2M: Endocrine System Drugs

• growth hormone analogue

• growth hormone suppressant drugs

• growth hormone analogue

• growth hormone suppressant drugs

— drug classifications under growth hormone

growth hormone analogue

drugs that increases GH level

used to treat dwarfism and growth failure

somatropin

a growth hormone analogue that stimulates the growth of essentially all tissues of the body mostly the bone

• prader-wili syndrome

• severe respiratory impairment

• corticosteroids

• antidiabetic drugs

— somatropin contraindications:

GH suppressant drugs

drugs that decreases GH level

used to treat gigantism and acromegaly

• GH receptor antagonist

• Somatostatin analogues

• Dopamine agonists

— drug classifications under GH suppressant dugs

pegvisomant

a GH receptor antagonist that blocks the GH receptor site

lanreotide acetate / octreotide acetate

a somatostatin analogue that prevents the pituitary gland to secrete growth hormone

in depot formulation

bromocriptine mesylate

a dopamine agonist that inhibits the secretion of growth hormone caused by a tumor in pituitary gland

available in oral formulation

thyrotropin

a thyroid-stimulating hormone drug that stimulates the thyroid gland to release T3 (triiodothyronine) and T4 (thyroxine)

thyrotropin

used as diagnostic agent to differentiate between primary and secondary hypothyroidism

0.9 IM (gluteus maximus)

2nd dose given after 24 hrs

— thyrotropin administration

adrenocorticotropic hormone

stimulates the release of glucocorticoids (cortisol), mineralocorticoids (aldosterone), and androgen

• cosyntropin

• corticotropin

— examples under adrenocorticotropic hormone drugs

cosyntropin

a synthetic adrenocorticotropic hormone drug that stimulates the production and release of cortisol, aldosterone, and androgens

for diagnostic purposes

patients receiving antidiuretics

— caution for cosyntropin

corticotropin

an exogenous adrenocorticotropic hormone that controls the synthesis of ACTH

available in repository injection

diabetes insipidus

condition wherein there is a low antidiuretic hormone

“dry inside”

syndrome of inappropriate antidiuretic hormone

condition wherein there is a high antidiuretic hormone

antidiuretic hormone therapy drugs

ADH drugs that promote water reabsorption from the renal tubules

to increase ADH level

• desmopressin

• vasopressin

— examples under ADH therapy drugs

patients with renal disease

— contraindication of ADH therapy drugs

desmopressin

ADH therapy drug that is given to patients with hemophilia A or vin willebrand disease type 1

vasopressin

ADH therapy drug used to introduce the release of adrenocorticotropic hormone which increases the serum cortisol level

vaptans (vasopressin receptor antagonist)

ADH drug that increases serum sodium and free water clearance

to decrease ADH level

patients with hypovolemia

— contraindications of vaptans

• conivaptan

• tolvaptan

• demeclocycline

— drug examples under vaptans

conivaptan

vaptan drug contraindicated to patients with corn allergy

tolvaptan

vaptan drug given orally

demeclocycline

vaptan drug that induces nephrogenic diabetes insipidus with SIADH

tetracycline antibiotics

photosensitivity

— common complaint of taking demeclocycline

thyroid gland

gland that secretes T3 (triiodothyronine) and T4 (thyroxine), and calcitonin

thyroid drugs

drugs that increases thyroid level

used to treat hypothyroidism

• levothyroxine sodium

• liothyronine

• desiccated thyroid

• liotrix

— examples under thyroid drugs

levothyroxine sodium

a thyroid drug that increases T4 which also increases metabolic rate

T3 now acts on the target itself

DOC for replacement therapy & treatment of primary hypothyroidism

• thyrotoxicosis

• myocardial infarction

— contraindications of levothyroxine sodium

liothyronine sodium

a synthetic T3

a thyroid drug used as a replacement or supplemental treatment for hypothyroidism

initial treatment for myxedema

desiccated thyroid

a thyroid drug that contains both levothyroxine and liothyronine

used to treat hypothyroidism

liotrix

a thyroid drug with a mixture of levothyroxine and liothyronine (4:1)

anti-thyroid drugs

drugs that decreases thyroid level

used to treat hyperthyroidism

propylthiouracil

an antithyroid drug that blocks the thyroid action reducing hormones

less potent and allowed during pregnancy

enhances anticoagulant effect when taken with warfarin

methimazole

an antithyroid drug that is 10x more potent than PTU

can induce goiter/cretinism

parathyroid gland

gland that secretes parathormones, regulates calcium levels, promotes calcium absorption from the GI tract, promotes calcium reabsorption from renal tubules, and activates vitamin D

vitamin D analogue

increase PTH level

used to treat hypoparathyroidism

calcitriol

a vitamin D analogue drug that promote calcium absorption from the GI tact and secretion of calcium from the bone to the bloodstream

calcimimetics

drugs that decreases PTH level

used to treat hyperparathyroidism

• cinacalcet

• calcitonin-salmon

— drugs examples for calcimimetics

calcitonin-salmon

drug for hyperparathyroidism used to increase bone density

used primarily to prevent bone loss and fractures

fish allergy

— contraindications for calcitonin-salmon

cincalcet

a calcimimetic drug that increases the sensitivity of the calcium sensing receptors of the cells of the thyroid gland, thereby reducing PTH

8-10 md/dL

normal serum calcium level

• epinephrine

• norepinephrine

— hormones secreted by the adrenal medulla

• androgen

• estrogen

• cortisol

• aldosterone

— hormones secreted by adrenal cortex

glucocorticoid drugs

aka cortisone

drugs that suppresses inflammation, humoral immune response, and adrenal function

may cause risk for infection

• dexamethasone

• prednisone

• cortisone acetate

— examples under glucocorticoid drugs

severe untreated infections

— contraindication if prednisone

given with foods

— intervention for cortisone acetate

glucocorticoid therapy

the administration of glucocorticoid drugs

indications: trauma, surgery, inflammation, emotional upsets, and anxiety

should be tapered

fludrocortisone

a mineralocorticoid drug that promotes reabsorption of sodium from the renal tubules

given with glucocorticoids

corticosteroid deficiency

occurs when there is a mineralocorticoid deficiency and glucocorticoid deficiency

type 1 diabetes

occurs when the pancreas fails to produce insulin

juvenile onset

type 2 diabetes

occurs when there is a defective insulin receptor site (cells)

adult onset

insulin

promotes the uptake of glucose, amino acids, and fatty acids and converts them to substances that are stored in the body cells

hemoglobin A1c (HbA1c) or glycerated hemoglobin test

5.7% - 6.4%

measures the amount glucose attached to hemoglobin

provides the average blood glucose level over the past 2-3 months

fasting plasma glucose (FPG)

100-125 mg/dL

8 hours fasting required before the exam

done usually first thing in the morning before breakfast

oral glucose test (OGT)

140-199 mg/dL

a 2 hour test that checks blood sugar levels before and 2 hours after drinking a special sweet drink

random (casual) plasma glucose test

test blood glucose any time of the day

human insulin

humulin R & novolin N

duplicates insulin produced by the pancreas of the human body

low incidence of allergic reactions & insulin resistance

human insulin analogues

insulin lispro & aspart

are modifications of human insulin with alterations in onset and duration of action

• lispro (humalog)

• aspart (novolog)

• gluisine (apidra)

• oral inhalation (afrezza)

10-15 mins before meal time

— rapid-acting insulin

• regular

  • humulin R

  • novolin R

30-60 mins before meals

— short-acting insulin

• isophane

  • humulin N

  • novolin N

— intermediate-acting insulin

• glargine (lantus)

• detemir (levemir)

• degludec (tresiba)

— long-acting insulin

1. air cloudy

2. air clear

3. draw clear

4. draw cloudy

— steps in mixing insulin

• sulfonylureas

• non-sulfonylureas

— classifications under oral antidiabetic drugs

sulfonylureas

oral antidiabetic drugs used to stimulate pancreatic beta cells to secrete insulin

increases the ability of cell to bind insulin for glucose metabolism

• tolbutamide

• chlorpropamide

• tolazamide

— examples of 1st generation sulfonylureas

• glipizide

• gylburide

• gimepiride

— examples of 2nd generation sulfonylureas

2nd generation sulfonylureas

oral antidiabetic drugs that has greater hypoglycemic potency

contraindicated to patients with liver/kidney dysfunction

• biguanides

• alpha-glucosidase inhibitors

• thiazolidenidiones

• meglitinides

• incretin modifiers

— drug examples of non-sulfonylureas

biguanides

metformin

oral antidiabetic drug that increases binding insulin to receptors and improved tissue to sensitivity to insulin

alpha-glucosidase inhibitors

acarbose

oral antidiabetic drug that increases digestive system enzymes in the small intestine

intended for patients who do not want to achieve results with diet

meglitinides

repaglinide

oral antidiabetic drug that stimulate beta cells to release insulin

contraindicated to patients with liver dysfunction

incretin mimetics/ glucagon-like peptide

exenatide, liraglutide

parenteral antidiabetic drug that acts on beta cell to improve its responsiveness

amylin analogues

pramlintide

parenteral antidiabetic drug that suppresses glucagon secretions, slows gastric emptying, modulate appetite by inducing satiety

gliptins

sitagliptin

oral antidiabetic drug that increase the level of incretin hormones, increase insulin secretion, and decrease glucagon production

used as adjunct therapy

hyperglycemic drugs

drugs used to increase blood sugar levels

used to treat insulin-induced hypoglycemia when other means of providing glucose are not available

glucagon

diazoxide

a hyperglycemic drug used to increase blood glucose by stimulating glycogenolysis

combined hormonal contraceptives (CHCs)

drugs that contain a synthetic version of estrogen and progestin

causes drug-induced anovulatory cycles

inhibits ovulation

by preventing the formation of a dominant follicle

estrogen MOA

suppresses LH surge

progestin MOA

withdrawal bleeding

pseudomenstruation

scheduled monthly (when taking CHCs) to mimic normal 28-day menstrual cycle

ethinyl estradiol and norelgestromin transdermal patch

weekly form of CHC patch given transdermally

administered once a week for 3 weeks in a row (4th week is patch-free)

ethinyl estradiol and etonogestrel transvaginal contraception

a form of 2-inch flexible indwelling vaginal ring

placed during first 5 days of period and left in place of 3 weeks and removed for 1 week

progestin only oral contraceptive pills

minipills

progestin contraceptives that:

• alters cervical mucus

• interferes endometrial lining

• decreases fallopian tube peristalsis

• interferes with LH surge

taken continuously without a break within a 3 hour window

depot medroxyprogesterone acetate (DMPA)

progestin contraceptive; highly effective, long-acting injectable

progestin implant

a progestin contraceptive that inserts a single-rod device in the inner side of the upper non-dominant arm

contains barium and may not be effective in women with BMI of >30

• progestin only oral contraceptive pills (POPs)

• depot medroxyprogesterone acetate (DMPA)

• progestin implant

— examples under progestin contraceptives

• 21-days tablet pack

• 28-days tablet pack

• ethinyl estradiol &

  • norelgestromin transdermal patch

  • etonogestrel transvaginal contraception

— examples under combined hormonal contraceptives (CHCs)

androgens

aka male sex hormones

hormones that control the development and maintenance of sexual process, accessory organs, cellular metabolism, and bone & muscle growth

used to replace deficient hormones