Week 16: Endocrine Meds Flashcards
How fast does rapid acting insulin take to work
10-15 minutes
How long do long acting insulins work
at least 24 hours
Endocrine drugs are generally used to do what things
- Supply addtl hormone because glands are not producing enough
- prevent release of addtl hormone because the gland produced too much (negative feedback mechanisms)
Prototype Endocrine Drugs
- ACTH (crticotropin)
- Vasopressin (ADH, pitressin)
- Oxytocin (Pitocin)
- Vitamin D (Hytakerol)
- Calcitonin (Calcimar)
- Alendronate (Fosamax)
- Levothyroxine (Synthroid)
- Sodium iodide 131
- Insulin
- metformin (Glucophage)
- Pioglitazone (Actos)
- Cortisone
- Testosterone
- Progesterone
- Estrogen
Corticotropin (ACTH) Classification
Hormone, Anterior Pituitary
Action fo Cortiotropin
stimulates the cortex of the adrenal gland - when stimulated it produced cortisol
What is the reason corticotropin is often given
Usually to diagnose adrenal insufficiency
Helps us figure out if the gland is not working or if there is not enough hormone being made
What does it mean if, after giving corticotropin, the cortisol levels fail to rise? What does it mean if the cortisol levels would rise?
If cortisol levels fail to rise then it is primary adrenal insufficiency
If cortisol levels do rise that means the anterior pituitary is not making enough ACTH
ADRs of Corticoptropin (ACTH)
Same as those for cortisone
Vasopressin (Pitressin, ADH) Classification
Post Pituitary Hormone
Action of Vasopressin
- Fxns as ADH - enhances water permeability of tubular epitherlial membranes of distal convoluting ducts and collecting ducts so water can be absorbed by osmotic flow - PROMOTES RENAL CONSERVATION OF WATER ( HOLD ONTO WATER)
- Causes contraction of smooth muscle of vascular beds enhancing motility and tone of GI tract (2nd action less strong)
ADRs of Vasopressin
- EXCESSIVE VASOCONSTRICTION (2ndary effect)
- WATER RETENTION AND INTOXIFICATION
Other: arrhythmias, decreased CO, intestinal and uterine cramps, marked facial pallor (from cutaneous vasoconstriction), allergic rxns
What is vasopressin used to treat
- Diabetes Insipidus - loss of /urinating large amounts og dilute urine
- Gaseous Distention - rarer use - increases GI tone
Oxytocin (Pitocin, Syntocinon) Classification
Posterior Pituitary Hormone
Action of Oxytocin
Stimulate uterine smooth muscle though non pregnant uterus is relatively insensitive
Does have SOME VASOPRESSOR ACTIVITY (some contracture of vasculature)
Stimulates let down reflex - milk
Has limited ADH effect (may hold some water) - get baby out but a non pregnant uterus does not act like that
Absorption/Route of Oxytocin
Mostly IV infusion, IM, Subcutaneous, Intranasal, Buccal (NOT ORAL)
ADRs of Oxytocin
- WATER INTOXICATION (with large doses over long periods)
- ALLERGIC RXNs INJUDICIOUS USE
Other: uterine rupture, HTN crisis (high BP from vasoconstriction), cerebral hemorrhage, pelvic hematomas, bradycardia, arrhythmias
Oxytocin is often used in what situations
Stop postpartum bleeding
Induction of labor
Cholecalciferol and Ergocalciferol Classification
Parathyroid:
Vitamind D (Modified Form)
Cholecalciferol - D3
Ergocalciferol - D2
(MORE A HORMONE THAN VITAMIN)
Action of Cholecalciferol and Ergocalciferol
- Stimulate intestinal Ca absorption
- Decrease Ca excretion
- Bone Ca mobilization (resorption) in absence of parathyroid hormoen and fxning renal tissue - analog of Vitamin D
Vitamin D
“Sunshine Vitamin”
Can get from food or sun
Stimulates calcium absorption in the intestines and decreases Calcium excretion
Cholecalciferol/Ergocalciferol may be used when a person…
has low aprathyroid hormone
What is unique about the metabolism of Cholecalciferol/Ergocalciferol
It is activated in the liver AND kidneys
Kidney is pretty unique (plays a big part in bones)
What happens with Cholecalciferol/Ergocalciferol if there is no kidney function
No kidney function –> cannot activate Vitamin D –> Renal Osteodystrophy (bad kidneys means bad bones)
ADRs of Cholecalciferol/Ergocalciferol
- Hypercalcemia
Hypercalcemia causes - anorexia, NV, weakness, constipation, lethargy, depression, amnesia, disorientation, hallucination, syncope, diarrhea, vertigo, HA, polyuria, thirst ataxia
Calcitrol
Drug for renal patients on dialysis with hypocalcemia
Increase GI absorption of Ca when you have renal disease
It is already activated Vitamin D since the kidneys would normally do this
Calcitonin-Salmon (MIacalcin, Calcimar) Classification
(Fish Form)
Hypocalcemic Hormone (from thyroid)
Action of Calcitonin-Salmon
Direct inhibition of osteoclasts
Decreases tubular resorption leading to increased excretion of Ca
When is calcitonin-salmon used
in diseases like osteoporosis, Pagets disease, or Hypercalcemia
It is going to save the bones and inhibit resorption/osteroclast breakdown
Parathyroid Hormone v Calcitonin
PH will pull Ca from bone while Calcitonin keeps it in the bone
ADRs of Calcitonin Salmon
- HYPOCALCEMIA (with tetany)
Other: NV, allergy, tenderness and swelling of hands, flushing
What is the max amount of calcitonin-salmon given IM and SubQ?
IM - no more than 2 cc per site
SubQ - no more than 1 cc
Alendronate Sodium (Fosamax) Classification
Bone resorption inhibitor, Biphosphonate
Action of Alendronate Sodium
Inhibits osteoclast activity
Absorption/Route of Alendronate Sodium
Oral
FOOD GREATLY DELAYS ABSORPTION
Biphosphonates
class fo drugs inhibiting osteoclast activity
ex: Alendronate Sodium
ADRs of Alendronate Sodium
- MOST ARE MILD - MAY HAVE SOME MILD GI DISTRESS, ULCERS, ESOPHAGITIS/ESOPHAGUS ULCER
- BRONJ ? JAW NECROSIS
Other: A fib concerns (may be correlation not causation
BRONJ
Biphosphonate related osteonecrosis of the jaw
There is concern with a higher incidence of bone death in the jaw / jaw necrosis with dental procedures when taking alendronate sodium
When is alendronate sodium taken
AT LEAST 30 minutes before FIRST intake of the day
Taken with a full glass of water
What must not be done up to 30 minutes after taking alendronate sodium
you must not lay down (prevent esophagus ulcers)
What is the Alendronate Sodium drug holiday
This drug can stay in bones for a long time so sometimes people can take breaks from taking it
Levothyroxine Sodium (Synthroid, Levothroid) Classification
Thyroid Hormone
Synthetic T4 (which converts to T3 in the body)
Action of Levothyroxine Sodium
- Regulate growth/dev through control of PROTEIN SYN
- Calorigenic effect - increase metabolic rate
- Metabolic - increase metabolic rate by various modes
- Inhibition of thyrotropin secretion by pituitary
Absorption/Route of Levothyroxine Sodium
Oral
Food delays absorption - give on empty stomach
When is levothyroxine sodium given
it is used as hypothyroidism hormone replacement therapy
treatment for this is lifelong
ADRs of Levothyroxine Sodium
(Look like Hyperthyroidism)
- CNS - Nervous, insomnia
- CV - arrhythmia, palpitation
- GI - WEIGHT LOSS, cramp, diarrhea
- GU - menstrual irregularities
OVERDRIVE OF SNS
Levothyroxine sodium will enhance the effect of oral ____
anticoagulants
Caution using levothyroxine sodium in what patients
patients with heart disease, esp. coronary insufficiency
patients with diabetes
patients on tricyclic antidepressants
Levothyroxine cannot be taken within 4 hours of taking…
calcium carbonate (TUMS and other local antacids)
How big are the Levothyroxine Sodium doses
thyroid hormone is given in mcg (tiny doses)
If there is not enough T4 being made and a patient needs levothyroxine sodium, what lab value will be different?
TSH (Thyroid Stimulating Hormone) will be high
Iodine 131 Classification
Radioactive Thyroid Hormone
Action of Iodine 131
Destroy thyroid tissue mainly through Beta rats
Goal to produce clinical remission without complete thyroid destruction - in hyperthyroidism/Graves dx
ADRs of Iodine 131
- DELAYED HYPOTHYROIDISM (10% a year after)
Other: Depressed hematopoietic system, anemia, thyroiditis
What is another, more uncommmon use, of Iodine 131
since it is uptook by the thyroid gland it can be given in miniscule non damaging amounts for diagnostic purposes
Iodine 131 should not be used on what patients
Pregnant Patients
children
lactating patients
Insulin
drug used for management of hyperglycemia by promoting cellular uptake of glucose
varies in onset peak and duration of action