PHARMA-ENDOCRINE

s/e: arthralgia, myalgia, peripheral edema, weakness, paresthesia, cephalgia

side effects of somatropin

a/e: seizures, intracranial hypertension, leukemia

adverse effects of somatropin

inhibits the effect of somatropin

contraindication of GH: those taking with corticosteroids effect

enhances efficacy of the drug leading to \n further hypoglycemia

contraindication of GH: those taking antidiabetics effect

Prader Willi Syndrome

(GH HORMONE) contraindicated to pediatric patients with growth hormone deficiency due to what diseae?

pegvisomant

MOA: blocks GH receptor sites

hyperhydorsis, cephalgia, fatigue

side effects of pegvisomant

chest pain, hypertension, elevated hepatic transaminase

adverse effects of pegvisomant

GH receptor antagonist

pegvisomant is a ????

lanreotide acetate

prevents pituitary gland to secrete GH and the effect is dependent on the dose given

lanreotide acetate, octreotide acetate

somatostatin analogues example

4 weeks

lanreotide is given every?

s/e: diarrhea, abdominal pain, nausea & vomiting, constipation, weight loss, and flatulence

side effects of lancreotide acetate

octreotide acetate

MOA: inhibits production of GH

s/e: nausea, bloating, flatus

side effects of octreotide acetate

a/e: cardiac toxicity, bradycardia, arrhythmia

adverse effects of octreotide acetate

bromocriptine asylate

inhibits the secretion of Gh caused by tumor in the pituitary gland

bromociptine asylate

GH hormone drug that can be taken orally since it does not entirely focus on GH

s/e: nausea, anorexia, dyspepsia, xerostomia

side effects of bromocriptine asylate

a/e: hypertension, myocardial infarction, stroke, seizure

adverse effects of bromocriptine asylate

thyrotropin

stimulates thryoid gland to release T3 (triiodothyronine) and T4 (thyroxine)

adrenocorticotropic hormone

a hormone released by the pituitary corticotrophs; stimulates the release of glucocorticoids (cortisol), mineralocorticoids (aldosterone), and androgen

thyrotropin

used as diagnostic agent to differentiate between primary and secondary hypothyroidism (given to the patient; if there is an increase of TSH level - PRIMARY. if there is still a very low TSH -SECONDARY)

ACTH

secretion follows a diurnal rhythm (secretion is higher in the morning and decreases throughout the day)

diurnal rhythm

rhythm in which secretion is higher in the morning and decreases throughout the day

cosyntropin

a synthetic ACTH, given via IM or IV routes

given via IM or IV routes

route of cosyntropin

a/e: bradycardia, hypertension, sinus tachycardia

adverse effects of cosyntropin

s/e: peripheral edema

side effects of cosyntropin

corticotropin

exogenous ACTH; primarily used to diagnose adrenal gland disorders, treat multiple sclerosis, and infantile spasms

corticotropin

MOA: control the synthesis of ACTH

available as Repository Corticotropin Injection (RCI); given via IM OR SubQ routes

route of corticotropin, also available as what?

neurohypophysis

other name of posterior lobe

Diabetus Insipidus

excessive urination which leads to sever dehydration and electrolyte loss;decreased of ADH

antidiuretic hormone theraphy

MOA: promotes water reabsorption from the renal tubules

patients with renal disease

contraindication for antidiuretic hormone theraphy

patients receiving diuretics (increases electrolyte loss)

contraindication of cosyntropin

Every month SUBQ

Octreotide acetate as depot formulation is given how?

TID SUBQ

Octreotide acetate as immediate released is given how?

Trioodothyronine

T3 is?

Thyroxine

T4 is?

Desmopressin

given to patients with Hemophilia A or von Willebrand Disease Type 1

administered oral, or intranasally, or by injection IV or Subcutaneously

Route of administration for Desmopressin

Vasopressin

induce the release of adrenocorticotropic hormone (which increases serum cortisol leve

administered IM or IV and intranasally

Vasopressin route of adminsitration?

Syndrome of Inappropriate Antidiuretic Hormone

excessive amount of water retention expanding the intracellular and intravascular volume; increased ADH

Syndrome of Inappropriate Antidiuretic Hormone

results in water intoxication and dilutional hyponatremia

s/s: fluid overload, changes in level of consciousness and mental status changes, weight gain without edema, hypertension, low urinary output, concentrated urine

Syndrome of Inappropriate Antidiuretic Hormone symptoms

Demeclocyline

induces nephrogenic DI

photosensitivity

common complaint of demeclocycline

s/e: dental discoloration, enamel hypoplasia

side effects of demeclocycline

Vaptans (Vasopressin Receptor Antagonist)

increase serum sodium an free water clearance

patients with hypovolemia (because this further decreases the water level in the body)

contraindication of vaptans

patients with corn allergy

contraindication of Conivaptan

Conivaptan

should be administered IV in large veins and rotated every 24 hours (therefore you need multiple IV lines for this medication)

orthostatic hypotension, syncope, hypertensio, atrial fibrillation, electrolyte imbalance

CONIVAPTAN ADVERSE EFFECTS

s/e: thirst, dry mouth, constipation, hyperglycemia, dizziness, weakness

Tolvaptan side effects

Levothyroxine Sodium

increases T4 (increases metabolic rate, oxygen consumption, utilization and mobilization of glycogen stores) and metabolically is deiodinated to T3 (T3 acts on the target cells)

Levothyroxine Sodium

DOC for replacement therapy for the treatment of primary hypothyroidism

\: thyrotoxicosis, mycocardial infarction

contraindications of Levothyroxine sodium

nausea, vomiting, diarrhea, cramps, tremors, nervousness, irritability, insomnia, headache, weight loss

s/e of Levothyroxine sodium

hypertension, osteoporosis, seizures

a/e of Levothyroxine sodium

digoxin and lithium

increases the action of thyroid drugs

Liothyronine

\-synthetic T

\-biologic half life of 2.5 days with a rapid (within few hours) onset of action

\-given PO or IV

Liothyronine

used as an replacement or supplemental treatment for hypothyroidism and as an initial therapy for myxedema (due to its short half life)

Desiccated Thyroid

contains both Levothyroxine and Liothyronine

Desiccated Thyroid

used to treat hypothyroidism due to thyroid atrophy, hormone deficiency, goiter

Liotrix

mixture of Levothyroxine sodium and liothyronine, 4:1

hypothyroidism

decrease in thyroid hormone secretion

Secondary hypothyroidism

\- pituitary gland disorder which results to lack of TSH secretion

Tertiary hypothyroidism

hypothalamus disorder which results to lack of TRH secretion

Myxedema

severe hypothyroidism in adults

cretinism

congenital hypothyroidism in children which causes delayed physical and mental growth

Myxedema and cretinism

forms of worsened hypothyroidism

Thiourea Derivatives/ Thioamides

types of Antithyroid Drugs

Thiourea Derivatives/ Thioamides

\-block thyroid action reducing excessive secretion of thyroid hormones

\-enhances anticoagulant effect when taken with warfarin

Methimazole

\- 10 times more potent than PTU

\- given PO

- longer half life

\- euthyroid is achieved in 2 to 4 months of treatment

\- preferred due to its lesser s/e

hyperthyroidism

hyperfunction of thyroid gland leading to an increase level of circulating T3 and T4

Graves disease and Thyrotoxicosis

common types of hyperthyroidism

s/s: tachycardia, heat intolerance, nervousness, irritability, exophthalmos, weight loss

s/s of hyperthyroidism

parathryoid hormone

• regulates serum calcium levels

• promotes calcium absorption from the GI tract

• promotes calcium reabsorption from the renal tubules

• activates Vitamin D

hypoparathyroidism

decrease functioning of the parathyroid gland leading to low level of PTH

causes: damage to parathyroid gland, hypomagnesemia, hypocalcemia , renal impairment, diuretic therapy

Calcitriol

promotes calcium absorption from the GI tract and secretion of calcium from bone to the bloodstream; vitamin D analogue

\: hypersensitivity, hypercalcemia, hypevitaminosis D

contraindications of Calcitriol

(early signs of hypercalcemia) fatigue, weakness, somnolence, cephalgia, nausea, vomiting, diarrhea, cramps, drowsiness, dizziness, vertigo, metallic taste, lethargy, constipation, xerostomia

s/e of Calcitriol

\: anorexia, photophobia, dehydration, cardiac arrhythmias, decreased libido, hypertension, sensory disturbances, hypercalciuria, hypercalcemia, hyperphosphatemia

a/e of Calcitriol

Calcitonin-salmon

increases bone density, used primarily to prevent bone loss and fractures

patients with fish allergy

contraindication of Calcitonin-salmon

nausea, vomiting, cephalgia

s/e of Calcitonin-salmon

severe hypocalcemia, tetany, seizure

a/e of Calcitonin-salmon

Calcimimetics

increases the sensitivity of the calcium sensing receptors of the cells of the thyroid gland, thereby reducing PTH. This action causes a decrease in serum calcium and slow the progression of bone disease.

Cinacalcet

used for patient with hyperparathyroidism due to chronic renal disease and parathyroid cancer, given PO

adrenal medulla

secretes epinephrine and norepinephrine

adrenal cortex

secretes epinephrine and norepinephrine

cortisol (glucocorticoids)

most potent natural cortisol

aldosterone (mineralocorticoids)

promote sodium retention and potassium and hydrogen excretion

Glucocorticoid drugs

frequently called cortisone; usually ends with the suffix -one

Glucocorticoid drugs

suppresses inflammation, humoral immune response and adrenal function

orally, parenterally (IM or IV), topical (creams, ointments, lotions) and aerosol (inhaler)

how can Glucocorticoid drugs be administered?

Glucocorticoid drugs

used to treat Addison’s disease, inflammation, allergic reaction, debilitating conditions, autoimmune disorders (MS, rheumatoid arthritis, MG), ulcerative colitis, glumerulonephritis, shock, ocular and vascular inflammation, polyarteritis nodosa, hepatitis, organ transplant recipients to prevent organ rejection