoid with B-blocker, diuretics, oral contraceptives, corticosteroids etc,
•Nursing Implications:
•Assess the patient blood sugar before administering insulin.
•Insulin should be administered on schedule time.
•Monitor clients for signs of hypoglycemia. Administer glucose if hypoglycemia
occurs.
•Unopened insulin vials should refrigerated be until needed.
•Once vial is opened label it with date and time Opened vials should also be kept at
2-8 degree (refrigerated) for one month.
•Encourage clients to wear a medical alert bracelet.
•Instruct clients to systematically rotate injection sites and to allow 1 inch between
injection sites to prevent from Lipohypertrophy.

15. Quiz
•The physician orders blood glucose testing in the morning and
before meals.
•The order reads to give 1 unit of rapid acting insulin for every 10 mg
/ dL over 150 mg / dL
•The morning reading is 200 mg / dL
•How many units of rapid acting insulin would you need to give?
_______________

16. Diabetes Type II Non-insulin dependent or
adult-onset diabetes.
•Obesity is one of the major risk factors
•African Americans, Hispanic Americans, and Native Americans are all at
higher risk than whites.
•10% have circulating anti-bodies that suggest an autoimmune origin of the
disease.
•Elevated blood glucose (higher than 126 mg/dL)
•Impaired fasting glucose level (110 mg/dL or higher but less than 126 mg/dL)

17. Hemoglobin A1c Glycated hemoglobin
•Used to monitor glucose control of diabetes over time.
•ADA recommends that this test be done 4 times a year in a known
diabetic (in addition to blood glucose tests).
•Has become a screening tool to detect diabetes.
•A1c Healthy level should be 4 – 5.9 Blood glucose would be 60 to
100.

21. Glipizide
Mechanism of Action
•Glipizide is in the sulfonylurea class of antihyperglycemic medication.
•It stimulates insulin secretion from the beta cells of pancreatic islet
tissue and is thus dependent on functioning beta cells in the pancreatic
islets.
•Peak plasma concentrations occur 1 to 3 hours after a single oral dose.
•May cause severe hypoglycemia- give 30 minutes before a meal
•Glipizide is contraindicated in type 1 diabetics or for use of diabetic
ketoacidosis; insulin should be used to treat this condition
•Patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency
with sulfonylurea can lead to hemolytic anemia.

22. Glipizide
NSAIDs and Other protein bound drugs- potentiate hypoglycemia
Patient Teaching & Education
•Take the medication at the same time each day.
•Understand that the medication helps control episodes of
hyperglycemia but does not cure diabetes.
•Patients should be instructed regarding the signs of hyperglycemia
and hypoglycemia.
•The use of sulfonylureas and alcohol may cause a disulfiram-like
reaction.

23. Metformin
Biguanide class
•Decreases hepatic glucose production
•decreases intestinal absorption of glucose, and
•improves insulin sensitivity by increasing peripheral glucose uptake and
utilization.
•Specific Administration Considerations
•Divided doses with meals
•monotherapy or in combination
•Common adverse reactions include diarrhea, nausea/vomiting,
weakness, flatulence, indigestion, abdominal discomfort, and
headache.

24. Metformin
Contraindicated in patients with
•kidney disease (e.g., serum Cr levels ≥1.5 mg/dL [M] or ≥1.4 mg/dL [F])
•Temporarily discontinued in patients undergoing radiologic studies
involving intravascular administration of iodinated contrast materials.
•Patients with metabolic acidosis.
•Patient Education:
•Metallic taste
•Lactic acidosis is a rare, but serious.
•should report chills, low blood pressure, muscle pain, or dyspnea
immediately

25. Sitagliptin
•orally-active inhibitor of dipeptidyl peptidase-4 (DPP-4) enzyme that
•Slows the inactivation of incretin hormones involved in the regulation of
glucose homeostasis and thus,
•Increases insulin release and decreases glucagon levels in the circulation
•Once daily, with or without food
•Can cause hypoglycemia.
•Dose adjustment in kidney disease
•Report hypersensitivity reactions (stop treatment), blisters/erosions,
headache, or symptoms of pancreatitis, heart failure, severe arthralgia,
and upper respiratory infection

26. Thyroid and Anti-thyroid Drugs

27. T3 and T4
•Both produced in the thyroid gland through the
iodination and coupling of the amino acid
tyrosine.
•Body needs about 1 mg of iodine per week from
the diet.
• Iodine Rich Foods: Kelp, Yogurt, Cow’s milk,
Strawberries, Mozzarella Cheese.
•Control intracellular protein synthesis and so
exert different physiological impact on body.
Thyroid-Stimulating Hormone:
TSH is released from the anterior pituitary and is
stimulated when the blood levels of T3 and T4 are
low.

28. Common Disorders of the Thyroid
Grave’s Disease
•Autoimmune
disorder that
attacks the
thyroid gland,
causing an
overproductio
n of thyroid
hormones
Hashimoto’s
thyroiditis
•Autoimmune
disorder involving
chronic
inflammation of
the thyroid
causing gradual
decline in thyroid
function leading
to
hypothyroidism.
Thyroid Storm
•Life-threatening
medical
emergency due
to extreme fever
and heart
issues, caused
by high levels of
thyroid hormone
and low levels of
thyroid-
stimulating
hormone (TSH) in
the blood
Goiters
•An overall
enlargement of
the thyroid, or it
may be the result
of irregular cell
growth that forms
one or more
lumps (nodules)
in the thyroid
•It may cause an
increase or
decrease in
hormones
produced.

29. Hypothyroidism vs Hyperthyroidism

30. Hypothyroidism
•TSH – thyroid stimulating hormone will be increased.
• it is working hard to stimulate the production of T3 and T4
•T3 and T4 levels would be low.
•Primary hypothyroidism starts from an abnormality in the gland itself.
•Secondary hypothyroidism begins at the level of the pituitary gland and
results from reduced levels of TSH (thyroid stimulating hormone).
•Third type is caused by reduction in the amount of TRH of thyrotropin
releasing hormone by the hypothalamus.
•Down Syndrome have high incidence in Hypothyroidism.
•All newborns are tested at birth for thyroid function.
•If untreated can lead to retardation due to effects on brain development

31. Treatment: Thyroid drugs
•Levothyroxine – Synthroid® (Adult: 25 to 300 mcg / day) or Levothroid®
•Increase metabolic rate in body tissue.
•Stimulate protein synthesis and gluconeogenesis.
•Use: hypothyroidism and myxedema coma
•Side effects: GI upset, cardiac overload
•Considerations:
•Take on empty stomach in the morning.
•Do not take with antacids or iron preparations.
•If patient is on Coumadin may need to use smaller dose of Coumadin.
•Do not stop when feeling better.
•Dosage of other drugs may need to be reduced due to slow metabolism in
liver and excretion in urine.

32. Hyperthyroidism
•Excessive secretion of thyroid hormones.
Causes:
•Graves’ disease
•Plummer’s disease or toxic nodular disease.
•Thyroid storm: caused by stress or infection

33. Treatments
•Anti-thyroid Drugs
•Methimazole and propylthiouracil (PTU) act by inhibiting the
incorporation of iodine molecules into the amino acid tyrosine.
•Propylthiouracil:
•Most commonly used
•Has the added ability to inhibit the conversion of T4 to T3 in the
peripheral circulation.
•Will take about two weeks before the patient will see change.
•Dosing: adults 300 to 900 mg / day
•Pediatrics: 50 to 150 mg / day

34. Mechanism of Action:
•Blocks the synthesis of thyroid hormones
•Prevents the oxidation of iodide
•Blocks conversion of T4 to T3
Indication:
•Treatment of Graves' disease
•Producing a euthyroid state prior to thyroid removal surgery
•As an adjunct to irradiation of the thyroid gland In the emergency treatment of
thyrotoxicosis
Contraindications
•Pregnancy, Lactating mothers, Marrow depression, Immunosuppression,

35. Side effects
•Hypothyroidism
•Liver damage
•Agranulocytosis
•GI problems
•Nursing Assessment Teaching Alert:
•Instruct patient to report signs of hypothyroidism.
•Monitor patients for early signs of agranulocytosis.
•Monitor the client's blood and LFT's count at baseline and periodically.
•Never discontinue the drugs abruptly
•Follow-up is important to monitor dosing and therapeutic effects of the drug
therapy.

36. Iodine Preparations
Mechanism of action: High levels of iodide that will reduce iodine uptake
Inhibit thyroid hormone production.
•Block the release of thyroid hormones into the bloodstream.
•Example: Sodium iodide, Patassium iodide
Indication:
•To achieve euthyroid state
•Reduction of thyroid gland size prior surgery.
Contraindication:
•Pregnancy or patient of childbearing age
•Lactating mothers

37. Side Effects
•Radiation sickness, Bone marrow depression, hypothyroidism,
iodism symptoms
Nursing implications:
•Monitor for radiation sickness
•Instruct patient to report the signs of hypothyroidism
•Monitor blood count periodically
•Instruct to take medications with meals to reduce GI distress
•Instruct client to dilute strong iodine solution with juice to improve
taste and drink with straw to avoid tooth discoloration.

38. Pituitary Gland
•The pituitary gland is a small gland that sits base Of the skull.
•The pituitary gland has two main parts:
•Anterior pituitary gland
•Posterior pituitary gland
•It secretes a variety of hormones into the bloodstream
•The anterior pituitary gland is connected to the brain-by short blood vessels.
•The posterior pituitary gland is actually part of the brain.
•As replacement drug therapy to make up for hormone deficiency
•As a diagnostic aid to determine if there is hypo or hyper function of a gland

39. Anterior pituitary drug
Mechanism of action:
•It stimulate overall growth
•and the production of
protein
•Decrease the use of glucose
Examples:
•Somatropin
•Somatrem
Indications:
•Growth hormone
deficiencies
•Turner's syndrome
Contraindications:
•Pregnancy
•Severely obese
•Diabetes
Side Effects:
•Hyperglycemia
•Hypothyroidism

40. Nursing Implications
•Observe clients or signs of hyperglycemia
•Monitor thyroid function
•Obtain the client's baseline height weight.
•Monitor growth patterns during medication administration, usually
monthly.
•Reconstitute medication per directions.
•Rotate gently, and do not shake, prior to administration.

41. Posterior pituitary drug
Mechanism of action:
•Anti-diuretic hormones promote
reabsorption of water within the
kidneys.
•Vasopressin cause vasoconstriction
because of the contraction of vascular
Smooth muscle.
Examples:
•Desmopressin
•Vasopressin

42. Posterior pituitary drug
Indications:
•ADH for diabetes insipidus
•Vasopressin in cardiac arrest
Contraindications:
•Pregnancy
•Coronary artery disease
•Decreased peripheral circulation
Side Effects:
•Fluid Overload
•MI due to vasoconstriction

43. Nursing implications:
•Monitor patient for symptoms Of overload
•Instruct patient to reduce fluid intake during therapy.
•Monitor ECG and blood pressure. advise patient to notify the
provider of chest pain, tightness, diaphoresis.
•With IV administration Of vasopressin, monitor patient's IV site
carefully because extravasation led to gangrene
•Monitor electrolytes periodically

44. https://news-medical.net/health/What-are-Adrenal-Disorders.aspx

45. ADRENAL CORTEX
It produces types of hormones:
•Glucocorticoids: Carbohydrate metabolism
•Mineralocorticoids: salt and water balance
•Adrenal androgens: expression of Sex Characteristics
•All three hormone are collectively known as corticosteroids or
Steroids.

46. https://www.ncbi.nlm.nih.gov/books/NBK595005/

47. GLUCOCORTICOD
Mechanism Of Action:
•The affect carbohydrate, protein
and fat metabolism.
•It also helps in inflammatory,
and immune processes.
Examples:
•Hydrocortisone (short acting)
•Methylprednisolone
(intermediate acting)
•Dexamethasone (long acting)
Indication
•Trauma and Surgery
•Infection
•Autoimmune disorder
•Allergic condition
Contraindications:
•Hypersensitivity
•Psychosis (cause mood swings)
•Systemic fungal infection

48. Side effects:
•Increase blood sugar
•Abnormal rat redistribution
(face and trunk)
•Muscle wasting
•High blood pressures
•Edema
•Euphoria
•long term use can cause
adrenal atrophy (loss of
adrenal gland function)
•Use cautiously in patient with Diabetes.
Monitor blood sugar and treat accordingly
•Patients with renal and cardiac
impairment should be monitored closely
•Obtain baseline weight
•Check for edema
•Check baseline BP and also monitor
during therapy
Nursing Implications

49. Mineralocorticoids
•Mechanism Of Action:
•A maintain fluid balance by
promoting the reabsorption
Of sodium and water
•Increases loss of potassium
•Example: Fludrocortisone
•Routes: IV, PO Topically
Indication:
•Adrenogenital syndrome
•Postural hypotension
•Adrenal insufficiency
Contraindications:
•Fungal infection
•Hypothyroidism
•Diabetes
•Cushing's syndrome
•Low amount of potassium in blood

50. Mineralocorticoids
Side effects:
•Vision Problem
•Fluid overload
•GI upset
•Mood changes
•Low potassium
•High blood pressures
Nursing implications:
•Note baseline BP
•Assess lab reports especially
electrolytes
•Obtain patient weight before and
during therapy.
•Monitor for signs of fluid overload
•Administer antiemetics for
disturbance.

51. ADRENALANDROGENS
•Mechanism of action:
•They increase protein synthesis
and helps in increasing muscle
mass and strength.
•Affect in development of male
and female secondary sex
characteristics.
•Examples:
•Fluoxymesterone
•Methyltestosterone
Indication:
•Androgen deficiency
•Palliative treatment of metastatic
breast cancer
•Treat endometriosis
•Anemia
Contraindications
•Hypersensitivity
•Kidney and liver impairment
•Heart disease
•Prostate cancer and breast cancer
in male

52. ADRENALANDROGENS
•Side effects:
•Mild Acne
•Hair loss or thinning of
hair.
•Infection, pain, redness,
or other irritation at site
of injection.
•Gl upset
•Trouble in sleeping.
Nursing implications:
•Assist the patient to use the drug
accurately
•Teach patient to reduce sodium intake if
edema develops
•Record weight and blood pressure at
regular intervals
•Encourage not to take OTC drugs
•Teach the patient to avoid overuse Of the
drug
•Teach the patient about therapeutic and
adverse effect

53. Thank You