Hormones Pharmacology III Practical Sessions Cairo University Faculty of Pharmacy Department of Pharmacology & Toxicology Pharmacology III Practical Sessions Hormones

Hormones Pharma-III Practical Hormones: compounds which are synthesized and secreted from special secretory or endocrine glands.

Hormones Pharma-III Practical Hormones release is regulated by either: Other hormones (feedback mechanism): e.g. TSH stimulates the thyroid gland to secrete thyroid hormones. Chemical agents; e.g.  glucose in blood   insulin secretion.  Na in blood   aldosterone.  Ca2+ in serum   parathyroid (PTH)hormone. 3. Nervous system: e. g.: Sympathetic activation  Adrenaline secreted from adrenal medulla

Hormones Pharma-III Practical Clinical disorders of endocrine system: Overproduction of a certain hormone (hyperfunction). Deficency or absence of a certain hormone (hypofunction).

Hormones Pharma-III Practical The case will be divided into: Chief complaint: the symptoms the patient is complaining from and they are the first guide lines for diagnoses of the case. History of patient illness: it includes the pt’s age-physical examination (heart rate, blood pressure)- any apparent features that may lead to the diagnosis of the cause of his complain (skin swelling, tremors, convulsions, fatigue, etc…..)

Hormones Pharma-III Practical Family history: illness history of his family, which may help if his illness related to inheritance (genetics). Medications: any drug the pt takes either for treatment of a chronic disease as hypertension of diabetes. Or a drug he recently took before the appearance of the symptoms he complains from.

Hormones Pharma-III Practical Laboratory values (lab values): these values may include parameters which are directly related the case, e.g. the level of T3 and T4 in case of simple goiter.

Hormones Pharma-III Practical Lab values includes: I-Liver function tests: Serum albumin test: measures the amount of albumin in serum  helps in determining liver or kidney diseases or  protein absorption. Alkaline phosphatase (ALP): Tissue è high amounts of ALP include (liver, bile duct & bone) used to diagnose liver, bone diseases (non-specific).

Hormones Pharma-III Practical ALT (alanine transaminase) SGPT: used to determine liver damage. AST (asparatate transaminase) SGOT: found in high conc. in heart muscle, liver cells & skeletal muscles  used to determine liver damage (NON specific). Prothrombin time (PT): time taken for blood (plasma ) to clot.

Hormones Pharma-III Practical Bilirubin: it is a product that results from the breakdown of haemoglobin, used to monitor liver or gallbladder problems. Most of bilirubin is chemically attached to another molecule before it is released in bile (Conjugated=direct) while unconjugated bilirubin is called indirect. - Impairment of liver function indirect bilirubin and direct bilirubin Impairment of liver secretion to gall bladder due to biliary stone direct bilirubin. N.B. liver disease should be monitored using combination of ALP, ALT, AST & bilirubin.

Haem proteins (P450, Myoglobin,etc..) Senescent RBCs Haem proteins (P450, Myoglobin,etc..) HAEM For illustration only Extremely water insoluble Highly bound to albumin (Hence non-excretable) UCB PLASMA LIVER OATP CB UDP-GT * More water soluble Less bound to albumin (Bile-excretable) Both UCB and CB were reported to be increased in some liver diseases due to impaired conjugation as well as the inability of the liver to excrete conjugated bilirubin in bile duct by MRP-2 MRP-2 INTESTINES BILE OATP: Organic anion transporter protein UDP-GT: Uridine diphosphate glucuronyl transferase * : rate limiting step MRP-2 : multi drug resistance protein 2 ELIMINATION

Common Examples  UCB  CB MIXED Haemolysis ( production)  Diseases with  UDP-GT activity (the enzyme responsible for conjugation) and/ or levels  UCB Cholestasis  CB Hepatitis (conjugation but obstructed bile flow) Drugs induced hepatotoxicity Alcoholism MIXED

Hormones Pharma-III Practical II-Kidney function test: Serum creatinine: is the breakdown product of creatine ŵ is important part of muscle  performed to evaluate kidney function Glomerular filteration rate (GFR)= Creatinine clearance: it is the volume of blood that is cleared of creatinine per unit time. It is measured as ml/min and used to estimate glomerular filteration rate .

Hormones Pharma-III Practical Blood urea nitrogen (BUN): urea nitrogen is product as result of breakdown of protein used to evaluate kidney function.  BUN  liver failure, low protein diet or malnutrition.  BUN  Xss protein, kidney diseases. Heart failure ( blood flow to the kidney) GIT bleeding (ulcers) (blood clots degradation in GIT nitrogenous compounds urea in blood  

Hormones Pharma-III Practical III-Complete blood picture (blood profile): Haemoglobin (Hb): the mass concentration of haemoglobin. (g/dL) Red cell count (RBCs): the number of red blood cells/litre. Packed cell volume (PCV) (hematocrit): the proportion of the volume of blood taken up by red blood cells (%) Mean cell haemoglobin concentration (MCHC): the average haemoglobin concentration in the red blood cells (Hb/PCV). Mean cell volume (MCV): the average volume of the red blood cells (PCV/RCC).

Diagnosis of the type of anemia may be assisted by relating the measurements of red blood cell count, hematocrit and hemoglobin to derive the mean corpuscular volume (MCV) and the mean corpuscular hemoglobin concentration (MCHC). Erythrocytes that have a normal size or volume (normal MCV) are called normocytic, When the MCV is high, they are called macrocytic. When the MCV is low, they are termed microcytic. Erythrocytes containing the normal amount of hemoglobin (normal MCHC) are called normochromic. When the MCHC is abnormally low they are called hypochromic, and when the MCHC is abnormally high, hyperchromic. The terms above are used together to describe different forms of anemia. For example, iron deficiency anemia is described as microcytic and hypochromic, whereas vitamin B12 deficiency is macrocytic and normochromic. Erythrocytes containing the normal amount of hemoglobin (normal MCHC) are called normochromic. When the MCHC is abnormally low they are called hypochromic, and when the MCHC is abnormally high, hyperchromic. The terms above are used together to describe different forms of anemia. For example, iron deficiency anemia is described as microcytic and hypochromic, whereas vitamin B12 deficiency is macrocytic and normochromic.  

Hormones Pharma-III Practical Mean cell haemoglobin (MCH): the average haemoglobin content of red blood cells.(Hb/RCC). Basophils (Basos): the number of basophils/litre. Platelet count (Plt): the number of platelets/litre. Lymphocytes (Lymphs): the number of lymphocytes/litre. White cell count (WBCs): the number of white cells/litre. Monocytes (Monos): the number of monocytes/litre. Erythrocyte sedimentation rate (ESR): the velocity of sedimentation of red cells in 1st hour (mm/hr). It is a non-specific measure of inflammation and infection.

Hormones Pharma-III Practical IV- Serum electrolytes: Na+: many factors affect Na levels, including the hormone aldosterone ( Na+loss in the urine)& ANP (atrial natriuretic peptide) ( Na+loss from the body): . K+: Small changes in K-level can affect nerves and muscles especially heart. Hypokalemia muscle cramps and arrhythmia. Hyperkalemia Cardiac arrest. Aldosterone is among the factors affecting K level ( K loss in the urine).

Hormones Pharma-III Practical IV- Blood glucose: glucose is a major source of energy including brain. Hyperglycemia may indicate acromegaly, Cushing’s & diabetes mellitus. Hypoglycemia may indicate Addison’s d& hyperinsulinemia (Pancreatic tumor).

Hormones Pharma-III Practical V- Blood pH: The normal blood pH is tightly regulated between 7.53 and 7.45. The pH of any fluid is the measure of hydrogen ion concentration. A variety of factors affect blood pH. Vomiting loss of HCl alkalosis. Severe vomiting hyponatremia, hypokalemia Kidney response aldesterone Na+ retention H+ loss metabolic alkalosis Diarrhea loss of HCO3- acidosis.

-Hyperventilation flushing CO2out of the blood respiratory alkalosis. Lung function -Hypoventilation accumulation of CO2 and consequently carbonic acid respiratory acidosis -Hyperventilation flushing CO2out of the blood respiratory alkalosis. -Endocrine dysfunction Diabetes mellitus Ketoacidosis. Cushing syndrome metabolic alkalosis.

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