Drugs that Affect the Endocrine System > ↑ insulin resistance

> dawn phenomenon – spike in blood sugar at 5-6 AM due to

> pathophysiology mainly revolves around the lack or excess peak of GH production
(matter of regulation) of substances > acromegaly – enlargement of extremities
> endocrine – released hormones; regulate various bodily > assess weight and height prior to giving
functions, including growth, metabolism, and reproduction. > perform glucose tolerance test and GH levels prior to giving
> exocrine – enzymes released from ducts towards the body’s Growth Hormone Antagonists - bromocriptine (Pardolel),
external environment ocreotide acetate (Sandostatin)
> major endocrine glands and corresponding hormones: > bromocriptine - Dopamine agonists inhibit GH secretion by
> drugs often given via subcutaneous or IV acting directly on postsynaptic dopamine receptors in the brain
> The Endocrine System (oral)
- hypothalamus > oreotide acetate - Somatostatin analogue that has more
a. Gonadotropin-releasing hormone (GnRH) potent inhibitory action on GH release (subq)
b. Growth hormone-releasing hormone (GHRH) > ↓ effectiveness w/ phenothiazine
c. Thyrotropin-releasing hormone (TRH) > assess weight and height prior to giving
d. Corticotropin-releasing hormone (CRH) > perform glucose tolerance test and GH levels prior to giving
e. Prolactin-releasing hormone (PRH) Synthetic ADH – desmopressin (DDAVP)
f. Prolactin-inhibiting hormone (PIH) aka dopamine > Has pressor and antidiuretic effects; causing the cortical and
g. Oxytocin medullary parts of the collecting duct to become permeable to
h. Antidiuretic hormone (ADH) water, thereby increasing water reabsorption and decreasing
- pituitary gland (anterior and posterior) urine formation
a. anterior (produces and secretes hormones) > can cause edema
1. Growth hormone (GH) - ascites - accumulation of fluid in the peritoneal cavity
2. Adrenocorticotropic hormone (ACTH): - anasarca – severe and generalized form of edema
3. Thyroid-stimulating hormone (TSH): > diabetes insipidus – excessive loss of water
4. Follicle-stimulating hormone (FSH): > ↓ urine output ↑ urine concentration
5. Luteinizing hormone (LH): > ↑ risk for slight increase in BP and water intoxication
6. Prolactin (PRL): > ↑ effectiveness w/ carbamazepine and chlorpromazine
7. Melanocyte-stimulating hormone (MSH): Vasopressin Blockers – conivaptan (Vaprisol), tolvaptan
b. posterior (stores and releases hormones) (Samsca)
1. Oxytocin > loss of water through the urine and therefore increase in serum
2. Antidiuretic hormone (ADH) aka vasopressin sodium levels as the water level decreases
- thyroid gland > ↑ urine output ↓ urine concentration
a. Thyroxine (T4) > take anthropomorphic measurements daily
b. Triiodothyronine (T3)
c. Calcitonin Drugs Affecting the Adrenal Cortex
- parathyroid gland Glucocorticoids – cortisone, hydrocortisone (Cortef), prednisone
a. Parathyroid hormone (PTH) (Rayos), methylprednisolone (Omnipred), betamethasone
- adrenal gland (Celestone)
a. Adrenaline (epinephrine) > block the actions of arachidonic acid, which leads to a
b. Noradrenaline (norepinephrine) decrease in the formation of prostaglandins and leukotrienes;
c. Cortisol involves cortisol
d. Aldosterone > cortisol does:
e. Androgens - gluconeogenesis
- pancreas - glycogenolysis
a. Insulin - immunosuppressant
b. Glucagon > Addison’s disease – insufficient hormones (cortisol)
c. Somatostatin > ↓ ability of phagocytes and lymphocytes
d. Pancreatic polypeptide (immunosuppressant)
- gonads > passes through placenta and breast milk
a. Testosterone > ↑ risk for toxicity w/ erythromycin and ketoconazole
b. Estrogen Mineralocorticoids – fludrocortisone, CHPMB (glucocorticoids)
c. Progesterone > Increases sodium reabsorption in the renal tubules and
- pineal gland increases potassium and hydrogen excretion, leading to water
a. Melatonin and sodium retention; placenta and breast milk; involves
- thymus aldosterone
a. Thymosin > can cause arthralgia, frontal and occipital headaches, edema
> oxytocin is related to emotions (women tend to perceive lies > ↓ effectiveness of salicylates, barbs, and anticholinesterase
more often; better emotional understanding > assess for CV status, Na, and K levels
> Adrenal Medulla – releases epinephrine and norepinephrine
> BIGASD (in pancreas) – beta-cells = insulin; alpha-cells = Drugs Affecting the Thyroid and Parathyroid Glands
glucagon; delta-cells = somatostatin (GHIH) Thyroid Agents – levothyroxine (Synthroid, Levoxyl, and
> always consider d-to-d interactions Levothroid), liothyronine (Cytomel, Triostat)
> Increases the metabolic rate of body tissues, increasing
Drugs Affecting the Pituitary Gland oxygen consumption, respiration, and heart rate; the rate of fat,
Growth Hormone Agonists - somatropin protein, and carbohydrate metabolism; and growth and
> Replaces human GH; stimulates skeletal growth, growth of maturation; can cause tremors, loss of hair, ↓ digoxin effect,
internal organs, and protein synthesis increased bleeding w/ AC
> iatrogenic hypothyroidism – caused by medical
treatment/advice
> goiter – enlargement of thyroids (either caused by hypo or
hyper)
> levothyroxine to be given w/ empty stomach
Antithyroid Agents – Thioamides: propythiouracil (PTU),
methimazole (Tapazole); Iodine Solution: potassium iodide
(lostat, Thyrosafe, Thyroshield), sodium iodide
> Thioamides: preventing the formation of thyroid hormone in
the thyroid cells; bone marrow suppression
> Iodine solution: oversaturates the thyroid gland with iodine
resulting in hormone production inhibition; can leave metallic
taste and burning sensation in mouth
> euthyroid – normalized thyroid state; cretinism – congenital
hypothyroidism; iodism – high levels of iodine
> Lugol’s solution – diagnose thyroid disorders; treat
hyperthyroidism
Parathyroid Agents (Anti-Hypocalcemic) – calcitriol (Rocaltrol,
teriparatide (Forteo)
> regulates the absorption of calcium and phosphate from the
small intestine, mineral resorption in bone, and reabsorption of
phosphate from the renal tubules.
> ↓ Ca in bones ↑ Ca in blood serum ↓ electrical impulses in
muscles
> can cause metallic taste
> sliding filament theory - muscle fibers generate force and
produce movement by the interaction between actin and myosin
filaments.
> ↑ digoxin toxicity d/t hypercalcemia; ↑ hypermagnesemia w/
Mg-containing antacids; assess PTH levels and Ca levels
Parathyroid Agents (Anti-Hypercalcemic) – alendronate
(Fosamax), pamidronate (Aredia), zolendronic acid (Zometa),
calcitonin
> Slows normal and abnormal bone resorption without inhibiting
bone formation and mineralization; slow onset; contraindicated
for hypocalcemia; causes esophageal erosion and bone pain
> given upon arising in morning; full glass of water 30 mins
before food and must remain upright for at least 30 mins
a. Glargine
b. Detemir
- premixed human (30% reg insulin + 70% NPH)
a. Mixtard
b. Humulin
- premixed analogue
a. Novomix
b. Humalog Mix
> beta-blockers mask the effects of hypoglycemia
Antidiabetic Agents – Sulfonylureas, Meglitinides, DPP-4
Inhibitors, Biguanides, Thiazolidinediones, a-Glucosidase
inhibitors
> mainly enhances insulin effectivity
> type 1 diabetes mellitus – lack of insulin
> type 2 diabetes mellitus – insulin resistance
> metformin is often used for type 2 diabetes
> common adverse reaction = hypoglycemia
> alcohol can alter glucose levels
Glucose Elevating Agents – glucagon (Glucagen)
> accelerates the breakdown of glycogen to glucose in the liver,
causing an increase in blood glucose levels
> can cause hypokalemia with overdose
> can increase anticoagulation with anticoagulants

Drugs Affecting the Pancreatic Glands

Insulin – insulin analog or lispro (Humalog), insulin aspart
(Novolog), insuline glargine (Lantus, Toujeo), insuline glusiline
(Apidra), insulin detemir (Levemir), regular insulin (Novolin R),
NPH (neutral protamine Hagedorn), insulin (Novolin N), inhaled
insulin (Afrezza)
> Promotes the storage of the body’s fuels, facilitates the
transport of various metabolites and ions across cell
membranes, and stimulates the synthesis of glycogen from
glucose, of fats from lipids, and of proteins from amino acids
> used for glucose metabolism
> glucose stays in blood w/o insulin
> often subcutaneous
> CBG – capillary blood glucose – routine before insulin
administration
> when mixing insulin, always withdraw from regular (clear)
insulin first.
> classifications under pharmacokinetics:
- short-acting, regular
a. Actrapid
b. Humulin R
- rapid-acting analogue
a. Novorapid
b. Humalog
c. Apidra
- intermediate-acting, NPH
a. Insulatard
b. Humulin N
- long-acting analogue