Drugs for Endocrine Disorders Chapter 29

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Drugs for Endocrine DisordersChapter 29
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Introduction

• The endocrine system is a major controller of
  homeostasis.
• A hormone from the endocrine system may affect
  all body cells and take as long as several days
  to produce a measureable response.
• Small amounts or deficiencies of small quantities
  of hormones may produce very profound effects on
  the body.

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Chemical Messengers

• The endocrine system consists of glands that
  secrete hormones.
• Hormones are released as changes in the internal
  environment of the body occur.
• Hormones are transported by the blood through the
  body.
• One hormone may control the secretion of another
  hormone.
• Hormone action is controlled by a negative
  feedback mechanism.

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Chemical Messengers

• Hormones are used as replacement therapy, as
  antineoplastics, and for their natural,
  therapeutic effects.
• Figure 29.1 pg. 546 The Endocrine System

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Chemical Messengers

• Used for replacement therapy for clients who are
  unable to secrete sufficient quantities of
  endogenous hormones
• Administration of thyroid hormone following a
  thyroidectomy.
• Supplying insulin when the pancreas is not
  functioning.
• Given in the same low-level amounts as if
  secreted by the gland.

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Chemical Messengers

• Used in cancer chemotherapy
• Testosterone for breast cancer
• Estrogen for testicular cancer
• Given in doses much larger than normally secreted
  by the gland.

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Chemical Messengers

• Used to produce an exaggerated response that is
  part of the normal action of the hormone for a
  therapeutic effect
• Giving hydrocortisone to suppress inflammation
  the normal action of glucocorticoids but in
  higher amounts than normally present.
• Supplying small amounts of estrogen or
  progesterone to prevent ovulation and pregnancy.

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Hypothalamus

• The hypothalamus secretes releasing factors
  (hormones) that travel by way of the blood the
  anterior pituitary.
• Releasing factors tell pituitary which hormone to
  release.

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Pituitary Gland

• Pituitary gland releases the appropriate hormone
  into the blood which travels to its target organ
  to cause its effect
• Thyrotropinreleasing hormone (hypothalamus)
  thyroid stimulating hormone (pituitary
  gland)thyroid hormone (thyroid gland target
  organ)

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Pancreas

• Pancreas is essential to both the digestive and
  endocrine systems.
• 1. Exocrine functionsecretes several enzymes
  into the duodenum via the pancreatic duct
• Assist in chemical digestion

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Pancreas

• 2. Endocrine functionislets of Langerhans
  secrete glucagon and insulin directly into the
  blood.

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Insulin

• Insulin secretion is regulated by a number of
  chemicals, hormonal and nervous factors.
• 1. Glucose in the blood stimulates islets of
  Langerhans in the pancreas to secrete insulin.
• 2. Insulin affects carbohydrate, lipid and
  protein metabolism.
• 3. Without insulin glucose cant enter the cells
  to be used for fuel.

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Glucagon

• Glucagon is secreted by the Islets of Langerhans
  in the pancreas when levels of glucose in the
  blood are low.
• 1. Maintains adequate levels of glucose in the
  blood between meals.
• 2. Moves glucose from liver to the blood.

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Type I Diabetes Mellitus
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Type I Diabetes Mellitus

• Treated with dietary restrictions, exercise and
  insulin injections.
• Need meals regularlyevery 4-5 hours to regulate
  blood glucose levels
• Regular, moderate exercise to help cells respond
  to insulin
• Insulin therapy to keep blood glucose levels
  within normal limits.

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Type I Diabetes Mellitus

• Insulin therapy goal is to maintain blood glucose
  levels within strict,normal levelsTable 29.2 pg.
  551.
• 1. Five types/categories of insulin available,
  differing in onset of action and duration of
  action.
• 2. Most insulin today obtained through
  recombinant technology.
• 3. Route of administrationSC
• 4. Doses of insulin highly individualized
• 5. Self-monitoring of blood glucose is
  important.

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Type I Diabetes Mellitus

• Cannot be give orally because it is destroyed by
  digestive enzymes.
• Occasionally, 2 different types of insulin are
  mixed to obtain the desired therapeutic effect.
• Drug Profile (Regular Insulin) on pg.550.
• Actions
• Adverse effects

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Nursing Process for Pts Receiving Insulin

• Pg. 552 !!!!

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Type 2 Diabetes Mellitus

• Type 2 DMadult-onset diabetes
• Pancreas secretes insulin in small amounts but
  insulin receptors in target cells insensitive or
  resistant to insulin.
• Common in overweight clients and those having low
  HDL-cholesterol and high triglyceride levels.

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Type 2 Diabetes Mellitus

• Controlled through lifestyle changes and oral
  hypoglycemic agentsTable 29.3 pg. 554.
• Proper diet and exercise can sometimes increase
  sensitivity of insulin receptors to the point
  drug therapy is not needed for Type 2 diabetes.

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Type 2 Diabetes Mellitus

• Oral hypoglycemic drugs are prescribed when diet
  and exercise have failed to bring blood glucose
  levels within normal limits.
• Five classes of oral hypoglycemics are used
• Be careful with allergies to sulfa
• Classifications based on chemical structure and
  mechanism of action.

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Type 2 Diabetes Mellitus

• All oral hypoglycemics lower blood glucose levels
  when taken on a regular basis.
• Drug profileglipizide (Glucotrol) pg. 555
• Actions
• Adverse effects

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Nursing Process for Pts Receiving Oral
Hypoglycemics

• Pg. 555 !!!

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The Thyroid Gland

• The thyroid gland controls the basal metabolic
  rate and affects every cell in the body.
• Regulates basal metabolic rate and controls
  critical growth of the nervous system.
• Iodine is necessary for the production of thyroid
  hormoneswhich can be found in iodized salt.

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The Thyroid Gland

• Thyroid disorders may be treated by administering
  thyroid hormone or by decreasing the activity of
  the thyroid gland.
• Hypothyroidisminsufficient secretion of thyroid
  hormonetreated with replacement therapy.
• Hyperthyroidismtoo much thyroid hormone
  secretedtreated with thyroidectomy if due to
  tumor, given antithyroid agents to kill or
  inactivate some of the thyroid cells and ionizing
  radiation to kill or inactivate thyroid cells.

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The Thyroid Gland

• Drug profilelevothyroxine (Synthroid)thyroid
  hormone replacement pg. 560.
• Drug profilepropylthiouracil (Propacil)antithyro
  id agent pg. 562.

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The Thyroid Gland

• The correct dose of thyroid or antithyroid drug
  is highly individualized and require periodic
  adjustment.

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Nursing Process for Pts Receiving Thyroid
Hormones

• Pg. 560 !!!

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Glucocorticoids

• The gluccorticoids are released during periods of
  stress and influence carbohydrate, lipid, and
  protein metabolism in most cells.

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Glucocorticoids

• Adrenal glands secrete several classes of steroid
  hormones
• 1. Glucocorticoids
• 2. Mineralocorticoids
• 3. androgens

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Glucocorticoids

• Glucocortiocids affect metabolism of nearly every
  cell.
• 1. During long-term stress mobilize the
  formation of glucose.
• 2. Increase the breakdown and utilization of
  proteins and lipids.
• 3. Potent anti-inflammatory effect
• 4. Promote homeostasis of the cardiovascular,
  nervous, and musculoskeletal systems.

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Glucocorticoids

• Glucocorticoids are prescribed for adrenocortical
  insufficiency and a wide variety of other
  conditions
• Table 29.5 pg. 564

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Glucocorticoids

• Adrenocortical insufficiencydecrease production
  of corticosterioid(Addisons Disease).
• Glucocorticoids are used to dampen inflammatory
  and immune responsesdisorders that may be
  treated with corticosteroids(allergies, seasonal
  rhinitis, asthma, contact dermatitis and rashes,
  hodgkins, leukemias, shock, rheumatoid arthritis,
  ulcerative colitis, crohns disease, renal
  disorders with edema and following transplant
  surgery ..)

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Glucocorticoids

• Significant adverse effects can occur during
  long-term therapy
• Known as Cushings syndrome
• Adrenal atrophy
• Osteoporosis
• Increased risk of infections
• Delayed wound healing
• Peptic ulcer
• Accumulation of fat around shoulders and neck
• Mood and personality changes

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Glucocorticoids

• Drug Profilehydrocortisone (Cortef,
  Hydrocortone) pg. 564.

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Nursing Process for Pts Receiving Glucocorticoids

• Pg. 565 !!!

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Pts Need To Know

• Pg. 567 !!!