Pharmacology Pharmacology Drugs Drugs that that Affect Affect the the Endocrine Endocrine System System
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Topics Topics •• •• •• •• •• ••
Pituitary Pituitary Drugs Drugs Parathyroid/Thyroid Parathyroid/Thyroid Drugs Drugs Adrenal Adrenal Drugs Drugs Pancreatic Pancreatic Drugs Drugs Reproductive Reproductive Drugs Drugs Sexual Sexual Behavior Behavior Drugs Drugs
Functions Functions •• ••
Regulation Regulation Control Control
Glands Glands Exocrine Exocrine
Endocrine Endocrine
•• ••
•• ••
Secrete Secrete enzymes enzymes Close Close to to organs organs
Secrete Secrete hormones hormones Transport Transport via via bloodstream bloodstream •• Require Require receptors receptors
Nervous Nervous
Endocrine Endocrine
Wired Wired
Wireless Wireless
Neurotransmitters Neurotransmitters
Hormones Hormones
Short ShortDistance Distance
Long LongDistance Distance
Closeness Closeness
Receptor ReceptorSpecificity Specificity
Rapid RapidOnset Onset
Delayed DelayedOnset Onset
Short ShortDuration Duration
Prolonged ProlongedDuration Duration
Rapid RapidResponse Response
Regulation Regulation
Mechanism Mechanism of of Action Action
Hypothalamus Hypothalamus
Hypothalamic Hypothalamic Control Control Pituitary Pituitary
Posterior Posterior Pituitary Pituitary Target
Actions
Oxytocin
Uterus Mammary
ADH
Kidneys
↑ Contraction ↑ Milk let-down ↑ Water reabsorption
Anterior Anterior Pituitary Pituitary Target
Action
GH
Most tissue
↑Growth
TSH
Thyroid
ACTH
Adrenal Cortex
↑TH secretion ↑Cortisol secretion
Anterior Anterior Pituitary Pituitary Target
Action
FSH
Ovaries Testes
LH
Ovaries Testes
Follicles Estrogen Sperm Ovulation Progesterone Testosterone
Anterior Anterior Pituitary Pituitary
Prolactin
Target
Action
Mammary Gland
Milk production
Pituitary Pituitary Hormones Hormones
Thyroid Thyroid
Thyroid Thyroid Target Thyroxine Most cells Triiodothyronine Calcitonin
Action ↑ BMR
Mostly bone ↓ Calcium
Hypothyroidism Hypothyroidism
Hyperthyroidism Hyperthyroidism
Parathyroid Parathyroid
Parathyroid Parathyroid
Parathyroid (PTH)
Target
Action
Bone Kidney GI Tract
↑Calcium
Calcium Calcium Regulation Regulation
Pancreas Pancreas
Pancreas Pancreas •• ••
Alpha Alpha cells: cells: glucagon glucagon Beta Beta cells: cells: insulin insulin
Pancreas Pancreas Target
Action
Glucagon
Liver
↑Glucose
Insulin
General
↓Glucose
Glucose Glucose Regulation Regulation
Adrenal Adrenal
Adrenal Adrenal Medulla Medulla
Norepi Epi
Target
Action
Heart Blood vessels Liver
Prolongs SNS Effects
Adrenal Adrenal Cortex Cortex Target Aldosterone Kidney
Cortisol
Action ↑Na reabsobtion ↑Water retention
Most Tissue ↑Glucose ↓inflammation
Anterior Anterior Pituitary Pituitary Drugs Drugs •• •• ••
Inadequate Inadequate Growth Growth Hormone Hormone Dwarfism Dwarfism ®® somatrem (Protropin somatrem (Protropin )) homatropin homatropin ® (Humatrope (Humatrope®))
•• •• •• ••
Excessive Excessive Growth Growth Hormone Hormone Acromegaly Acromegaly Gigantism Gigantism Surgical Surgical removal removal 1º 1º octreotide octreotide (Sandostatin®) (Sandostatin®)
Posterior Posterior Pituitary Pituitary Drugs Drugs •• ••
Oxytocin Oxytocin ADH ADH –– Diabetes Diabetes insipidus insipidus –– Nocturnal Nocturnal enuresis enuresis
•• •• ••
®® vasopressin (Pitressin vasopressin (Pitressin )) ®® desmopressin (Stimate desmopressin (Stimate )) ®® lypressin (Diapid lypressin (Diapid ))
Parathyroid Parathyroid Diseases Diseases •• Hypoparathyroidism Hypoparathyroidism –– Inadequate Inadequate calcium calciumlevels levels •• TX: TX:increased increaseddietary dietarycalcium calcium
•• Hyperparathyroidism Hyperparathyroidism –– Excessive Excessive calcium calcium levels levels •• TX: TX:surgical surgicalremoval removal
Thyroid Thyroid Disease Disease •• Hypothyroidism Hypothyroidism –– Hormone Hormone replacement replacement –– levothyroxine levothyroxine (Synthroid®) (Synthroid®)
•• Hyperthyroidism Hyperthyroidism –– Thyrotoxicosis Thyrotoxicosis –– Surgical Surgical removal removal –– propylthiouracil propylthiouracil (PTU) (PTU)
Adrenal Adrenal Cortex Cortex
•• ••
ACTH ACTH Hypersecretion Hypersecretion Cushing’s Cushing’s Disease Disease Surgical Surgical removal removal Inhibit Inhibit adrenal adrenal secretion secretion ®® –– ketoconazol (Nizoral ketoconazol (Nizoral ))
•• Symptomatic Symptomatic tx: tx: –– Antihypertensives Antihypertensives
ACTH ACTH Hyposecretion Hyposecretion Addison’s Addison’s Disease Disease •• Replacement Replacement therapy therapy ® •• Cortisone Cortisone (Cortistan (Cortistan®)) •• Hydrocortisone Hydrocortisone ®® (SoluCortef (SoluCortef )) •• Fludrocortisone Fludrocortisone ® (Florinef (Florinef Acetate Acetate®))
Pancreas Pancreas Blood Blood Potassium Potassium
Blood Blood Glucose Glucose
Insulin Insulin Preparations Preparations •• Regular Regular Insulin Insulin –– Natural Natural insulin insulin
•• Modified Modified Insulin Insulin –– Increased Increased duration duration of of action action –– NPH NPH (neutral (neutral protamin protamin Hagedorn) Hagedorn) •• Natural Naturalplus plusprotamin protamin
–– Lente Lente •• Attached Attachedto tozinc zincto toprolong prolongabsorption absorption
Oral Oral Hypoglycemic Hypoglycemic Agents Agents Sulfonylureas Sulfonylureas ⇑⇑ insulin insulin secretion secretion
® tolbutamide tolbutamide(Orinase (Orinase)®) ® chlorpropamide chlorpropamide(Diabinese (Diabinese)®) ® glipizide glipizide(Glucotrol (Glucotrol)®) ® glyburide glyburide(Micronase (Micronase)®)
Biguanides Biguanides
® metformin metformin(Glucophage (Glucophage®))
⇓⇓Glucose Glucosesynthesis synthesis ⇑⇑Glucose Glucoseuptake uptake
Alpha-glucosidase Alpha-glucosidase
inhibitors inhibitors
•• Delay Delaycarbohydrate carbohydrate metabolism metabolism ® acarbose acarbose(Precose (Precose)®) ® miglitol miglitol(Glyset (Glyset)®)
Thiazolidinediones Thiazolidinediones
⇑⇑ Insulin Insulineffectiveness effectiveness ® troglitazone troglitazone(Rezulin (Rezulin®))
Hyperglycemic Hyperglycemic Agents Agents •• Glucagon Glucagon
⇑⇑gluconeogenesis gluconeogenesis
•• D D5050W W
•• diazoxide diazoxide (Proglycem®) (Proglycem®) –– Inhibits Inhibitsinsulin insulinrelease release
Estrogens Estrogens & & Progestins Progestins •• Estrogens Estrogens used used for for post-menopausal post-menopausal hormone hormone replacement replacement therapy. therapy. ® –– estradiol estradiol(Estrace (Estrace)®) –– conjugated conjugatedestrogens estrogens ® (Premarin (Premarin®)) ®® –– estropipate (Ogen estropipate (Ogen))
•• Progestin Progestin –– Diminish Diminishside sideeffects effects of ofestrogen estrogentherapy therapy –– Nausea, Nausea,fluid fluidretention, retention, breast breasttenderness tenderness –– medroxyprogesterone medroxyprogesterone ®® acetate (Provera acetate (Provera)) –– norethindrone norethindroneacetate acetate ®® (Aygestin (Aygestin))
Oral Oral Contraceptives Contraceptives •• Combination Combination of of estrogen estrogen and and progestin progestin
® ® ® ® ® –– Loestrin Loestrin®,, Levora Levora®,, Nordette Nordette®,, Ovocon Ovocon®,, Norinyl Norinyl® plus plus many many others others
•• Minipill: Minipill: progestin progestin only only
®® ®® ®® –– Micronor , Nor-Q.D. , Orvette Micronor , Nor-Q.D. , Orvette
•• Prime Prime side side effect: effect: ⇑⇑ risk risk of of thromboembolism thromboembolism
Uterine Uterine Stimulants Stimulants & & Relaxants Relaxants •• Stimulants Stimulants (Oxytocics) (Oxytocics) •• Relaxants Relaxants (tocolytics) (tocolytics) ∀∀ ⇑⇑ uterine uterine contraction contraction •• Relax Relax uterine uterine smooth smooth •• Indication: muscle Indication: muscle –– Induce Inducelabor labor •• Beta Beta2 2 agonists agonists •• ••
–– Postpartum Postpartum hemorrhage hemorrhage
® oxytocin oxytocin (Pitocin (Pitocin®)) ergonovine ergonovine ® (Ergotrate (Ergotrate®))
®® –– terbutaline (Brethine terbutaline (Brethine)) ® –– ritodrine ritodrine(Yuptopar (Yuptopar)®)
Infertility Infertility Agents Agents •• •• ••
Promote Promote maturation maturation of of ovarian ovarian follicles follicles ®® clomiphene (Clomid clomiphene (Clomid )) ®® urofollitropin (Metrodin urofollitropin (Metrodin ))
Male Male Reproductive Reproductive Agents Agents •• Testosterone Testosterone Replacement Replacement ® –– methyltestosterone methyltestosterone (Metandren (Metandren®)) ® –– fluoxymesterone fluoxymesterone (Halotestin (Halotestin®))
•• Benign Benign Prostatic Prostatic Hypertrophy Hypertrophy –– Surgery Surgery ® –– finasteride finasteride (Proscar (Proscar®))
Sexual Sexual Behavior Behavior •• Most Most are are side side effects effects from from other other medications medications –– Antihypertensives Antihypertensives & &psychoactive psychoactive drugs drugs ®® •• sildenafil (Viagra sildenafil (Viagra ))
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