IVMS Endo IV-Organ System Pharmacology- Drugs that Affect the Endocrine System

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IVMS Endo IV-Organ System Pharmacology- Drugs that Affect the Endocrine System

IVMS Endo IV-Organ System Pharmacology- Drugs that Affect the Endocrine System

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  • 1. Organ System Pharmacology Drugs that Affect the Endocrine System IVMS BMS Endocrinology 4 of 4 Prepared and presented by: Marc Imhotep Cray, M.D. COMPANION RLOs:IVMS Endocrine Secretion and Action Part I Part II Part III WebPath Pathology: Endocrine Pathology 70 ImagesRecommended Reading: Management of Diabetes Formative Assessment Practice question set #1
  • 2. Topics DiscussedI. Endocrine Glands / Hormones Action and Secretion ReviewI. Pituitary DrugsII. Parathyroid and Thyroid DrugsIII. Adrenal DrugsIV. Pancreatic DrugsV. Reproductive Drugs 2
  • 3. Endocrine Glands / Hormones Action and Secretion ReviewFunctions Regulation Control 3
  • 4. GlandsExocrine Endocrine Secrete enzymes  Secrete hormones Close to organs  Transport via bloodstream  Require receptors 4
  • 5. Nervous versus Endocrine Wired WirelessNeurotransmitters Hormones Short Distance Long Distance Closeness Receptor Specificity Rapid Onset Delayed Onset Short Duration Prolonged DurationRapid Response Regulation 5
  • 6. Mechanism of Action 6
  • 7. Hypothalamus 7
  • 8. Hypothalamic Control Pituitary 8
  • 9. Posterior Pituitary Target ActionsOxytocin Uterus  Contraction Mammary  Milk let-downADH Kidneys  Water reabsorption 9
  • 10. Anterior Pituitary Target ActionGH Most tissue  GrowthTSH Thyroid  TH secretionACTH Adrenal  Cortisol Cortex secretion 10
  • 11. Anterior Pituitary Target ActionFSH Ovaries Follicles Testes Estrogen SpermLH Ovaries Ovulation Testes Progesterone Testosterone 11
  • 12. Anterior Pituitary Target Action Prolactin Mammary Milk Gland production 12
  • 13. Pituitary Hormones 13
  • 14. Thyroid 14
  • 15. Thyroid Target ActionThyroxine Most cells  BMRTriiodothyronineCalcitonin Mostly bone  Calcium 15
  • 16. Hypothyroidism 16
  • 17. Hyperthyroidismhttp://library.med.utah.edu/WebPath/ENDOHTML/ENDOIDX.html 17
  • 18. Parathyroid 18
  • 19. Parathyroid Target Action Parathyroid Bone  Calcium (PTH) Kidney GI Tract 19
  • 20. Calcium Regulation 20
  • 21. Pancreas 21
  • 22. Pancreas Alpha cells: glucagon Beta cells: insulin 22
  • 23. Pancreas Target ActionGlucagon Liver  GlucoseInsulin General  Glucose 23
  • 24. Glucose Regulation 24
  • 25. Adrenal 25
  • 26. Adrenal Medulla Target ActionNorepi Heart ProlongsEpi Blood SNS Effects vessels Liver 26
  • 27. Adrenal Cortex Target ActionAldosterone Kidney  Na reabsobtion  Water retentionCortisol Most Tissue  Glucose inflammation 27
  • 28. Anterior Pituitary Drugs Inadequate Growth Excessive Growth Hormone Hormone Dwarfism  Acromegaly somatrem (Protropin®)  Gigantism homatropin  Surgical removal 1º (Humatrope®)  octreotide (Sandostatin®) 28
  • 29. Posterior Pituitary Drugs Oxytocin ADH  Diabetes insipidus  Nocturnal enuresis vasopressin (Pitressin®) desmopressin (Stimate®) lypressin (Diapid®) 29
  • 30. Parathyroid Diseases Hypoparathyroidism  Inadequate calcium levels  TX: increased dietary calcium Hyperparathyroidism  Excessive calcium levels  TX: surgical removal 30
  • 31. Thyroid Disease Hypothyroidism  Hormone replacement  levothyroxine (Synthroid®) Hyperthyroidism  Thyrotoxicosis  Surgical removal  propylthiouracil (PTU) 31
  • 32. Adrenal Cortex ACTH Hypersecretion ACTH Hyposecretion Cushing’s Disease Addison’s Disease Surgical removal  Replacement therapy Inhibit adrenal  Cortisone (Cortistan®) secretion  Hydrocortisone  ketoconazol (Nizoral ®) (SoluCortef®) Symptomatic tx:  Fludrocortisone  Antihypertensives (Florinef Acetate®) 32
  • 33. Insulin Preparations Regular Insulin  Natural insulin Modified Insulin  Increased duration of action  NPH (neutral protamin Hagedorn)  Natural plus protamin  Lente  Attached to zinc to prolong absorption 33
  • 34. Oral Hypoglycemic Agents Sulfonylureas Alpha-glucosidase  insulin secretion inhibitors tolbutamide (Orinase®)  Delay carbohydrate chlorpropamide (Diabinese®) metabolism acarbose (Precose®) glipizide (Glucotrol®) miglitol (Glyset®) glyburide (Micronase®) Biguanides Thiazolidinedionesmetformin (Glucophage®)  Insulin effectiveness Glucose synthesis troglitazone (Rezulin®) Glucose uptake 34
  • 35. Hyperglycemic Agents Glucagon  diazoxide   gluconeogenesis (Proglycem®)  Inhibits insulin release D50W 35
  • 36. Estrogens & Progestins Estrogens used for  Progestin post-menopausal  Diminish side effects of hormone replacement estrogen therapy therapy.  Nausea, fluid  estradiol (Estrace®) retention, breast tenderness  conjugated estrogens (Premarin®)  medroxyprogesterone acetate (Provera®)  estropipate (Ogen®)  norethindrone acetate (Aygestin®) 36
  • 37. Oral Contraceptives Combination of estrogen and progestin  Loestrin®, Levora®, Nordette®, Ovocon®, Norinyl® plus many others Minipill: progestin only  Micronor®, Nor-Q.D.®, Orvette® Prime side effect:  risk of thromboembolism 37
  • 38. Uterine Stimulants & Relaxants Stimulants (Oxytocics)  Relaxants (tocolytics)  uterine contraction  Relax uterine smooth Indication: muscle  Induce labor  Beta2 agonists  Postpartum hemorrhage  terbutaline (Brethine®) oxytocin (Pitocin®)  ritodrine (Yuptopar®) ergonovine (Ergotrate®) 38
  • 39. Infertility Agents Promote maturation of ovarian follicles clomiphene (Clomid®) urofollitropin (Metrodin®) 39
  • 40. Male Reproductive Agents Testosterone Replacement  methyltestosterone (Metandren®)  fluoxymesterone (Halotestin®) Benign Prostatic Hypertrophy  Surgery  finasteride (Proscar®) 40
  • 41. End of SessionServices provided by Imhotep Virtual Medical SchoolIndividualized Webcam facilitated USMLE Step 1 Tutorials with Dr. Cray Starting at$50.00/hr., depending on pre-assessment. 1 BMS Unit is 4 hr. General Principles and some OrganSystem require multiple units to complete in preparation for the USMLE Step 1A HIGH YIELD FOCUS in Biochemistry / Cell Biology, Microbiology / Immunology, the 4 P’s-Physiology, Pathophys., Path and Pharm and Intro to Clinical MedicineWebcam Facilitated USMLE Step 2 Clinical Knowledge and Clinical Skills didactic tutorialsstarting at $75.00 per hour /1 Unit is 4 hours, individualized one-on-one and group sessions,Including Introduction to Clinical Medicine and all Internal Medicine sub-specialities at the clerkshiplevel. For questions or more information. drcray@imhotepvirtualmedsch.comALL e-books and learning tools provided 41