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

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 Images
Recommended Reading:
Management of Diabetes
Formative Assessment
Practice question set #1

2. Topics Discussed
I. Endocrine Glands / Hormones
Action and Secretion Review
I. Pituitary Drugs
II. Parathyroid and Thyroid Drugs
III. Adrenal Drugs
IV. Pancreatic Drugs
V. Reproductive Drugs
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3. Endocrine Glands / Hormones
Action and Secretion Review
Functions
 Regulation
 Control
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4. Glands
Exocrine Endocrine
 Secrete enzymes  Secrete hormones
 Close to organs  Transport via
bloodstream
 Require receptors
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5. Nervous versus Endocrine
Wired Wireless
Neurotransmitters Hormones
Short Distance Long Distance
Closeness Receptor Specificity
Rapid Onset Delayed Onset
Short Duration Prolonged Duration
Rapid Response Regulation 5

6. Mechanism of Action
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7. Hypothalamus
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8. Hypothalamic Control Pituitary
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9. Posterior Pituitary
Target Actions
Oxytocin Uterus  Contraction
Mammary  Milk
let-down
ADH Kidneys  Water
reabsorption
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10. Anterior Pituitary
Target Action
GH Most tissue  Growth
TSH Thyroid  TH
secretion
ACTH Adrenal  Cortisol
Cortex secretion
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11. Anterior Pituitary
Target Action
FSH Ovaries Follicles
Testes Estrogen
Sperm
LH Ovaries Ovulation
Testes Progesterone
Testosterone
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12. Anterior Pituitary
Target Action
Prolactin Mammary Milk
Gland production
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13. Pituitary Hormones
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14. Thyroid
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15. Thyroid
Target Action
Thyroxine Most cells  BMR
Triiodothyronine
Calcitonin Mostly bone  Calcium
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16. Hypothyroidism
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17. Hyperthyroidism
http://library.med.utah.edu/WebPath/ENDOHTML/ENDOIDX.html
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18. Parathyroid
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19. Parathyroid
Target Action
Parathyroid Bone  Calcium
(PTH) Kidney
GI Tract
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20. Calcium Regulation
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21. Pancreas
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22. Pancreas
 Alpha cells: glucagon
 Beta cells: insulin
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23. Pancreas
Target Action
Glucagon Liver  Glucose
Insulin General  Glucose
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24. Glucose Regulation
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25. Adrenal
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26. Adrenal Medulla
Target Action
Norepi Heart Prolongs
Epi Blood SNS Effects
vessels
Liver
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27. Adrenal Cortex
Target Action
Aldosterone Kidney  Na
reabsobtion
 Water
retention
Cortisol Most Tissue  Glucose
inflammation
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28. Anterior Pituitary Drugs
Inadequate Growth Excessive Growth
Hormone Hormone
 Dwarfism  Acromegaly
 somatrem (Protropin®)  Gigantism
 homatropin  Surgical removal 1º
(Humatrope®)  octreotide
(Sandostatin®)
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29. Posterior Pituitary Drugs
 Oxytocin
 ADH
 Diabetes insipidus
 Nocturnal enuresis
 vasopressin (Pitressin®)
 desmopressin (Stimate®)
 lypressin (Diapid®)
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30. Parathyroid Diseases
 Hypoparathyroidism
 Inadequate calcium levels
 TX: increased dietary calcium
 Hyperparathyroidism
 Excessive calcium levels
 TX: surgical removal
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31. Thyroid Disease
 Hypothyroidism
 Hormone replacement
 levothyroxine (Synthroid®)
 Hyperthyroidism
 Thyrotoxicosis
 Surgical removal
 propylthiouracil (PTU)
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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®)
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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
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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 Thiazolidinediones
metformin (Glucophage®)
 Insulin effectiveness
 Glucose synthesis troglitazone (Rezulin®)
 Glucose uptake
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35. Hyperglycemic Agents
 Glucagon  diazoxide
  gluconeogenesis (Proglycem®)
 Inhibits insulin release
 D50W
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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®)
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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
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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®)
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39. Infertility Agents
 Promote maturation of ovarian follicles
 clomiphene (Clomid®)
 urofollitropin (Metrodin®)
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40. Male Reproductive Agents
 Testosterone Replacement
 methyltestosterone (Metandren®)
 fluoxymesterone (Halotestin®)
 Benign Prostatic Hypertrophy
 Surgery
 finasteride (Proscar®)
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41. End of Session
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