Agents Used for Endocrine disorders
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| Which Thyroid hormone is more active | Triiodothyronine (T3)
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| Grave's Disease | most common form of hyperthyroidism
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| Myxedema | term used for hypothyroidism in adults
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| Cretinism | term used for hypothyroidism in infants
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| Clinical presentation of hypothyroidism | pale, puffy face, cold, dry skin, brittle hair or loss of hair, dec HR and Temp, lethargy, fatigue, cold intolerance, impaired mentality
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| Levothyroxine (Synthroid) | used to treat hypothyroidism, synthetic form of T4 converted to T3
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| Synthroid adverse effects | tachycardia, angina, tremors, intensify effects of WARFARIN
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| Liothyronine | synthetic form of T3, used to tx hypothyroidism, often combined with synthroid
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| Plummer's Disease | toxic nodular goiter, same as grave's disease but no exopthalmos
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| Clinical presentation of hyperthyroidism (Graves) | exophthalmos (protrusion of eyeballs), inc. HR, flushed warm skin, always hot, tremors, nervousness, anxiety, insomnia, increased appetite, weight loss, diarrhea
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| Thyrotoxic Crisis (Thyrotoxic storm) | when pts experience significant stress, not triggered by rise in thyroid hormones, causes hyperthermia, severe tachycardia, restlessness, agitation, tremor, unconsciousness, coma, hypotension, heart failue
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| Methimazole (Taazole)...thionamide drug | prototype for tx of hyperthyroidism, blocks synthesis of thyroid hormone by inhibiting peroxidase which prevents formation of iodine and pervens coplin of MIT and DIT
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| Propylthiouracil (PTU) | 2nd line of tx for hyperthryroidism, similar to methimazole, causes liver dmage, shorter half-life, safer in pregnancy, blocks conversion of T4 to T3
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| Methimazole | 1st line tx for hyperthyroidism, no LIVER damage, longer 1/2 life, not safe in 1st trimester or lactation, does not block conversion of T4 to T3
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| Radioactive Iodine | used to destroy thyroid tissue, to produce chemical remission without causing complete destruction of the gland
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| MOA of Radioactive Iodine | emits beta particles to destroy thyroid tissue, takes several months to be effective
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| Adverse Effects of Radioactive Iodine | delayed hypothyroidism, contraindicated in pregnancy and lactation
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| Non-Radioactive Iodine (Lugol's solution) | decreases circulating T4 and T3, used for thyroidectomy and thyrotoxic crisis. Side effect: Iodism
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| Anterior Pituitary Hormones | Growth hormone (GH), Corticotropin (ACTH), Thyrotropin (TSH), FSH, Lutenizing hormone (LH), prolactin
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| Posterior Pituitary Hormones | Oxytocin, antidiuretic hormone (Vasopressin)
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| Growth Hormone (GH) | promotes growth, promotes protein synthesis, carbohydrate metabolism, used for: ped and adult growth hormone deficiency, non-GH related short stature, Prader-Willi Syndrome (PWS),
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| Adverse effects of GH | hypergylcemia, neutralizing antibodies, carpal tunnel syndrome, fatality in Prader-Willi syndrome, interacts with glucocorticoids
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| Somatropin | growth hormone preparation
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| Mecasermin (Increlex) | synthetic of natural insulin-like gowth factor-1, used in GH deficiency that is not responsive to GH tx
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| Adverse Effect of Mecasermin | hypoglycemia, hypertrophy of tonsils, intracranial hypertension, vomiting, arthalgia, OM, elevated aminotransferases and lipids, overgrowth of fat, facial bones, and kidneys
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| Octreotide and Lanreotide | analogs that suppress GH release, given by injection
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| Pegvisomant | blocks GH receptors, used for acromegaly
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| Prolactin | produced by anterior pituitary, stimulates milk production
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| Effects of hypersecretion of Prolactin | Females: amenorrhea, galactorrhea, infertility
Males: reduced libido and potency, galactorrhea
Possible delayed puberty
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| Thyrotropin | synthetic form of TSH used for diagnosis of thyroid CA
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| Corticotropin/Cosyntropin | synthetic form of adrenocorticotropic hormone (ACTH), used for dx of adrenocortical dysfunction
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| Gonadotropins | FSH and LH-regulate gonadal function, used to treat infertility
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| FSH | females: stimulates follicular growth and development in ovaries
males: stimulate sperm production
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| LH | females: promote ovulation and formation of corpus luteum
males: stimulates testosterone synthesis by Leydig cells
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| Menotropins (Menopur, Repronex) | 50/50 of LH/FSH
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| Urofollitropin (Bravelle) | FSH
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| Follitropin alpha (Gonal-f) & Follitropin beta (Follistin AQ) | human FSH preparation
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| Oxytocin | produced by the hypothalamus, stored in post pituitary, promotes uterine cntx and stimulates milk production
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| Antidiuretic Hormone (ADH)-Vasopressin | promotes renal conservation of water, increase premeabilit of collecting ducts, produced in hypothalamus
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| Therapeutic uses of ADH | diabetes insipidus, cardiac arrest, post-op abd distention, prep for abd radiography, nocturnal enuresis, hemophila A, Von Willebrands disease
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| Adverse effect of ADH | water intoxication, excessive vasoconstriction
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| Conivaptan (Vaprisol) & Tolvaptan | ADH antagonist, used for hyponatremia. monitor SODIUM levels d/t risk for hypernatremia
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| Leuprolide | GnRH analog, suppress LH and FSH release, used to tx endometriosis, uterine fibroids, central precocious puberty, and prostate CA
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| Nafarelin | GnRH analog, used to tx endometriosis, but does not improve fertility, suppress LH and FSH release
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| Bromocriptine | dopamine agonist, inhibits prolactin secretion, can correct amenorrha, galactorrhea, and infertility
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| Cabergoline | dopamine agonist, inhibits prolactin secretion, used in infertility as reducing prolactin leads to return of ovulation
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| Demopressin | ADH preparation, used for diabetes insipidus, nocturnal enuresis, and hemophilia
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| Addison's Disease (chronic adrenal insufficiency) | adrenocortical insufficiency, obesity, fat redistribution to face, stomach and upper back, hyperglycemia, glycosuria, HTN, fluid & electrolyte imbalances
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| Cushing's Disease | adrenal hormone excess, causes weakness, hypotension, emaciation, hypoglycemia, hyperkalemia, hyponatremia, increase pigmentation of skin and mucous membranes
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| Hydrocortisone | synthetic steroid identical to cortisol. used to tx adrenal insufficiency (Addison's), allergic rxn to INFLAMMATION, and CA
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| Cortisone, Prenisone, and Dexamethasone | preferred drugs for tx of chronic adrenal insufficiency (Addison's)
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| Dexamethasone | used to dx Cushing's (dex suppresion test)
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| Cortisone | prodrug that converts to hydrocortisone
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| Fludrocortisone | potent mineralcorticoid, used to tx Addison's, primary hypoaldosteronism, and congenital adrenal hyperplasia.
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| Adverse Effects of Fludrocortisone | HTN, edema, cardiac enlargement, hypokalemia
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| Adreoncorticotropic Hormone (ACTH) | used for diagnostic testing
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| Cosyntropin | synthetic analog of ACTH, when used cortisol levels rise above 20 = normal, if does not rise then adrenal insufficiency is present
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| Ketoconazole | off label use for prostate CA, works by inhibiting testicular, adrenal, and prostatic production of androgens
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| Side effects of long-term use of high-dose corticosteriods | Redistribution of fat, Glucose intolerance, Moon face or buffalo hump
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| Adrenal crisis | acute adrenal insufficiency, s/s hypotension, dehydration, weakness, lethargy, and GI symptoms
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| How to tx adrenal crisis | rapid fluid replacement, sodium, glucose, and glucocorticoids,
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