Applied: MT Endocrine Medication

Examples of endocrine diseases

• Diabetes

• Hyperthyroidism

• Hypothyroidism

• Addison's disease

Function of thyroid gland

secretes hormones that control basal metabolic rate, growth, body temp and affects the cardiac and respiratory rate

What is hyperthyroidism?

autoimmune disease - caused by activation of TSH (thyroid stimulating hormone) receptors, enlarging the gland and secreting excess hormone

Most common cause of hyperthyroidism

Grave’s disease

Clinical features of hyperthyroidism

• Exophthalmos

• Tachycardia

• Tremor

• Weight loss (↑ appetite)

• Warm skin

• Goitre

Hyperthyroidism drugs

• Carbimazole

• Propanolol

How does carbimazole treat hyperthyroidism?

interferes with synthesis of TSH

Why is Propranolol used in hyperthyroidism?

used in combination with carbimazole to decrease thyrotoxic symptoms

Hormone levels in hypothyroidism

↓ Thyroxine, ↑ TSH

Hypothyroidism drugs

• thyroxine

Symptoms of hypothyroidism

• Lethargy

• Cold intolerance

• Dry, puffy skin

• Weight gain

• GI disturbance (ulcers possible)

What is the risk of adrenaline-containing LA in thyroid patients?

Dysrhythmias if excessive dose used

Is adrenaline LA contraindicated in thyroid patients?

No, safe if used within correct dose and technique

What causes diabetes?

an absolute or relative insulin deficiency resulting in abnormal blood sugar levels

Normal blood glucose range

3.5–7 mmol/L

What causes Type 1 diabetes?

Autoimmune destruction of pancreatic β-cells - no insulin produced

What characterises Type 2 diabetes?

Insulin resistance ± reduced insulin production

Where is insulin produced?

Islets of Langerhans in pancreas

Types of insulin

• Rapid-acting

• Intermediate/long-acting

Action of insulin

• controls blood glucose concentration

  • increases glycogenesis (glucose to glycogen)

  • decreases glycogenolysis (glycogen to glucose)

Side effects of insulin therapy

• Injection site reactions

• Hypoglycaemia

How is insulin administered?

Subcutaneous injection or pump

What causes hypoglycaemia in diabetics?

Excess insulin or missed meals

Hypoglycaemic symptoms

• slurred speech, confusion, aggression, mood changes

  • little glucose in brain cause reduction in brain function (lack of brain cell energy)

• tremors, weakness, tiredness

  • insufficient glucose within muscle cells

• rapid pulse

  • body works hard to transport available glucose around the body

Examples of oral hypoglycaemics

• sulfonylurea

• biguanides

Example of sulfonylurea

Gliclazide

Mechanism of sulfonylureas

augment insulin secretion by the pancreas to achieve optimal glycaemic control

Side effects of sulfonylureas

• Nausea, vomiting

• Constipation

• Liver dysfunction

• Skin reactions

• Interaction with aspirin

Example of biguanide

Metformin

Mechanism of metformin

decreases gluconeogenesis and increases utilisation of glucose

Side effects of metformin

• Nausea

• Abdominal pain

• Metallic taste

• Anorexia

Oral effects of diabetes

• Xerostomia

• Candidiasis

Patient management of diabetes

• “what is your usual blood sugar range?”

• “is your blod sugar range stable, or up and down?”

• “have you had your usual dose of insulin and food today?”

• “how often do you have a ‘hypo’ and do you know when it’s coming? what warning signs do you get?”

  • nb. some type 2 diabetics will never have had a hypo - those on medication may have

  • all type 1 diabetics will have had hypos

• “do you have a warning card or medical alert bracelet?”

Why is healing impaired in diabetics?

Reduced immune function (↓ neutrophils, chemotaxis)

Why is LA relevant to hypoglycaemia?

May mask warning signs (e.g. tingling)

What drug interaction is relevant in diabetes?

High-dose salicylates

Oral effects of oral contraceptive pill

• ↑ Gingivitis

• ↑ Dry socket risk

• Xerostomia

Which antibiotics reduce OCP effectiveness?

• Penicillin

• Amoxicillin

• Tetracycline