PHARMACOLOGY MIDTERMS

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ENDOCRINE DRUGS: PITUITARY, THYROID, AND ADRENAL DISORDERS

ENDOCRINE SYSTEM
PITUITARY GLAND: ANTERIOR (Stimulating Hormones)

 FSH (Follicle Stimulating Hormone)

 LH (Luteinizing Hormone)
 Prolactin
 ACTH (Adrenocorticotropic Hormone)
 TSH (Thyroid-stimulating Hormone)
 GH/Somatotropin (Growth Hormone)

 hormones- enter circulation- target organ

PITUITARY GLAND: POSTERION

 Endocrine System  Vasopressin (ADH)

 Glands  Oxytocin
 Hormones
 Hormones – (Hypothalamus- Posterior pituitary gland
for storage)
HYPOTHALAMUS

 Master Gland
 Diencephalon of the brain
 Activates, control, endocrine processes, somatic
functions (Body temp, sleep, appetite)
 Coordinating center (nervous and endocrine
responses)
 Secretes releasing hormones (stimulate pituitary
gland-stimulate specific glands)

PITUITARY GLAND

 Hypophysis
 Located on the bony Sella turcica under dura matter
 Over secretion or under secretion of hormones
 hypersecretion - growth hormone and results in
acromegaly - excess of growth hormone in adults
 bone and soft tissue deformities
 enlargement of the viscera without an increase in
height
 Dwarfism - insufficient secretion of growth hormone
Pituitary Gland
• Anterior pituitary gland
• Growth hormone (GH)
• Stimulates growth in tissue and bone
• Thyroid-stimulating hormone (TSH)
• Acts on thyroid gland
• Adrenocorticotropic hormone (ACTH)
• Stimulates adrenal gland
• Gonadotropins (FSH), (LH)
• Affects ovaries
Pituitary Gland (cont’d)
• Anterior pituitary gland
• Growth hormone
• Drugs for growth hormone deficiency: somatrem
(Protropin), somatropin (Humatrope)
• Drugs for growth hormone excess: bromocriptine
(Parlodel), octreotide (Sandostatin)  - Treat hypothyroidism, myxedema, cretinism
Thyroid Gland
 Anterior part of the neck
 Controls rate of body metabolism and growth
 T4-,T3-, thyrocalcitonin
Thyroid Hormones
 unique property of containing iodine molecules
 These hormones are synthesized and stored bound to
proteins in the cells of the thyroid gland until needed
for release into the bloodstream.
The thyroid hormones
 cell replication
 brain development
 normal growth
 cellular metabolism
 influence every major organ system
Hypothyroidism
• Decrease in thyroid hormone secretion
• Etiology
• Primary: thyroid gland disorder, more common
- Due to thyroid gland inflammation, radioiodine
therapy, excess intake of antithyroid drugs,
surgery
- Myxedema (adult), cretinism (child)
• Secondary: lack of TSH secretion
Thyroid Gland (cont’d)
• Levothyroxine (T4, Synthroid)
• Action
- Increase metabolism, body growth
• Use
• Contraindications
- Thyrotoxicosis, MI, severe renal disease
• Interactions
• Increased cardiac insufficiency with epinephrine
• Increased effects of anticoagulants, TCAs,
vasopressors, decongestants
• Decreased effects of antidiabetics, digitalis
• Decreased absorption with cholestyramine,
colestipol
• Side effects/adverse reactions
• Nervousness, insomnia, weight loss
• Tremors, headache
• Nausea, vomiting, diarrhea, cramps
• Tachycardia, palpitations, hypertension
 • Dysrhythmias, angina • Warn of foods that inhibit thyroid secretion
• Thyroid crisis * • Administer antithyroid drugs with meals
• Warn of iodine effects and presence in iodized salt,
Thyroid Gland (cont’d) shellfish, OTC cough medications
Hyperthyroidism • Do not abruptly stop antithyroid drugs
• Increase in T4 and T3 • Advise reporting of symptoms of hypothyroidism
• Etiology
• Hyperfunction of thyroid gland Pituitary Gland (cont’d)
• Excess release of thyroid hormones Posterior pituitary gland
• Symptoms • Antidiuretic hormone
• Tachycardia, palpitations, excess sweating, heat • Vasopressin (Pitressin)
intolerance, nervousness, irritability, exophthalmos, • Desmopressin acetate (DDAVP)
weight loss
DIABETES INSIPIDUS

 disorder of the posterior lobe

 deficiency of antidiuretic hormone (ADH), or
vasopressin
 Great thirst (polydipsia) and large volumes of dilute
urine
 may be secondary to head trauma, brain tumor, or
surgical ablation or irradiation of the pituitary gland.

Hyperthyroidism Clinical Manifestation

• Propylthioruacil (PTU), methimazole (Tapazole)  Without the action of ADH on the distal nephron of
• Action the kidney
• Reduce excess secretion of T4, T3 by inhibiting
thyroid secretion  daily output of very dilute, water-like urine
• Use  specific gravity of 1.001 to 1.005 occurs
• Treat thyrotoxic crisis, preparation for subtotal  urine contains no abnormal substances such as glucose
thyroidectomy and albumin
 Thirst (tends to drink 2 to 20 liters of fluid
 daily and craves cold water)

PHARMACOLOGIC THERAPHY

Desmopressin (DDAVP)

 synthetic vasopressin without the vascular effects of

natural ADH
 longer duration of action and fewer adverse effects
 administered intranasally
Hyperthyroidism  One or two administrations daily or every 12 to 24
• Propylthioruacil (PTU), methimazole (Tapazole) hours
• Interactions
• Increase effect of anticoagulants
• Decrease effect of antidiabetics
• Digoxin and lithium increase action of thyroid drugs
• Phenytoin increases T3 level

Nursing interventions
• Monitor vital signs, weight
• Administer thyroid replacement drug before breakfast
• Check labels prior to using OTCs
• Advise reporting of symptoms of hyperthyroidism
• Encourage medic-alert tag  IM administration of ADH or vasopressin tannate in oil
 administered every 24 to 96 hours.
 the vial of medication should be warmed or shaken
vigorously before administration
 administered in the evening so that maximum results
are obtained during sleep
 SE: Abdominal cramps
 Rotation of injection sites is necessary to prevent
lipodystrophy
 Excess parathormone -elevated levels of serum
calcium, a potentially life-threatening situation.
 When the product of serum calcium and serum
phosphorus (calcium × phosphorus) rises, calcium
phosphate may precipitate in various organs of the
body and cause tissue calcification.
PARATHYROID DISORDERS

 Inadvertent surgical removal is the most common

cause of hypoparathyroidism

Clinical Manifestation
• Hypocalcemia -irritability of the neuromuscular system
• Tetany is a general muscle hypertonia with tremor and
spasmodic or uncoordinated contractions occurring
with or without efforts to make voluntary movements
 Clofibrate- antidiuretic effect  Numbness
 Chlorpropamide (Diabinese) and thiazide diuretics -  Tingling
used in mild forms of the disease - potentiate the  cramps in the extremities
action of vasopressin.  stiffness in the hands and feet
 The patient receiving chlorpropamide should be
warned of the possibility of hypoglycemic reactions Parathyroid Glands
Parathyroid hormone
PARATHYROID FUNCTION • Action
• Corrects blood calcium deficit
 Parathormone - regulates calcium and phosphorus • Use
metabolism. • Treat hypoparathyroidism, hypocalcemia in
 Increased secretion of parathormone results in chronic renal failure
increased calcium absorption from the kidney, Parathyroid Glands (cont’d)
intestine, and bones, thereby raising the blood calcium Calcitriol (Rocaltrol)
level. Some actions of this hormone are increased by • Action
the presence of vit d. • Promotes calcium absorption from GI tract and
 Parathormone also tends to lower the blood renal tubules
phosphorus level. • Use
• Treat hypoparathyroidism, hypocalcemia
• Contraindications
• Hypercalcemia, hyperphosphatemia, excess vitamin
D, malabsorption syndrome
• Interactions
• Increased dysrhythmias with digoxin, verapamil
• Decreased calcitriol absorption with cholestyramine
• Side effects/adverse reactions
• Drowsiness, headache, dizziness, lethargy,
photophobia, GI distress, hypercalciuria,
hyperphosphatemia, hematuria
Nursing interventions
• Monitor calcium levels
• Advise reporting of symptoms of hypocalcemia
• Tetany, twitching of mouth, tingling, numbness
of fingers, carpopedal spasm, spasmodic
contractions, laryngeal spasms
• Warn about checking OTC drugs for calcium content
 • Mineralocorticoids (aldosterone)
• Secretes aldosterone
• Promotes sodium and water retention
• Controlled by RAAS

ADRENAL GLAND

 One gland on top of each kidney

 Regulates Na and electrolyte balance
 Affects CHO, fat and CHON met
 Sexual characteristics
 Fight or flight response

ADRENAL CORTEX
- Outer shelf
- Small amount of sex hormones (androgens, estrogens)
- adapt to stress of all kinds.
- steroid hormones produced
- glucocorticoids - hydrocortisone
- mineralocorticoids – aldosterone
GLUCOCORTICOIDS
 important influence on glucose metabolism
 increased hydrocortisone secretion results in elevated
blood glucose levels.
CUSHING’S SYNDROME
 Generalized muscle weakness and wasting
 Moon face, buffalo hump
 Truncal obesity, thin extremities, supraclavicular fat
pads, weight gain
 Hirsutism (masculine characteristics in female)
 Hyperglycemia, hypernatremia
 Hypokalemia, hypocalcemia
 Hypertension
 Fragile skin that easily bruises
 Reddish purple striae on abdomen and upper thighs

MINERALOCORTICOIDS TREATMENT:

 Mineralocorticoids exert their major effects on  Cortisol synthesis inhibitor: Medications to control the
electrolyte metabolism. production of cortisol.
 Glucocorticoid type II receptor antagonist: Blocks the
ADRENAL MEDULLA
effect of cortisol
- Inner core
- Sympathetic nervous system, Epi, Norepi

Adrenal Glands

• Adrenal medulla
• Adrenal cortex
• Produces glucocorticoids (cortisol)
• Promote sodium retention, K excretion
• Adrenal hyposecretion (Addison’s disease)

• Levels controlled by negative feedback

Treatment: Addison's Syndrome Hormonal Replacement
Therapy
• Glucocorticoids
• Prednisone (Deltasone)
• Action
- Suppresses inflammation,
immunosuppression
• Use
- Decrease inflammation
• Interactions
- Increased effect with barbiturates, phenytoin,
rifampin, ephedrine, theophylline
- Decreased effects of aspirin, anticonvulsants,
INH, antidiabetics

Adrenal Glands (cont’d)

• Glucocorticoids
• Prednisone (Deltasone)
• Side effects/adverse reactions
• Increased appetite, sweating, headache, flushing
• Mood changes, depression, psychosis
• Tachycardia, hypertension
• Hyperglycemia, abnormal fat deposits, muscle
wasting, edema
• Glaucoma, peptic ulcers