Endocrine Meds Flashcards
what categories of drugs are included in endocrine pharmacology?
thyroid meds
drugs that affect bone mineral homeostasis
diabetic meds
adrenocorticosteroids
what are the fxns of the thyroid?
growth and development
metabolism
does hypo or hyperthyroidism result in being hot all the time, weight loss, and tachycardia?
hyperthyroidism
does hypo or hyperthyoidism result in being cold all the time, weight gain, and bradycardia?
hypothyroidism
what is thyrotoxicosis?
hyperthyroidism
what are some cuases of hyperthyroidism?
Goiter
Grave’s disease
Thyroiditis
thyroid tumors
hypothalamus/pituitary gland pathology
how does Goiter cause hyperthyroidism?
enlargement and hyperfunctioning of the thyroid
how does Grave’s disease cause hyperthyroidism?
it is an autoimmune disorder that causes antibodies to be released, stimulating the thyroid to overproduce thyroid hormone
how does thyroiditis cause hyperthyroidism?
inflammation of the thyroid gland causes leakage of thyroid hormone, increasing level in the bloodstream
t/f: thyroiditis sometimes occur post partem
true
how does hypothalamus and/or pituitary gland pathology cause hyperthyroidism?
it can lead to excessive TRH and TSH
what are the s/s of hyperthyroidism?
increased in SNS symptoms
tachycardia, dysrhythmias, HF
increased RR
restlessness/anxiety
fatigue
hair loss
muscles wasting
changes in menstruation
unexplained weight loss
calcium metabolism (dec bone density)
what s/s are older ppl more at risk for with hyperthyroidism?
CV s/s
what are the rx options for hyperthyroidism?
anti-thyroid agents
thyroidectomy
iodide or radioactive iodine
beta blockers
do beta blockers treat hyperthyroidism at the thyroid level?
nope, just the cardiac symptoms (tachycardia)
what is thionamide?
an anti-thyroid agent used to treat hyperthyroidism
what is PTU?
a type of thionamide that inhibits thyroid hormone synthesis
what is Methimazole (Tapazole)?
a type of thionamide that is 10x more potent than PTU
describe the pharmacokinetics of antithyroid agents
slow onset (about 2-3 weeks)
what is a contraindication for antithyroid agents?
being pregnant or nursing
why is it contraindicated to use antithyroid agents when pregnant or nursing?
bc it can cause hypothyroidism in the fetus that can affect growth and development
what are the side effects of antithyroid agents?
nausea, GI distress
black, tarry stool
painful/difficult urination
maculopapular rash (not very serious)
severe liver disease
cholestatic jaundice (obstruction of bile flow in the liver)
agronulocytosis (dangerous but rare)
what is cholestatic jaudice?
obstruction of bile flow in the liver
what is agranulocytosis?
granulosis or granulopenia
leukocytopenia so monitor WBC count and bone marrow count
what does iodide do?
inhibits all steps involved in thyroid hormone synthesis and release
does iodide work fast or slow?
fast
is iodide a large or small dose?
large
t/f: iodide can be used to protect the thyroid from radiation
true
effects of iodide begin to diminish after how long?
about 2 weeks
t/f: susceptible individuals can have a severe hypersensitive rxns to iodide
true
what can be a temporary treatment for hyperthyroidism b4 permanent rx like ablation or removal?
iodide
what is radioactive iodine?
radioactive dye that is only absorbed by the thyroid tissues causing radioactive destruction of the thyroid gland
what are common side effects of radioactive iodine?
hypothyroidism
diarrhea
nausea
burning and metallic taste in the mouth
swollen salivary glands
what is a contraindication for radioactive iodine?
pregnancy or planning of getting pregnant in the next 6 months
why do you need to be in an isolated environment for a few days after receiving radioactive iodine?
bc you emit radioactivity
how do beta blockers treat hyperthyroidism?
they symptomatically treat CV symptoms of hyperthyroidism
antihypertensive and antiaginal
they suppress cardiac symptoms related to hyperthyroidism (tachycardia, palpitations, restlessness)
what do beta blockers end in?
-olol
what is the most common endocrine disorder, esp in women over 50?
hypothyroidism
what is a common cause of hypothyroidism?
Hashimoto disease
what is Hashitmoto disease?
the most common cause of hypothyroidism in the US
autoimmune disorder primarily affecting middle aged populations
what does iodine deficiency cause?
hypothyroidism
where do we get iodine from?
our diet in foods like soy milk and shellfish
what are the s/s of hypothyroidism?
decreased metabolism
bradycardia
jt and muscle pain
lethargy
depression
changes in menstruation
mental impairment
weight gain
dry skin and hair
cold intolerance
myxedema
increased LDL and CV disease
what is myxedema?
thickening of the skin
non pitting peripheral edema
what is the rx for hypothyroidism?
Levothyroxine (Synthroid)
what is Levothyroxine (Synthroid)?
synthetic thyroid hormone (t4)
does Levothyroxine (Synthroid) work fast or slow?
slow
people on Levothyroxine (Synthroid) need dose adjustments every ___ weeks
4-8
what is the 1/2 life of Levothyroxine (Synthroid)?
about 6 days
what is the pro of the long half life of Levothyroxine (Synthroid)?
it reduces misdosing
what are the s/s of overdose of Levothyroxine (Synthroid)?
s/s of hyperthyroidism (CV risks and fx risk)
what are the adverse effects of Levothyroxine (Synthroid)?
vomiting, diarrhea
tachycardia
dysrhythmias
hair loss
insomnia
changes in menstrual cycle
weight/appetite changes
what are the drug/food interactions with Levothyroxine (Synthroid)?
calcium carbonate
iron supplements
antacids with albumin or magnesium
walnuts
grapefruit juice
high fiber foods
what elements are involved in management of bone mineral density?
calcium and phosphate
what are the primary regulators of calcium and phosphate homeostasis?
parathyroid hormone (PTH)
fibroblast growth factor 23
vitamin D
how does PTH regulate calcium and phosphate?
by increasing blood calcium by breaking down bone
how does fibroblastgrowth factor 23 regulate calcium and phosphate?
by decreasing phosphate levels in the blood
how does vitamin D regulate calcium and phosphate?
by increasing the absorption of calcium and phosphate from the intestines and kidneys
what are the secondary regulators of calcium and phosphate?
calcitonin
glucocorticoids
estrogen
what are some disorders affecting bone mineral homeostasis?
hypoparathyroidism
hyperparathyroidism
osteoporosis
Paget’s disease
chronic kidney disease
vitamin D deficiency
what are some drugs to maintain bone mineral homeostasis?
calcium supplement
vitamin D analog
bisphosphonate
calcitonin
estrogen
rPTH, RANKL inhibitor, calcimimetics, thiazide diuretics
what are the indications for a calcium supplement?
deficiency
hypocalcemia
osteoporosis
hypoparathyroidism
a calcium supplement is often combined with ___ and ___
vit D, bisphosphonate
what are the side effects of calcium supplements?
thrist
frequent urination
bone and muscle pain
fatigue
confusion (more severe if hypercalcemia is not resolved soon)
nausea/vomiting
cardiac arrythmias, HTN
what are the indications for a vitamin D analog?
hypocalcemia, vit D deficiency secondary to malabsorption of hepatic diseases
what is the prescription vitamin D analog?
Calcitrol (Calcijex, Vectocal, ROcaltrol)
what is vit D toxicity?
hypercalcemia
calcium stones, renal failure, mood changes, seizures
increasing ____ and _____ enhances bone formation
calcium and phosphate
is a vit D analog used alone going to be effective for osteoporosis?
nope
t/f: biphosphanates are antiresorptive
true
what does it mean if a drug is anti-reabsorptive?
it inhibits the osteoplastic activity in the reabsorption bone phase
what are the indications for biphosphanates?
osteoporosis
Paget’s disease
do biphosphanates have a high or low bioavailability?
very low
are biphosphanates taken daily?
no!
how often is the bisphosphonate Alendronate (Fosamax) taken?
weekly
how often is the bisphosphonate Risedronate (Actonel) taken?
weekly or monthly
how often is the bisphosphonate Ibandronate (Boniva) taken?
every 3 months
how often is the bisphosphonate Zoledronate (Reclast) taken?
yearly injection (usually have bone pain few days after)
what are the side effects of biphosphanates?
bone pain (with injection)
GI disturbances (should be taken with plenty of water and maintain upright position for 30 min after)
t/f: calcitonin is an anti-reabsorptive drug
true
what are the indications for calcitonin?
osteoporosis
hypercalcemia
Paget’s disease
what are the 2 types of calcitonin?
human calcitonin (Fortical)
salmon calcitonin (Miacalcin)
how is calcitonin administered?
SQ, IM, or intranasal
t/f: calcitonin use can lead to flushing of the hands and face
true
what are the side effects of calcitonin?
nausea, vomiting
paresthesia (tingling hands and feet) - very mild symptom
what are the indications for estrogen replacement therapy?
osteoporosis in females post-menopause
why does estrogen replacement therapy work in post menopausal women with osteoporosis?
bc menopause decreased estrogen and estrogen helps with bone formation, so increasing estrogen can increase bone density
what are the side effects of estrogen replacement therapy?
increased risk of endometrial and breast cancer
increased risk of CV disease (already at risk post-menopause)
what is the common estrogen replacement therapy drug?
selective estrogen receptor modulators (SERMs)
what do SERMs do?
they act as estrogen agonist in bones and estrogen antagonist in breast and uterine tissues
what are the names of a couple of SERMs?
Raloxifene (Evista)
Tamoxifen (Soltamox)
what are the side effects for estrogen replacement therapy?
flu-like symptoms
hot flushes
leg cramps
peripheral edema
what meds increase risk for osteoporosis?
anticoagulants that affect hepatic vit D metabolism (phenytoin, carbamazepine)
anticoagulants (heparin, warfarin)
immunosuppressants (cyclosporine A, methotrexate, tacrolimus)
PPIs (Omeprazole, esomeprazole, pantoprazole,)
thiazolidinedrones (Proglitazone)
SSRIs (sertraline, paroxetine, fluoxentine)
what are the PT implications for durgse to maintain bone mineral homeostasis?
be aware of s/s of hypercalcemia
don’t take oral bisphosphonate w/food and take w/lots of water
schedule pt about an hour after taking meds (don’t lay down within half hour of taking meds)
potential side effects of the drugs
pt education (exercise to Rx and prevent osteoporosis, adherence to med regimine)
exercises for osteoporosis (weight bearing, plyometrics, jumping)
what is type 1 DM?
born with it
insulin supply problem
what is type 2 DM?
acquired
peripheral resistance to insulin
does insulin inc or dec blood glucose levels after eating?
dec
____ is converted to ____ to be stored in the liver
glucose, glycogen
how is insulin administered?
SQ with a small syringe or needle tipped pen
insulin pump
IV in emergencies
what are the types of insulin?
insulin aspart
insulin glulisine
insulin lispro
regular (R)
NPH (N)
insulin detemir
insulin glargine
what lifestyle factors affect insulin dosing?
eating habits and exercise habits
what are the non-insulin pharmacotherapy options?
sulfonureas
biguanides (Metformin)O
thiazolidinediones (Proglitazone)
Semaglutide injection (Ozempic)
what is the only non-insulin med that can be used for both type 1 and 2 DM?
sulfonylureas
what is the target of sulfonylureas?
pancreatic beta cells
what is the MOA of sulfonylureas?
inc insulin release
what are the adverse effects of sulfonylureas?
hypoglycemia
what is the target of Biguanides (Metformin)?
liver, peripheral tissues
what is the MOA of Biguanides (Metformin)?
dec glucose production by liver
dec peripheral insulin resistance
what are the adverse effects of Biguanides (Metformin)?
GI disturbance
what is the target of Thiazolidinediones (Pioglitazone)?
liver, peripheral tissues
what is the MOA of Thiazolidinediones (Pioglitazone)?
dec glucose production by liver
dec peripheral insulin resistance
inc peripheral insulin sensitivity
what are the side effects of Thiazolidinediones (Pioglitazone)?
headache, dizziness, fatigue/weakness, back pain; worsen HF
what is the target of Semaglutide injection (Ozempic)?
pancreatic beta cells
brain
liver
what is the MOA of Semaglutide injection (Ozempic)?
inc insulin release
dec glucose production by liver
dec glucagon release
what are the side effects of Semaglutide injection (Ozempic)?
increased risk of thyroid cancer; affects muscle-can lead to muscle wasting (encouraged to have higher protein diet)
what are common adverse reactions to anti-diabetic meds?
hyperglycemia and hypoglycemia
what are the s/s of hyperglycemia?
extreme thirst
frequent urination
extreme hunger
weakness
blurred vision
upset stomach/vomiting
SOB
fruity breath
Dec/loss of consciousness
confusion
seizure
which is the greater risk, hyperglycemia or hypoglycemia?
hyperglycemia
what are the s/s of hypoglycemia?
shakiness/tremor
pale skin
hunger
weakness
dizziness/lightheadedness
sweating
sudden changes in behavior/mood
nervousness/irritability
headache
numbness/tingling around the mouth
clumsy/jerky movements
are interactions bw anti-DM drugs and beta blockers usually bw selective or non selective beta blockers?
non-selective beta blockers
what is the problem with interactions bw DM meds and beta blockers?
beta blockers may lead to a delayed response to hypoglycemia bc they keep tremors and tachycardic symptoms are bay
t/f: pts with DM should be advised or use selective beta blockers is they must be on beta blockers
true
when is cortisone, released?
in the morning
what is the role of adrenocorticosteroids?
to controll glucose metabolism and coping with stress
if there is too much cortisol or steroids, what may happen?
DM-like insulin resistance
t/f: steroids are immunosupressants and anti-inflammatory
true
what is the role of glucocorticoids?
increased blood glucose, anti-inflammatory, and immunosuppressant effects
how do muscles cells increase glucose when cortisol acts on it?
by breaking down protein
how do fat cells increase glucose when cortisol acts on it?
by breaking down fat
how do liver cells increase glucose when cortisol acts on it?
by increasing transformation of glycogen to glucose
t/f: steroids affect bone marrow homeostasis and can lead to osteoporosis
true
t/f: steroids also have CNS and CV effects
true
what are endocrine disorder associated with glucocorticoid use?
adrenocortical insufficiency
congenital adrenal hyperplasia
adrenocortical hypersecretion
after adrenalectomy or destruction of pituitary gland
what is primary adrenocortical insufficiency?
deficient glucocorticoid from deficient adrenal cortex
Addison’s disease
what is secondary adrenocortical insufficiency?
lack of ACTH (adrenocorticotropic hormone) release from the anterior pituitary gland which normally signals the release of glucocorticoids
what is congenital adrenal hyperplasia?
enlarged adrenal cortex leads to adrenal cortex not releasing cortisol
low cortisol, high ACTH
what is adrenocortical hypersecretion?
Cushing’s syndrome from too much glucocorticoids
inc glucose in blood can lead to DM
what are the non-endocrine disorders associated with glucocorticoid use?
inflammatory conditions of bones and joints (ie. RA, OA, gout)
allergic reactions
skin diseases
organ transplant (meds suppress immune system)
autoimmune disorders (ie. RA, MS
chronic infections (ie. tuberculosis)
resp disorders
GI tract diseases
hyperthyroidism
what are examples of glucocorticoids?
short to medium-acting
intermediate-acting
long-acting
what are the short to medium- acting glucocorticoids?
hydrocortisone-short
prednisolone- medium
methylprednisolone-medium - intraarticular injections
what is the half life of short to medium-acting glucocorticoids?
3-12 hours
what are the intermediate-acting glucocorticoids?
triamcinolone
paramethasone
what is the half life of intermediate-acting glucocorticoids?
12-36 hours
what are the long-acting glucocorticoids?
dexamethasone (one of the most commonly seen meds in PT) where the drug molecules are pushed across the skin using US or electricity
betamethasone
what is the half life of long-acting glucocorticoids?
36-72 hours
what is the physiologic dose?
the dose used for replacement therapy bc the body doesn’t make enough of the steroid
what is the pharmacological (supraphysiololgic) dose?
the dose given for inflammation for RA, MS, allergies, etc
adrenal steroids given at higher dose to produce a specific benefit
what are the different routes of administration of steroids?
systemic (oral or IV)
topical
intra-articular
inhalation (for asthma)
ophthalmic
nasal
otic
t/f: glucocorticoids are metabolized mostly in the liver
true
do glucocorticoids have a high or low first pass effect?
high
does half life inc or dec with liver damage?
inc
how are glucocorticoids excreted?
urination
what are the adverse reactions to glucocorticoids?
immunosuppression
Iatrogenic Cushing syndrome-drug induced Cushing syndrome from taking too much oral steroid/hormone
breakdown of connective tissues-skin, muscles, and bones (osteoporotic changes in bone, muscles wasting, thin skin, etc) bc cortisol wants to inc blood glucose by converting fatty tissue into glucose and amino acids from muscle cells into glucose, etc
hyperglycemia
HTN
slow growth in children (from stunted bone and musc growth)
ocular side effects
psychosis
peptic ulcer
what are the general principles of glucocortioid use?
local administration is preferred
LT use is potentially hazardous
no abrupt withdrawal after >2-3 weeks of administration
–> may precipitate adrenal insufficiency
–> body learns to produce less steroid bc of exogenous source
what are the PT implications for glucocorticoids?
proceed with caution when selecting treatments and modalities
infection control (immunosuppressant effect)
monitor signs of developing osteoporosis or DM (hyperglycemia s/s)
monitor vitals (HTN secondary to corticosteroid use)
FALL RISK (visual disturbances)
skin integrity
muscles wasting (MMT)
