/
 Drugs that affect the Endocrine System  Drugs that affect the Endocrine System

Drugs that affect the Endocrine System - PowerPoint Presentation

giovanna-bartolotta
giovanna-bartolotta . @giovanna-bartolotta
Follow
344 views
Uploaded On 2020-04-05

Drugs that affect the Endocrine System - PPT Presentation

Pharmacology 1950 Unit 8 1 1 define hormone Maintain homeostasis within the blood system Example 2 List the endocrine glands Pineal hypothalmus pituitary Parathyroid thyroid thymus ID: 775780

insulin objective thyroid oral insulin objective thyroid oral glucose identify drug blood describe list hours drugs acting hypoglycemia hormones

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document " Drugs that affect the Endocrine System" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

Drugs that affect the Endocrine System

Pharmacology 1950Unit 8

1

Slide2

1. define hormoneMaintain homeostasis within the blood systemExample: 2. List the endocrine glandsPineal hypothalmus pituitaryParathyroid thyroid thymusAdrenal pancreas gonad

2

Slide3

3. Identify ant. Pituitary hormones

ACTH

TSH

GH

ProlactinFSHLH

3

Slide4

ADHOxytocin5. Identify main thyroid hormonesCalcitoninthyroid

4

4. Identify post. Pituitary hormones

Slide5

Thyroid glandRegulates BMRIodine is essential for synthesis of T3 and T4Negative feedback mechanism to limit secretion as needed.Thyroid hormone attaches to a carrier pro-TBGWhen it reaches the tissue level thyroxin converts to T3 where it enters the cell level.

5

6. Describe how the body synthesizes the thyroid hormones

Slide6

Objective 7: identify the actions of drugs used to treat hyperthyroidismInterferes with synthesis of T3 T4 and prevents conversion to target tissuesDelayed action from several days to weeks.

6

Slide7

7

Slide8

Objective 8: list the anti-thyroid agents used to treat hyperthyroidism (Graves Disease)S/S: increased BMR, tachycardia, wt loss, 4-8x more common in womenDrugs are:Iodine-131 (131I)Propylthiuracil (PTU, Propacil)prototypeMethimazole (Tapazole

8

Slide9

Radioactive iodine Taken up by thyroidDestroys hyperactive thyroid tissueEssentially no other tissue is affectedTakes 3-6 months for fully assess effectIf more than one dose needed, three months between doses is needed

9

Slide10

Dosing is oralAdd to waterNo colorNo taste Be very careful not to spill (hazardous)Client can not be pregnantBecomes euthyroid stateAvoid children/preg women for 1 week..others for few days

10

Slide11

Side effectsTenderness in thyroid glandHyperthyroidism in 40%, second dose neededHypothyroidism

11

Slide12

Drug interactionsLithium carbonate Hypothyroidism develops

12

Slide13

PTU and TapazoleBlock synthesis of T3 and T4Takes days to 3 weeks to see effectCan use long termCan use short term pre subtotal thyroidectomy

13

Slide14

Side effectsPurpuric, maculopapular rashHeadaches, salivary and lymph node enlargementBone marrow suppression HepatotoxicityNephrotoxicity

14

Slide15

Hypothyroid condition in adults called myxedema General s/sWeakness, muscle cramping, slurred speech, intolerance to coldCongenital hypothyroidism called cretinism

15

Objective 9: identify the hypothyroid conditions

Slide16

16

Slide17

Objective 10: list the thyroid agentsLevothyroxine replaces T3 and T4prototype

17

Slide18

Liothyronine synthetic T3Onset of action more rapid than levothyroxineLiotrix synthetic mixture levothyroxine and liothyronine (4 to 1 ratio)Provides consistent levels of T3 and T4

18

Slide19

Thyroid USPFrom beef, pork, or sheep thyroid glandsOldest form available, cheapestLacks purity, uniformity, stabilityClients should avoid changing agents

19

Slide20

Side effectsHyperthryoidismDrug interactionsWarfarin: larger doses neededDigitalis: smaller doses neededHyperglycemia can occur early in therapy

20

Slide21

Objective 11: describe the nursing process associated with administering thyroid or anti-thyroid preparations

21

Slide22

Assessment importantClients sensitive to replacement therapy, monitor for adverse effectsLevothyroxine started low and dose increased over weeks

22

Slide23

Safe handling, storage and disposal of radioactive materials via institution policyBlood levels need to be monitoredClients need to be alert to side effects and reportClients need to report if no improvement

23

Slide24

Objective 12: name the parts of the adrenal glandMedullacortexObjective 13: list the types of hormones secreted by the adrenal glands

24

Slide25

Two hormones from adrenal glandMineralcorticoidsGlucocorticoids

25

Slide26

MineralcorticoidsMaintain fluid and electrolyte balanceUsed to treat adrenal insufficiency Fludrocortisone (Florinef)Aldosterone(prototype)Act on distal tubules, causes water and sodium retentionCauses excretion of potassium and hydrogen

26

Slide27

Objective 14: describe the metabolic effects of the glucocorticoids, and the consequences of these effects

27

Slide28

Increase blood sugarIncrease protein breakdownSuppress immune responsesIncrease sensitivity of smooth muscle to norepinephrineAffects mood and brain excitability

28

Slide29

Objective 15: describe how glucocorticoids suppress inflammationCorticosteroids secreted by adrenal cortex of adrenal gland Glucocorticoids

29

Slide30

Glucocorticoids includeCortisone, hydrocortisone, prednisone etc.Have antiinflammatory, antiallergic activity

30

Slide31

Also affect glucose, protein and fat metabolismGlucocorticoids secreted in response to stressorsCause release of epinephrine

31

Slide32

Objective 16: identify therapeutic uses of glucocorticoidsGlucocorticoids used for replacement therapy when adrenal gland not functionalHigh doses used for inflammation, allergy, asthma

32

Slide33

Use of corticosteroidsUsed with caution in those withDiabetes mellitusHeart failureHypertensionPeptic ulcerMental disturbanceSuspected infection

33

Slide34

After one week, discontinue drug slowly (wean off)Interacts with many drugsMay need to administer every other dayAbrupt discontinuationFever; Malaise; FatigueWeakness; orthostatic dizziness, hypotensionDyspnea; hypoglycemia

34

Slide35

Topical: apply as directed, may use occlusive dressingAlternate –day therapy: give between 6 & 9 AM; give with meals

35

Slide36

Side EffectsElectrolyte imbalance, fluid accumulationSusceptibility to infectionBehavioral changesHyperglycemiaPeptic ulcer formationDelayed wound healing

36

Slide37

Drug interactionsLoop diuretics: can enhance electrolyte lossWarfarin: can have increased or decreased effectHyperglycemia: diabetics and children need to be monitored

37

Slide38

Objective 17: list the glucocorticoid preparations

38

Slide39

Various drugs for topical, oral, injection, inhalationCortisoneDexamethasone (Decadron, Dexone)Fludrocortisone (Florinef)-also mineralcorticoid

39

Slide40

Hydrocortisone (Cortef, Solu-Cortef)prototypeMethlprednisolone (Solu-Medrol, Depo-Medrol)Prednisolone (Delta-Cortef)Prednisone (Deltasone, Apo-Prednisone)prototypeTriamcinolone (Aristocort, Kenalog)

40

Slide41

Objective 18: describe nursing care responsibilities associated with administering glucocorticoidsProvide education, VS, glucose levels, long term use may lead to osteoporosis, Cushing syndrome

41

Slide42

Objective 19: identify the functions of insulin in the bodyGlucose transportAffects carbohydrate, lipid and pro metabolismObjective 20: define diabetes mellitusGroup of metabolic diseases with decreased insulin production or decrease in receptor cells

42

Slide43

Objective 21: identify the site of insulin production in the bodypancreasObjective 22: list the types of diabetesInsulin dependent Type I10% of population; onset 11-13 years of ageInsuline dependent Type 2Deficient amounts of insulin production or insulin resistant cellsGestational Associated with pregnancy

43

Slide44

Objective 23: explain the functions of insulinHormone from beta cells of the pancreas (islets of Langerhans)Normally: 0.5 – 1 unit per hour secretedAdult: 30-50 units per day Insulin transports glucose into cells; helps metabolize protein and fat.Diabetes is a metabolic disorder: all body systems affected

44

Slide45

Objective 24: identify the onset, the peak, and the duration of action for rapid, intermediate, long acting and fixed combinations of insulin

45

Slide46

Lispro and AspartMost rapid acting of insulinsThey are synthetic insulin analogsGive within 10-15 minutes of a mealOnset: 10 minutesPeak: 30 to 60 minDuration: 5 hours

46

Rapid-Acting Insulin

Slide47

Regular insulinHuman regular insulin available, not just animal derivationGive within 30-60 minutes of mealsOnset: 30 minutesPeak: 2.5-5 hoursDuration: 5-10 hoursAdministration: subcutaneous or IV

47

Short-Acting Insulin

Slide48

Neutral protamine Hagedorn (NPH)Contains regular insulin and protamineProtamine binds to insulin: slow releaseOnset: 1-4 hours (pork is 1-1.5 hrs)Peak: 8-12 hours (pork: 8-12 hrs)Duration: 18-24 hours (pork: 24 hrs)

48

Intermediate-Acting Insulin

Slide49

Lispro: can be mixed with protamineHumalog mix 75/2575% Lispro with protamine25% LisproRapid acting insulin with intermediate duration of action (12-24 hours)

49

Slide50

50

Slide51

Humulin UltralenteCrystalline form of Lente insulinOnset: 4-8 hoursPeak: 12-18 hoursDuration: 24-28 hours

51

Long-Acting Insulin

Slide52

Insulin-Glargine solution (Lantus)Biosynthetic Absorbed in a uniform manner-no large fluctuations of insulin levels = reduction in possible hypoglycemiaOnset: 5 hoursPeak: no pronounced peak activityDuration: 24 hours Do NOT mix with other insulins

52

Slide53

53

Slide54

54

Slide55

55

Slide56

56

Slide57

57

Slide58

58

Slide59

Objective 25: describe the local tissue responses that can occur with repeated insulin injections

59

Slide60

Two problems can occurAllergic reactionsFrom proteins in insulin, alcohol, the insulin itselfSwitch types of insulinUse unscented alcoholWill resolve

60

Slide61

LipodystrophiesAtrophy or hypertrophy of subcutaneous fatUse the area because of anesthesia effect

61

Slide62

62

Slide63

Use of the site decreases insulin absorptionCauses erratic absorption of insulinIs cosmetic problem

63

Slide64

Objective 26: list the symptoms of insulin shock Hypoglycemia HeadacheNauseaWeaknessHunger

64

Slide65

LethargyDecreased coordinationGeneral apprehensionSweatingConfusion Blurred or double visionCan progress to coma and death

65

Slide66

Objective 27: discuss glucose elevating drugsThe drug used to raise blood sugarGlucagon Glucose

66

Slide67

GlucagonHormone from alpha cells of pancreas Breaks down stored glycogen to glucoseAids in gluconeogenesisMust have glycogen available or drug will not work

67

Slide68

May see 50% glucose administered IVRaises blood sugarUse when no glycogen is stored

68

Slide69

Objective 28: describe what is meant by sliding scale insulin administration

69

Slide70

Sliding scale insulinPhysician orders doses of insulin based upon blood glucose levelRegular insulin is usedSliding scale is “catch-up”Read the orders carefully

70

Slide71

Blood sugar Insulin0-150 0 units151-200 2 units201-300 5 unitsOver 300, call physician

71

Example

Slide72

Objective 29: describe the action of the oral antidiabetic agentsSome act on the cells to decrease resistanceSome act on the beta cells to increase productionSome inhibit glucose absorption

72

Slide73

Objective 30: identify the conditions under which an oral antidiabetic agent would be usedType 2 diabetesNo control with diet/exercise

73

Slide74

Objective 31: list the oral antidiabetic agents

74

Slide75

Classifications areBiguanide oral hypoglycemic agentsSulfonylurea oral hypoglycemic agentsMeglitinide oral hypoglycemic agentsThiazolidinedione oral hypoglycemic agentsAntihyperglycemic agents

75

Slide76

Metformin (Glucophage)Does not stimulate insulin releaseWill not cause hypoglycemiaCan be used in combination with sulfonylureasDecreases serum triglycerides and LDLSlightly increases HDL

76

Biguanide Oral Hypoglycemics

Slide77

Initial dose: 500 mg BIDCan go up to 2500 mg dailyUse divided dosesIf blood sugar not controlled, add another agent

77

Slide78

Side effects to expectN/VAnorexiaAbdominal crampsFlatulence Will resolveTake with meals to decrease SE

78

Slide79

SE to reportMalaiseMyalgiasRespiratory distressHypotensionLactic acidosis can occurMore if renal failure or excess alcohol intake

79

Slide80

Drug interactionsDrugs that depend upon kidney for excretion can block metformin excretionCan have lactic acidosis develop

80

Slide81

Drugs that cause hyperglycemia with metforminOBCCorticosteroidsPhenothiazinesDiureticsThyroid replacement

81

Slide82

Stimulate release of insulinUse when pancreas can still secrete insulin

82

Sulfonylurea Oral Hypoglycemic Agents

Slide83

Two generationsFirst generationExample: Dymelor (500 mg daily)Second generationExample: Glucotrol (2.5-5 mg daily) Prototype

83

Slide84

Allergy: if allergic to sulfonamides, probably allergic to sulfonylureasDo not administer

84

Slide85

SE to expectN/VAnorexiaAbdominal crampsUsually mildDecrease with continued therapy

85

Slide86

SE to reportHypoglycemiaMonitor blood sugarTreat with glucose sourceHepatotoxicityAnorexia, N/V, jaundice, increased liver function tests

86

Slide87

Blood dyscrasiasRBC, WBCMonitor for sore throat, fever, purpura, jaundiceDermatologic reactionsRash or pruritusIf occurs: hold drug, call MD

87

Slide88

Drug interactionsVarious drugs can cause hypoglycemia such as Warfarin, ethanol

88

Slide89

Hyperglycemia with corticosteroids, phenothiazines and othersBeta-adrenergic blockers: cause hypoglycemia or mask the symptomsAlcohol: Antabuse-like reaction

89

Slide90

Stimulate release of insulin from pancreasCan be used alone or in combinationHave short duration of actionMust take up to QID

90

Meglitinide Oral Hypoglycemics

Slide91

Examples of drugsRepaglinide (Prandin)Nateglinide (Starlix)

91

Slide92

Dosing Can take 1-30 minutes before a mealMust take up to QID: complianceIf skip meal, skip dose

92

Slide93

SE to expect and reportHypoglycemiaDose adjustments may be neededMonitoring of blood glucose important

93

Slide94

Drug interactionsHypoglycemiaEthanol, NSAIDs, Warfarin, MAOIsHyperglycemia Corticosteroids, phenothiazines, estrogens

94

Slide95

B-blockers: cause hypoglycemia or mask symptomsTegretol and others: increase repaglinide metabolismSome macrolides and antifungals can inhibit repaglinide metabolism

95

Slide96

Increase sensitivity of muscle and fat tissue to insulinAllows more glucose to enter cellsInhibit gluconeogenesisDecreases hepatic output of glucoseDo not increase insulin output

96

Thiazolidinedione OHA

Slide97

Can be used alone or in combination with other OHA’s or insulinExamples Pioglitazone (Actos)Rosiglitazone (Avandia)

97

Slide98

Baseline labs: liver function and alkaline phosphatase, CBC, WBC, HDL, LDL, triglyceridesPremenopausal, anovulatory femalesOvulation may resume

98

Nursing Process for TZD’s

Slide99

SE to expectN/VAnorexia Abdominal crampsMildResolve with continued therapy

99

Slide100

SE to reportHypoglycemiaHepatotoxicity Weight gain

100

Slide101

Drug interactionsVarious drugs can cause an increase in hypoglycemia or hyperglycemiaB-adrenergics can mask hypoglycemia or cause itPioglitazone can enhance metabolism of ethinyl estradiol and norethindroneOvulate, become pregnant

101

Slide102

Two drugsAcarbose (Precose)Miglitol (Glyset)They inhibit pancreatic and GI enzymes from digesting sugarsThis delays glucose absorption and decreases postprandial hyperglycemia

102

Antihyperglycemic Agents

Slide103

Acarbose Does not cause hypoglycemiaCan be used with sulfonylureas or metforminDosingTID at start of main meals

103

Alpha

glucosidase

inhibitors

Slide104

SE to expectAbdominal crampsDiarrheaFlatulenceCaused by metabolism of carbohydrates in gutUsually mild, resolve

104

Slide105

SE to reportHypoglycemiaHepatotoxicity Can cause increased AST, ALTHas caused hyperbilirubinemia

105

Slide106

Hyperglycemia can occur with some drugs such as corticosteroids, phenothiazines, OBC, thyroidDigestive enzymes and intestinal adsorbents reduce effect of acarboseAcarbose can decrease absorption of digoxin

106

Slide107

Miglitol (Glyset)Used alone or with sulfonylureasCheck liver function before treatmentAssess for malabsorption syndrome or obstruction in gut

107

Slide108

Dosing Take with first bite of foodStart with 25 mg TID

108

Slide109

SE to expectAbdominal crampsDiarrheaFlatulence

109

Slide110

SE to reportHypoglycemia

110

Slide111

Drug interactionsHyperglycemia with various agents such as cortisone, phenothiazinesPropranolol, Ranitidine not absorbed with concurrent miglitolDigestive enzymes, intestinal adsorbents reduce effect of miglitol

111

Slide112

Objective 32: describe the nursing interventions associated with teaching the diabetic about the treatment

112

Slide113

Objective 33: list the therapeutic uses of estrogen and progesteroneStimulate maturation of female sex organsResponsible for menstrual cycleDrugs used for replacement, birth control, control of prostate cancer, breast cancer, osteoporosis (controversial use)

113

Slide114

Objective 34: name the estrogen preparationsVarious estrogens Conjugated estrogen (Premarin)Esterified estrogens (Estratab)Estradiol (Estrace)Estropipate (Ogen)Ethinyl estradiol (Estinyl)

114

Slide115

Objective 35: name the progesterone preparationsProgestins inhibit ovulation Norethindrone Ethynodiol diacetateDesogestrelLevonorgestrel

115

Slide116

Objective 36: identify the most commonly used ovulatory agentsClomiphene citrate (Clomid)Structurally similar to natural estrogensStimulates ovaries to release ovaUsed for women with reduced circulating estrogen

116

Slide117

Objective 37: describe the actions of the oral contraceptivesEstrogens and progestins induce contraception by inhibiting ovulationEstrogen blocks pituitary release of FSHProgestin inhibits LHBoth alter cervical mucusMay change endometrial wall

117

Slide118

Minipill is progestin-onlyMust take every dayCombination pill Take in 21 day cycle

118

Slide119

Complete physical needed before therapySE expected: nausea, weight gain, spotting, changed menstrual flow, missed periods, depression, mood changes, chloasma, headaches

119

Slide120

SE to report: vaginal discharge, breakthrough bleeding, yeast infectionsBlurred vision, severe headaches, dizziness, leg pain, chest pain, shortness of breath, acute abdominal pain

120

Slide121

Various drugs can decrease effect of OBCBarbiturates, Tegretol, St. John’s Wort, antibacterial agentsDrugs enhance effect and toxic effectsSome antifungals, Warfain, phenytoin, thyroid hormones, benzodiazepines

121

Slide122

< 72 hours after unprotected intercoursePrevinAction: prevents implantation or ovulation

122

Emergency Contraception

Slide123

Objective 38: identify the nursing process for clients with conditions for which female hormones are usedKnowledge deficeitNauseaNoncompliance

123

Slide124

Blood pressure increaseDVTSmoking contributing factor

124

Major S/E