Endocrine Drugs

Question 1

Thyroid

What are the two drugs produced by the thyroid? Which one is produced in larger quantities?

Answer 1

T3 (triiodothyronine) and T4 (thyroxine)

T4 is about 80-90% of the output

Question 2

What is hypothyroidism?

Compare primary and secondary hypothyroidism

Answer 2

Reduced thyroid hormone production

Primary - gland itself
Secondary - other body system dysfunction

Question 3

What is hypothyroidism called in infants?

Answer 3

Cretinism - low metabolic rate and mental retardation

Question 4

Some hypothyroidism signs

Answer 4

• firm edema (myxedema)
• intolerance to cold
• weight gain
• slow HR (always fatigued)
• loss of hair

Question 5

Goiter is an _____ of the thyroid gland caused by elevated levels of ______

Answer 5

enlargement

TSH

Question 6

Goiter occurs in:

a) hypothyroidism
b) hyperthyroidism
c) both

Answer 6

c) both

because is occurs in situations where the thyroid gland is overstimulated

Question 7

Treatment of hypothyroidism 
name one drug
what is the half-life
AEs
Care

Answer 7

levothyroxine

• synthetic T4 hormone
• replacement therapy

half-life is 7 days!
since it takes 4-5 half lives of a drug to reach plateau, then it’ll take 4-5 weeks to reach full effect

AEs: think hyperthyroidism
- palpitations, tachycardia, tremors, anxiety, weight loss

Care: report chest pain, palpitations
- take 30 to 60 min before breakfast

Question 8

Hyperthyroidism
what is it
name two types of the disease
Treatments

Answer 8

excessive thyroid hormone secretion

1. Graves disease - autoimmune (antibody stimulation)
2. Toxic nodular goiter

Treatments:

1. radioactive iodine to destroy thyroid gland
2. surgery to remove
3. antithyroid drugs (e.g., methimazole) which prevent thyroid hormone synthesis

Question 9

thyrotoxicosis symptoms

Answer 9

palpitations, increase HR
CNS stimulation (nervousness, rapid speech, insomnia)
High metabolic rate (heat intolerance, skin flushed and moist)
Muscle weakness and atrophy
Increased appetite but weight loss

Question 10

Glucocorticoids - review
name our endogenous one
they \_\_\_\_\_\_\_ (promote or reduce?) glucose availability 
Pathophysiology: 
- over secretion leads to \_\_\_\_\_\_
- under secretion leads to \_\_\_\_\_\_\_

Answer 10

cortisol

promote glucose availability (gluconeogenesis in liver)

over = Cushing's syndrome
under = Addison's disease

Question 11

Glucocorticoids drugs
name one
routes of admin
help control: 
Indications (conditions);
Cautions
AEs

Answer 11

Prednisone

routes: inhalation (asthma), nasally (rhinitis), topically (inflammation), systemic (IV, PO for hormone replacement therapy)

help control: inflammatory and immune responses

Indications: deficiency, COPD, asthma, organ transplant

Caution: infections, Diabetes (can cause hyperglycemia), HF, pregnancy

AEs: excess can mimic Cushing’s syndrome (moon face, thin skin, striae), steroid psychosis mood swings, peptic ulcers

Question 12

Care implications of glucocorticoids

Answer 12

• Sudden discontinuation of glucocorticoids can precipitate an adrenal crisis (can be fatal, low BP and shock)
• take same time every day with food
• don’t use with NSAIDs
• rinse your mouth (inhalers)
• try not to get an infection

Question 13

Anterior pituitary drugs

GH - two related drugs

Answer 13

replacement therapy: somatropin (is basically GH )

excess: octreotide (mimics somatostatin to reduce GH secretion)

Question 14

Posterior pituitary drugs
what’s the condition called where you produce large volumes of urine?
Vasopressin vs desmopressin - which is preferred?

Answer 14

Diabetes insipidus

desmopressin is preferred (can be given PO, no vasoconstrictor activity)

Question 15

What blood disorder does desmopressin help with?

Answer 15

Hemophilia A because it causes the release of clotting factor VIII (8)