Drugs affecting the Endocrine System

Anatomy of Endocrine
 Endocrine consists of glands
 The glands of the endocrine system delivers chemicals called hormones to various parts of your body. They regulate the
processes of your body and make sure all the hormones to get where they need to go on schedule.Each gland produces
different hormones and each hormone has different jobs. The glands are spread out through the body and a lot of them are
controlled by a little grand near the base of your brain called a pituitary.
 Pituitary gland
⁃ Produces growth hormones
 Thyroid gland
⁃ Regulating how fast your body uses the calories from the food you eat called metabolism
 Adrenal Gland
⁃ Produces adrenaline
 Pancreas
⁃ Biggest glad
⁃ Produce insulin
 Ovaries/Testes
⁃ produce estrogen and testosterone
Thyroid Agents
A. Thyroid preparations: used in replacement therapy for hypothyroidism
B. Synthroid (synthetic) preparations (Lifetime):
• Levothyroxine (levoxyl)- are generally preferred because is a T4 is a prohormone, and this allows the patient’s own physiological
mechanisms to control the production of T3
Hypo- low thyroid hormones (T3 & T4)
Hyper- increase T4 and T3
Anti-thyroid agents
⁃ Are used to relieve symptoms of hyperthyroidism
⁃ Methimazole- treatment of choice
⁃ Tapazole
⁃ Propylthiouracil or PTU- can cause liver injury
Antidiabetic Agents
• Insulin
different types of insulin:
1. Rapid
• Preparation: Aspart
⁃ Trade name: Novolog
⁃ Onset: 10-30min
⁃ Peak: 1-2hr
⁃ Duration: 3-8hr
• Preparation: glulisline
⁃ Trade name: Apidra
• Preparation: Lispro
⁃ Trade name: Humalog
2. Short
• Preparation: Regular
⁃ Trade name: Humulin R
⁃ Onset: 30-60min
⁃ Peak: 1-5hr
⁃ Duration: 6-10hr
⁃ Trade name: Novolin R
3. Intermediate
• Preparation: Isophane (NPH)
⁃ Trade name: Humulin N
⁃ Onset: 1-3hr
⁃ Peak: 6-12hr
⁃ Duration: 18-24hr
4. Long
• Preparation: Glargine
⁃ Trade name: Lantus
⁃ Onset: 1-2hr
⁃ Peak: No pronounced peak
⁃ Duration: up to 24 hr dose dependent
5. Ultra long acting
• Preparation: Detemir
⁃ Trade name: levemir
⁃ Onset: 1-2hr
• Preparation: Degludec
⁃ Trade name: tresiba
⁃ Onset: 1-2hr
⁃ Peak: No pronounced peak
⁃ Duration: improved glycemic control
• Preparation: Glargine
⁃ Trade name: toujeo
⁃ Onset: 1-2hr
⁃ Peak: No pronounced peak
⁃ Duration: Up to 24hr
6. Mixtures
• Preparation: NPH/reg
⁃ Trade name: Humulin/ Novolin 70/30, 50/50, Humalog mix 75/25, 50/50 Novolog mix 70/30
⁃ Onset: 30-60
⁃ Peak: 1-4hr
⁃ Duration: 16-24
• Preparation: NPH/lispro
⁃ Onset: 15-30min
⁃ Peak: 1-4hr
⁃ Duration: 12-24
• Preparation: NPH/aspart
⁃ Onset: 10-20min
⁃ Peak: 1-4hr
⁃ Duration: up to 24hr
Anti-diabetic drugs
1. Biguanides: Metformin (Glucophage)
⁃ work by decreasing hepatic glucose production and enhancing insulin uptake in muscle tissues.
⁃ Preferred initial first line monotherapy or can be used in combination with sulfonylureas, alpha glucosidase inhibitor, or insulin to
treat type 2 diabetes
type 1- due to genetics
type 2- insulin dependent diabetic
2. Sulfonylureas
⁃ Works by increasing insulin production from the pancreas and by improving peripheral insulin activity.
• 1st generation: Chlorpropamide, tolbutamide
• 2nd generation: glipizide, glyburide
3. Alpha-Glucosidase Inhibitors: Acarbose (Precose)
⁃ Delay digestion of complex carbohydrates and subsequent absorption of glucose, resulting in a smaller rise in blood glucose
concentrations following meals.
⁃ Can be used as monotherapy or part of combination regimen that includes insulin, metformin, or oral sulfonylureas
4. Meglitinidesnateglinide (Starlix); repaglidine (prandin)
⁃ Stimulate the beta cells of the pancreas to produce insulin
⁃ have a rapid onset and short duration of action, and are to be taken before meals.
5. Thiazolidinediones: pioglitazone (Actos); rosiglitazone (Avandia)
⁃ Lowers blood glucose by decreasing insulin resistance and improving sensitivity to insulin in muscle, liver, and adipose tissue
6. SGLT2 Inhibitor Therapy: sodium-gluocose co transporter 2 inhibitors
⁃ Indicated for type 2 diabetes
⁃ Work by decreasing the reabsorption of glucose in the kidney, essentially lowering available glucose to the body via excretion
SUMMARY
Thyroid and Antithyroid drugs
⁃ Thyroid drugs: given when patient is experiencing hypothyroid state
⁃ Indications of hypothyroid state:
• cretinism
• Myxedema
• Myxedema coma
⁃ Preparations:
• Levothyroxine (T4)
• Liothyronine (T3)
• Combination of T3 and T4
⁃ Uses:
• Cretinism- delayed developmeny (Give ASAP)
• elderly patient with hypothyroidism- start with low dose and increase gradually
• young Adults- life-long therapy: give one dose in morning before eating
• myxedema- severely advance hypothyroidism. Signs and Symptoms:
• dry hairline
• peri orbital edema
• benign thyroid nodule- supplemenation of T4 will decrease Thyroid stimulation hormone
• thyroid carcinoma- cancer
Anti-Thyroid drugs
⁃ Used when/for:
• Thyroid toxicosis
• hyperthyroidism
⁃ 5 classifications
1. Thyroid H synthesis inhibitors
⁃ No:
• peroxidase
• Iodination
• Coupling
⁃ examples
• PTU- drug of choice for pregnant women
• methimazole
• carbimazile
2. Inhibit of Iodine Trapping
⁃ High in toxicity in body
⁃ rarely used
3. Hormone Release Inhibitors
⁃ has paradoxical effect
4. Thyroid tissue destroying agent
⁃ not drug of choice for pregnant and children
5. Propanolol and Dexamethosone
⁃ control tachycardia
Nursing Intervention for Insulin Therapy:
• monitor blood glucose during peak because of risk of hypoglycemia. Signs and symptoms of Hypoglycemia:
• dizziness
• tremors
• irritable
• increase sweating
• confusion/ altered mental status
• cold clammy skin
• Patient should always have candy