Endocrine Drugs

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  1. Hormones are?
    Chemical messengers
  2. Hormones are released in response to what?
    A change in the body's internal environment
  3. Parts of the endocrine system are?
    • Pineal gland
    • Hypothalamus
    • Pituitary gland
    • Parathyroid gland
    • Thyroid gland
    • Thymus
    • Adrenal glands
    • Pancreas
    • Gonad (ovaries)
    • Gonad (testes)
  4. Goals of hormone pharmacotherapy are?
    Replacement Therapy- for those who aren't able to secrete sufficient quantities of their own endogenous hormones

    Cancer Chemotherapy- testosterone for breast cancer & estrogen for testicular cancer

    To produce exaggerated response taht is part of the normal action of the drug to achieve some therapeutic advantage.
  5. Adrenal Cortex secretes what hormone?
    Its endocrine disorders & drug treatment for it are?

    Hypersecretion: Cushing's Syndrome -- NO DRUGS

    Hyposecretion -- GLUCOCORTICOIDS
  6. Pancreas (Islets of Langerhans) secretes what hormone?
    Its endocrine disorders and drug treatment for it are?

    Hyposecretion: diabetes mellitus -- INSULIN
  7. Pituitary secretes what hormones?
    Its endocrine disorders & drug treatment for it are?
    • Growth Hormone
    • Antidiuretic Hormone


    Hyposecretion: diabetes insipidus -- VASOPRESSIN DESMOPRESSIN (DDAVP, STIMATE)
  8. Thyroid secretes what hormones?
    Its endocrine disorders & drug treatment for it are?
    Thyroid Hormone (T3 & T4)

    Hypersecretion: Graves' Disease -- PROPHYLTHIOURACIL (PTU)

    Hyposecretion: myxedema (adults) & cretinism (children) -- THYROID HORMONE (SYNTHROID)
  9. The hypothalamus secretes chemicals called?
    Releasing factors or releasing hormones that travel via blood vessels a short distance to the anterior pituitary gland.

    Hypothalamus > releasing factors > anterior pituitary gland > target organ
  10. The pancreas is a gland that is essential to?
    The digestive & endocrine system
  11. Function of the pancreas cells, Islets of Langerhans, are?
    Pancreas' endocrine function: secretion of glucagon & insulin.
  12. The prancreas secretes these hormones directly where?
    Into blood capillaries, where they are available for transport to body tissues.
  13. Insulin is regulated by various...?
    1 of the most important regulators is the level of...?
    Chemical, hormonal, & neural regulators

    Level of glucose in blood stream
  14. Action of the pancreas after a meal, blood glucose rise (hyperglycemia) & when blood glucose levels fall (hypoglucemia)?
    Pancreas stimulated to secrete insulin.

    Islet cells sends pancreas a message to STOP screting insulin when blood glucose levels fall (hypoglycemia)
  15. Insulin affects which 3 metabolisms in most cells of the body?
    • Carbohydrate
    • Fat
    • Protein
  16. Insulin's most important actions is?
    to assist in glucose transport.
  17. Primary function of glucagon is?
    To maintain adequate levels of glucose in the blood between meals.
  18. Glucagon has what kind of an effect?
    Hyperglycemic effect: its presence moves glucose from cells, primarily in the liver to bloodstream.
  19. Type 1 Diabetes Mellitus is also called?
    Juvenile-onset diabetes; most common diseases of childhood (ages 11-13)
  20. Type 1 diabetes mellitus is a result from a lack of?
    Insulin secretion by the pancreas
  21. Who has a higher risk of acquiring type 1 diabetes mellitus?
    Genetic component; children & siblings of people w/ disease have higher risk
  22. Most diagnostic sign of Type 1 diabetes?
    Sustained hyperglycemia; Fasting plasma glucose levels of 126mg/dL or greater on 2 separate occasions
  23. Typical s/s of type 1 diabetes
    • Hyperglycemia-fasting blood glucose greater than 126mg/dL
    • Polyuria-excessive urination
    • Polyphagia-increase in hunger
    • Glucosuria-high levels of glucose in the urine
    • Weight loss
    • Fatigue
  24. Untreated type 1 & type 2 diabetes produces?
    Serious long-term damage to arteries leading to Heart Disease, Stroke, Kidney Disease, & Blindness.
  25. Ketoacids
    • Produced in type 1 diabetes when glucose can't enter cells & lipids are used as energy source.
    • Ketoacids are producd as waste products.
    • Gives breath an acetone-like, fruity odor.
  26. High levels of ketoacids changes what?
    pH of the blood, producing acidosis & possibly coma.
  27. Type 1 diabetes requires drug therapy w/?
    • Insulin - reserved for more severe deficiency states
    • hypoglycemics - given for milder forms of diabetes
  28. Type 1 is treated with?
    A combination of prper meal planning, exercise (regular moderate), & insulin.
  29. Insulin therapy goal?
    Maintain blood glucose levels within strict, normal limits.
  30. Type 2 diabetes cause?
    • Secretion of insulin amounts too small.
    • Insulin receptors in target tissues have become insensitive/ resistant to hormone.
    • Small amounts present does not bind effectively to receptor = no effect achieved.
  31. Type 2 diabetics usually controlled w/?
    Oral hypoglycemic agents.

    Insulin given in severe cases.
  32. Many type 2 diabetics are?
    Obese & need medically supervised plan to reduce weight gradually & exercise safely.
  33. 6 General classes of oral hypoglycemic medications for Type 2 diabetes?
    • Sulfonylureas
    • Biguanides
    • Thiazolidinediones
    • Alpha-Glucosidase Inhibitors
    • Meglitinides
    • Dipeptidyl-Peptase 4 Inhibitors
  34. Therapy with oral hypoglycemics is usually initiated w/?
    • A single agent
    • If therapeutic goals not achieved, 2 agents may be administered
    • Failure to achieve normal blood glucose w/ 2 oral hypoglucemics indicates need for insulin
  35. Insulin Analogs (Rapid Acting)
    • Insulin aspart (NovoLog) - 5-10min before meals
    • Insulin glulisine (Apidra) - 5-10min before meals
    • Insulin lispro (Humalog) - 0-15min before meals
  36. Insulin Analog (Longer Acting)
    Insulin glargine (Lantus) - For type 1 diabetes; Given same time each day (usualy @ bedtime)
  37. Insulin Mixtures (Short To Intermediate Acting)
    • NPH 70%
    • Regular 30%
    • (Humulin 70/30, Novolin 70/30) - appear cloudy/milky

    • NPH 50%
    • Regular 50% - applear cloudy/milky
  38. Short-Acting Insulin (Peak Activity is Usually Between 2 & 4 Hours)
    Regular insulin (Humylin R, Novolin R, Pork Regular Iletin II, Reualr Purified Pork Insulin) - 30min before meal.
  39. Intermediate-Acting Insulin (Peak Activity Usually Between 4-12 Hours)
    Isophane insulin suspension (NPH, NPH Iletin II, Humulin N, Novolin N) - 30min before 1st meal of day. 2nd smaller dose may be prescribed 30min before supper/ @ bedtime.

    Insulin zinc suspension (Lente Iletin II, Lente L, Humulin L, Novolin N) - 30min before breakfast. Some require another 30min for supper/bedtime.
  40. Longer-Acting Insulin (Peak Activity Usually 6-20 Hours)
    Extended insulin zinc suspension (Humulin U, Ultralente) - 30min before breakfast by deep subQ. May be mixed w/ Semilente but not others.
  41. NPH means?
    Neutral Protamine Hagedorn
  42. Alpha-Glucosidase Inhibitors (Oral Hypoglycemics)
    Acarbose (Precose) - avoid use w/ chronic intestinal disease

    Miglitol (Glyset) - Cautiously used w/ renal impairment
  43. Biguanides (Oral Hypoglycemics)
    Metformin HCL (Glucophage) - Lactic acidosis may be a complication
  44. Meglitinides (Oral Hyperglycemics)
    Nateglinide (Starlix) - cautiously used in hepatic/ renal impairment.

    Repaglinide (Prandin) - Glitazone type. Cautiously used in hepatic/ renal impairment.
  45. Sulfonylureas, 1st generation (Oral Hyperglycemics)
    Chlorpropamide (Diabinese, Novopropamide) - Known sensitivity to sulfonylureas & sulfonamides.

    Tolazamide (Tolamide, Tolinase) - Short-acting, older drug used when others fail to control blood glucose.

    Tolbutamide (Orinase) - Similar to tolazamide, used when others fail to control.
  46. Sulfonylureas, 2nd Generation (Oral Hypoglycemics)
    Glimepiride (Amaryl) - Not recommended during pregnancy

    Glipizide (Glucotrol)

    Glyburide (DiaBeta, Micronase, Glynase) - Combination drug containing glyburide & metformin.
  47. Thiazolidinediones (Oral Hypoglycemics)
    Pioglitazone (Actos) - Given w/out regart to meals

    Rosiglitazone (Avandia) - Often combination w/ metformin or insulin to control blood glucose
  48. Dipeptidyl-Peptidase 4 Inhibitors (Oral Hypoglycemics)

    AKA DDP-4 inhibitors
    Saxaglipton (Onglyza) - May be used in combination w/ antidiabetics

    Sitagliptin (Januvia) - Actions occur only in presence of rising serum glucose levels; type of incretin enhancement therapy
  49. Combinatin Drugs (oral hypoglycemics)
    • Glipizide/metformin (Metaglip)
    • Glyburide/metformin (Glucovance)
    • Rosiglitazone/metformin (Avandamet)

    Lactic Acidosis is a complication in many cases if meds no taken properly.
  50. Dipeptidylpeptidase 4 (DDP-4) inhibitors or incretin enhancers are effective at what when taken within proper parameter?
    Effective at lowering blood glucose without causing extreme hypoglycemia.
  51. DDP-4 inhibitors are for type 2 diabetics that is responsible for?
    Breaking down gastric hormones called incretins.
  52. Incretin's action
    In response to food presence in small intestine, incretins normally inhibit release of glucagon, stimulating release of insulin from pancreas.

    Also delays gastric emptying & convey impulses to brain about satiety (Feeling of being full)
  53. Inhancement of incretin results in?
    A decreased glucagon secretion, increaed insulin secretion, & stabilization of hormone fluctuations after a meal.
Card Set:
Endocrine Drugs
2012-04-25 16:47:03

Chapter 31
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