Organ System Pharmacology                   Drugs that Affect the Endocrine System                             IVMS BMS En...
Topics DiscussedI.     Endocrine Glands / Hormones       Action and Secretion ReviewI.     Pituitary DrugsII.    Parathyro...
Endocrine Glands / Hormones     Action and Secretion ReviewFunctions Regulation Control                                 ...
GlandsExocrine              Endocrine   Secrete enzymes      Secrete hormones   Close to organs      Transport via    ...
Nervous         versus      Endocrine     Wired                        WirelessNeurotransmitters                Hormones S...
Mechanism of Action                      6
Hypothalamus               7
Hypothalamic Control Pituitary                                 8
Posterior Pituitary            Target    ActionsOxytocin    Uterus     Contraction            Mammary    Milk           ...
Anterior Pituitary          Target        ActionGH        Most tissue    GrowthTSH       Thyroid        TH              ...
Anterior Pituitary          Target     ActionFSH       Ovaries    Follicles          Testes     Estrogen                  ...
Anterior Pituitary             Target    Action Prolactin   Mammary   Milk             Gland     production               ...
Pituitary Hormones                     13
Thyroid          14
Thyroid                 Target       ActionThyroxine        Most cells    BMRTriiodothyronineCalcitonin       Mostly bone...
Hypothyroidism                 16
Hyperthyroidismhttp://library.med.utah.edu/WebPath/ENDOHTML/ENDOIDX.html                                                  ...
Parathyroid              18
Parathyroid               Target     Action Parathyroid   Bone        Calcium (PTH)         Kidney               GI Tract...
Calcium Regulation                     20
Pancreas           21
Pancreas Alpha cells: glucagon Beta cells: insulin                          22
Pancreas           Target    ActionGlucagon   Liver      GlucoseInsulin    General    Glucose                           ...
Glucose Regulation                     24
Adrenal          25
Adrenal Medulla         Target    ActionNorepi   Heart     ProlongsEpi      Blood     SNS Effects         vessels         ...
Adrenal Cortex           Target      ActionAldosterone Kidney      Na                       reabsobtion                  ...
Anterior Pituitary Drugs     Inadequate Growth            Excessive Growth          Hormone                      Hormone ...
Posterior Pituitary Drugs   Oxytocin   ADH       Diabetes insipidus       Nocturnal enuresis   vasopressin (Pitressin...
Parathyroid Diseases   Hypoparathyroidism       Inadequate calcium levels            TX: increased dietary calcium   H...
Thyroid Disease   Hypothyroidism       Hormone replacement       levothyroxine (Synthroid®)   Hyperthyroidism       T...
Adrenal Cortex    ACTH Hypersecretion               ACTH Hyposecretion      Cushing’s Disease                Addison’s Dis...
Insulin Preparations   Regular Insulin       Natural insulin   Modified Insulin       Increased duration of action    ...
Oral Hypoglycemic Agents          Sulfonylureas                    Alpha-glucosidase     insulin secretion               ...
Hyperglycemic Agents   Glucagon                   diazoxide        gluconeogenesis       (Proglycem®)                 ...
Estrogens & Progestins   Estrogens used for            Progestin    post-menopausal                   Diminish side eff...
Oral Contraceptives   Combination of estrogen and progestin       Loestrin®, Levora®, Nordette®, Ovocon®,        Norinyl...
Uterine Stimulants & Relaxants   Stimulants (Oxytocics)         Relaxants (tocolytics)    uterine contraction        ...
Infertility Agents   Promote maturation of ovarian follicles   clomiphene (Clomid®)   urofollitropin (Metrodin®)       ...
Male Reproductive Agents   Testosterone Replacement       methyltestosterone (Metandren®)       fluoxymesterone (Halote...
End of SessionServices provided by Imhotep Virtual Medical SchoolIndividualized Webcam facilitated USMLE Step 1 Tutorials ...
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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

  1. 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. 2. Topics DiscussedI. Endocrine Glands / Hormones Action and Secretion ReviewI. Pituitary DrugsII. Parathyroid and Thyroid DrugsIII. Adrenal DrugsIV. Pancreatic DrugsV. Reproductive Drugs 2
  3. 3. Endocrine Glands / Hormones Action and Secretion ReviewFunctions Regulation Control 3
  4. 4. GlandsExocrine Endocrine Secrete enzymes  Secrete hormones Close to organs  Transport via bloodstream  Require receptors 4
  5. 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. 6. Mechanism of Action 6
  7. 7. Hypothalamus 7
  8. 8. Hypothalamic Control Pituitary 8
  9. 9. Posterior Pituitary Target ActionsOxytocin Uterus  Contraction Mammary  Milk let-downADH Kidneys  Water reabsorption 9
  10. 10. Anterior Pituitary Target ActionGH Most tissue  GrowthTSH Thyroid  TH secretionACTH Adrenal  Cortisol Cortex secretion 10
  11. 11. Anterior Pituitary Target ActionFSH Ovaries Follicles Testes Estrogen SpermLH Ovaries Ovulation Testes Progesterone Testosterone 11
  12. 12. Anterior Pituitary Target Action Prolactin Mammary Milk Gland production 12
  13. 13. Pituitary Hormones 13
  14. 14. Thyroid 14
  15. 15. Thyroid Target ActionThyroxine Most cells  BMRTriiodothyronineCalcitonin Mostly bone  Calcium 15
  16. 16. Hypothyroidism 16
  17. 17. Hyperthyroidismhttp://library.med.utah.edu/WebPath/ENDOHTML/ENDOIDX.html 17
  18. 18. Parathyroid 18
  19. 19. Parathyroid Target Action Parathyroid Bone  Calcium (PTH) Kidney GI Tract 19
  20. 20. Calcium Regulation 20
  21. 21. Pancreas 21
  22. 22. Pancreas Alpha cells: glucagon Beta cells: insulin 22
  23. 23. Pancreas Target ActionGlucagon Liver  GlucoseInsulin General  Glucose 23
  24. 24. Glucose Regulation 24
  25. 25. Adrenal 25
  26. 26. Adrenal Medulla Target ActionNorepi Heart ProlongsEpi Blood SNS Effects vessels Liver 26
  27. 27. Adrenal Cortex Target ActionAldosterone Kidney  Na reabsobtion  Water retentionCortisol Most Tissue  Glucose inflammation 27
  28. 28. Anterior Pituitary Drugs Inadequate Growth Excessive Growth Hormone Hormone Dwarfism  Acromegaly somatrem (Protropin®)  Gigantism homatropin  Surgical removal 1º (Humatrope®)  octreotide (Sandostatin®) 28
  29. 29. Posterior Pituitary Drugs Oxytocin ADH  Diabetes insipidus  Nocturnal enuresis vasopressin (Pitressin®) desmopressin (Stimate®) lypressin (Diapid®) 29
  30. 30. Parathyroid Diseases Hypoparathyroidism  Inadequate calcium levels  TX: increased dietary calcium Hyperparathyroidism  Excessive calcium levels  TX: surgical removal 30
  31. 31. Thyroid Disease Hypothyroidism  Hormone replacement  levothyroxine (Synthroid®) Hyperthyroidism  Thyrotoxicosis  Surgical removal  propylthiouracil (PTU) 31
  32. 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. 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. 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. 35. Hyperglycemic Agents Glucagon  diazoxide   gluconeogenesis (Proglycem®)  Inhibits insulin release D50W 35
  36. 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. 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. 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. 39. Infertility Agents Promote maturation of ovarian follicles clomiphene (Clomid®) urofollitropin (Metrodin®) 39
  40. 40. Male Reproductive Agents Testosterone Replacement  methyltestosterone (Metandren®)  fluoxymesterone (Halotestin®) Benign Prostatic Hypertrophy  Surgery  finasteride (Proscar®) 40
  41. 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

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