Endocrine Drugs Lecture Notes PDF

**Lecture Notes** **ENDOCRINE DRUGS** I. **Diabetes Mellitus** A. [Definition]: abnormalities in glucose homeostasis -\> hyperglycemia. Lack or dec in insulin production, or the insulin produced is ineffective. B. [Types of DM:] 1\. [Type I - IDDM] Insulin production dec or absent due to dec in...

**Lecture Notes** **ENDOCRINE DRUGS** I. **Diabetes Mellitus** A. [Definition]: abnormalities in glucose homeostasis -\> hyperglycemia. Lack or dec in insulin production, or the insulin produced is ineffective. B. [Types of DM:] 1\. [Type I - IDDM] Insulin production dec or absent due to dec in number of B-cells. 2\. [Type II -- NIDDM] amount of insulin produced may be normal, inc or dec. Dec tissue responsiveness to insulin because of defects at receptor sites, dec \# C. [Meds for DM] 1\. insulin 2\. oral antidiabetic agents D. [Insulin] IND Type I, some Type II diabetics Types: 1\. [Short Duration: Rapid Acting] ex/ insulin lispro/*Humalog,* insulin aspart/*Novolog* given 5-10 mins before eating or with meal -sq. Effects last 3-5 hrs, given at every meal, combined with intermediate acting for long term control. 2\. [Short Duration: Slower Acting] ex. regular insulin/*Humulin R, Novolin R* given 30 min before meal. Effects last 6-10 hrs, combined with intermediate acting. 3\. [Intermediate Acting] ex. neutral protamine hagedorn insulin (NPH)/*Humulin N, Novolin N* Used to control blood sugar between meals and during night. Injected 2x day, can be mixed with short duration insulins. Usually given at breakfast and dinner, duration 16-24 hrs. 4\. [Long acting] ex. insulin glargine/*Lantus* Given once a day at bedtime. Duration 24 hrs. SQ only, can't be mixed. Dosing: 1\. Conventional schedule: 2 injections/day, one at breakfast and one at dinner. Both doses contain short-acting insulin and intermediate insulin. Mix in one syringe. Or use pre-mixed solution -- 70/30. 2\. Intensive conventional schedule: 4 injections/day. Short-acting insulin before every meal and long acting at bedtime. 3\. continuous infusion -- pump AE: hypoglycemia lipodystrophy DI: hypoglycemic agents hyperglycemic agents beta blockers Nursing: T/L re: use of insulin, administration, storage T/L re: check blood sugars, S&S of hypo and hyperglycemia E. [Oral antidiabetic agents] IND: Type II diabetics 1\. [Biguanide]: [Metformin/*Glucophage*] MOA: lowers blood sugar by dec production of glucose by liver, suppresses gluconeogenesis. Also inc glucose uptake by muscles. Used for initial tx. 2x/day with meal AE: GI lactic acidosis DI: alcohol 2\. [Sulfonylureas]: First generation: tolbutamide/*Orinase* tolazamide/*Tolinase* chlorpropamide/*Diabinese* Second generation: glipizide/*Glucotrol* glyburide/*Micronase, DiaBeta* glimepiride/*Amaryl* [Glipizide/*Glucotrol* ] MOA: stimulates release of insulin by pancreas, given with breakfast AE: hypoglycemia teratogenic DI: alcohol beta blockers 3\. [Meglitinides] [Repaglinide/*Prandin*] MOA: stimulates release of insulin by pancreas, short half-life so take with every meal AE hypoglycemia DI gemfibrozil/*Lopid* clopidogrel/*Plavix* 4\. [Thiazolidinediones]: [Pioglitazone/*Actos*] MOA: reduces insulin resistance by inc uptake of glucose by skeletal muscles and adipose cells and dec glucose production by liver. 1x/day AE: headache fluid retention ovulation high dose -- inc risk bladder cancer, inc risk of fractures DI: insulin F. [Non-Insulin Injectables] [Exenatide/*Byetta*] - Glucagon-like Peptide Receptor Agonist MOA Activates GLP-1 receptors -\> produces same effects as endogenous incretins -\> inc insulin release, slows gastric emptying, suppresses appetite, dec release of glucagon. SQ 2x/day or extended release 1x/wk - before meals IND Type 2 AE GI: n/v, diarrhea pancreatitis renal impairment DI sulfonylureas some oral meds (Abx, oral contraceptives) II\. **Thyroid Meds** A. [Hypothyroidism] 1\. Def: dec production of thyroid hormone. 2\. [Meds for Hypothyroidism]: Hormone replacement [Levothyroxine (T4)/*Levothyroid, Synthroid*] MOA: synthetic preparation of thyroxine --T4. taken po once a day. IND: all forms of hypothyroidism AE: rare at therapeutic levels. toxic levels: extreme hyperthyroidism - thyrotoxicosis DI: iron, calcium supplements warfarin dilantin, rifampin, phenobarbital Nursing: monitor TSH levels B. [Hyperthyroidism] 1\. Def: excess thyroid hormone. Graves disease: autoimmune disease, stimulate thyroid Toxic goiter: cells or nodules function autonomously, secrete TH hormone. 2\. [Meds for Hyperthyroidism]: a\. methimazole/*Northyx,Tapazole* b\. radioactive iodine/*Iodotope* c\. non-radioactive iodine d\. beta-blockers a\. [Methimazole/*Northyx* ] MOA: inhibits thyroid hormone synthesis, inhibits an enzyme, peroxidase. IND: Graves disease AE: hypothyroidism agranulocytosis CI: pregnancy b\. [Radioactive iodine/*Iodotope*] MOA: destroys thyroid tissue by emission of beta particles. IND: Graves, alternative to surgery AE: hypothyroidism III\. **Anterior Pituitary Meds** A. [Growth Hormone Deficiency] 1\. [Pathophysiology]: damage to the pituitary gland -\> dec GH. 2\. [Meds for Growth Hormone Deficiency]: [Somatropin/*Humatrope, Genotropin*] MOA: form of GH. given as SQ or IM IND: pediatric growth hormone deficiency pediatric non-growth hormone deficient short statue adults: wasting in AIDS patients AE: hyperglycemia DI: glucocorticoids B. [Excess Growth Hormone] 1\. [Pathophysiology]: Excess causes soft tissue and bony overgrowth -- Gigantism/Acromegaly. Metabolic effects: hyperglycemia -\> DM 2\. [Meds for excess GH]: [Octreotide/*Sandostatin*] MOA: suppresses GH release. IND: acromegaly AE: GI: nausea, diarrhea, flatulence IV\. **Posterior Pituitary Meds** A. [ADH Deficiency - Diabetes Insipidus] 1\. [Pathophysiology]: dec ADH or dec action. Leads to excretion of large amounts of dilute urine and excess thirst. 2\. [Meds for DI]: a\. [Desmopressin/*DDAVP*] (po/nasal spray) MOA: structural analog of natural ADH. Promotes renal conservation of water. AE: water intoxication VI\. **Adrenal Cortex Meds** A. [Adrenocortical Deficiency: Addison's Disease] 1\. [Pathophysiology]: dec synthesis of corticosteroids hormones with elevated serum ACTH 2\. [Meds for Addison's Disease] a\. [Hydrocortisone] MOA: synthetic steroid similar to cortisol IND: Addison's disease and all forms of adrenocortical insufficiency (po) adrenal crisis given IV AE: well tolerated b\. [Fludrocortisone/*Florinef*] MOA: mineralocorticoid activity, used in combination with hydrocortisone. IND: Addison's disease hypoaldosteronism AE: water and sodium retention -\> hypertension hypokalemia