Topic 7 drugs affecting the endocrine system
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Topic 7 Drugs affecting the ENDOCRINE SYSTEM. How Metabolism is controlled and mediated by hormones. Many disorders are due to either over or under secretion of a hormones Endocrinology Can potentiate normal hormonal action Inhibit hormonal action. Drugs affecting THYROID gland.

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Topic 7 drugs affecting the endocrine system
Topic 7Drugs affecting the ENDOCRINE SYSTEM


How metabolism is controlled and mediated by hormones
How Metabolism is controlled and mediated by hormones

  • Many disorders are due to either over or under secretion of a hormones

  • Endocrinology

  • Can potentiate normalhormonal action

  • Inhibit hormonal action.


Drugs affecting thyroid gland
Drugs affecting THYROID gland

  • Thyroid gland produces hormones Thyroxine and triiodothyronine which influence growth, development and metabolism.

  • Production of these hormones depends on the thyroid gland receiving iodine from the body


Hypothyroidism
HYPOTHYROIDISM

Decrease in thyroid activity caused by :

1. Hashimotos thyroiditis (Auto immune disorder.)

2. Myxoedema If hypothyroidism not treated

3. Iodine deficiency.

4. Radioactive iodine ingestion.

5. Atrophy of thyroid gland.

6. Surgical removal of all or part of gland.


Signs and symptoms
SIGNS AND SYMPTOMS

  • Tiredness

  • Lethargy

  • Weight Gain

  • Intolerance to heat

  • Dry skin

  • Bradycardia

  • Mental impairment


Hypothroidism
HYPOTHROIDISM

NURSING IMPLICATIONS.

  • Monitor symptoms related to BMR

  • Monitor heart rate, reporting tachycardia and palpitations.

  • Education re life long treatment of deficient hormones.

  • Diabetics need to monitor BSL as insulin or oral hypoglycaemics may need increasing.


Hyperthroidism thyrotoxicosis
HYPERTHROIDISM(Thyrotoxicosis)

  • Overproduction of thyroid hormone.

  • Graves Disease is an example of hyperthyroidism. More common in women than in men and occurs between 20-40 years of age and often arises after emotional or physical stress or infection.


Signs and symptoms1
SIGNS AND SYMPTOMS

  • Exophthalmos

  • Tremor

  • Nervousness

  • Constant hunger

  • Weight loss

  • Fatigue

  • Heat tolerance

  • Palpitations


Drugs for adrenal cortex problems
Drugs for ADRENAL CORTEX problems.

3 Naturally occurring Groups

  • Mineralocorticoids. Electrolyte and water balance. Natural occurring is aldosterone.

  • Glucocorticoids. Affect fat, protein and carbohydrate metabolism and also have an anti-inflammatory effect.

  • Gonadocorticoids, sex hormones.


Mineralocorticoids
Mineralocorticoids

  • These drugs primarily responsible for regulating sodium and potassium in the body.

  • Treat adrenocortical insufficiencies.

  • Potent immunosuppressants, prevent organ transplant rejection

  • Lung maturation in premature infants

  • Aldosterone, causes Sodium and Water retention increases blood volume and BP

  • Fludrocortisone (Florinef)


Glucocorticoids
GLUCOCORTICOIDS

  • Classified according to their duration of action

  • Increases blood glucose, mobilizes fats, stimulates protein catabolism, depresses immunity, and inflammatory responses.

  • Natural = Hydrocortisone

  • Synthetic = All others, prednisone


Examples
Examples

  • Betamethasone

  • Dexamethasone

  • Prednisone

  • Flixotide

  • Betnovate cream


Effects
Effects

  • Euphoria, psychiatric problems

  • Fluid retention, electrolyte imbalance

  • Delayed wound healing, bruising, acne

  • Fungal infections exacerbated

  • Hyperglycaemia, insomnia

  • Increased appetite, obesity

  • Osteoporosis (long term effect)

  • Cushings syndrome (Metabolic disorder resulting from chronic and excessive production of cortisol by the adrenal cortex.


Cushings syndrome
CUSHINGS SYNDROME

SIGNS & SYMPTOMS

1. Moon Face

2. Buffalo hump

3. Depression

4. Anxiety

5. Menstrual irregularities

6. Acne


Nursing implications
Nursing Implications

  • Monitor BP

  • Inhaled steroids, wash mouth

  • IMI deep

  • Not withdrawn immediately, tapered over at least 2 weeks

  • BSL monitoring

  • Taken with food


Gonadocorticoids
Gonadocorticoids

Oestrogen only preparations

  • Replacement (menopause)

  • Morning after pill

  • Induces uptake of Ca into bone, therapy for menopausal women with osteoporosis

  • S.E. = breast tenderness, Fluid retention, thrombosis


  • Gonadocorticoids1
    Gonadocorticoids

    Progesterone only preparations

    • Suppress ovarian function

    • Mini pill

    • S.E. similar to Oestrogen only symptoms


    Gonadocorticoids2
    Gonadocorticoids

    • Oral contraceptives

    • Combination

    • S.E. thromboembolism, heart disease, CVA, liver disease


    Gonadocorticoids3
    Gonadocorticoids

    • Androgens (testosterone),

    • Treat deficiencies.

    • Nandrolone, a anabolic androgen, Produces masculinising effect


    Drugs used in disorders of the pancreas
    Drugs used in disorders of the PANCREAS

    • When the pancreas no longer secrete sufficient effective insulin the glucose cannot enter the cells.

    • NIDDM, IDDM, Glucogon.

    • Glucagon acts on the liver to increase blood glucose levels by stimulating the breakdown of glycogen into glucose, and amino acids and free fatty acids


    Insulin
    INSULIN

    • IVI, S/C, IMI (rare).

    • Short medium or long acting.

    • Observe for Hypoglycemic episodes

    • Requirements may vary with pregnancy, infections, stress,

    • Never change type quickly.


    Hypoglcemia
    HYPOGLCEMIA

    Do you know the signs and symptoms of a “hypo” ?


    Oral hypoglycaemic agents 2 types
    Oral Hypoglycaemic agents2 types

    • Sulfonylureas, (Daonil)

      1: Stimulates insulin secretion

      2: inhibits gluconeogenesis (forming glucose from amino acids and fatty acids)

      3: increases the number of insulin receptors in the target cells

    • Biguanide, (Metformin) acts by promoting glucose uptake into cells .

    • Used in precaution with renal disorders


    Nursing implication
    Nursing Implication

    • Monitor BSL

    • Reduced tolerance to alcohol and need to restrict intake

    • Pt to carry medi alert tag

    • Educate family

    • Monitor liver enzymes


    Drugs used on disorders of the parathyroid
    Drugs used on disorders of the PARATHYROID

    • Calcitonin (Decreases) (thyroid) and parathyroid (Increases) blood Calcium.

    • Calcitonin inhibits bone reabsorption

    • S/E dose related nausea and vomiting, local inflammation at inj site, alopecia, headache, Oesopageal pain,

    • Alendroate (Fosamax), increases Ca level. Avoid laying flat ½ hour after ingestion


    Posterior pituitary hormones
    Posterior Pituitary Hormones

    • Antidiuretic Hormone (ADH) Vasopressin

    • Cannot be administered orally.

    • Oxytocin, smooth muscle stimulant, used to initiate labour.

    • Oxytocin


    Identification of drugs
    Identification of Drugs

    • Daonil

    • Actrapid

    • Prednisilone

    • Metformin

    • Syntocinon

    • Thyroxin


    Identification of drugs1
    Identification of Drugs

    • Tolbutamide

    • Gliclazide

    • Dexamethasone

    • Humalin 70:30

    • Pulmicourt


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