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Pharm Endocrine

QuestionAnswer
Thyroid Gland regulation T3(active) and T4 -- stimulation of energy use (calorigenic), stimulation of heart (increases HR and blood flow), promote growth and development
hypothyroidism not enough thyroid hormone, can occur at any age, maternal (retardation, cretinism)
causes of hypothyroidism malfunction of thyroid, autoimmune (Hashimotos), surgical removal of thyroid, insufficient iodine diet
symptoms of hypothyroidism fatigue, lethargy, intolerance to cold, bradycardia, myxedema
Levothyroxine (Synthroid) synthetic prep of T4, converts to T3, highly protein bound, half life 7 days (longer), concentration at steady state (~1month)
Liothyronine (Cytomel) synthetic prep of T3, more potent but shorter half life, higher cost, and increased cardiotoxicity
thyroid hormone replacement- adverse effects tachycardia, tremor, nervousness, insomnia
Hyeprthyroidism forms Graves Disease (autoimmune) and Toxic nodular goiter (Plummers disease)
Graves Disease thyroid stimulating immunoglobulin (TSIs)- autoantibodies that mimic TSH effects- overstimulates the thyroid
Plummer's disease (nodular goiter) result of thyroid autonomy (nodules create thyroid hormone independent of TSH stimulation)
Symptoms of hyperthyroidism tachycardia, irritability, nervousness, heat intolerance, goiter, exopthalmos (protrusion of eyeballs) in Grave's disease
Methimazole (Tapazole) suppression of thyroid hormone synthesis
Propylthiouracil (PTU) 2nd line, suppresses thyroid hormone synthesis (shorter half life than methimazole)
Beta Blockers for hyperthyroidism suppress tahcycardia and other symtpoms
Radioactive iodine destroys thyroid tissue- but hypothyroidism occur in 80% (1st choice in elderly and post menopausal)
non radioactive iodine (Lugol's solution) at high concentrations, iodide suppresses thyroid
Surgical removal of thyroid tissue 80-90% will require supplementation
Growth Hormone (somatropin) promote growth, promotes protein synthesis, carbohydrate metabolism
Therapeutic uses of Growth hormone (somatropin) IM or SubQ- pediatric GH deficiency, Pediatric short stature, adult GH deficiency, sports "doping"
Somatostatin inhibitor of growth hormone (synthetic form is Sandostatin)
Adverse effects of Growth hormone edema, musculoskeletal pain, hyperglycemia
Prolactin stimulates milk production after giving birth
hypersecretion of prolactin (female) amenorrhea, galatorrhea, infertility
hyeprsecretion of prolactin (male) libido and potency reduced (lowers testosterone), galactorrhea
Cabergoline (Dostinex) dopamine agonist, suppression of prolactin release
Oxytocin promotes uterine contractions during labor, stimulate milk ejection during breast feeding
Pitocin synthetic oxytocin, used to induce labor near term
Desmopressin agent of choice to treat diabetes insipidus (ADH deficiency)- long duration of action
Therapeutic uses of desmopressin diabetes insipidus, cardiac arrest (enhance CPR), nocturnal enuresis (bedwetting)
adrenal medulla releases catecholaminesin coordination with SNS
adrenal cortex produces steroid hormones
3 classes of adrenocortical hormones (steroid hormones) 1) glucocorticoids 2) mineralocorticoids (aldosterone) 3) Androgens (androstenedione)
Metabolic effects of Glucocorticoids (cortisol) carbohydrate metabolism (promote glucose availability), protein metabolism, fat metabolism, maintain integrity of vascular system, promote renal sodium and water retention
Pharmacologic Effects of glucocorticoids antiinflammatory at high doses in therapy of non endocrine diseases (rheumatoid arthritic, lupus, IBD, others), immunosuppressant effects
Cushing's Syndrome adrenal hormone excess; caused by hypersecretion of ACTH, hypersecretion of glucocorticoids, or glucocorticoid therapy in large doses
symptoms of Cushing's syndrome obesity, moon face, buffalo hump, hyperglycemia, glycosuria, hypertension, fluid and electrolyte disturbances
Treatment of Cushing's syndrome surgical removal of adrenal gland, aldosterone antagonist (spironolactone), Mifepristone
Mifepristone (Korlym) cortisol receptor blocker; high daily dose treatment of hyperglycemia secondary to hypercortisolism in adults with endogenous cushing's syndrome
Off label indications of Mifepristone emergency contraception, spontaneous abortion- in combo with misoprostol = abortion < 49 days of pregnancy.
Adverse effects of Mifepristone reproductive (abnormal bleeding), CV (HTN,edema)
Addison's Disease adrenal hormone deficiency
symptoms of addison's disease weakness, emaciation, hypoglycemia, increased pigmentation of skin and mucous membranes
Treatment of Addisons disease replacement therapy with adrenocorticoids, hydrocortisone, mineralcorticoid replacement (Florinef)
Florinef- MOA binds to aldosterone receptor; mineralcorticoid property and glucocorticoid activity- retains sodium and excretes potassium
Florinef- indications Addison's disease, adrenogenital disorder
Florinef- adverse effects edema, hyperglycemia, decreased body growth
Long term therapy with glucocorticoids- problem therapy >2 weeks- adrenal suppression by negative feedback regulation
adverse effects of glucocorticoids adrenal insufficiency with long term therapy, susceptibility to infection, osteoporosis, hyperglycemia, fluid and electrolyte disturbance, edema, hypokalemia, cardiac enlargement, hypertension, myopathy, muscle weakness, PUD, growth retardation, Cushings
short to medium acting glucocorticoid Hydrocortisone (cortef)
Intermediate Acting glucocorticoids prednisone, methylprednisolone, triacinolone (Kenalog)
Long acting glucocorticoids dexamethasone (Dex Pax)
Created by: alexadianna