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Chapter 27 Chapter 27

The Endocrine Glands and Hormones

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Endocrine SystemEndocrine System

• Endocrine glands secrete into the bloodstream

• Organs of the endocrine system – Pituitary (master gland)– Thyroid– Parathyroids– Adrenals– Gonads– Pancreatic (islets of Langerhans)

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Endocrine SystemEndocrine System

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Pituitary GlandPituitary Gland

• Small gland at base of brain

• Anterior lobe secretes hormones that regulate other endocrine glands

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Thyroid GlandThyroid Gland

• 2 lobes, secreting 3 main hormones…Thyroxine(T4), Tri-iodothyronine(T3), & calcitonin

• Abnormal conditions– Cretinism (congenital hypothyroidism in children)– Myxedema (adult hypothyroidism)– Graves Disease (hyperthyroidism)– Goiter (enlarged Thyroid gland) can be caused by

either hypothyroid or hyperthyroid production

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Thyroid PreparationsThyroid Preparations

• OK during pregnancy

– Natural thyroid replacement hormone (from thyroid gland of hogs)

– Synthetic thyroid preparations (provide greater accuracy and predictability when treating thyroid dysfunction)

• Levothyroxine ( Levothroid, Synthroid, T4)

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Antithyroid AgentsAntithyroid Agents

• Reduce thyroid gland’s hormone output• Treat hyperthyroidism (Graves’ disease)• Should not be taken by pregnant women• Types

– Methimazole (Tapazole) • Inhibits synthesis of thyroid hormone

– Propylthiouracil (PTU)• Same function as methimazole• Used to suppress thyroid gland before surgery

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Parathyroid GlandsParathyroid Glands

• 4 glands located at ‘poles’ of thyroid gland• Regulate calcium between blood and bone

metabolism • Hyperparathyroidism

– Too much calcium leaves the bones, weakening them. Increased calcium level in the blood causes kidney stones.

Rx = Teriparatide (Forteo) from Recombinant-DNA

– a synthetic (produced via Recombinant-DNA) parathyroid hormone, used to treat osteoporosis.

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Adrenal GlandsAdrenal Glands

• Located above each kidney• 2 parts: the *cortex & the *medulla • Secretes primary hormones

– cortisone– hydrocortisone – aldosterone

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PancreasPancreas

• Produces the hormone insulin

• Purpose of insulin– Aids in turning glucose to energy– Stores excess glucose in liver– Converts glucose to fat

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Diabetes MellitusDiabetes Mellitus

• Cells starved for glucose (needed for energy)

• Excess glucose in urine

• High blood glucose (damages tissues)

• Produces permanent complications

• Potentially fatal

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Insulin TherapyInsulin Therapy

• Factors determining dose– Weight of patient– Metabolic rate– Physical activity– remaining Pancreatic function

• Accurate dosing imperative !!!– Insulin shock or diabetic coma can result

from too much or too little insulin

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Insulin TherapyInsulin Therapy

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Insulin ProductsInsulin Products

• Combination insulin products– Humulin 50/50– Humulin 70/30– Novolin 70/30

• Insulin pump therapy - Type 1 diabetes – GOAL: to closely match natural Insulin production

• Factors in successful treatment– Frequency in monitoring/nutritional control– Keeping a logbook

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Oral Hypoglycemic AgentsOral Hypoglycemic Agents

• These lower blood glucose by stimulating pancreas to produce more insulin and by decreasing insulin resistance of cells

• Not oral insulin• Drug examples:

– Acarbose (Precose)– Chlorpropamide (Diabinese)– Glipizide (Glucotrol)– Glyburide (Diabeta, Micronase, Glynase)– Metformin hydrochloride (Glucophage)– Tolbutamide (Orinase)

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ProgesteroneProgesterone

• Progesterone: induces most favorable conditions for the growth of the fetus– Produced by corpus luteum– Prepares uterus for ovum– Controls first half of menstrual cycle– Develops placenta– Develops mammary glands during pregnancy– Multiplies uterine muscle fibers

• Decrease in progesterone induces labor

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Hormone Replacement Therapy

Hormone Replacement Therapy

• Estrogen replacement therapy (ERT)– Estrogens, conjugated (Premarin)– Esterified estrogens tablets (Estratab)

• Estrogen agonist-antagonists– Raloxifene hydrochloride (Evista)

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Oral ContraceptivesOral Contraceptives

• Suppress ovulation by releasing FSH• Side effects

– Breast changes– Loss of hair– Dermatoses– Headache– Nervousness– Thromboembolic disorders– Emotional instability– Accelerated growth of fibroids– Less effective with antibiotic agents

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Other Types of ContraceptivesOther Types of Contraceptives

• Medroxyprogesterone acetate (Depo-Provera) – Bone loss an issue– Limit use to 2 years

• Norelgestromin plus ethinyl estradiol (Ortho Evra) transdermal patch

• Ethinyl estradiol and etonogestrel ring (NuvaRing)– Intravaginal for 3 weeks per month

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Other Types of ContraceptivesOther Types of Contraceptives

• Emergency contraceptives – Taken within 72 hours after intercourse – Drugs

• Ethinyl estradiol plus levonorgestrel (Preven)• Levonorgestrel plus ethinyl estradiol (Ovral)• Levonorgestrel (Plan B)

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Oxytocic Agents Oxytocic Agents

• Uterine stimulant, like hormone oxytocin• Used during pregnancy, delivery, and

postpartum• Drugs

– Oxytocin injection (Pitocin, Syntocinon)– Ergonovine maleate (Ergotrate)– Methylergonovine maleate (Methergine)– Sodium chloride 20% injection– Urea 40% to 50% injection (carbamide)– Dinoprostone (Prostin E2)– Dinoprostone cervical gel (Prepidil)– Mifepristone (RU-486, Mifeprex)

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Male HormonesMale Hormones

• Testosterone– Therapeutic uses

• Ovarian dysfunctions • Hormone deficiency

– Types• Testosterone gel (Angrogel)• Testosterone transdermal patch (Androderm)

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Chapter 28Chapter 28

Diuretics and Other Drugs That Affect the Urinary System

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KidneysKidneys

• Maintain the body’s water balance – Positive water balance: intake of water

exceeds output– Negative water balance: output of water

exceeds intake (dehydration)

• Excrete water through urination • As well as …

• Perspiration • Respiration

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Diuretic AgentsDiuretic Agents

• Increase urine flow

• Prevents/reverses fluid accumulation– Lungs– Extremities– Abdomen

• Several classes of diuretic agents

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Thiazide (Benzothiadiazine) Diuretic Agents

Thiazide (Benzothiadiazine) Diuretic Agents

• Inhibit the enzyme ‘carbonic anhydrase’• Exert action directly on the collecting tubules

of kidney• Promote excretion of the following:

– Sodium– Potassium– Chloride– Bicarbonate– Water

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Thiazide (Benzothiadiazine) Diuretic Agents

Thiazide (Benzothiadiazine) Diuretic Agents

• Potassium depletion can be a problem with long-term use.

• A potassium supplement (or foods high in potassium such as oranges, bananas) are often added to the diet.

• Thiazide diuretic agents are generally contraindicated during pregnancy.

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Thiazide (Benzothiadiazine) Diuretic Agents

Thiazide (Benzothiadiazine) Diuretic Agents

• Side effects are as follows:– Decreased blood pressure– Tachycardia, jaundice, anemia, alkalosis,

hypotension

• Used with caution in patients who have the Gout, Liver or kidney disorders

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Steroid Antagonist AgentsSteroid Antagonist Agents

• These agents inhibit aldosterone, an adrenal hormone.

• They promote excretion of the following:– Sodium– Potassium– Water

• Example:– Spironolactone (Aldactone)

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Miscellaneous Diuretic AgentsMiscellaneous Diuretic Agents

• triamterene • triamterene + hctz (Dyazide)• furosemide (Lasix)

– Loop diuretic

** see more misc. diuretics in Textbook!

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Urinary Antiseptic AgentsUrinary Antiseptic Agents

• UTI ‘specific’ antibiotics

• Treat bacterial infections of the urinary tract– Cystitis– Pyelitis– Pyelonephritis

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Urinary Antiseptic AgentsUrinary Antiseptic Agents

• Drugs exclusively used to treat urinary infections – nitrofurantoin (Furadantin)– methenamine mandelate (Mandelamine)– Urised – phenazopyridine hydrochloride (Pyridium)– sulfamethoxazole (Bactrim, Septra)

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Drugs Used to Treat EnuresisDrugs Used to Treat Enuresis

• Enuresis – “Involuntary urination” at night– Common in children– Caused by a spastic bladder that is

stimulated to empty when small amount of urine is present

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Drugs Used to Treat EnuresisDrugs Used to Treat Enuresis

• imipramine (Tofranil)• oxybutynin (Ditropan)

– Antispasmodic effect on smooth muscle of the bladder

• desmopressin (DDAVP Nasal Spray)– Antidiuretic that affects renal water

conservation

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Drugs Used to Treat Incontinence

Drugs Used to Treat Incontinence

• Incontinence– Inability to control urine or feces– Affects 10% to 35% of community-dwelling

adults– Affects 50% to 70% of nursing home

population– Twice as common in women

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Drugs Used to Treat Incontinence

Drugs Used to Treat Incontinence

• oxybutynin (Ditropan XL)– Exerts a direct antispasmodic effect on

smooth muscle of the bladder

• tolterodine (Detrol, Detrol LA)– Increases bladder capacity– Decreases urge urinary incontinence

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Drugs Used to Treat Benign Prostatic Hypertrophy

Drugs Used to Treat Benign Prostatic Hypertrophy

• Benign prostatic hypertrophy (BPH), hyperplasia– Increase in number of prostate cells– Abnormal enlargement of prostate gland– Males older than 55 years

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Drugs Used to Treat Benign Prostatic Hypertrophy

Drugs Used to Treat Benign Prostatic Hypertrophy

• finasteride (Proscar)– Reduces prostate size and associated

urinary obstruction

• tamsulosin hydrochloride (Flomax)– Relieves mild to moderate obstructive

manifestations

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Drugs Used to Treat Erectile Dysfunction

Drugs Used to Treat Erectile Dysfunction

• Erectile dysfunction– Inability to maintain erection– Important to rule out other causes

• Hypertension• Antihypertensive drugs• Thyroid disease• Cardiovascular disease• Psychologic disorders

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Drugs Used to Treat Erectile Dysfunction

Drugs Used to Treat Erectile Dysfunction

• sildenafil (Viagra)– Acts as a vasodilator

• vardenafil (Levitra)– Prolongs duration of erections

• tadalafil (Cialis)– Duration of action of 36 hours– May result in priapism