Topic 7 Drugs affecting the ENDOCRINE SYSTEM

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Topic 7Drugs affecting the ENDOCRINE SYSTEM
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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.

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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

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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.

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SIGNS AND SYMPTOMS

• Tiredness
• Lethargy
• Weight Gain
• Intolerance to heat
• Dry skin
• Bradycardia
• Mental impairment

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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.

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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.

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SIGNS AND SYMPTOMS

• Exophthalmos
• Tremor
• Nervousness
• Constant hunger
• Weight loss
• Fatigue
• Heat tolerance
• Palpitations

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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.

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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)

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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

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Examples

• Betamethasone
• Dexamethasone
• Prednisone
• Flixotide
• Betnovate cream

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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.

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CUSHINGS SYNDROME

• SIGNS SYMPTOMS
• 1. Moon Face
• 2. Buffalo hump
• 3. Depression
• 4. Anxiety
• 5. Menstrual irregularities
• 6. Acne

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Nursing Implications

• Monitor BP
• Inhaled steroids, wash mouth
• IMI deep
• Not withdrawn immediately, tapered over at least
  2 weeks
• BSL monitoring
• Taken with food

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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

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Gonadocorticoids

• Progesterone only preparations
• Suppress ovarian function
• Mini pill
• S.E. similar to Oestrogen only symptoms

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Gonadocorticoids

• Oral contraceptives
• Combination
• S.E. thromboembolism, heart disease, CVA, liver
  disease

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Gonadocorticoids

• Androgens (testosterone),
• Treat deficiencies.
• Nandrolone, a anabolic androgen, Produces
  masculinising effect

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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

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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.

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HYPOGLCEMIA

• Do you know the signs and symptoms of a hypo ?

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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

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Nursing Implication

• Monitor BSL
• Reduced tolerance to alcohol and need to restrict
  intake
• Pt to carry medi alert tag
• Educate family
• Monitor liver enzymes

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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

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Posterior Pituitary Hormones

• Antidiuretic Hormone (ADH) Vasopressin
• Cannot be administered orally.
• Oxytocin, smooth muscle stimulant, used to
  initiate labour.
• Oxytocin

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Identification of Drugs

• Daonil
• Actrapid
• Prednisilone
• Metformin
• Syntocinon
• Thyroxin

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Identification of Drugs

• Tolbutamide
• Gliclazide
• Dexamethasone
• Humalin 7030
• Pulmicourt