Topic 7Drugs affecting the

ENDOCRINE SYSTEM

How Metabolism is controlled and mediated by hormones

• Many disorders are due to either over or under secretion of a hormones

• Endocrinology

• Can potentiate normal hormonal action

• Inhibit hormonal action.

Drugs affecting THYROID gland

• Thyroid gland produces hormones Thyroxine and triiodothyronine which influence growth, development and metabolism.

• Production of these hormones depends on the thyroid gland receiving iodine from the body

HYPOTHYROIDISM

Decrease in thyroid activity caused by :

1. Hashimotos thyroiditis (Auto immune disorder.)

2. Myxoedema If hypothyroidism not treated

3. Iodine deficiency.

4. Radioactive iodine ingestion.

5. Atrophy of thyroid gland.

6. Surgical removal of all or part of gland.

SIGNS AND SYMPTOMS

• Tiredness

• Lethargy

• Weight Gain

• Intolerance to heat

• Dry skin

• Bradycardia

• Mental impairment

HYPOTHROIDISM

NURSING IMPLICATIONS.• Monitor symptoms related to BMR• Monitor heart rate, reporting tachycardia

and palpitations.• Education re life long treatment of deficient

hormones.• Diabetics need to monitor BSL as insulin

or oral hypoglycaemics may need increasing.

HYPERTHROIDISM(Thyrotoxicosis)

• Overproduction of thyroid hormone.

• Graves Disease is an example of hyperthyroidism. More common in women than in men and occurs between 20-40 years of age and often arises after emotional or physical stress or infection.

SIGNS AND SYMPTOMS

• Exophthalmos• Tremor• Nervousness• Constant hunger• Weight loss• Fatigue• Heat tolerance• Palpitations

Drugs for ADRENAL CORTEX problems.

3 Naturally occurring Groups

1. Mineralocorticoids. Electrolyte and water balance. Natural occurring is aldosterone.

2. Glucocorticoids. Affect fat, protein and carbohydrate metabolism and also have an anti-inflammatory effect.

3. Gonadocorticoids, sex hormones.

Mineralocorticoids• These drugs primarily responsible for

regulating sodium and potassium in the body.• Treat adrenocortical insufficiencies.• Potent immunosuppressants, prevent organ

transplant rejection• Lung maturation in premature infants• Aldosterone, causes Sodium and Water

retention increases blood volume and BP• Fludrocortisone (Florinef)

GLUCOCORTICOIDS

• Classified according to their duration of action

• Increases blood glucose, mobilizes fats, stimulates protein catabolism, depresses immunity, and inflammatory responses.

• Natural = Hydrocortisone

• Synthetic = All others, prednisone

Examples

• Betamethasone

• Dexamethasone

• Prednisone

• Flixotide

• Betnovate cream

Effects

• Euphoria, psychiatric problems• Fluid retention, electrolyte imbalance• Delayed wound healing, bruising, acne• Fungal infections exacerbated• Hyperglycaemia, insomnia• Increased appetite, obesity• Osteoporosis (long term effect)• Cushings syndrome (Metabolic disorder

resulting from chronic and excessive production of cortisol by the adrenal cortex.

CUSHINGS SYNDROME

SIGNS & SYMPTOMS

1. Moon Face

2. Buffalo hump

3. Depression

4. Anxiety

5. Menstrual irregularities

6. Acne

Nursing Implications

• Monitor BP• Inhaled steroids, wash mouth• IMI deep• Not withdrawn immediately, tapered over

at least 2 weeks• BSL monitoring• Taken with food

Gonadocorticoids

Oestrogen only preparations– Replacement (menopause)– Morning after pill

• Induces uptake of Ca into bone, therapy for menopausal women with osteoporosis

• S.E. = breast tenderness, Fluid retention, thrombosis

Gonadocorticoids

Progesterone only preparations

• Suppress ovarian function

• Mini pill

• S.E. similar to Oestrogen only symptoms

Gonadocorticoids

• Oral contraceptives

• Combination

• S.E. thromboembolism, heart disease, CVA, liver disease

Gonadocorticoids

• Androgens (testosterone),

• Treat deficiencies.

• Nandrolone, a anabolic androgen, Produces masculinising effect

Drugs used in disorders of the PANCREAS

• When the pancreas no longer secrete sufficient effective insulin the glucose cannot enter the cells.

• NIDDM, IDDM, Glucogon.

• Glucagon acts on the liver to increase blood glucose levels by stimulating the breakdown of glycogen into glucose, and amino acids and free fatty acids

http://en.wikipedia.org/wiki/Image:Illu_pancrease.jpg

INSULIN

• IVI, S/C, IMI (rare).

• Short medium or long acting.

• Observe for Hypoglycemic episodes

• Requirements may vary with pregnancy, infections, stress,

• Never change type quickly.

HYPOGLCEMIA

Do you know the signs and symptoms of a “hypo” ?

Oral Hypoglycaemic agents2 types

• Sulfonylureas, (Daonil)1: Stimulates insulin secretion 2: inhibits gluconeogenesis (forming glucose from

amino acids and fatty acids) 3: increases the number of insulin receptors in the

target cells• Biguanide, (Metformin) acts by promoting

glucose uptake into cells .• Used in precaution with renal disorders

Nursing Implication

• Monitor BSL

• Reduced tolerance to alcohol and need to restrict intake

• Pt to carry medi alert tag

• Educate family

• Monitor liver enzymes

Drugs used on disorders of the PARATHYROID

• Calcitonin (Decreases) (thyroid) and parathyroid (Increases) blood Calcium.

• Calcitonin inhibits bone reabsorption• S/E dose related nausea and vomiting,

local inflammation at inj site, alopecia, headache, Oesopageal pain,

• Alendroate (Fosamax), increases Ca level. Avoid laying flat ½ hour after ingestion

http://en.wikipedia.org/wiki/Image:Illu_thyroid_parathyroid.jpg

Posterior Pituitary Hormones

• Antidiuretic Hormone (ADH) Vasopressin

• Cannot be administered orally.

• Oxytocin, smooth muscle stimulant, used to initiate labour.

• Oxytocin

Identification of Drugs

• Daonil

• Actrapid

• Prednisilone

• Metformin

• Syntocinon

• Thyroxin

Identification of Drugs

• Tolbutamide

• Gliclazide

• Dexamethasone

• Humalin 70:30

• Pulmicourt