Principles of Endocrine Pharmacology PDF

PHARMACOLOGY AND TOXICOLOGY PRINCIPLES OF ENDOCRINE PHARMACOLOGY WO N G C H U N K E U N G 30 SEP 2024 1 PRINCIPLES OF ENDOCRINE PHARMACOLOGY Concerns with the therapeutic use of hormones and hormone like substances or drugs acting either by enhancing...

PHARMACOLOGY AND TOXICOLOGY PRINCIPLES OF ENDOCRINE PHARMACOLOGY WO N G C H U N K E U N G 30 SEP 2024 1 PRINCIPLES OF ENDOCRINE PHARMACOLOGY Concerns with the therapeutic use of hormones and hormone like substances or drugs acting either by enhancing or suppressing the metabolism of certain glands of internal secretion https://biologia-geologia.com/BG3/821_glandulas_endocrinas.html 2 DIFFERENCE BETWEEN ENDOCRINE AND EXOCRINE GLANDS What is a gland? Examples of exocrine glands – Functional unit of cells working Sweat gland, salivary glands, mammary glands, together etc – Releasing a certain products into Examples of endocrine glands either a duct or to the bloodstream Adrenal gland, pituitary Exocrine gland gland, thyroid gland, etc – Secretes the products via a ductal system to an epithelial surface, Endocrine gland – Secrete products directly into the bloodstream https://www.medschoolcoach.com/endocrine-vs-exocrine-glands-mcat-biology/ 3 WHAT IS THE THYROID? A small, butterfly-shaped gland Located in the middle of the lower neck Produces three types of hormones, namely: – Triiodothyronine (T3), thyroxine (T4), and calcitonin Thyroid not producing the proper amount of thyroid hormones in thyroid disease Regulating body functions such as body temperature, heart rate, metabolism and energy https://www.pftforum.com/blog/goiter-upper-airway-obstruction-and-the-flow-volume-loop/ 4  OVERACTIVE THYROID UNDERACTIVE THYROID (HYPERTHYROIDISM) (HYPOTHYROIDISM) The thyroid gland makes too The thyroid gland do not make many hormones. Side effects may enough hormones. Side effects include: may include: Weight loss Weight gain Nervousness Irregular pulse Depression Irritability Forgetfulness Sleep problems Fatigue Vision problems Dry skin Muscle weakness Feeling cold all the time Feeling hot all the time 5 HOW ARE THYROID DISORDERS DIAGNOSED? Physical examination, ultrasounds and a blood test for levels of T4, T3, and thyroid stimulating hormone (TSH) Hypothyroid - A high TSH, low T3, and/or low T4 Hyperthyroid – A low TSH, high T3, and/or high T4 Thyroid antibodies levels - Diagnose autoimmune thyroid disorders such as Grave’s disease https://www.picpedia.org/post-it-note/d/diagnosis.html 6 THYROID DISEASE AND WOMEN Thyroid disease is particularly common in women Women usually have a more vigorous immune response than men Women are more prone to autoimmune diseases, such as Graves' disease, leading causes of hypothyroidism and hyperthyroidism Thyroid disease is usually a life-long condition Effective medications are thus required to https://bio.libretexts.org/Courses/Butte_College/BC:_BIOL_2_- _Introduction_to_Human_Biology_(Grewal)/Text/12:_Endocrine_System/12.5:_Thyroid_Gland restore the proper thyroid hormone levels 7 MEDICATIONS FOR TREATING HYPERTHYROID Anti-thyroid medicines are named thionamides Most common treatment for overactive thyroid Stop the thyroid from producing excess hormones Main medications are methimazole and propylthiouracil Other including propranolol for extreme symptoms of hyperthyroidism https://en.wikipedia.org/wiki/Propranolol 8 MEDICATIONS FOR TREATING HYPERTHYROID Methimazole is the first line of treatment of hyperthyroidism –It works quickly and has few side effects Propylthiouracil is the first line of treatment in pregnant women –lower risk of birth defects Usually needs 1-2 months for noticing the change in symptoms after starting these medications 9 ACTIONS OF MEDICATIONS FOR TREATING HYPERTHYROID Propranolol Decreasing the heart rate and facilitating the heart to pump blood around the body Works differently if applying it for anxiety – In situation of anxious, the brain makes the chemical messengers of adrenaline and noradrenaline. It results in a fasting heart rate, sweating or shaking – Propranolol reduces anxiety by blocking the effects of these chemical messengers 10 OTHER TREATMENT OPTIONS FOR HYPERTHYROID Radioactive iodine treatment: –Damages the cells of the thyroid –Prevent it from producing as many thyroid hormones Surgical removal of the thyroid gland https://medlineplus.gov/ency/presentations/100135_4.htm 11 MEDICATIONS FOR TREATING HYPOTHYROID Hypothyroidism is commonly treated by replacing the missing thyroid hormones of patients with oral synthetic thyroid hormones such as levothyroxine, liothyronine, or liotrix. Regular blood tests are required clinically for ensuring that patients taking the suitable dose since the dosage vary among patients 12 MEDICATIONS FOR TREATING HYPOTHYROID Two types of thyroid replacement medications for treating hypothyroidism –Synthetic medicine –Desiccated thyroid extract Thyroid gland dried and powdered for medical use Used to treat hypothyroidism 13 SYNTHETIC THYROID MEDICATION FDA approved Synthetic version of Thyroxine (T4) Levothyroxine, liothyronine, or liotrix Narrow therapeutic index – Small variances in blood levels of drug - Result in changes in the effectiveness or toxicity – Body is sensitive to small variations in drug Do not switch between generic and brand-name versions of synthetic thyroid 14 DESICCATED THYROID EXTRACT For treatment of hypothyroidism Thyroid gland dried and powdered for medical use May need up to three weeks for maximal effects to occur Less preferred than levothyroxine Serious side effects of Thyroid desiccated – Changes in menstrual periods – Changes in appetite – Diarrhea – Headache – Irregular or fast heartbeat – Chest pain – Fever 15 NOTES FOR TAKE THYROID MEDICATIONS Study the medication label Take thyroid medication away from other medications – Within 4 hours of taking thyroid medication: Avoid taking multivitamins or supplements containing calcium, iron or magnesium – Because they interfere with proper absorption. Avoid coffee – Caffeine in coffee or caffeinated beverages – Affect the absorption of thyroid drug levothyroxine – Make the drug pass through the gut too quickly https://upload.wikimedia.org/wikipedia/commons/c/c8/ Cappuccino_at_Sightglass_Coffee.jpg 16 PHARMACOLOGY OF BONE MINERAL HOMEOSTASIS Calcium and phosphorus – Major elements of bone – Important for mechanical strength of the skeleton – Important for normal function of other cells in the body A complex regulatory mechanism exists for regulating calcium and phosphate homeostasis – Primary regulators - Parathyroid hormone and vitamin D – Secondary roles - Calcitonin, glucocorticoids, and estrogens – Drugs or hormones mimic or suppress their actions - Used for treatment of bone mineral disorders 17 PHARMACOLOGY OF BONE MINERAL HOMEOSTASIS Active metabolites of vitamin D – Increase absorption of calcium from both bone and gut – Stimulates both calcium and phosphate homeostasis – Provides adequate mineral for normal bone formation Parathyroid hormone – Increases calcium reabsorption from bone – Effects on bone, gut and kidney for maintaining serum calcium in tight range – With a reciprocal effect on phosphate metabolism Parathyroid hormone and Vitamin D metabolites both reduce urinary excretion of calcium 18 PHARMACOLOGY OF BONE MINERAL HOMEOSTASIS Calcitonin, glucocorticoids, and estrogens – These hormones, or drugs mimic or suppress their actions, and are commonly used in treatment of bone mineral disorders (Such as rickets and osteoporosis) Rickets – A condition affecting bone development in children – It causes soft and weak bones, poor growth and bone pain leading to bone deformities Osteoporosis – Health condition that weakens bones, making them fragile and more likely to break – Usually developing slowly over several years – Commonly diagnosed after a fall causing bone fracture – Most common osteoporosis injuries - Broken wrist 19 MEDICATIONS COMMONLY USED IN CALCIUM REGULATION Calcitonin – Hormone produced by thyroid gland – Regulate levels of calcium and phosphate in the blood – Opposing the action of parathyroid hormone (Increases calcium reabsorption from bone) Patients with acute symptomatic hypocalcemia – Intravenous (IV) calcium gluconate preferred Chronic hypocalcemia – Treated with oral calcium and vitamin D supplements https://s3.amazonaws.com/static.wd7.us/9/99/Calcitonin_ingredients_and_appearance.png 20 CALCITONIN NASAL SPRAY Calcitonin nasal spray usually used with calcium and vitamin D For treating bone loss in women with postmenopausal osteoporosis For patients who have been postmenopause for at least 5 years – Such patients cannot/do not want to take estrogen products https://5.imimg.com/data5/VY/JI/MY-2581214/calcitonin-nasal-spray-500x500.jpg 21  WHY CALCITONIN NASAL SPRAY CALLED CALCITONIN-SALMON SPRAY? Calcitonin, being a human hormone, is also found in salmon Synthetic salmon calcitonin commonly used therapeutically in humans Salmon calcitonin is twenty times more active than human calcitonin and has a longer half-life It prevents bone breakdown and Salmon calcitonin | Buchi.com https://www.buchi.com/en/knowledge/applications/salmon-calcitonin increasing bone density (thickness) 22 WHY NOT TAKING ESTROGEN AFTER MENOPAUSE? Treating menopausal symptoms with estrogen – Estrogen therapy Although estrogen therapy improves menopause symptoms, it may increases the risk of having cancer of the uterus (endometrial cancer) Estrogen therapy may be only safe for women who do not have the uterus: – An example is for those with hysterectomy – Hysterectomy: A surgical procedure for removing the uterus https://news.va.gov/123133/know-body-know-the-symptoms-of-uterine-cancer/ 23 PARATHYROID HORMONE PRESCRIPTION Parathyroid hormone prescription Used with calcium and vitamin D Control hypocalcemia (low calcium levels) https://5.imimg.com/data5/SELLER/Default/2023/9/341571057/NP/TM/AO/1 43971760/teriparatide-recombinant-human-parathyroid-hormone- injection-500x500.jpg – For patients with hypoparathyroidism – Parathyroid gland in the neck do not make enough parathyroid hormone https://morseshealthcenter.com/wp- content/uploads/2023/01/ParaNTN-600x600.jpg 24 MEDICATION FOR HYPERPARATHYROIDISM Cinacalcet commonly used for: Treating hyperparathyroidism, particularly if the patient is not a surgery candidate Cinacalcet decreases the amount of parathyroid hormone of the parathyroid glands and lowers calcium levels in the blood https://www.wikidoc.org/index.php/Cinacalcet Treat high calcium levels in patients with primary hyperparathyroidism who cannot have surgery 25 PHARMACOLOGY OF REPRODUCTION Reproductive pharmacology refers to Groups of drugs used for The management of pathologies affecting the genitourinary tracts The male and female genitourinary tracts are regions specialized for reproduction of men and women 26 MEDICATION SPECIFICALLY FOR THE FEMALE REPRODUCTIVE SYSTEM https://medkare.co/wp-content/uploads/2021/05/vector-a-set-of-medicine-and-prescription-removebg-preview-2048x1773.png 27 ESTROGENS PRESCRIPTION Treat symptoms of conditions for estrogen deficiency – Such as amenorrhea and menopause Commonly used as contraceptives, in combination with progestins Amenorrhea: – The absence of menstruation, characterized by missing one or more menstrual periods Menopause – Periods stop due to lower hormone levels – Usually affects women between the ages of 45 and 55 – But it may happen earlier 28 PROGESTINS PRESCRIPTION Help other hormones work properly Regulate the menstrual cycle and treat unusual stopping of the menstrual periods (amenorrhea) Prevent anemia (low iron in blood) and too much menstrual blood loss and cancer of the uterus Progestins are also used as contraceptives, in combination with https://www.npwomenshealthcare.com/progestins-in-combination-oral- contraceptives/ estrogens 29 ESTROGEN RECEPTOR MODULATORS Used in treatment of osteoporosis, postmenopausal symptoms and breast cancer Hormone receptor-positive (or hormone-positive) breast cancer cells have either estrogen (ER) or progesterone (PR) receptors or both These breast cancers can be treated with hormone therapy drugs that block the estrogen receptors This induces an antiproliferative effect in estrogen receptor (ER) positive breast cancer Preventing the estrogen's growth stimulating effects https://www.pngall.com/breast-cancer-ribbon-png/ in the tumor 30 MEDICINE FOR FEMALE INFERTILITY Clomiphene citrate (Clomid) Tablets Drug that stimulates ovulation Stimulate the growth of an ovarian follicle containing an egg Trigger the ovaries to make eggs By causing the pituitary gland to release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH) https://thuocdantoc.vn/wp-content/uploads/2019/10/thong-tin-thuoc- clomiphene-citrate.jpg Side effects - Generally mild, including bloating, blurred vision, nausea and headache, etc 31 MEDICINE FOR FEMALE INFERTILITY (CONTINUE) Fertility Drugs- Injected Hormones Human Chorionic Gonadotropin Prescribe gonadotropins when a woman does not respond to clomiphene Or to stimulate follicle growth for assisted reproductive technology Injected in the early part of the menstrual cycle for 7 to 12 days Follicle-stimulating hormone https://globmed.co.uk/blog/what-are-the-best-fertility-drugs-to-get-pregnant/ Trigger the growth of eggs in ovaries 32 MEDICATION SPECIFICALLY FOR THE MALE REPRODUCTIVE SYSTEM https://ajp.com.au/wp-content/uploads/2015/03/Dollarphotoclub_75783184.jpg 33 MEDICATION SPECIFICALLY FOR THE MALE REPRODUCTIVE SYSTEM Androgens Male sex hormone Testosterone is the predominant androgen in all genders Important for male sexual and reproductive function Crucial for development of secondary sexual characteristics in men – Such as facial and body hair growth and voice change Affect muscle and bone development as well as metabolism 34  USE OF ANDROGEN MEDICATION Replace the hormone if the body is unable of producing enough on its own Stimulate the beginning of puberty for boys with late starting puberty To treat certain types of breast cancer in females 35 COMMON ANDROGENS FOR THE MALE REPRODUCTIVE SYSTEM Danazol Fluoxymesterone Testosterone Methyltestosterone 36 SIDE EFFECTS OF ANDROGENS MEDICATION Hypertension Fluid and nitrogen retention Erythropoiesis Bone-density changes High doses androgens used in women May develop male-like changes Such as deepening of the voice unnatural hair growth Unusual hair loss. 37  ANDROGENS - ANABOLIC STEROIDS Anabolic steroids - Medications that are manufactured forms of testosterone Common technical term - Anabolic-androgenic steroids (AAS) Anabolic - Refers to tissue building (mainly muscle) Androgenic - Refers to a group of sex hormones called androgens Testosterone - Main androgen Steroids are legally available only with a prescription  Treat conditions such as delayed puberty and Body-wasting for patients suffering from AIDS (Acquired immunodeficiency syndrome) 38  WHAT CAUSES BODY WASTING ? Body wasting is unwanted weight loss which is A symptom of various chronic conditions such as HIV, chronic renal failure, multiple sclerosis and cancer, etc 39 ATHLETE AND ANABOLIC STEROIDS Using anabolic steroids Commonly experience an increase in muscle strength Help build muscle tissue Increase body mass However, steroids cannot improve an athlete's agility or skill Factors determine athletic ability https://technofaq.org/posts/2018/01/5-tips-for-becoming-a- successful-student-athlete/ Including genetics, age, sex, diet, body size and how hard the athlete trains. 40  DRUGS FOR TREATING PENILE ERECTILE DYSFUNCTION What is Penile erectile dysfunction? A type of penile disorder Affects the ability to get and maintain an erection firm enough for sexual intercourse  Corpus cavernosum not fill with blood to allow for penile erection 41 TYPES OF ERECTILE DYSFUNCTION Psychogenic erectile dysfunction Involves psychological conditions Conditions affecting the feelings, thoughts and behavior Vascular erectile dysfunction The most common type of erectile dysfunction Causes that affect the blood vessels Problems of sending blood to tissues of penis to get and maintain an erection Hormonal erectile dysfunction A result of testosterone deficiency 42 TYPES OF ERECTILE DYSFUNCTION (CONTINUE) Neurogenic erectile dysfunction Due to neurologic conditions like stroke or other conditions such as pelvic surgery, trauma or radiation therapy A result of nerve problems Problem for signals to travel from the https://upload.wikimedia.org/wikipedia/commons/3 /3e/Nerve.nida.jpg brain to penis for creating an erection 43 EFFECT OF OTHER PRESCRIPTION DRUGS ON ERECTILE DYSFUNCTION Erectile dysfunction is a common side effect of many prescription drugs such as: Antihistamines. Anti-anxiety medications Antidepressants. Parkinson’s disease drugs. Chemotherapy drugs. Blood pressure medications. Antiarrhythmics 44 TIPS FOR ERECTILE DYSFUNCTION? Quit smoking may lead to improvement after months Oral medications help to increase blood flow to the penis – Common medications includes sildenafil (Viagra®), vardenafil (Levitra®), tadalafil (Cialis®) and avanafil (Stendra®) – Oral medications commonly start working within an hour https://cratusketamineclinic.com/correlation-between-smoking- and-erectile-dysfunction-in-men/ 45  DIABETES TYPE 1 AND TYPE 2 Type 1 diabetes –A lifelong condition –Immune system of body attacks and destroys the cells that produce insulin Type 2 diabetes –The body does not produce enough insulin, or –Body's cells do not react to insulin properly 46 MEDICINE FOR TYPE 1 DIABETES Insulin is the main medicine Insulin given either by – Injection or – Released by a small insulin pump attached to body https://healthjade.com/insulin-pump/ https://www.diabetes.co.uk/about-insulin.html 47 INSULIN PEN Introduced in the late 1980s as an alternative to vials and syringes Containing the hormone insulin for lowering levels of glucose in blood People with diabetes use it for administering insulin Providing a convenient, simple and accurate delivery For each application, simply: https://www.drugs.com/cg/insulin-pens.html – Add in a new needle, dial a dose, inject the insulin, and carefully put the used needle into a sharps container 48 STEPS FOR USING THE INSULIN PEN Remove a new pen from the refrigerator – Wait 30 minutes for bringing to room temperature before use Wash the hands – Use soap and water or alcohol-based hand rub Remove the cap from the pen and wipe the area with alcohol Attach a new needle to the pen – Do not remove the outer cap of the needle – Make sure the needle is straight Remove the needle caps Remove air from the pen – Gently tap the pen to move air bubbles Select the correct dose on the pen by turning the dial 49 BODY SITES FOR INJECTING INSULIN Inject insulin into the upper outer arms, abdomen, buttocks or upper outer thighs Insulin works fastest for injection into the abdomen Do not inject insulin into areas of a wound or a bruise May not get into body correctly Use different body area within the site each time for injection Injected into the same area may lead to swelling, lumps or thickened skin https://www.drugs.com/cg/insulin-pens.html 50 INJECTION OF INSULIN WITH A PEN Clean the skin of injecting the insulin with alcohol pad Grab a fold of the skin between the thumb and first finger Insert the needle straight into the skin Push the injection button to inject the insulin Pull the needle out Remove the needle from the pen and put into sharp box Replace the pen cap Store the pen as directed 51 INSULIN PUMP An alternative to insulin injections A wearable medical device Holds a given amount of insulin in a cartridge or reservoir Supplies a continuous flow of insulin underneath the skin Entering the bloodstream, then insulin allows cells of the body to absorb glucose and metabolize it as energy Easier and painless to take additional insulin https://www.bmj.com/content/365/bmj.l1226 as required, without need for injection 52 DISADVANTAGES OF AN INSULIN PUMP Need to be attached to the pump most of the time Increased risk of diabetic ketoacidosis if pump not working correctly Risk of skin infection or irritation at the application site 53 BEST MEDICINE FOR TYPE 2 DIABETES Metformin is generally the first medicine prescribed for type 2 diabetes Works mainly by lowering glucose production in the liver Improve the body's sensitivity to insulin Uses insulin more effectively Lower intestinal sugar absorption Metformin is considered the safest medicine for type 2 diabetes Used for many decades, effective, affordable and safe 54  TOXICITY OF METFORMIN Patients with metformin toxicity typically present with Gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) and Mental status changes 55 TUTORIAL Thyroid problems https://www.youtube.com/watch?v=SVSBo065hmw Teaching patients to use nasal sprays https://www.youtube.com/watch?v=_ytYj1TLojM Pharmacology for Nursing - Diabetic drugs Insulin Types & Memory Tricks (Peak, Onset, & Duration) RN https://www.youtube.com/watch?v=cm839JGmSFc&t=3s 56 PRINCIPLES OF ENDOCRINE PHARMACOLOGY 57