Drugs Affecting the Pituitary Gland • Anterior Pituitary Gland • Conditions treated are those of abnormal growth, specifically: * Dwarfism * Acromegaly * Gigantism
Anterior Pituitary Drugs • Dwarfism • Somatrem (protropin) • Somatropin (hymatrope) • Both are similar to endogenous growth hormone • Side effects include: * Pain * Redness at injection site
Anterior Pituitary Drugs • Acromegaly & Gigantism • Treatment of choice is surgical removal of the tumor • Octreotide (sandostatin) * Synthetic drug similar to somatostatin. * Inhibits the release of growth hormone * Side effects include: bradycardia, diarrhea and stomach distress
Posterior Pituitary Drugs • Two posterior hormones are oxytocin and antidiuretic hormone. • Antidiuretic analogues are used to treat diabetes insipidus, nocturnal enuresis (bedwetting). • ADH can cause vasoconstriction and increased BP. • Other names: Vasopressin (pitressin), desmopressin (stimate), lypressin (diapid)
Drugs Affecting the Parathyroid & Thyroid Glands • Parathyroid glands regulate calcium levels. • Thyroid gland produces thyroid hormones. Play a role in regulating growth, maturation, and metabolism. • Hyperparathyroidism, results from a tumor and treatment is surgical removal of all or part of the glands.
Hypothyroidism • Treatment is aimed at thyroid hormone replacement. • Prototype drug: levothyroxine (Synthroid) • No significant side effects in therapeutic doses. • Overdose could lead to thyrotoxicosis or thyroid storm.
Goiter • Not common in developed countries. • AKA Hashimoto’s disease • Chronic autoimmune disease • Treatment is aimed at supplementing the inadequate iodine.
Hyperthyroidism • Typically a result of tumors • Most common cause is Grave’s Disease • Treatment is typically surgical removal of all or part of the gland. • Radioactive iodine may be given • Propylthiouracil (PTU), may be given alone or in conjunction with radiation
Drugs Affecting the Adrenal Cortex • Adrenal cortex secretes 3 classes of hormones: • Glucocorticoids • Mineralocorticoids • Androgens • Two diseases associated with the adrenal cortex: • Cushing’s Disease • Addison’s disease
Cushing’s Disease • Treatment is typically surgical. • Pharmacologic intervention with a antihypertensives: • Spironolactone (Aldactone) • ACE inhibitors – Captopril (Capoten)
Addison’s Disease • Therapy is aimed at replacement therapy. • Cortisone (cortistan) and hydrocortisone (solucortef) are the drugs of choice. • Fludrocortisone (florinef acetate) is a mineralocorticoid that is also available for use
Drugs Affecting the Pancreas • Insulin Preparations • Three Sources: • Beef • Pork • Human • Differ primarily in their onset and duration of action and incidence of allergic reaction. • Preparations may be short acting, intermediate acting or long acting. (table 9-10)
Insulin Preparations • Also classified as nature (regular) or modified. • Natural insulins are used as they occur in nature. • Insulin can also be modified to increase their duration of action, decreasing the number of administrations necessary
Insulin Preparations • Modified insulin preparations include: • Neutral Protamine Hagedorn (regular insulin attached to a large protein to delay absorption) • Lente (attached to zinc) • Insulin preparations derived from beef or pork, lentes, may lead to allergic reactions. • Natural human insulin preparations do not have allergic reactions.
Oral Hypoglycemic Agents • Used to stimulate insulin secretion from the pancreas is patients with NIDDM. • Four Pharmacologic classes: • Sulfonylureas • Biguanides • Alpha-glucosidase inhibitors • Thiazolidinediones
Sulfonylureas • First class of oral hypoglycemics. • Drugs include: • Tolbutamide (Orinase) • Chlorpropamide (Diabinese) • Glipizide (Glucotrol) • Glyburide (Micronase) • Increase insulin secretion from the pancreas. • Side effect: hypoglycemia
Biguanide • Metformin (Glucophage) • Decreases glucose synthesis and increases glucose uptake. • Does not stimulate release of insulin. • Side effects: nausea, vomiting, decreased appetite
Alpha-glucosidase Inhibitors • Acarbose (precose) • Miglitol (glyset) • Delay carbohydrate metabolism • Side effects: flatulence, cramps, diarrhea, abdominal distention
Thiazolidinediones • New class of oral hypoglycemic agents. • Troglitazone (Rezulin) • Promotes tissue response to insulin, making available insulin more effective • Has no major side effects
Hyperglycemic Agents • Two agents: • Glucagon • Diazoxide (proglycem) • Increase blood glucose levels.
Glucagon • Given IM when IV live is unobtainable • Converts glycogen stores into glucose • Side effects: N/V, allergic reactions (rare)
Diazoxide • Inhibits insulin release • Typically used for patient with hyperinsulin secretion from pancreatic tumors • Not indicated for treating diabetes-induced hypoglycemia
D50 • Sugar solution given intravenously for acute hypoglycemia. • Primary side effect is local tissue necrosis if infiltration occurs
Generic Name: Brand Name: Classification: Dextrose 50% None Hyperglycemic DEXTROSE 50%
DEXTROSE 50%Actions • Rapidly increases serum glucose levels • Provides short-term osmotic diuresis
DEXTROSE 50%Indications • Coma of unknown origin • Hypoglycemia • Status Epilepticus
DEXTROSE 50%Contraindications • Intracranial hemorrhage • Delirium tremens • Use with caution in acute alcoholism - ineffective without thiamine; may make thiamine deficiency more severe • Severe pain (paradoxical excitement may occur) • Know or suspected CVA unless hypoglycemia is documented
DEXTROSE 50%Adverse Reactions • Extravasation leads to tissue necrosis
DEXTROSE 50%Dose: • Adult: 25-50 g IV bolus • Pediatric: 25% dextrose, 2-4 ml/kg IV bolus
DEXTROSE 50%Incompatible Reactions • Sodium bicarbonate • Coumadin
DEXTROSE 50%Notes • Onset: Immediate • Peak: Variable • Duration: Variable
Generic Name: Brand Name: Classification: Glucose (oral) Glucola, Insta-Glucose Hyperglycemic GLUCOSE
GLUCOSEActions • A quickly absorbed form of glucose to increase blood glucose levels
GLUCOSEIndications • Hypoglycemia • Conscious patients
GLUCOSEContraindications: • Decreased level of consciousness • Nausea/vomiting
GLUCOSEPrecautions: • Assure that the airway is patent
GLUCOSEDose: • ADULT: sipped slowly by the patient until a feeling of improvement is reported. It is not essential to administer the entire bottle. • PEDIATRIC: Same as adult
GLUCOSENotes: • Onset: Minutes • Peak: Variable • Duration: Variable • Glucola - 300 ml bottles • Glucose pastes and gels also available in various forms
Generic Name: Brand name: Classification: Glucagon None Hyperglycemic GLUCAGON
GLUCAGONActions • Protein secreted by the alpha cells of the pancreas (islets of Langerhans) • Causes a breakdown of stored glycogen to glucose (glycogenesis); increases circulating blood glucose • Unknown mechanism of stabilizing cardiac rhythm in beta-blocker overdose
Actions • Positive inotropic and chronotropic • Decreases GI motility and secretions, pancreatic secretions, and blood pressure
GLUCAGONIndications • Hypoglycemia • Beta-blocker overdose
GLUCAGONContraindications • Hyperglycemia • Known hypersensitivity
GLUCAGONAdverse Reactions • Hypersensitivity (protein-based drug) • Nausea/vomiting
GLUCAGONPrecautions • Caution with administration to patients with a history of cardiovascular or renal disease
GLUCAGONDose • ADULT: 0.5-1.0 mg IV; repeat 1-2 times if no response within 20 minutes • PEDIATRIC: Not used
GLUCAGONIncompatible/Reactions • Incompatible in solution with most other substances
GLUCAGONNotes • Onset: 1 minute • Peak: 30 minutes • Duration: Variable • Should always be used in conjunction with D5W • Must be reconstituted before administration. Must be used or refrigerated after reconstitution.
Generic Name Brand Name Classification Thiamine (Vitamin B) Betalin Vitamin THIAMINE