1. Endocrine Pharmacology

2. Thyroid
Primary goal is to return the patient to a EUTHYROID state.

3. Thyroid Replacement Hormones
Hypothyroidism is treated by replacing the deficient T3 and T4 hormones.
Thyroxine is one of the two primary hormones, (T4), it is partially metabolized (T3)
Synthetic LEVOTHYROXINE (Synthroid, Levoxyl) is considered the drug of choice.

4. Thyroid Hormones Increase metabolic rate Cardiac output Body temp
Growth
Enzyme activity
Check B/P, pulse, weight, TSH

5. Thyroid Hormones Contraindications Side effects/adverse reactions
Adrenal insufficiency MI
thyrotoxicosis
Side effects/adverse reactions
Insomnia( take in am)
Tremors
Palpitations, angina, dysrhythmias
Weight loss
Changes in appetite
Thyroid storm

6. ThYROID HORMONES Hair loss that occurs in children is temporary
Report excitability, heat intolerance, cardiac deviations
Do not switch brands
Treatment is not to loss weight
Avoid iodine

7. Levthyroxine T4 Liothyronie T3 Liotrix Thyroid USP (Natural sheep, cow, pig)

8. Antithyroid Medications
Iodine 131
Radio active isotope of iodine
It is absorbed in the thyriod gland in high concentrations and destroys the hyperactive thyroid tissue
Used for poor surgical risks, patients beyond childbearing years, and people with severe complicating diseases
May take 3 to 6 months to fully asses benefits

9. Antithyroid Medications
Administered in water
DANGEROUS, radioactive, wear gloves
Present in patient’s excreta
Avoid spills
Side effects
Tenderness in thyroid gland
Rebound hyperthyroidism
Hypothyroidism
Interacts with Lithium Carbonate

10. Antithyroid Medications
Propacil, propythiouracil
Tapazole, methimazole
Actions
Block the synthesis of T3 and T4, may take 3 weeks
Used for longterm hyperthyroidism and short term prior to thyroidectomy

11. Antithyroid Medications
Side effects
Purpuric Maculopapular rash, (most common)
Headaches, Salivary gland and Lymph node enlargement, Loss of taste
Bone marrow suppression, stress the importance of returning lab for lab work
Hepatotoxicity
Nephrotoxicity

12. Antithyroid Medications
Drug Interactions
Warfarin, reduce dosage
Digoxin , may require increased dosage

13. Corticosteroids Secreted by the adrenal cortex of the adrenal gland
2 Categories:
Mineralcorticoids
Fludrocortisone, aldosterone
Maintain fluid and electrolyte balance used to treat adrenal insufficiency caused by hypopituitarism or Addison’s

14. Corticosteroids Glucocorticoids
Cortisone, hydrocortisone, prednisone, +
Regulate carbohydrate, fat and protien
Antiinflammatory, antiallergenic and immunosuppressant

15. Corticosteroids
Through assessment must be completed before initial dose
Lab test: prone to electrolyte imbalances (hypernatremia, hypokalemia)
Hyperglycemia
Infectious disease testing should be test prior to first dose
Do not tolerate stress well
Weight gain can be significant

16. Corticosteroids IMPORTANT:
Steroid therapy must be gradually discontinued in small increments to ensure the patient’s adrenal glands are able to start secreting steroids appropriately as the drug dosage is reduced.
Should carry identification
Avoid infections

17. Respriatory

18. Steroids

20. Glucocorticoids Adrenal cortex: Cortisol
Widely used because of their anti inflammatory properties
Do not cure, but relieve symptoms
Question about infections
May cause psychotic behaviors
Delayed wound healing, dehiscence

21. Cortisol Feedback

22. Gonadal Hormones Estrogens Development of sex organs
Capillary dilatation, fluid retention, protein metabolism
Used for contraception, treatment of osteoporosis, severe acne in females, advanced prostate cancer

23. Gonadal Hormones Estrogen
Weight gain, edema, breast tenderness, nausea
Hypertension, hyperglycemia, thrombophlebitis,
Break through bleeding

24. Gonadal Hormones Progestins Inhibits ovulation Uses Contraception
Relief of symptoms of endometriosis
Hormonal balance to relieve abnormal bleeding

25. Gonadal Hormones Progestins Side effects to expect:
Weight gain, edema, nausea, vomiting, diarrhea
Side effects to report:
Breakthrough bleeding, amenorrhea, continuing headache, jaundice, mental depression

28. Androgens Testosterone
Restoration of hormonal balance in androgen deficiency
Reduce discomfort associated with breast cancer
Side effects to expect:
Gastric irritation
Side effects to report:
Electrolyte imbalance, edema, masculinzation, hypercalcemia, hepatotoxicity

29. Desmopressin D davp
DDAVP is a potent antidiuretic which, when administered, may lead to water intoxication and/or hyponatremia. Unless properly diagnosed and treated hyponatremia can be fatal. Therefore, fluid restriction is recommended and should be discussed with the patient and/or guardian. Careful medical supervision is required.

30. fLORINEF
Fludrocortisone is in a class of drugs called steroids. Fludrocortisone prevents the release of substances in the body that cause inflammation.
Fludrocortisone is used to treat conditions in which the body does not produce enough of its own steroids, such as Addison's disease, and salt-losing adrenogenital syndrome.

31. Calcitonin
Bone: Calcitonin suppresses resorption of bone by inhibiting the activity of osteoclasts, a cell type that "digests" bone matrix, releasing calcium and phosphorus into blood.
Kidney: Calcium and phosphorus are prevented from being lost in urine by reabsorption in the kidney tubules. Calcitonin inhibits tubular reabsorption of these two ions, leading to increased rates of their loss in urine.

32. ADH Aldosterone
Aldosterone is a hormone that increases the reabsorption of sodium and water and the release (secretion) of potassium in the kidneys. This increases the volume of fluid in the body, and drives blood pressure up. Many drugs, such as spironolactone, lower blood pressure by blocking the aldosterone receptor. Aldosterone is part of the renin-angiotensin system.
effect of aldosterone is to increase reabsorption of ions and water in the kidney.

33. ADH
Aldosterone is a steroid hormone (mineralocorticoid family) produced by the outer-section (zona glomerulosa) of the adrenal cortex in the adrenal gland, and acts on the distal tubules and collecting ducts of the kidney to cause the conservation of sodium, secretion of potassium, increased water retention, and increased blood pressure. The effect of aldosterone is to increase reabsorption of ions and water in the kidney.
Its activity is reduced in Addison's disease