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Advanced Pharmacology > Endocrine Part I > Flashcards

Endocrine Part I Flashcards

1
Q

Major endocrine glands

A
  1. pineal gland
  2. hypothalamus
  3. anterior pituitary
  4. posterior pituitary
  5. Thyroid
  6. parathyroid
  7. adrenal gland
  8. pancreas
  9. gonads
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2
Q

Pineal Gland

A

melatonin

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3
Q

Hypothalamus

A

GnRH, CRH, TRH

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4
Q

Anterior Pituitary

A

FSH, LH, TSH, ACTH, GH, Prolactin

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5
Q

Posterior Pituitary

A

oxytoxin, vasopressin

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6
Q

Thyroid

A

T3, T4, free T3, free T4, RT3

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7
Q

Parathyroid

A

PTH

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8
Q

Adrenal gland

A

cortex secretes, aldosterone, cortisol, sex hormones, medulla secretes epinepherine, norepinepherine

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9
Q

Pancreas

A

insulin, glucagon, others

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10
Q

Gonads

A

estrogen, androgens, testosterone

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11
Q

Type of proteins

A

insulin, GH, prolactin

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12
Q

Type of glycoproteins

A

FSH, LH, TSH

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13
Q

Types of polpeptides

A

ADH, glucagon

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14
Q

Types of Amines

A

T3, T4

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15
Q

Types of lipid-steroids

A

estrogen, cortisol, aldosterone, progesteron, testosterone

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16
Q

Glucocorticoid Indications

A

 Usedforanti-inflammatoryand immunosuppressive actions; replacement in adrenal insufficiency
 Long
actingdexamethasone[and betamethasone] can be used in suppression tests in an attempt to suppress ACTH
◦ To measure plasma cortisol levels for diagnosis of Cushing’s syndrome or excess glucocorticoid secretion from various etiologies

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17
Q

Glucocorticoid Production

A

Adrenal Cortex Produces:

  1. cortisol (glucocorticoid)
  2. aldosterone
  3. androgen
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18
Q

What does cortisol do?

A

 Powerfulant
ainflammatory,modifiesimmunesystem and influences metabolic processes
 RegulatedbyHPAaxisfeedback
 Highestsecretion—0200until0700;lowest—1800
until midnight
 Total10mg/dayinadults[physiologicaldose]

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19
Q

What does aldosterone do?

A

Underinfluenceofrenin-angiotensinsystem;regulates

Na+, K+, water retention

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20
Q

What are androgens?

A

sex hormones

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21
Q

What do Steroids do?

A

 Affects metabolism of CHO/fats/proteins
 Mineralocorticoid effects are related to K+, Na+, water and blood pressure regulation→Florinef®TM
 Cortisone and hydrocortisone have glucocorticoid and mineralocorticoid effects;p&U

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22
Q

Synthetic analogs prednisone, prednisolone and methylprednisolone have what kind of effect?

A

glucocorticoid predominate

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23
Q

Triamcinolone, dexamethasone, betamethasone have what kind of effect

A

glucocorticoid anti-inflammatory effect only

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24
Q

Actions of CHO and protein

A

Stimulates liver gluconeogenesis and inhibits peripheral glucose use
Stimulates protein breakdown to amino acids which supports glycogen deposits and decreases glycolysis

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25
Q

Long term use of glucocorticoids causes

A

◦ Serum glucose ↑, glucose tolerance ↓, insulin
resistance, glycosuria
◦ Muscle atrophy, osteoporosis, impaired wound
healing, skin thinning; weight gain ◦ Growth impairment in children

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26
Q

Actions on Lipid Metabolism

A

Mobilization of fats from areas of deposition
 Increases lipolysis
Increases deposits of fat in back of neck and
supraclavicular areas (buffalo hump), cheeks
and face (moon facies)
 Loss off at in extremities

27
Q

Action on Immune Response

A

 Masks cellular and humoral immunity activity
12
 Can inhibit development of antibodies and impede ability to mount an effective response
◦ Action used to block transplant rejection
 Redistribution of WBCs

28
Q

What happens when there is a redistribution of WBCs/

A

◦ Can see an increased number of WBCs, but ↓ eosinophils, basophils, lymphocytes and monocytes in circulation—more in lymphoid tissues
◦ This decrease in circulating lymphs and macrophages alters immunity

29
Q

Actions—Anti-inflammatory and Stress

A

Inhibits inflammation and immune response Actions useful in asthma and acute allergic
reactions, but can mask serious infection
 Stress causes increased release of glucocorticoids, epinephrine and norepinephrine from adrenal medulla
◦ Steroids support catecholamines to increase HR, BP, glucose for “fight or flight” reaction

30
Q

Adverse effects of steroids

A

 Dermatological
◦ Acne, striae, skin-thinning, delay of wound healing
 CV
◦ Increases BP, blood clots
 GI
◦ PUD, pancreatitis, ulcerative colitis
 Endocrine
◦ Menstrual changes, increases glucose, increases insulin need, hirsutism
 MS
◦ Muscle mass loss, tendon rupture, femoral head
necrosis, fractures  CNS
◦ Headache, vertigo, seizures, steroid psychosis  Electrolytes
◦ Decreases K+, Ca++; Na+ retention
 Ophthalmology
◦ Glaucoma, cataracts

31
Q

What should you monitor with steroids

A

 Short term therapy—Not needed
 Long term therapy
◦ Monitor weight gain, edema, electrolytes, BP
◦ Monitor for infection
◦ Monitor withdrawal
◦ Monitor growth and milestones in children
◦ Monitor for fractures, osteoporosis, thin skin in elderly
 Pregnancy
◦ Doses less than 20 mg/day no effect
◦ Higher doses monitor infant if breastfeeding

32
Q

Patient Eduction with steroids

A 
 Carry wallet card
 Take with food before 9:00am
 Teach adverse effects
 Do not discontinue abruptly
 Avoid live vaccines if on oral Prednisone greater than or equal to 20 mg/day, [or its
equivalent]
 Do not use in fungal infection
33
Q

What does the endocrine system do?

A

 Regulates growth, pubertal development, reproduction, homeostasis, and the production, storage and utilization of energy
 Hormones are often activated by a feedback loop
 Hormone
secretion can be regulated by nerve cells and the immune system
 Hormones stimulate action in target organ to produce a hormone to control body functions

34
Q

Normal Thyroid Function

A

Thyroid controls BMR, O2 use, respiratory rate, body temp, cardiac output, CHO/fat/protein metabolism, enzyme activity, growth and maturation
 Thyroid released T4is90-99.97%protein bound while T3 is 10-99.7% protein bound
 T4 is converted to T3 by removal of iodine– the body reduces T4 to T3, so usually only T4 is given as replacement
 Unbound hormone is active or free [can now measure free hormone levels]

35
Q

Elevated TSH indicates

A

hypothyroidism which is a failure within the thyroid gland

36
Q

A low TSH with a low T3 and T4 is indicative of

A

secondary hypothyroidism from a lack of secretion of TSH from pituitary

37
Q

CNS growth can be impaired without thyroid hormone

A

In children can cause mental retardation

In adults can cause CV, GI, MS and CNS function impairment

38
Q

Hypothyroidism

A

 Women more often affected
 Signs and symptoms–tiredness, lethargy,
decreased BMR, cold sensitivity, menstrual irregularities
 TSH most sensitive test
 Can draw free T4 if diagnosis still in question after TSH results obtained

39
Q

Symptoms of hypothyroidism

A

◦ Pale, puffy, expressionless face
◦ Cold dry skin, brittle hair
◦ ↓ heart rate, fatigue, lethargy, ↓ mental acuity

40
Q

Common drugs for hypothyroidism

A

◦ Levothyroxine—Synthroid®TM [T4]
◦ Liothyronine—Cytomel®TM [T3]
◦ Armour Thyroid USP

41
Q

Thyroid supplements

A

 Thyroxine(T4)is used to treat uncomplicated hypothyroidism and is usually taken lifelong
 Triiodothyronine(T3) is used in the suppression treatment of thyroid cancer
 All drugs must be individualized to patient
 STARTLOWANDGOSLOW!
 Treatment based on labs and patient’s clinical
response; titration is done every 6-8 weeks [no sooner]

42
Q

T4: Levothyroxine (Synthroid®TM) dosage

A

 T4 converted to T3 in plasma–T3 is most active and has more risk for cardiotoxicity
 Mean replacement dosage is 1.6mcg/kg/day
 Give daily before breakfast; longt 1 ⁄2, can be
held for 2 weeks
 75mcg=0.075mg
 Adults<65 without CAD begin with50-100 mcg
 Elderly or those with CAD begin with 25 mcg
 Titrate with TSH level and clinical picture
 Maintenance is usually75-150mcg

43
Q

Pharmacokinetics is Levothyroxine

A

drug of choice (DOC)

 T 1⁄2 6-7 days (euthyorid)
 9-10 days (hypothyroid)
 3-4 days (hyperthyroid)
 Highly protein bound

 Dosing for children—3-5 mcg/kg/day [to a max of 100-150 mcg]

44
Q

Levothyroxine info

A 
 GI absorption is 50-80%
 Drug has narrow therapeutic range and
absorption changes can make changes in
blood level
 Cautious use with recent MI
 Do not stop drug abruptly
 Diabetes mellitus can be aggravated with initiation of the drug
45
Q

Drug interaction with Levothyroxine

A

◦ Ferrous sulfate, Carafate, aluminum hydroxide antacids, estrogen, insulin, oral hypoglycemics, Digoxin, Warfarin

46
Q

Toxicity of Levothyroxine

A

◦ Narrow TI, stop 3-5 days, then restart at lower dose

35

47
Q

Side effects of Levothyroxine

A

◦ CV – angina, arrhythmia, palpitations
◦ GI – abdominal cramps, n/v, diarrhea
◦ CNS – insomnia, headaches, nervousness

48
Q

True or false: Generics are approved of levothyroxine and are equal

A

FALSE they are not. If you must use generic do not change manufacturers

**Many patients need brand name drug in order to be euthyroid

49
Q

T3-Liothyronine [Cytomel] pharmacokinetics

A

T1⁄2 2-5days

 Not protein bound

50
Q

T3-Liothyronine [Cytomel]

Dosing

A

 Adult—25 mcg increase by 25 mcg q 6-8 weeks [to a maximum of 100 mcg/d]
 Elderly—5 mcg/d increase by 5 mcg every 6-8 weeks [maintenance is 25-75 mcg/d]
 Children—5 mcg/d increase by 5 mcg every 3- 4 weeks to 20 mcg/d infants, 50mcg/d in children [ages 1-3]

51
Q

Precautions with

T3-Liothyronine [Cytomel]

A

◦ Cardiovascular

52
Q

Interactions with T3-Liothyronine [Cytomel]

A

◦ Cholestyramine , oral sulfonylureas,

estrogen, warfarin, phenytoin, cardiac glycosides

53
Q

Dessicated-Armour Thyroid

A

 Natural—ground up thyroid gland of a pig or cow
 Ratio of T3/T4 varies from “batch to batch”
 Erratic oral absorption
 Bioabilability 50-75%
 Prescribing this agent is not EB and not
supported by AACE
 Do not give this agent!!

54
Q

Goals of thyroid therapy

A

 Return patient to the euthyroid state

 TSH in the range of 0.5-4.0  IU/mL

55
Q

Thyroid Hormone Pearls

A 
 Dose carefully-start low go slow
 Encourage compliance—morning dose or
evening dose [2 hours after food]
 Teach signs and symptoms of hypothyroidism
and hyperthyroidism
 Hold drug if HR>100
 Caution changing manufacturers—use brand
name if possible
 PregnancyCategoryA
 Caution with hx of CV disease/recentMI
56
Q

Hyperparathyroidism

A

 Grave’s Disease, toxic goiter, thyroiditis
 Use drugs to suppress iodine so T4 cannot be
made
 Once euthyroid(normal)for6-12months,
may decide to continue treatment for 12 months more, then try to stop – however, signs and symptoms may return
◦ Toxic goiter will never remit with short term use
of meds—will have to continue them for life, or have ablation with I131

57
Q

Antithyroid Drugs

A 
Antithyroid Agents
◦ Thiourea drugs
◦ Iodine salts & radioactive iodine
Three mechanisms of action
 Interfere with hormone production
 Modify the response to the hormone 
 Destroy the Gland
58
Q

Thyroid suppressants

A

 Propylthiouracil (PTU)[generic]
◦ 300-400 mg day; maintenance 100-150 mg day 45
 Methimazole (TAPAZOLE®TM)daily
◦ Up to 60 mg day divide TID; maintenance 5-15 mg
day divide TID
Drugs block production of T4 and change to T3 – does not affect stored or circulating
hormones
 Monitor blood count for agranulocytosis, infection with > 40 mg day; other drugs which suppress bone marrow has additive effect

59
Q

Antithyroid Drug: Tapazole

A 
◦ Most potent [10 x’s more
potent than PTU]
◦ Category D
◦ Cross to breast milk
◦ Effects seen sooner
◦ Clears body faster
◦ Adult—5 mg q 8 hr
[can be given once/d]
◦ Children—0.4
mg/kg/d [in divided doses every 8 hrs.]
60
Q

Antithyroid Drug: PTU

A

💠CategoryD
💠Takes weeks to see effect 💠Short t 1⁄2 life—frequent dosing
💠Adult: 300-450 mg/day [divided q 8 hours]; maintenance dose is : 100-150 mg/day divided into BID or TID doses]
💠Children: 5-7 mg/kg/d [up to 300mg/day;
maintenance dose is 1⁄3 to 2⁄3 of initial dose]

61
Q

Thyroid Suppressants

A

 Avoid iodine ingestion [shellfish; kelp]
 Drug interactions – Digoxin, anticoagulants
 Can use β blockers for symptom control only

62
Q

Adverse effects of thyroid suppressants

A 
◦ Pruritic
maculopapular rashes, arthralgia, & fever
◦ Leukopenia
◦ Hepatotoxicity
◦ Agranulocytosis 
◦ Hypothyroidism
63
Q

Other treatment options for hyperthyroidism

A 
 Radioactive iodine [I131])
 Antithyroid agents
 Surgery
 Beta Adrenergic Receptor Agonists
◦ Propranolol [Inderal];
Nadalol [Corgard]
 Calcium Channel Blockers
◦ Diltiazem
 Iodide Salts
◦ Potassium iodide solution—SSKI [Lugol’s solution] 
 Radioactive iodine
◦ Sodium Iodide 131

Advanced Pharmacology (18 decks)

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