05 Endo GIT Renal

ENDOCRINE, GIT,
AND RENAL DRUGS

BY: DR. MARY JOYCE D. VALERA
ENDOCRINE
ENDOCRINE
ANATOMY AND PHYSIOLOGY
includes glands—organized
groups of specialized cells that
produce and secrete hormones,
or chemical messengers, directly
into the bloodstream to
communicate within the body
HYPOTHALAMUS
works to maintain internal

homeostasis and to
integrate the body’s
response to the external
environment
HYPOTHALAMUS
PITUITARY GLAND
The pituitary gland has three lobes:
The anterior lobe produces stimulating hormones in response

to hypothalamic stimulation.
The posterior lobe of the pituitary stores ADH and oxytocin,

which are two hormones produced by the hypothalamus.
The intermediate lobe of the pituitary produces endorphins and

enkephalins to modulate pain perception
HYPOTHALAMUS-PITUITARY-ENDOCRINE GLAND
NEGATIVE FEEDBACK
NEGATIVE FEEDBACK
NEGATIVE FEEDBACK
Thyroid Gland
Thyroid Gland
The thyroid gland is located in the

middle of the neck, where it
surrounds the trachea like a shield
Hormones produced:
(1) Thyroid Hormone
a. Triiodothyronine (T3)
b. Thyroxine (T4)
(2) Calcitonin
- affects Ca++ levels
- balances
Thyroid Gland
Share a common goal with

parathyroid glands:
Calcium homeostasis
Thyroid Gland
A vascular gland with two lobes and a

small isthmus connecting the lobes
The thyroid cells remove iodine from the

blood → concentrate it → prepare it for
attachment to tyrosine, an amino acid
A person must obtain sufficient amounts

of dietary iodine to produce thyroid
hormones.
Thyroid Gland
✓ Regulates the rate of metabolism in

almost all the cells of the body
✓ Affect heat production and body

temperature
✓ Affects oxygen consumption and cardiac

output; blood volume
✓ Affects enzyme system activity
✓ Affects metabolism of carbohydrates,

fats, and proteins.
Thyroid Gland
✓ Regulator of growth and dev’t

(reproductive and nervous systems)
Because the thyroid has such

widespread effects throughout the
body, any dysfunction of the thyroid
gland will have numerous systemic
effects
Thyroid Gland
Thyroid Hormone Control
HYPOTHALAMUS
| TRH: Thyrotropin-Releasing Hormone
PITUITARY GLAND
| TSH: Thyroid Stimulating Hormone
THYROID GLAND
T3 & T4
Thyroid Hormone Control
HYPOTHALAMUS
PITUITARY GLAND
THYROID GLAND
T3 & T4
Thyroid Dysfunction
HYPO PHYSIOLOGY HYPER

Slow metabolism Regulates metabolism rate Fast metabolism
Decreased appetite Increased appetite
Constipation Diarrhea
Weight gain Affects metabolism of CHO, Weight loss
CHON, Fats
Cold intolerance Heat production and body Heat intolerance
temperature
Bradycardia Oxygen consumption, cardiac Tachycardia,
output, blood volume Palpitations, Arrythmias
Fatigue, Depression, CNS effects Anxiety, Nervousness,
Impaired memory Tremors, Irritability
and concentration
Thyroid
Hypothyroidism
CAUSES:
• Lack of TRH related to a
tumor or disorder of the
hypothalamus
• Lack of TSH due to pituitary

disease
• Absence of the thyroid gland
• Lack of sufficient iodine
• Lack of sufficient functioning

thyroid tissue due to tumor
or autoimmune disorders
MEDICATION
CAUSES:
• Lack of TRH related to a
tumor or disorder of the GOALS:
hypothalamus
Increase TRH and TSH production
• Lack of TSH due to pituitary
disease Thyroid Hormone replacement
• Absence of the thyroid gland Increase iodine in diet
• Lack of sufficient iodine
• Lack of sufficient functioning

thyroid tissue due to tumor
or autoimmune disorders
THYROID AGENTS
MECHANISM CLASSIFICATION DRUG LIST

thyroid replacement Thyroid Hormones Levothyroxine
hormones → physiologic Liothyronine
function of thyroid gland
Thioamides: preventing the Antithyroid Agents Thioamides
formation of TH in the - Methimazole
thyroid cells - Propylthiouracil
Iodine solution: High doses Iodine solution

of iodine block thyroid - strong iodine solution
function - potassium iodide
Thyroid Hormones
Indication:
✓ treat thyroid toxicity
✓ prevent goiter formation during
thyroid overstimulation
✓ treat thyroid overstimulation during
pregnancy
These drugs are not approved for

weight loss and carry a warning that
they are not to be used for weight loss
CI: Allergies, acute MI
Caution: pregnant, lactating

Thyroid Hormones
Implementation with Rationale
✓ Administer a single daily dose before breakfast each day ensure that the
drug is not expired before use to ensure consistent therapeutic levels.
✓ Administer with a full glass of water to help prevent difficulty swallowing

and esophageal atresia.
✓ Monitor response carefully when beginning therapy to adjust dose

according to patient response.
✓ Monitor cardiac response to detect cardiac adverse effects.

Thyroid Hormones
✓ Assess patient carefully to detect any potential drug–drug interactions if

giving thyroid hormone in combination with other drugs.
✓ Arrange for periodic blood tests of thyroid function to monitor the

effectiveness of the therapy.
✓ Provide thorough patient teaching, including drug name, dosage and

administration, measures to avoid adverse effects, warning signs of
problems, and the need for regular evaluation if used for longer than
recommended to enhance patient knowledge of drug therapy and promote
compliance.
Hyperthyroidism
CAUSES:
• Excessive amounts of thyroid

hormones are produced
• Autoimmune (Graves
disease)
MEDICATION
CAUSES: GOALS:
• Excessive amounts of thyroid Removal of gland: total or partial

hormones are produced
Inhibit TH production
• Autoimmune (Graves disease)
THYROID AGENTS


THIOAMIDE
Indication:
✓ Treatment of hyperthyroidism
CI: Allergies, pregnancy, lactating
A/E: thyroid suppression:

drowsiness, lethargy, bradycardia,
nausea, skin rash
Drug Interactions: cardiac meds

IODINE SOLUTION
Indication:
✓ Adjunct therapy for
hyperthyroidism
CI: Allergies, pregnancy,

lactating, pulmonary edema, PTB
A/E: hypothyroidism, iodism

(metallic taste, sore teeth and
gums), teeth staining
Drug Interactions: cardiac meds

Antithyroid Agents
✓ Administer propylthiouracil three times a day around the clock to ensure

consistent therapeutic levels.
✓ Give iodine solution through a straw to decrease staining of teeth; tablets

can be crushed.
✓ Monitor response carefully and arrange for periodic blood tests to assess
patient response and to monitor for adverse effects.
Antithyroid Agents
✓ Monitor patients receiving iodine solution for any sign of iodism so the
drug can be stopped immediately if such signs appear.
✓ Provide thorough patient teaching, including measures to avoid adverse

effects, warning signs of problems, and the need for regular evaluation if
used for longer than recommended to enhance patient knowledge of drug
therapy and promote compliance..
THYROID AGENTS


Parathyroid
Parathyroid Gland
Share a common goal with

thyroid glands:
Calcium homeostasis
Parathyroid Gland
four very small groups of

glandular tissue located on the
back of the thyroid gland
Hormone: PTH
- regulator of serum calcium
levels
Parathyroid Gland
PTH function:
✓ Stimulation of osteoclasts or
bone cells to release calcium
from the bone
✓ Increased intestinal
absorption of calcium
✓ Increased calcium
reabsorption from the kidneys
✓ Stimulation of cells in the

kidney to produce calcitriol,
the active form of vitamin D,
which stimulates intestinal
transport of calcium into the
blood
Serum Calcium Control
Parathyroid Dysfunction
HYPO PHYSIOLOGY HYPER

Hypocalcemia Calcium regulation Hypercalcemia
Hyperactive reflexes, CNS Lethargy, behavior changes,
parethesia, Chvostek & polydipsia, stupor, coma
Trosseau sign
Hypotension CV Hypertension
Abdominal spasms GI Anorexia, N&V, Constipation
Tetany, cramps, spasm Muscular Weakness, atrophy
Bone pain, osteomalacia Skeletal Osteopenia, osteoporosis
PARATHYROID AGENTS

Vitamin D compounds regulate Antihypocalcemic Calcitrol
the absorption of calcium and Agents PTH Hormone
phosphate from the small Teriparatide
intestine, mineral resorption in
bone, and reabsorption of
phosphate from the renal
tubules
Biphosphonates: block bone Antihypercalcemic Biphosphonates
resorption Agents - Alendronate
- Pamidronate
Calcitonins: TH to balance effect - etidronate
of PTH, inhibits bone resorption
Calcitonins
- calcitonin salmon
ANTIHYPOCALCEMIA
Indication:
✓ Treatment of hypocalcemia
CI: Allergies, pregnancy, lactating
A/E: GI effects – metallic taste,

N&V, dry mouth, constipation,
anorexia
Drug Interactions: digoxin

toxicity (Digoxin Immune Fab)
Antihypocalcemia Agents
✓ Monitor serum calcium concentration before and periodically during

treatment to allow for adjustment of dose to maintain calcium levels within
normal limits.
✓ Provide supportive measures to help the patient deal with GI and CNS
effects of the drug (analgesics, small and frequent meals, help with activities
of daily living).
✓ Arrange for a nutritional consultation if GI effects are severe to ensure

nutritional balance.

effects, warning signs of problems, and the need for regular evaluation to
enhance the patient’s knowledge about drug therapy and promote
compliance.
PARATHYROID AGENTS

Vitamin D compounds regulate Antihypocalcemic Calcitrol
the absorption of calcium and Agents PTH Hormone
phosphate from the small Teriparatide
intestine, mineral resorption in
bone, and reabsorption of
phosphate from the renal
tubules
Biphosphonates: block bone Antihypercalcemic Biphosphonates
resorption Agents - Alendronate
- Pamidronate
Calcitonins: TH to balance effect - etidronate
of PTH, inhibits bone resorption
Calcitonins
- calcitonin salmon
BIPHOSPHONATES
Indication:
✓ Treatment of hypercalcemia
CI: Allergies, hypocalcemia,

pregnancy, lactation
A/E: headache, nausea, diarrhea,

bone pain
Drug Interactions: Gi distress if

with aspirin
CALCITONINS
Indication:
✓ Treatment of hypercalcemia
CI: pregnancy*, lactating
A/E: flushing of the face and

hands, skin rash, N&V, urinary
frequency
Drug Interactions: none

✓ Ensure adequate hydration with any of these agents to reduce the risk of
renal complications.
✓ Arrange for concomitant vitamin D, calcium supplements, and hormone

replacement therapy if used to treat postmenopausal osteoporosis.
✓ Rotate injection sites and monitor for inflammation if using calcitonins to

prevent tissue breakdown and irritation.
✓ Monitor serum calcium regularly to allow for dose adjustment as needed.
✓ Assess the patient carefully for any potential drug–drug interactions if

giving in combination with other drugs to prevent serious effects.
✓ Arrange for periodic blood tests of renal function if using gallium to

monitor for renal dysfunction.
✓ Provide comfort measures and analgesics to relieve bone pain if it returns

as treatment begins.

effects, warning signs of problems, and the need for regular evaluation to
enhance the patient’s knowledge about drug therapy and promote
compliance.
Blood Glucose
Antidiabetic Agents
Used to treat diabetes mellitus, the

most common of all metabolic
disorders
Maintaining the appropriate glucose

level is a complicated process that
involves diet, exercise, and drug
management
Glucose Levels
Blood Glucose

promotes the storage of the Insulin Insulin
body’s fuels, stimulates the
synthesis of glycogen from
glucose, of fats from lipids,
and of proteins from amino
acids
bind to potassium channels Sulfonylureas Chlorpropamide
on pancreatic beta cells. Glimepiride
improve insulin binding to

insulin receptors and
increase the number of
insulin receptors
INSULIN
Insulin
✓ Ensure that the patient is following a dietary and exercise regimen and
using good hygiene practices to improve the effectiveness of the insulin and
decrease adverse effects of the disease.
✓ Gently rotate the vial containing the agent and avoid vigorous shaking to
ensure uniform suspension of insulin.
✓ Select a site that is free of bruising and scarring to ensure good absorption
of the insulin.
✓ Give maintenance doses by the subcutaneous or inhaled routes only and

rotate injection sites regularly to avoid damage to muscles and to prevent
subcutaneous atrophy.
✓ Give regular insulin IM or IV in emergency situations.

Insulin
✓ Monitor response carefully to avoid adverse effects; blood glucose

monitoring is the most effective way to evaluate insulin dose.
✓ Monitor the patient for signs and symptoms of hypoglycemia, especially

during peak insulin times, when these signs and symptoms would be most
likely to appear, to assess the response to insulin and the need for dose
adjustment or medical intervention.
✓ Always verify the name of the insulin being given because each insulin has a
different peak and duration, and the names can be confused.
✓ Store insulin in a cool place away from direct sunlight to ensure

effectiveness. Predrawn syringes are stable for 1 week if refrigerated; they
offer a good way to ensure the proper dose for patients who have limited
vision.
Insulin
✓ Monitor the patient’s exercise and activities; ensure that the patient
considers the effects of exercise in relationship to eating and insulin dose to
ensure therapeutic effect and avoid hypoglycemia.
✓ Protect the patient from infection, including good skin care and foot care, to
prevent the development of serious infections and changes in therapeutic
insulin doses.
✓ Monitor the patient’s sensory losses to incorporate his or her needs into
safety issues as well as potential problems in drawing up and administering
insulin.
✓ Help the patient to deal with necessary lifestyle changes, including diet and
exercise needs, sensory loss, and the impact of a drug regimen that includes
giving injections to help encourage compliance with the treatment
regimen.
Blood Glucose

promotes the storage of the Insulin Insulin
acids
bind to potassium channels Sulfonylureas Chlorpropamide
on pancreatic beta cells. Glimepiride

insulin receptors
SULFONYLUREAS
Blood Glucose

promotes the storage of the Biguanide Metformin
acids
bind to potassium channels DPP-4 Inhibitors Linagliptin
on pancreatic beta cells. Alogliptin

insulin receptors
BIGUANIDE
Blood Glucose

promotes the storage of the Biguanide Metformin
acids
bind to potassium channels DPP-4 Inhibitors Linagliptin
on pancreatic beta cells. Alogliptin

insulin receptors
DPP-4 Inhibitor
Antidiabetic Agents
✓ Administer the drug as prescribed in an appropriate relationship with meals

to ensure therapeutic effectiveness.
✓ Ensure that the patient is following diet and exercise modifications to

improve effectiveness of the drug and decrease adverse effects.
✓ Monitor nutritional status to provide nutritional consultation as needed.
✓ Monitor response carefully; blood glucose monitoring is the most effective

way to evaluate dose. Obtain blood glucose levels as ordered to monitor
drug effectiveness.
Antidiabetic Agents
✓ Monitor liver enzymes of patients receiving pioglitazone or rosiglitazone

carefully to avoid liver toxicity; arrange to discontinue the drug to avert
serious liver damage if liver toxicity develops.
✓ Monitor patients during times of trauma, pregnancy, or severe stress,and

arrange to switch to insulin coverage as needed.
Glucose-Elevating Agents
raise the blood level of glucose when

hypoglycemia occurs (lower than 70
mg/dL)
pancreatic disorders, kidney disease,

certain cancers, disorders of the
anterior pituitary, and unbalanced
treatment of diabetes mellitus
Two agents are used to elevate

glucose in these conditions:
diazoxide (Proglycem) and

glucagon (GlucaGen)
Glucose-elevating Agents
✓ Monitor blood glucose levels to evaluate the effectiveness of the drug.
✓ Have insulin on standby during emergency use to treat severe

hyperglycemia if it occurs as a result of overdose.
✓ Monitor nutritional status to provide nutritional consultation as

✓ needed.
✓ Monitor patients receiving diazoxide for potential CV effects, including blood

pressure, heart rhythm and output, and weight changes, to avert serious
adverse reactions.
Glucose-elevating Agents
✓ Provide thorough patient teaching, including drug name, dosage, and

schedule for administration; signs and symptoms of hyperglycemia;
administration technique if indicated; signs and symptoms of adverse
effects; need for follow-up monitoring and laboratory testing if indicated;
nutritional measures; and blood glucose monitoring, to improve patient
knowledge and increase compliance to drug regimen.
RENAL
RENAL SYSTEM
composed of the kidneys and the

structures of the urinary tract: the
ureters, the urinary bladder, and the
urethra
RENAL SYSTEM
Maintaining the volume and composition
of body fluids within normal ranges,
including the following functions:
Clearing nitrogenous wastes from protein

metabolism
Maintaining acid–base balance and

electrolyte levels
Excreting various drugs and drug

metabolites
Regulating red blood cell production

through the production and
secretion of erythropoietin
RENAL SYSTEM
Regulating blood pressure through the

renin–angiotensin–aldosterone
system
Regulating red blood cell production

through the production and
secretion of erythropoietin
NEPHRON
Functional unit
All of the nephrons filter fluid and make urine, but only the medullary
nephrons can concentrate or dilute urine
The nephrons function by using three basic processes:

glomerular filtration (passage of fluid and small components of the
blood through the glomerulus into the nephron tubule),
tubular secretion (active movement of substancesfrom the blood into

the renal tubule)
tubular reabsorption (movement of substances from the renal tubule

back into the vascular system)
DIURETICS
DIURETICS
drugs that increase the amount of urine produced by the kidneys. Most
diuretics do increase the volume of urine produced to some extent, but
the greater clinical significance of diuretics is their ability to increase
sodium excretion
DIURETICS

block the chloride pump Thiazide Diuretics Hydrochlorothiazide
block the chloride pump in Loop Diuretics Furosemide

the ascending loop of Henle,
loss of sodium while Potassium-sparing diuretics Spironolactone
promoting the retention of
potassium
pull water into the renal Osmotic Diuretics Mannitol
tubule without sodium loss
catalyst for the formation of Carbonic Anhydrase Inhibitors Acetazolamide
sodium Bicarbonate
NEPHRON
NEPHRON
DIURETICS
THIAZIDE AND THIAZIDE-LIKE DIURETICS
Blocking of the chloride pump

keeps the chloride and the sodium
in the tubule to be excreted in the
urine → preventing the
reabsorption of both chloride and
sodium in the vascular system
Indication:
✓ first-line drugs used to manage
essential hypertension
CI: allergies
A/E: Hypokalemia
LOOP DIURETICS
decreases the reabsorption of

sodium and chloride; work even in
the presence of acid–base
disturbances, renal failure,
electrolyte imbalances, or nitrogen
retention
Indication:
✓ Acute HF, acute pulmonary
edema, edema, HPN
CI: allergies, anuria, pregnancy
A/E: Alkalosis
POTASSIUM-SPARING DIURETICS
used as adjuncts with thiazide or

loop diuretics or in patients who
are especially at risk if hypokalemia
Develops
Indication:
✓ DOC for Hyperaldosteronism
CI: allergies, pregnancy
A/E: Hyperkalemia
OSMOTIC DIURETICS
osmotic pull exerted by the large

sugar molecule
Indication:
✓ Decrease IOP before eye surgery
✓ Acute glaucoma attacks
✓ Increased ICP, acute renal failure
d/t shock, overdose, trauma
CI: renal disease, anuria, pregnancy
A/E: Sudden drop in fluid levels

CARBONIC ANHYDRASE INHIBITORS
block the effects of carbonic

anhydrase slow down the
movement of hydrogen ions; as a
result, more sodium and
bicarbonate are lost in the urine.
Indication:
✓ Glaucoma, HF
CI: allergies, chronic glaucoma
A/E: Metabolic acidosis

URINARY TRACT
URINARY TRACT
Ureters
One ureter exits each kidney, draining the filtrate

from the collecting ducts.
The ureters have a smooth endothelial lining and

circular muscular layers.
Urine entering the ureter stimulates a peristaltic

wave that pushes the urine down toward the
urinary bladder.
URINARY TRACT
Urinary Bladder
The urinary bladder is a muscular pouch that

stretches and holds the urine until it is excreted
from the body.
Urine is usually a slightly acidic fluid; this acidity

helps to maintain the normal transport systems
and to destroy bacteria that may enter the bladder.
Control of bladder emptying is learned control over

the external urethral sphincter.
Both the sympathetic and parasympathetic

nervous systems innervate the bladder muscle and
sphincters.
URINARY TRACT
URETHRA
In the female, the urethra is a short

tube that leads from the bladder to an
area populated by normal flora,
In the male, the urethra is much

longer and passes through the
prostate gland
UTI

Destroy bacteria, either through a Anti-infective Fosfomycin
direct antibiotic effect or through Methylene blue
acidification of Trimethoprim
the urine Trimethopprim-
sulfamethoxazole
relieve these spasms by blocking Antispasmodic Oxybutinin
parasympathetic activity
direct, topical analgesic effect on Analgesic Phenazopyridine
the urinary tract mucosa
Buffer to prevent irritants in the Protectant Pentosan polysulfate
urine sodium
UTI
CLASSIFICATION DRUG LIST

Anti-infective Fosfomycin
Methylene blue
Trimethoprim
Trimethopprim-
sulfamethoxazole
Antispasmodic Oxybutinin
Analgesic Phenazopyridine
Protectant Pentosan
polysulfate sodium
ANTI-INFECTIVE
Indication:
✓ Chronic UTI
✓ Pyelonephritis
CI: pregnancy, renal dysfunction
A/E: N&V, diarrhea, anorexia

ANTISPASMODIC
spasms lead to the uncomfortable

effects of dysuria (pain or discomfort
with urination), urgency,
incontinence, nocturia (recurrent
nighttime urination), and
suprapubic pain
CI: allergy, recent surgery,

obstructive UT problems
A/E: N&V, dry mouth, tachycardia

ANALGESIC
PROTECTANT
UTI

Destroy bacteria, either through a Anti-infective Fosfomycin
direct antibiotic effect or through Methylene blue
acidification of Trimethoprim
the urine Trimethopprim-
sulfamethoxazole
relieve these spasms by blocking Antispasmodic Oxybutinin
parasympathetic activity
direct, topical analgesic effect on Analgesic Phenazopyridine
the urinary tract mucosa
Buffer to prevent irritants in the Protectant Pentosan polysulfate
urine sodium
- BREAK -
GIT
GI SYSTEM
The GI system has four major activities:

Secretion of enzymes, acid, bicarbonate, and mucus
Absorption of water and almost all of the essential

nutrients needed by the body
Digestion of food into usable and absorbable

components
Motility (movement) of food and secretions through

the system
CENTRAL REFLEXES
Swallowing reflex is stimulated whenever a

food bolus stimulates
pressure receptors in the back of the throat
and pharynx
Vomiting reflex is another basic reflex that is

centrally mediated and important in
protecting the system from unwanted
irritants. (Chemoreceptor trigger zone: CTZ)
GI SECRETIONS: PUD
Peptic ulcer: erosion of the lining of the stomach or duodenum
Results from imbalance between acid produced and the mucous protection
of the gastrointestinal lining or possibly from infection by Helicobacter
pylori bacteria
GI SECRETIONS
GI Secretions: PUD, GERD

Prevents HCL acid release Histamine-2 Antagonist Cimetidine
Ranitidine
neutralize stomach acid by Antacids Sodium bicarbonate
direct chemical reaction Aluminum salts
suppress gastric acid Proton Pump Inhibitors Omeprazole
secretion Pantoprazole
protecting the sites against GI Protectant Sucralfate
acid, pepsin, and bile salts
inhibits gastric acid Prostaglandin Misoprostol
secretion and increases
bicarbonate and mucus
production in the stomach
INSULIN
INSULIN
GI Secretions: PUD, GERD

Prevents HCL acid release Histamine-2 Antagonist Cimetidine
Ranitidine
neutralize stomach acid by Antacids Sodium bicarbonate
direct chemical reaction Aluminum salts
suppress gastric acid Proton Pump Inhibitors Omeprazole
secretion Pantoprazole
protecting the sites against GI Protectant Sucralfate
acid, pepsin, and bile salts
inhibits gastric acid Prostaglandin Misoprostol
secretion and increases
bicarbonate and mucus
production in the stomach
GI Motility: Diarrhea, Constipation

inhibit local reflexes Antidiarrheal Loperamide
through direct action on the Bismuth subsalicylate
muscles of the GI tract to
slow activity, or through
action on CNS centers that
cause GI spasm
increase motility throughout Laxatives Bisacodyl
the rest of the GI tract by Psyllium
irritating the nerve plexus Magnesium citrate
Magnesium sulfate
make defecation easier Lubricants Mineral oil
without stimulating the
movement of the GI tract
ANTIDIARRHEAL
LAXATIVES
LUBRICANTS
GI Motility: Diarrhea, Constipation

inhibit local reflexes Antidiarrheal Loperamide
through direct action on the Bismuth subsalicylate
muscles of the GI tract to
slow activity, or through
action on CNS centers that
cause GI spasm
increase motility throughout Laxatives Bisacodyl
the rest of the GI tract by Psyllium
irritating the nerve plexus Magnesium citrate
Magnesium sulfate
make defecation easier Lubricants Mineral oil
without stimulating the
movement of the GI tract
Vomiting: Antiemetic

centrally acting antiemetics Phenothiazines Prochlorperazine
that change the Chlrorpromazine
responsiveness or
stimulation of the CTZ in the
medulla
reduce the responsiveness Nonphenothiazines Metoclopramide
of the nerve cells in the CTZ
to circulating chemicals that
induce vomiting
nausea and vomiting 5-HT3 Receptor Blockers Ondansetron
associated with emetogenic
chemotherapy
PHENOTHIAZINES
NONPHENOTHIAZINES
5 HT3 RECEPTOR BLOCKERS
BABALUNYTS
HERBAL
DOH-Approved Herbal Medications
Name Scientific name Indication
Bawang Allium sativum Hypertension, toothache, lowers cholesterol
Ampalaya Momordica charantia Diabetes mellitus
Bayabas Psidium guajava Antiseptic, toothache, diarrhea
Akapulko Cassia alata Ringworm, fungal infection
Lagundi Vitex negundo Asthma, cough, rheumatism
Ulasimang
Peperomia pellucida Arthritis, gout
bato
Niyog-niyogan Quisqualis indica L. Anti-helminthic, expels parasitic worms
Yerba Buena Mentha cordifelia Body aches
Tsaang Gubat Carmona retusa Intestinal motility, diarrhea, stomachache
Sambong Blumea balsamifera Diuretic, anti-edema, anti-urolithiasis
- REVIEW -
DOSAGE CALCULATION: ORAL & PARENTERAL
𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑎𝑔𝑒 (𝑚𝑔)

𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑡𝑎𝑏𝑙𝑒𝑡𝑠(𝑡𝑎𝑏 𝑜𝑟 𝑐𝑎𝑝) =
𝑠𝑡𝑜𝑐𝑘 𝑜𝑛 ℎ𝑎𝑛𝑑 (𝑚𝑔)
500 𝑚𝑔
𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑡𝑎𝑏𝑙𝑒𝑡𝑠(𝑡𝑎𝑏 𝑜𝑟 𝑐𝑎𝑝) =
100 𝑚𝑔
𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑡𝑎𝑏𝑙𝑒𝑡𝑠 𝑡𝑎𝑏 𝑜𝑟 𝑐𝑎𝑝 = 5 𝑡𝑎𝑏𝑙𝑒𝑡𝑠

DOSAGE CALCULATION: ORAL & PARENTERAL
𝑑𝑒𝑠𝑖𝑟𝑒𝑑 𝑑𝑜𝑠𝑎𝑔𝑒 𝑚𝑔
𝑎𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑚𝐿 = 𝑥 𝑠𝑡𝑜𝑐𝑘 𝑣𝑜𝑙𝑢𝑚𝑒(𝑚𝐿)
𝑠𝑡𝑜𝑐𝑘 𝑜𝑛 ℎ𝑎𝑛𝑑 𝑚𝑔
500𝑚𝑔
𝑎𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑚𝐿 = 𝑥 5𝑚𝑙
200𝑚𝑔
𝑎𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑚𝐿 = 2.5 𝑥 5𝑚𝑙
𝑎𝑚𝑜𝑢𝑛𝑡 𝑜𝑓 𝑠𝑜𝑙𝑢𝑡𝑖𝑜𝑛 𝑚𝐿 = 12.5 𝑚𝑙

INTRAVENOUS FLUID (IVF) CALCULATIONS
𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑚𝐿)

𝑣𝑜𝑙𝑢𝑚𝑒 𝑝𝑒𝑟 ℎ𝑜𝑢𝑟(𝑚𝐿/ℎ) =
𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 (ℎ)
𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑡𝑜 𝑖𝑛𝑓𝑢𝑠𝑒 (𝑚𝐿)

𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 ℎ𝑜𝑢𝑟 =
𝑚𝐿
𝑚𝐿 𝑝𝑒𝑟 ℎ𝑜𝑢𝑟 𝑏𝑒𝑖𝑛𝑔 𝑖𝑛𝑓𝑢𝑠𝑒𝑑 ( )
ℎ𝑟
𝑔𝑡𝑡𝑠 𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 𝑚𝐿 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟: 15 𝑔𝑡𝑡𝑠/𝑚𝑙

𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒 = 𝑥
𝑚𝑖𝑛 𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 ℎ𝑟 60 𝑚𝑖𝑛/ℎ𝑟
𝑔𝑡𝑡𝑠 1000 𝑚𝐿 15 𝑔𝑡𝑡𝑠/𝑚𝑙

𝑚𝑖𝑛 24 ℎ𝑟𝑠 60 𝑚𝑖𝑛/ℎ𝑟
𝑔𝑡𝑡𝑠 𝑚𝑙 1 𝑔𝑡𝑡𝑠/𝑚𝑙
𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒 = 41.6 𝑥
𝑚𝑖𝑛 ℎ𝑟 4 𝑚𝑖𝑛/ℎ𝑟




𝑔𝑡𝑡𝑠
𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒 = 10.41 𝑜𝑟 10 − 11 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
𝑚𝑖𝑛
𝑢𝑔𝑡𝑡𝑠 𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 𝑚𝐿 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟: 60 𝑔𝑡𝑡𝑠/𝑚𝑙

𝒎𝒊𝒄𝒓𝒐𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒 = 𝑥
𝑢𝑔𝑡𝑡𝑠 500 𝑚𝐿 60 𝑔𝑡𝑡𝑠/𝑚𝑙

𝑚𝑖𝑐𝑟𝑜𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒 = 𝑥
𝑢𝑔𝑡𝑡𝑠 𝑚𝑙 1 𝑔𝑡𝑡𝑠/𝑚𝑙
𝑚𝑖𝑐𝑟𝑜𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒 = 31.25 𝑥




𝑢𝑔𝑡𝑡𝑠
𝑚𝑖𝑐𝑟𝑜𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒 = 31.25 𝑜𝑟 31 − 32 𝑢𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
𝑚𝑖𝑛
- END -

05 Endo GIT Renal

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05 Endo GIT Renal

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ENDOCRINE, GIT,

AND RENAL DRUGS

works to maintain internal

The pituitary gland has three lobes:

The anterior lobe produces stimulating hormones in response

The posterior lobe of the pituitary stores ADH and oxytocin,

The intermediate lobe of the pituitary produces endorphins and

The thyroid gland is located in the

Share a common goal with

A vascular gland with two lobes and a

The thyroid cells remove iodine from the

A person must obtain sufficient amounts

✓ Regulates the rate of metabolism in

✓ Affect heat production and body

✓ Affects oxygen consumption and cardiac

✓ Affects enzyme system activity

✓ Affects metabolism of carbohydrates,

✓ Regulator of growth and dev’t

Because the thyroid has such

| TRH: Thyrotropin-Releasing Hormone

| TSH: Thyroid Stimulating Hormone

HYPO PHYSIOLOGY HYPER

• Lack of TSH due to pituitary

• Absence of the thyroid gland

• Lack of sufficient iodine

• Lack of sufficient functioning

• Lack of sufficient functioning

MECHANISM CLASSIFICATION DRUG LIST

Iodine solution: High doses Iodine solution

These drugs are not approved for

CI: Allergies, acute MI

Caution: pregnant, lactating

✓ Administer with a full glass of water to help prevent difficulty swallowing

✓ Monitor response carefully when beginning therapy to adjust dose

✓ Monitor cardiac response to detect cardiac adverse effects.

✓ Assess patient carefully to detect any potential drug–drug interactions if

✓ Arrange for periodic blood tests of thyroid function to monitor the

✓ Provide thorough patient teaching, including drug name, dosage and

• Excessive amounts of thyroid

• Excessive amounts of thyroid Removal of gland: total or partial

MECHANISM CLASSIFICATION DRUG LIST

Iodine solution: High doses Iodine solution

CI: Allergies, pregnancy, lactating

A/E: thyroid suppression:

Drug Interactions: cardiac meds

CI: Allergies, pregnancy,

A/E: hypothyroidism, iodism

Drug Interactions: cardiac meds

✓ Administer propylthiouracil three times a day around the clock to ensure

✓ Give iodine solution through a straw to decrease staining of teeth; tablets

✓ Provide thorough patient teaching, including measures to avoid adverse

MECHANISM CLASSIFICATION DRUG LIST

Iodine solution: High doses Iodine solution

Share a common goal with

four very small groups of

✓ Stimulation of cells in the

HYPO PHYSIOLOGY HYPER

MECHANISM CLASSIFICATION DRUG LIST

CI: Allergies, pregnancy, lactating

A/E: GI effects – metallic taste,

Drug Interactions: digoxin

✓ Monitor serum calcium concentration before and periodically during

✓ Arrange for a nutritional consultation if GI effects are severe to ensure