drugs and the endocrine system Flashcards by natalie fisher

what are endocrine diseases?

hormones involved - wide spread and diverse effects on body
hormone deficiency
hormone over activity

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what is thyroid disease and what does it affect?

can be hypothyroidism or hyperthyroidism

can affect CNS, metabolism and CV system

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what are the symptoms of hypothyroidism?

slow speech
lethargy
hypotension
bradycardia
anaemia
weight gain low body temp intolerant to cold
(everything depressed - under active)

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what are the symptoms of hyperthyroidism?

anxiety
nervousness
hypertension
tachycardia
low grade fever
inholerant to heat
weight loss
(everything activated - over active)

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is a goitre present in hypo or hyperthyroidism?

both

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what causes a goitre in hypothyroidism?

not enough iodine so insufficient T3 and T4
disrupts negative feedback
no TSH production

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what causes a goitre in hyperthyroidism?

activation of TSH receptors by antibodies

increase in size and function of thyroid gland

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what causes hyperthyroidism?

thyroid cells stimulated by auto-antibodies (autoimmune disease such as graves disease)

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can treatment cure hyperthyroidism?

no but can supress

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give two examples of drugs used to treat hyperthyroidism

Carbimazole
Propylthiouracil
(plus limited iodine intake)

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what treatments other an drugs can be used to treat hyperthyroidism?

surgery or radioactive iodine - block and replace therapy

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what does the drug carbimazole do to treat hyperthyroidism?

blocks T3 and T4 production - this is then replaced in small amounts
interferes with synthesis of thyroxine
(short half life)

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where is carbimazole absorbed, activated and excreted?

absorbed in gut
activated in liver
excreted in urine

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what are the side effects of carbimazole?

nausea
rash
agranulocytosis - deficiency of granulocytes in blood causing increased risk of infection
can cross placenta causing neonatal hyperthyroidism

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how is hypothyroidism treated?

with thyroxine substitute

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name two thyroxine substitutes

levothyroxine T4

triiodothyronine T3 - severe cases (IV)

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which thyroxine substitute has a shorter half life and balances blood level?

triiodothyronine T3

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name two drugs which can cause hypothyroidism

lithium (depression)

amiodarone (antiarrhythmic)

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which hormone promotes reabsorption of Ca2+ from the kidneys?

parathyroid hormone

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what does calcitonin (c-cells) do?

reduces Ca2+ - inhibits osteoclasts and reabsorption of Ca2+ from kidneys

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what does calcitriol (vit D3) do?

increases Ca2+ - increase bone mobilisation and increase reabsorption in gut

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what is hypocalcaemia?

not enough calcium

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what are the symptoms of hypocalcaemia?

neuromuscular probs
muscle cramps
mental probs
seizures
cataracts

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what are the causes of hypocalcaemia?

reduced Ca2+ intake (diet)
deficiency in PTH
lack of vit D (needed for absorption of Ca2+)
renal probs

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what is used to treat hypocalcaemia due to vit D deficiency?

ergocalciferol (vit D) - good kidney function needed | calcitriol

what is used to treat hypocalcaemia due to Ca2+ deficiency?

calcium glucornate IV infusion - with or within calcium

what is hypercalcaemia?

too much calcium - urgent help needed

what symptoms would hypercalcaemia cause?

kidney stones renal failure muscle probs cardiac arrest

what treatments would be used for hypercalcaemia?

Biphoshonates | Calcitonin - inhibits osteoblasts and reabsorption of Ca2+ from kidneys (reduces plasma Ca2+ levels)

which biphoshonate would be used to treat hypercalcaemia? and how does it do this?

alendronic acid - slows bone growth and turnover/ prevents Ca2+ loss (treats osteoporosis)

what side effects does alendronic acid have?

abdominal pain GI problems Oesophageal probs

why would alendronic acid be used instead of calcitonin?

(usually from salmon - salmaonin) expensive short half life ineffective long term

name 4 steroids that are released naturally from the adrenal cortex but can also be given synthetically to treat endocrine dysfunction and immune disorders

corticosteroids mineralocorticoids glucocorticoids endogenous hormones

what is the function of glucocorticoids?

lower BP | lower glucose

name five glucocorticoids?

``` hydrocortisone (cortisol) prednisolone methylprednisolone dexamethasone beclametasone ```

what is hydrocortisone (cortisol) used to treat and how is it administered?

treats Addison's disease/ crisis and adrenal insuffiency reduces inflammation in acute allergy administered - oral/ IV/ topically

what is prednisolone used to treat?

treats acute asthma attacks (5x stronger than hydrocortisone)

what is methylprednisolone used to treat?

prevents rejection of organ transplanted (given parentally - not via GI tract)

what is dexamethasone used to treat and how is it administered?

high anti-inflammatory action (20x stronger than hydrocortisone ) treats cerebral oedema administered orally or parentally

what is beclametasone used to treat?

asthma - brown inhaler

do glucocorticoids produce local or systemic effects?

wide systemic effects

list some of the adverse side effects of oral glucocorticoids

``` buffalo hump hypertension muscle wasting osteoporosis moon face increased abdo. fat thinning skin poor wound healing (known collectively as cushingoid features) ```

glucocorticoids cause stunting of growth, how does this differ between oral steroids and inhaled beclamethasone?

oral steroids - growth greatly stunted/ cushingoid features | inhaled beclamethasone - growth less affected/ no cushingoid features

what are the unwanted effects of inhaled glucocorticoids?

local immunosuppression in mouth/throat can cause opportunist candida albicans (oral thrush) vocal cords affected - dysphonia (hoarseness) can result

what can reduce the unwanted effects of inhaled glucocorticoids?

using a spacer | rinsing mouth after inhaler used

what other side effects are associated with glucocorticoids

- psychiatric reaction (rare - high dose of systemic glucocorticoids) - prescribe with care to patients with existing or predisposition to mental health issues. - risk of chickenpox

what would you advice patients when prescribing glucocorticoids?

immunosuppression adrenal suppression mood changes GI tract probs

when stopping glucocorticoids use how must the process be managed and why?

glucocorticoids must be withdrawn slowly | abrupt withdrawal causes neg. feedback of ACTH/cortisol disruption - patient could enter addisonian crisis

what are the symptoms of an addisonian crisis?

low BP low glucose high K+ high Na

name two commonly used reproductive steriods

oral contraceptives- combined pill mini pill

describe how the combined pill is used and how it works

oestrogen and progesterone inhibits ovulation 21days pill then 7days no pill

what are the benefits of the combined pill?

regulates menstrual cycle reliable/reversible reduces PMT high dose - morning after pill

what are the risks associated with taking the combined pill?

``` MI /stroke hypertension DVT or PE cervical/breast cancer headaches ```

describe how the mini pill works

``` progesterone only inhibits ovulation (40%) alters endometrium/cervical mucus ```

what is medroxyprogesterone?

depot - progesterone only contraceptive injection

what are the risks associated with the mini pill?

nausea vomiting breast pain

how does the combined pill inhibit ovulation?

stimulates negative feedback which in turn inhibits the release of FSH, LH and GnRH

what happens to women post menopausally?

reduced oestrogen levels = ovulation stops | increased LH/FSH

how is the menopause treated?

using HRT - oestrogen (50ug)/oestrodiols

what are the risks associated with HRT?

``` cardiovascular disease osteoporosis cancer DVTs breast cancer ```

what are hormone modulators?

drugs that can be given to modulate the effect of hormones occurring naturally in the body

name five drugs which are given to modulate hormones

- tamoxifen - breast cancer due to oestrogen - Clomiphene - stimulates ovulation - somatatrophin - oxytocin peptide hormones (PP)- induces labour (used with ergometrine to reduce haemorrhage - prostaglandins - causes muscle contraction - induce labour/abortion

what is somatatrophin used for?

analogue of hGH used in stunted growth (children) turners syndrome/ russel silver syndrome (no appetite) * also used after pituitary surgery