Pharm Session 13:

Non diabetic hormones and medications

 

Pituitary

 

What is the medication that mimics Oxytocin

  • Pitocin

 

Patients taking an antidiuretic are at risk for fluid overload. What patient would be at a high risk

Posterior Pituitary

 

  • Oxytocin
    • Pitocin is used to induce labor.
  • ADH – Antidiuretic hormone
    • Diabetes insipidus
      • too little ADH
      • can be genetic or injury to pituitary
      • Low specific gravity, bp high tirst
      • Need ADH meds

 

Anterior Pituitary

 

  • DDAVP (Desmopressin)
    • Antidiuretic hormones, for DI (deficiency of ADH) or a deficiency of Vasopressin
    • Nasal route, blow nose before administration
    • only works Neurogenic DI not Nephro-
    • so could be used after head injury and surgery
    • can be used for enuresis too which is bed wetting
    • Complications: water intoxication (imbalance of electrolytes and causes drowsiness headache convulsions and coma)
    • cardiac patients are at a high risk for s/s from fluid overload
  • Vasopressin
    • Antidiuretic Hormone
    • for DI from too little ADH and severe vasodilated shock
    • only excrete unbound water
    • alters renal permeability to reabsorb more water.
    • Decreases urine output and increases BP.
    • can cause an MI in a person with a cardiac pathology
    • Monitor BP, HR and ECG in cardiac patients
  • GH
    • promotes growth of bone and MM
    • GH turns into IGF 1
    • grow tall if the person is young and still growing
    • GH deficiency – these people are normal proportions just small. (treat with GH while young)
    • Acromegaly – when there is an increase in GH after growth is over, this causes bones to grow thicker ie. hands, face, big boggy heart. Self esteem issues.
  • Octreotide (sandostatin)
    • treats acromegaly by suppressing GH release
    • SE: GI, and gallstones (decrease renal function)
    • Assess for Frequency consistency of stools and bowel sounds
    • analog of hormone somatostatin
    • also suppresses Insulin and glucagon, really slow the person down
  • Pegvisomant (somavert)
    • GH receptor antagonist (binds the GH site so that GH cannot do its job)
    • Newest drug class for GH suppression
    • Well tolerated
    • sq injection monthly after loading dose
  • Prolactin
    • Makes milk
    • suppresses ovulation, but do not use this as contraceptive

 

Thyroid medication

 

hormones made here regulate metabolism, Heart function and growth/development

Dwarfism and cretinism may result if these hormones are absent

 

thyroid hormones – TRH ->  TSH ->  T3 and T4

TSH stimulates thyroid to release T3 and T4

 

T3 – active not bound form, and can cross membranes

T4 – is bound and converts to T3 to be used. There is much more T4 than T3.

 

Goiter can come from a lot of different pathologies. Including hypo 95% or goiters and hyperthyroidism 5%

 

Hypothyroidism – T3+4 Low and TSH HIGH. Myxedema

  • liothyronine – T3 analog
  • levothyroxine – T4 analog
  • there are also natural products that are from the ground up cow thyroid

 

Hyperthyroidism – T3+4 high and TSH low. Thyrotoxicosis

  • Graves disease can cause this
  • exophthalmos
  • Too much T3+4

 

  • levothyroxine (synthroid) T4 analog
    • this is T4 and gets converted by the body into T3
    • The dose is very patient dependent and there are MANY pill quantities. this also means that a Generic drug which can be plus or minus 20% of the drug, may cause the patient to be getting too much or too little of the drug.
    • Long H life of a week
    • daily dosing
    • takes about a month to get to the therapeutic effects
  • liothyronine (Cytomel) T3
    • shorter H life
    • more money
    • faster onset

 

  • Propylthiouracil (PTU)
    • used to treat thyroid storm
    • SE: agranulocytosis (discontinue drug if too low WBC count
  • radioactive Iodine-131
    • for hyperthyroidism and thyroid cancer.  
    • emits gamma and beta particles
    • 8 day H life
    • blocks hormone synthesis
    • needs synthroid after treatment for life (hypothyroid for life)
    • destroys the thyroid gland
    • Lugol’s solution – surgery prep, thyrotoxic crisis, it is an antiseptic

 

Effective hyperthyroidism results in decrease in palpitations

 

Adrenal Gland hormones

  • inner medulla stress
  • outer cortex stress, sex and salt
  • Classes
    • Catecholamines – Epinephrine, and norepinephrine
    • corticosteroids – Glucocorticoids work on glucose (cortisol), and mineralocorticoids work on the minerals and salts such as aldosterone
    • Androgens
  • these will be for Addison’s Dx and to suppress inflammation

 

glucocorticoids aka corticosteroids (hydrocortisone, and prednisone)

  • Always taper these meds if on for more than a week
    • glu, lipid, and protein increase blood levels
    • increase glu production and decrease the cellular uptake of glu
    • DO not take for long periods
    • increases cap permeability

 

  • hydrocortisone
    • synthetic cortisol, corticosteroid
    • for adrenocortical insufficiency
    • Altered glucose metabolism at the normal dose, shown by increased GLU levels.
      • HYPERGLYCEMIA, watch closely in DM patients
    • Can cause cushing’s syndrome or adrenal suppression if too much is given
    • Taper dose once the treatment is done.

 

  • Prednisone
    • steroidal Antiinflammatory, intermediate immune modifier
    • Taper the med
    • MAKE SURE THE PATIENT knows how to taper and understand the instructions
    • will go into an adrenal crisis if they do not taper and will look like a person with cushing’s disease
    • Cushing’s Dx test – Dexamethasone suppression test
      • Dexamethasone 1 mg at 2300, the measure the plasma cortisol at 0800. if the ACTH is suppressed

 

Mineralocorticoids

 

addison’s Dx patient need replacement and it comes from extreme adrenal stress. These patients need mineral and glucocorticoids.

 

  • Fludrocortisone (florinef)
    • for addison’s Dx
    • weight gain from edema so watch I and O’s
    • monitor K, BP and NA
    • geven IM in a Addisonian Crisis

 

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