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Published byBennett Harvey Modified over 9 years ago
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The Endocrine System Consists of glands and other structures that produce hormones which are released into the circulatory system
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The Endocrine System Consists of glands and other structures that produce hormones which are released into the circulatory system Regulation is established through hormones affecting target tissue
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Regulation Homeostatsis is achieved through feedback mechanisms
Negative feedback – negates change to bring levels back to normal
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Pituitary Gland Regulates other endocrine glands as well as other body activities
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Different hormones, different signals
Anterior pituitary Thyroid gland TSH hormones Negative feedback - + Hypo- thalamus Water absorption ADH osmolality Pancreas Liver, fat & muscle Insulin Glucose Para- thyroids Bone, GIT & Kidney PTH calcium
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Growth Hormone Non-endocrine related disorders can also cause growth delay: Intrauterine growth retardation, chromosomal defects, abnormal growth of cartilage or bone, poor nutrition, variety of systemic diseases
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Growth Hormone Deficiency of endogenous growth hormone causes growth retardation Growth delay may be caused by Family growth patterns, genetic disorders, malnutrition, systemic or chronic illness, psychosocial stress, or a combination of these Endocrine deficiency, or problems with thyroxine, cortisol, insulin, or GH
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Growth Hormone Release of GH is stimulated by the release of GHRF secreted by the hypothalamus GH is inhibited by Glucocorticoids Obesity Depression Progesterone Hypokalemia Altered thyroid function
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Synthetic Human Growth Hormones
Drug List Synthetic Human Growth Hormones somatrem (Protropin) somatropin (Humatrope)
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Growth Hormone The younger the patient at time of treatment the greater the height that may be achieved Little response is seen after age in boys and in girls
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Thyroid Gland Produces hormones (T3 and T4) that stimulate metabolic activity of body tissues Hypothalamus and pituitary glands work together to release TSH TSH stimulates T3 and T4 release
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Thyroid Hormone Feedback Loop
Thyroid hormones build up in the blood Signals are sent to the hypothalamic-pituitary axis that adequate levels have been met TSH levels decrease
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Feedback - + Anterior pituitary Thyroid gland TSH hormones Negative
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Hypothyroidism Production of thyroid hormones is below normal
Cretinism occurs in children at birth due to inadequate maternal iodine intake Can cause mental retardation, thick tongue, lethargy, lack of response, short stature – can be corrected if treated
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Primary and secondary disorders
Thyroid disease Secondary
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Hypothyroidism Symptoms
Apathy Constipation Decreased heart rate Depression Dry skin, nails, and scalp Easy fatiguing Enlarged thyroid Lowered voice pitch Myxedema Puffy face Reduced mental acuity Swelling of eyelids Tongue enlarged and thickened Weight gain
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Causes of Hypothyroidism
Autoimmune destruction of the gland Radioactive iodine therapy Surgical removal of the gland
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Treatment for Hypothyroidism
Thyroid replacement therapy Should not be used to treat obesity
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Agents for Hypothyroidism
Drug List Agents for Hypothyroidism levothyroxine, T4 (Levothroid, Levoxyl, Synthroid) liothyronine, T3 (Cytomel) liotrix (Thyrolar) thyroid (Armour Thyroid)
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levothyroxine, T4 (Levothroid, Levoxyl, Synthroid)
Used for chronic therapy Can be cardiotoxic Alters protein binding of other drugs Should not switch brands once stabilized
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levothyroxine Dispensing Issues
Warning! Can be cardiotoxic; report any of the following: Chest pain, increased pulse, palpitations, heat intolerance, excessive sweating
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levothyroxine Dispensing Issues
Warning! Look-alike and Sound-alike Drugs: levothyroxine (thyroid replacement) levofloxacin (antibiotic)
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Hyperthyroidism Excessive thyroid hormone
Most common cause is Grave’s disease Other causes: Excessive exogenous iodine Thyroid nodules Tumor in the pituitary causing overproduction of TSH
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Symptoms of Hypterthyroidism
Decreased menses Diarrhea Exophthalmos Flushing of the skin Heat intolerance Nervousness Perspiration Tachycardia Weight loss
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Agents for Hyperthyroidism
Drug List Agents for Hyperthyroidism methimazole (Tapazole) propylthiouracil, PTU radioactive iodine, 131I
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Discussion What are the treatment options for hyperthyroidism?
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Discussion What are the treatment options for hyperthyroidism?
Answer: in children: surgery and hormone replacement; adults: surgery or medications
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Diabetes/Hypoglycemic Agents
In the islets of Langerhans, in the pancreas, there are two primary specialized cells Alpha Cells Beta Cells
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Hypoglycemic Agents In the islets of Langerhans, in the pancreas, there are two primary specialized cells Alpha Cells Produce glucagon and raise blood glucose levels Beta Cells
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Hypoglycemic Agents In the islets of Langerhans, in the pancreas, there are two primary specialized cells Alpha Cells Produce glucagon and raise blood glucose levels Beta Cells Produce insulin and lower blood glucose levels
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Insulin Helps cells burn glucose for energy
Works with receptors for glucose uptake Enhances transport and incorporation of amino acids into protein Increases ion transport into tissues Inhibits fat breakdown
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Diabetes Caused by inadequate secretion or utilization of insulin
Leads to excessive blood glucose levels Normal: 100 mg/dL
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Type I Diabetes Occurs most commonly in children and young adults
Average age of diagnosis is 11 or 12 Patients are insulin dependent and have no ability to produce insulin on their own May be due to an autoimmune response Type I accounts for 5-10% of diabetic population
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Type II Diabetes Affect 80-90% of diabetics
Most patients are over 40 and more women than men are affected Could be caused by insulin deficiency or insulin receptor resistance Many of these patients are overweight and can treat their diabetes with weight loss
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Gestational Diabetes Occurs during pregnancy
Increases risk of fetal morbidity and death Onset is during the 2nd and 3rd trimesters Can be treated with diet, exercise, and insulin 30-40% of women with gestational diabetes will develop type II in 5-10 years
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Secondary Diabetes Caused by medications
Oral contraceptives Beta blockers Diuretics Calcium channel blockers Glucocorticoids phenytoin May return to normal when drug is stopped
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Symptoms of Diabetes Frequent infections Glycosuria Hunger
Increased urination and nocturia Numbness and tingling Slow wound healing Thirst Visual changes Vomiting Weight loss, easy fatigability, irritability, ketoacidosis
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Complications of Diabetes
Retinopathy leading to blindness Neuropathy Vascular problems can lead to inadequate healing which could lead to amputation Dermatologic involvement Nephropathy is the primary cause of end-stage renal disease
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Lack of Insulin Activity
Diabetics cannot use glucose therefore their bodies metabolize fat Gluconeogenesis is the formation of glucose from protein and fatty acids Fatty acid is oxidized into ketones
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Ketones Strong acids Cause the body pH to drop
Excreted in the urine or eliminated through respiration Causes a fruity acetone smell on the breath that can be mistaken for alcohol
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Treating Diabetes Treatment consists of diet, exercise, and medications Blood glucose monitoring must be done regularly throughout the day Type II diabetics may be able to control the disease through diet and exercise alone
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Treatment for Type II Lifestyle changes Oral monotherapy
Combination oral therapy Oral drug plus insulin Insulin only
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General Treatment Guidelines
Attention to diet Blood pressure control Compliance with medications Control of hyperlipidemia Daily foot inspections Increased physical activity Recognizing hypoglycemia Blood glucose testing Monitoring in the Dr’s office Patient education Prompt treatment of infections Setting goals
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Drug for Lower Extremity Diabetic Ulcers
Drug List Drug for Lower Extremity Diabetic Ulcers becaplermin gel (Regranex)
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Insulin Administered subcutaneously due to degradation in the GI tract
Different types of insulin have different onset of action times and duration of action times
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Insulin Duration of Action
Type Duration of Action Humalog, Novolog 1 hr (works in 15 mins and gone in about an hour) Regular 5-6 hours (onset – 30 mins) NPH 10-16 hours Lente 12-18 hours Lantus 24 hours mixed Quick onset, longer duration
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Insulin Dispensing Issues
Warning! It is very easy to grab the wrong insulin in the refrigerator Always double-check yourself They look exactly alike
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Insulin administration sites should be rotated
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Hypoglycemia Blood glucose levels of <70 mg/dL Can be caused by
Skipping meals Too much exercise Poor medication regimen Certain drugs
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Signs & Symptoms of Hypoglycemia
Confusion Double vision Headache Hunger Numbness and tingling in mouth and lips Nervousness Palpitations Sweating Thirst Visual disturbances Weakness
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Drug List Human Insulins NPH isophane insulin (Humulin N)
insulin aspart (NovoLog) insulin glargine (Lantus) insulin lispro (Humalog) regular insulin (Humulin R)
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insulin lispro (Humalog)
Rapid-onset insulin Can be injected immediately before or after meals May be used with a pump
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insulin aspart (NovoLog)
Rapid-acting insulin analog Each dose should be administered before meals May be used with a pump
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insulin glargine (Lantus)
Synthetic long-acting insulin Absorbed slowly and works over a 24-hour time period Works similarly to physiologic insulin release
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Human Insulins Mixtures
Drug List Human Insulins Mixtures insulin aspart w/ protamine-insulin aspart (NovoLog Mix 70/30) insulin lispro w/ protamine-insulin lispro (Humalog Mix 75/25) insulin with zinc (lente) (Humulin L) NPH-regular insulin (Humulin 70/30)
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Oral Hypoglycemic Agents First- Generation Sulfonylureas
Drug List Oral Hypoglycemic Agents First- Generation Sulfonylureas chlorpropamide (Diabinese) tolbutamide
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Oral Hypoglycemic Agents Second-Generation Sulfonylureas
Drug List Oral Hypoglycemic Agents Second-Generation Sulfonylureas glimepiride (Amaryl) glipizide (Glucotrol, Glucotrol XL) glyburide (DiaBeta, Glynase, Micronase)
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glipizide (Glucotrol, Glucotrol XL)
Taken with breakfast Promotes insulin release from beta cells Increases insulin sensitivity
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glipizide Dispensing Issues
Warning! Look-Alike and Sound-Alike Drugs Glucotrol Glucotrol XL
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glipizide Dispensing Issues
Warning! Look-Alike and Sound-Alike Drugs glipizide (Glucotrol, Glucotrol XL) glyburide (DiaBeta, Glynase, Micronase)
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Oral Hypoglycemic Agents
Drug List Oral Hypoglycemic Agents Enzyme inhibitors: acarbose (Precose) miglitol (Glyset) Biguanide: metformin (Glucophage, Riomet)
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metformin (Glucophage, Riomet)
Decreases intestinal absorption of glucose and improves insulin sensitivity Has an effect on serum lipid levels Best candidates are overweight diabetics with high lipid profile
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Oral Hypoglycemic Agents Glitazones/Thiazolidinediones
Drug List Oral Hypoglycemic Agents Glitazones/Thiazolidinediones pioglitazone (Actos) rosiglitazone (Avandia)
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pioglitazone (Actos) Depends on the presence of insulin
Liver enzymes should be carefully monitored May be taken without regard to food
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rosiglitazone (Avandia)
Increases insulin sensitivity in muscle and adipose tissue Can be taken without regard to food
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Oral Hypoglycemic Agents Meglitinides
Drug List Oral Hypoglycemic Agents Meglitinides nateglinide (Starlix) repaglinide (Prandin)
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Oral Hypoglycemic Agents Combinations
Drug List Oral Hypoglycemic Agents Combinations glipizide-metformin (Metaglip) glyburide-metformin (Glucovance) rosiglitazone-metformin (Avandamet)
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Discussion What does a diabetic have to be concerned with in relation to diet?
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Discussion What does a diabetic have to be concerned with in relation to diet? Answer: Eating at the same time everyday; to limit sugar intake by reading package labels
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