1. Chapter 27 The Endocrine Glands and Hormones

2. Endocrine System • Endocrine glands secrete into the bloodstream • Organs of the endocrine system • Pituitary (master gland) • Thyroid • Parathyroids • Adrenals • Gonads • Pancreatic (islets of Langerhans)

3. Endocrine System

4. Pituitary Gland • Small gland at base of brain • Anterior lobe secretes hormones that regulate other endocrine glands

5. Thyroid 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

6. Thyroid 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)

7. Antithyroid 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

8. Parathyroid 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.

9. Adrenal Glands • Located above each kidney • 2 parts: the *cortex & the *medulla • Secretes primary hormones • cortisone • hydrocortisone • aldosterone

10. Pancreas • Produces the hormone insulin • Purpose of insulin • Aids in turning glucose to energy • Stores excess glucose in liver • Converts glucose to fat

11. Diabetes Mellitus • Cells starved for glucose (needed for energy) • Excess glucose in urine • High blood glucose (damages tissues) • Produces permanent complications • Potentially fatal

12. Insulin 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

13. Insulin Therapy

14. Insulin 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

15. Oral 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)

16. Progesterone • 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

17. Hormone Replacement Therapy • Estrogen replacement therapy (ERT) • Estrogens, conjugated (Premarin) • Esterified estrogens tablets (Estratab) • Estrogen agonist-antagonists • Raloxifene hydrochloride (Evista)

18. Oral 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

19. Other 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

20. Other 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)

21. 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)

22. Male Hormones • Testosterone • Therapeutic uses • Ovarian dysfunctions • Hormone deficiency • Types • Testosterone gel (Angrogel) • Testosterone transdermal patch (Androderm)

23. Chapter 28 Diuretics and Other Drugs That Affect the Urinary System

24. Kidneys • 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

25. Diuretic Agents • Increase urine flow • Prevents/reverses fluid accumulation • Lungs • Extremities • Abdomen • Several classes of diuretic agents

26. 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

27. 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.

28. 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

29. Steroid Antagonist Agents • These agents inhibit aldosterone, an adrenal hormone. • They promote excretion of the following: • Sodium • Potassium • Water • Example: • Spironolactone (Aldactone)

30. Miscellaneous Diuretic Agents • triamterene • triamterene + hctz (Dyazide) • furosemide (Lasix) • Loop diuretic ** see more misc. diuretics in Textbook!

31. Urinary Antiseptic Agents • UTI ‘specific’ antibiotics • Treat bacterial infections of the urinary tract • Cystitis • Pyelitis • Pyelonephritis

32. Urinary Antiseptic Agents • Drugs exclusively used to treat urinary infections • nitrofurantoin (Furadantin) • methenamine mandelate (Mandelamine) • Urised • phenazopyridine hydrochloride (Pyridium) • sulfamethoxazole (Bactrim, Septra)

33. Drugs 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

34. Drugs 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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