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Endocrine Drugs

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Endocrine Drugs PharmacologyPharmacologyPharmacology DrugsDrugs thatthat AffectAffect thethe EndocrineEndocrine SystemSystem TopicsTopicsTopics •• Pituitary Pituitary DrugsDrugs •• Parathyroid/Thyroid Parathyroid/Thyroid DrugsDrugs •• Adrenal Adrenal DrugsDrugs •• Pancreatic Pancreatic DrugsDrugs •• Reproductive Reproductive DrugsDrugs •• Sexual Sexual BehaviorBehavior DrugsDrugs FunctionsFunctionsFunctions •• Regulation Regulation •• Control Control GlandsGlandsGlands ExocrineExocrine EndocrineEndocrine •• Secrete Secrete enzymesenzymes •• Secrete Secrete hormoneshormones •• Close Close toto organsorgans •• Transport Transport viavia bloodstreambloodstream •• Require Require receptorsreceptors NervousNervous EndocrineEndocrine WiredWired WirelessWireless NeurotransmittersNeurotransmitters HormonesHormones ShortShort DistanceDistance LongLong Distance Distance ClosenessCloseness ReceptorReceptor Specificity Specificity RapidRapid OnsetOnset DelayedDelayed Onset Onset ShortShort DurationDuration ProlongedProlonged Duration Duration RapidRapid ResponseResponse RegulationRegulation MechanismMechanismMechanism ofofof ActionActionAction HypothalamusHypothalamusHypothalamus HypothalamicHypothalamicHypothalamic ControlControlControl PituitaryPituitaryPituitary PosteriorPosteriorPosterior PituitaryPituitaryPituitary Target Actions Oxytocin Uterus ↑ Contraction Mammary ↑ Milk let-down ADH Kidneys ↑ Water reabsorption AnteriorAnteriorAnterior PituitaryPituitaryPituitary Target Action GH Most tissue ↑ Growth TSH Thyroid ↑ TH secretion ACTH Adrenal ↑ Cortisol Cortex secretion AnteriorAnteriorAnterior PituitaryPituitaryPituitary Target Action FSH Ovaries Follicles Testes Estrogen Sperm LH Ovaries Ovulation Testes Progesterone Testosterone AnteriorAnteriorAnterior PituitaryPituitaryPituitary Target Action Prolactin Mammary Milk Gland production PituitaryPituitaryPituitary HormonesHormonesHormones ThyroidThyroidThyroid ThyroidThyroidThyroid Target Action Thyroxine Most cells ↑ BMR Triiodothyronine Calcitonin Mostly bone ↓ Calcium HypothyroidismHypothyroidismHypothyroidism HyperthyroidismHyperthyroidismHyperthyroidism ParathyroidParathyroidParathyroid ParathyroidParathyroidParathyroid Target Action Parathyroid Bone ↑ Calcium (PTH) Kidney GI Tract CalciumCalciumCalcium RegulationRegulationRegulation PancreasPancreasPancreas PancreasPancreasPancreas •• Alpha Alpha cells:cells: glucagonglucagon •• Beta Beta cells:cells: insulininsulin PancreasPancreasPancreas Target Action Glucagon Liver ↑ Glucose Insulin General ↓ Glucose GlucoseGlucoseGlucose RegulationRegulationRegulation AdrenalAdrenalAdrenal AdrenalAdrenalAdrenal MedullaMedullaMedulla Target Action Norepi Heart Prolongs Epi Blood SNS Effects vessels Liver AdrenalAdrenalAdrenal CortexCortexCortex Target Action Aldosterone Kidney ↑ Na reabsobtion ↑ Water retention Cortisol Most Tissue ↑ Glucose ↓inflammation AnteriorAnteriorAnterior PituitaryPituitaryPituitary DrugsDrugsDrugs InadequateInadequate GrowthGrowth ExcessiveExcessive GrowthGrowth HormoneHormone HormoneHormone •• Dwarfism Dwarfism •• Acromegaly Acromegaly •• somatrem somatrem (Protropin (Protropin®®)) •• Gigantism Gigantism •• homatropin homatropin •• Surgical Surgical removalremoval 1º1º ® (Humatrope(Humatrope®)) •• octreotide octreotide (Sandostatin®)(Sandostatin®) PosteriorPosteriorPosterior PituitaryPituitaryPituitary DrugsDrugsDrugs •• Oxytocin Oxytocin •ADH•ADH –– Diabetes Diabetes insipidusinsipidus –– Nocturnal Nocturnal enuresisenuresis •• vasopressin vasopressin (Pitressin(Pitressin®®)) •• desmopressin desmopressin (Stimate (Stimate®®)) •• lypressin lypressin (Diapid (Diapid®®)) ParathyroidParathyroidParathyroid DiseasesDiseasesDiseases •• Hypoparathyroidism Hypoparathyroidism –– Inadequate Inadequate calciumcalcium levelslevels •• TX: TX: increased increased dietary dietary calcium calcium •• Hyperparathyroidism Hyperparathyroidism –– Excessive Excessive calciumcalcium levelslevels •• TX: TX: surgicalsurgical removalremoval ThyroidThyroidThyroid DiseaseDiseaseDisease •• Hypothyroidism Hypothyroidism –– Hormone Hormone replacementreplacement –– levothyroxine levothyroxine (Synthroid®) (Synthroid®) •• Hyperthyroidism Hyperthyroidism –– Thyrotoxicosis Thyrotoxicosis –– Surgical Surgical removalremoval –– propylthiouracil propylthiouracil (PTU) (PTU) AdrenalAdrenalAdrenal CortexCortexCortex ACTHACTH HypersecretionHypersecretion ACTHACTH HyposecretionHyposecretion Cushing’sCushing’s DiseaseDisease Addison’sAddison’s DiseaseDisease •• Surgical Surgical removalremoval •• Replacement Replacement therapytherapy •• Inhibit Inhibit adrenaladrenal •• Cortisone Cortisone (Cortistan(Cortistan®®)) secretionsecretion •• Hydrocortisone Hydrocortisone ® –– ketoconazol ketoconazol (Nizoral (Nizoral ®)) (SoluCortef(SoluCortef®®)) •• Symptomatic Symptomatic tx:tx: •• Fludrocortisone Fludrocortisone –– Antihypertensives Antihypertensives (Florinef(Florinef Acetate Acetate®®)) PancreasPancreasPancreas BloodBlood PotassiumPotassium BloodBlood GlucoseGlucose InsulinInsulinInsulin PreparationsPreparationsPreparations •• Regular Regular InsulinInsulin –– Natural Natural insulininsulin •• Modified Modified InsulinInsulin –– Increased Increased durationduration ofof actionaction –– NPH NPH (neutral(neutral protaminprotamin Hagedorn) Hagedorn) •• Natural Natural plusplus protaminprotamin –– Lente Lente •• Attached Attached to to zinc zinc to to prolong prolong absorption absorption OralOralOral HypoglycemicHypoglycemicHypoglycemic AgentsAgentsAgents SulfonylureasSulfonylureas Alpha-glucosidaseAlpha-glucosidase inhibitors ⇑⇑insulininsulin secretionsecretion inhibitors ® • Delay carbohydrate tolbutamidetolbutamide (Orinase (Orinase®)) • Delay carbohydrate metabolism chlorpropamide (Diabinese®®) metabolism chlorpropamide (Diabinese ) ® ® acarboseacarbose (Precose (Precose®)) glipizideglipizide (Glucotrol (Glucotrol®)) ®® ® miglitolmiglitol (Glyset (Glyset )) glyburideglyburide (Micronase (Micronase®)) BiguanidesBiguanides ThiazolidinedionesThiazolidinediones metformin (Glucophage®®) metformin (Glucophage ) ⇑⇑ InsulinInsulin effectivenesseffectiveness ⇓ Glucose synthesis ® ⇓ Glucose synthesis troglitazonetroglitazone (Rezulin (Rezulin®)) ⇑⇑GlucoseGlucose uptakeuptake HyperglycemicHyperglycemicHyperglycemic AgentsAgentsAgents •• Glucagon Glucagon •• diazoxide diazoxide –– ⇑⇑gluconeogenesisgluconeogenesis (Proglycem®)(Proglycem®) –– Inhibits Inhibits insulininsulin releaserelease •DW •D5050W EstrogensEstrogensEstrogens &&& ProgestinsProgestinsProgestins •• Estrogens Estrogens usedused forfor •• Progestin Progestin post-menopausalpost-menopausal –– Diminish Diminish side side effects effects hormonehormone replacementreplacement ofof estrogenestrogen therapytherapy therapy.therapy. –– Nausea, Nausea, fluidfluid retention,retention, breast tenderness –– estradiol estradiol (Estrace (Estrace®®)) breast tenderness – medroxyprogesterone –– conjugated conjugated estrogens estrogens – medroxyprogesterone acetate (Provera®®) (Premarin(Premarin®®)) acetate (Provera ) – norethindrone acetate –– estropipate estropipate (Ogen (Ogen®®)) – norethindrone acetate (Aygestin(Aygestin®®)) OralOralOral ContraceptivesContraceptivesContraceptives •• Combination Combination ofof estrogenestrogen andand progestinprogestin –Loestrin–Loestrin®®,, LevoraLevora®®,, NordetteNordette®®,, OvoconOvocon®®,, NorinylNorinyl®®plusplus manymany othersothers •• Minipill: Minipill: progestinprogestin onlyonly –– Micronor Micronor®®,, Nor-Q.D.Nor-Q.D.®®,, OrvetteOrvette®® •• Prime Prime sideside effect:effect: ⇑⇑riskrisk ofof thromboembolismthromboembolism UterineUterineUterine StimulantsStimulantsStimulants &&& RelaxantsRelaxantsRelaxants •Stimulants•Stimulants ((OxytocicsOxytocics)) •• Relaxants Relaxants ((tocolyticstocolytics)) •• ⇑⇑ uterineuterine contractioncontraction •• Relax Relax uterineuterine smoothsmooth •• Indication: Indication: musclemuscle –– Induce Induce laborlabor •Beta•Beta2 agonistsagonists – Postpartum 2 – Postpartum – terbutaline (Brethine®®) hemorrhagehemorrhage – terbutaline (Brethine ) – ritodrine (Yuptopar®®) •• oxytocin oxytocin (Pitocin (Pitocin®®)) – ritodrine (Yuptopar ) •• ergonovine ergonovine (Ergotrate(Ergotrate®®)) InfertilityInfertilityInfertility AgentsAgentsAgents •• Promote Promote maturationmaturation ofof ovarianovarian folliclesfollicles •• clomiphene clomiphene (Clomid (Clomid®®)) •• urofollitropin urofollitropin (Metrodin (Metrodin®®)) MaleMaleMale ReproductiveReproductiveReproductive AgentsAgentsAgents •• Testosterone Testosterone ReplacementReplacement –– methyltestosterone methyltestosterone (Metandren (Metandren®®)) –– fluoxymesterone fluoxymesterone (Halotestin (Halotestin®®)) •• Benign Benign ProstaticProstatic Hypertrophy Hypertrophy –Surgery–Surgery –– finasteride finasteride (Proscar (Proscar®®)) SexualSexualSexual BehaviorBehaviorBehavior •• Most Most areare sideside effectseffects fromfrom otherother medicationsmedications –– Antihypertensives Antihypertensives & & psychoactivepsychoactive drugsdrugs •• sildenafil sildenafil (Viagra (Viagra®®)) ThankThankThank You!You!You! •• To To TempleTemple CollegeCollege EMSEMS ProfessionsProfessions forfor permissionpermission toto useuse theirtheir materialsmaterials.
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