N306 - QUIZ 4 Lecture Pre review

negative feed back loop

• gland X releases hormone X → stimulates target cells to release hormone Y

• Excess of hormone Y → gland X decreases release of hormone X

Hypothalamus definition

• Gland above and behind pituitary gland

• secretes vasopressin and oxytocin → stored in pituitary gland

• secretes several hormone releasing factors that stimulate anterior pituitary gland to secrete hormones that control bodily functions

neuroendocrine system

regulates reactions to internal external stimuli involving activities of the endocrine glands and nervous system

SOMATROPIN

• human growth hormone that stimulates

  • growth

  • cell reproduction

  • regeneration

SOMATROPIN MOA

binds to growth hormone receptors on target cells → initiated signaling pathways promoting growth and metabolic effects 

• protein synthesis

• lipid metabolism

• carbohydrate metabolism

SOMATROPIN Indication

treat growth hormone deficiency in children and adults resulting in

• short stature in children

  • turner syndrome in girls

  • chronic kidney disease

• metabolic disturbances in adult

• chromosomal disorder by stature and other developmental abnormalities

• Used in treatment of children with prader willi syndrome

SOMATROPIN Contraindications

• active malignancy due to tumor growth risk

• acute critical illness due to potential risk complications and lack of efficacy

SOMATROPIN Adverse Effects

• intracranial HTN

• headache

• nausea

• vomiting

• visual changes

• hyperglycemia

• exacerbating existing DM

• injection site reasions

  • swelling

  • pain

  • redness

• Peripheral edema

• hyperthyroidism

SOMATROPIN Cautions

• intracranial lesions

• pituitary tumors

• glucose metabolism

• insulin sensitivity

  • monitor pts with diabetes

• Monitor skeletal growth and bone age in children

SOMATROPIN drug interactions

• insulin

• oral hypoglycemia agents

• use of glucocorticoids

OCTREOTIDE

synthetic analog of somatostatin

OCTREOTIDE MOA

binds to somatostatin receptors, subtype 2 receptors

• inhibits release of growth hormone, insulin, glucagon, gastrin, & serotonin

• decreased secretion of these hormones and helps control symptoms associated with hormone hypersecretion syndromes

OCTREOTIDE indications

treats

• acromegaly

• severe diarrhea

• flushing episodes → carcinoid syndrome

• tumors

OCTREOTIDE contraindications

• hypersensitivity to octreotide

• acromegaly PTs who have not responded to surgical resection of pituitary tumor

OCTREOTIDE Adverse Effects

• nausea

• vomiting

• abdominal discomfort

• flatulence

• diarrhea

• hyper/hypoglycemia

• injection site reactions

• bradycardia

• arrhythmias

• conduction abnormalities

• gallstone formation

OCTREOTIDE cautions

• hyper/hypoglycemia

  • monitor diabetic PTs

• PTs will gallstones

• thyroid function

• renal impairment

• cardiac conditions

OCTREOTIDE Drug interactions

• potentiate effects of insulin & oral hypoglycemia agents

• increase blood levels of cyclosporine

• Beta blockers → increased risk of bradycardia and conduction abnormalities

VASOPRESSIN

ANTIDIABETIC HORMONE

• regulates water balance and blood pressure

VASOPRESSIN MOA 

• acts on V1 V2 receptos

• V 1→ vasoconstriction on vascular smooth muscle → increasing peripheral vascular resistance elevating BP

• V 2 → renal collecting ducts → enhance reabsorption reducing urine output maintaining fluid balance

VASOPRESSIN Indication

• vasopressor agent in management of hypotension → esp in septic shock

• diabetes insipidus → used to replace deficient hormone reducing polyuria and polydipsia.

• controls acute variceal bleeding due to vasoconstriction in splenetic cirulation

VASOPRESSIN Contraindications

• hypersensitivity to drug

• CAD → exacerbation of myocardial ischemia

VASOPRESSIN Adverse Effects

• CV

  • HTN

  • Peripheral ischemia

  • myocardial ischemia

  • arrhythmias → due to excessive vasocontriction

• Hyponatremia

  • induced water retentions → dilutional hyponatremia esp in renal function impairment

• GI

  • nausea

  • vomiting

  • abdominal cramps

• Allergic reactions

  • anaphylaxis

VASOPRESSIN Cautions

• CV disease

  • HTN

  • HF

  • Hyponatremia

  • decreased serum sodium levels

  • renal impairment due to risk of fluid retention

VASOPRESSIN Drug Interactions

• norepniepherine or epinepherine can potentiate hypertensive effects → icnrease CV events

• enhance renal lithium effects → leads to lithium toxicity

drugs released by anterior pituitary drugs

• cosyntropin

• somatropin

• octreotide

drugs released by posterior gland

• vasopressin

• desmopressin

Levothyroxine

• Thyroxine produced by thyroid gland

• replacement for deficient or absent endogenous thyroxine

Levothyroxine MOA

Converts to triiodothyronine (T3) after absorption in peripheral tissue → binds to thyroid hormone receptors in the target cell → exerts effects thyroid hormone regulates metabolism, growth, and development

Levothyroxine indications

• treatment

  • hypothyroidism

  • hormone replacement therapy → due to thyroidextomy, radioactive iodine therapy for cancer

  • shrink goiters due to hypothyroidism

  • thyroid suppression to assess function

Levothyroxine contraindications

• acute MI

• thyrotoxicosis

• hypersensitivity to drug or components

Levothyroxine AE

• tachycardia

• palpitations

• HTN

• angina

• tremors

• nervousness

• insomnia

• diarrhea

• vomiting

• abdominal cramping

• osteoporosis and bone fracture risk

• hyperthyroidism

  • weight loss

  • heat intolerance

  • sweating

Levothyroxine cautions

• CV disease

• PTs with DM

• adrenal insufficiency

• elderly adults

Levothyroxine drug interactions

• antacids

• calcium

  • should be taken 4 hours apart from these agents

  • iron supplements

• warfarin

Propylthiouracil

antithyroid medication

• treats hyperthyroidism

Propylthiouracil MOA

inhibits T4 and T3 by interfering with thyroid peroxidase enzyme

Propylthiouracil indications

• hyperthyroidism management

• graves disease

• toxin nodular goiter

• thyroid storm

Propylthiouracil contraindications

• liver impairment → hepatic failure risk

• hypersensitivty 

Propylthiouracil AE

• liver damage

• agranulocytosis

• skin rashes, pruritus & urticaria

• joint and muscle pain

• Nausea, vomiting GI upset

Propylthiouracil cautions

• mild to moderate liver dysfunction → hepatotoxicity

• pregnancy

  • breastfeeding

Propylthiouracil drug interactions

• anticoagulants → increases risk of bleeding

• use with theophylline

• warfarin metabolism

Fludrocortisone

increases renal sodium reabsorption and potassium excretion

Fludrocortisone MOA

• binds to mineralcorticoid receptors in distal tubules & collecting ducts of kidneys → promotes sodium retention & water reabsorption

Fludrocortisone indications

• primary adrenocorical insufficiency (Addisons disease)

  • restores mineralcorticoid activity

• Salt wasting adrenogenital syndrome

  • management

Fludrocortisone Contraindications

• hypersensitivty

• systemic fungal infections

Fludrocortisone AE

• fluid retention, edema, HTN

• excessive sodium retention & potassium excretion

• HTN

• Glucose intolerance or DM

• Risk of osteoperosis and bone fractures

• GI

  • nausea

  • vomiting

  • abdominal cramping

• mood swings

• depression

• insomnia

Fludrocortisone cautions

• CV disease

• Renal impairment

• Metabolism

• Infection or exacerbation of infections

• pregnant or breastfeeding

Fludrocortisone Drug interactions

• antihypertensives

• NSAIDs

• diuretics

• potassium sparing diuretics

• estrogen-containing medications

Methylprednisolone

regulates physiological processes in body

• metabolism

• immune response

• stress response

Methylprednisolone MOA

• binds to glucocorticoid receptos

• translocates to nucleus and modulates gene transcription → wide range of anti inflammatory, immunosuppressive, metabolic effects

Methylprednisolone indications

Manage

• inflammatory conditions

• rheumatoid arthritis

• asthma

• IBD

• dermatologic conditons

• allergic reactions

• contact detmatitis

• Immunosuppressive for autoimmune disorders

  • lupus erythematosus, autoimmune hepatitis

Methylprednisolone contraindictions

• systemic fungal infections

• hypersensitivity

Methylprednisolone AE

• suppression of cortisol → adrenal insufficiency

• Immunosppressive effects

• glucose intolerance

• osteoporosis and bone fracture risk

• GI

  • gastritis

  • peptic ulcers

  • GI bleeding

• Psychiatric

  • mood swings

  • agitation

  • insomnia

Methylprednisolone cautions

• DM

• CV disease

• Infections

• Glaucoma

• hepatic impairment

Methylprednisolone Drug interactions

• anticoagulatns

• NSAIDs

• Cyclosporine

• reduce vaccine effectiveness

Prednisolone

act similar to endogenous glucocorticoids

Prednisolone MOA

• binds to glucocorticoid receptors → forms complex locates to nucleus of target cell

• modulated gene transcription → wide range of anti inflammatory, immunosuppressive, & metabolic effects

Prednisolone Indications

• inflammatory conditions

• rheumatoid arthritis

• asthma

• IBD

• dermatologic conditions

• allergic reactions

• Immunosuppressive agent in autoimmune disorders

  • systemic lupus

  • autoimmune hepatitis

  • vasculitis

  • acute COPD treatment

  • immunosuppressive in organ transplant → prevent rejection

Prednisolone contraindications

• hypersensitivity

• systemic fungal infection

Prednisolone AE

• adrenal insufficient

• susceptibility to infection

• glucose intolerance

• osteoporosis and bone fractures risk

• sodium and water retention → HTN

• GI

  • gastitis

  • peptic ulcer

  • bleeding

• mood swings

• agitation

• insomnia

Prednisolone cautions

• DM

• glucose intolerance

• CV disease

• infection

• hepatic impairment

Prednisolone drug interactions

• anticoagulants

• NSAIDS

• Vaccines