Pharm Week 2

• Endocrine system


  Made up of glands that secrete hormones, which act on specific receptor sites
• Hormones


  Target receptor sites to regulate responses to stress, growth, metabolism, and homeostasis
• Endocrine disorder


  Involves the over-secretion or under-secretion of hormones or an altered response by the target area or receptor
• Endocrine glands covered

  • Thyroid
  • Anterior and posterior pituitary
  • Pancreas
  • Adrenal glands
• Three main thyroid hormones

  • Triiodothyronine (T3)
  • Tetraiodothyronine (T4)
  • Calcitonin
• Function of thyroid hormones


  Regulate the rate at which your body uses calories (energy), affecting weight loss or weight gain and heart rate
• How thyroid hormones are made


  1. Hypothalamus produces Thyroid Releasing Hormone (TRH)

  2. Anterior Pituitary Gland produces Thyroid Stimulating Hormone (TSH)

  3. Thyroid produces T4 and T3

  4. T4 is converted into T3, the active form of thyroid hormone
• As we age

  T3 can increase or decrease due to disease, medications, surgery, or injury to the pituitary gland or hypothalamus
• Levothyroxine

  Synthetic form of thyroxine (T4), a form of liothyronine (T3), or a combination of T3 and T4, that increases the metabolic rate, protein synthesis, cardiac output, renal perfusion, oxygen use, body temperature, blood volume and growth processes
• Myxedema


  Severe hypothyroidism, usually occurs after a thyroidectomy
• Cretinism


  Congenital hypothyroidism caused by a deficiency of thyroid hormones while a fetus is developing or shortly after birth, usually due to iodine deficiency or a genetic defect in thyroid gland development
• Simple goiter


  Enlargement of the thyroid gland
• Thionamides (Methimazole, Propylthiouracil)


  Treat hyperthyroidism by blocking the synthesis of thyroid hormones and preventing the conversion of T4 into T3
• Radioactive Iodine 131


  Radioactive Iodine is absorbed by the thyroid and destroys some of the thyroid hormone-producing cells
• Lugol's Solution (SSKI – Saturated Solution of Potassium iodine; or Strong iodine solution: nonradioactive iodine)


  Nonradioactive iodine creates high levels of iodine that will reduce iodine uptake (by the thyroid gland), inhibit thyroid hormone (TH) production, and block the release of thyroid hormones into the bloodstream
• ALDOSTERONE


  A mineralocorticoid that plays a critical role in regulating concentrations of minerals, particularly Na+ and K+ in extracellular fluids, Affects the balance of Na+ and K+ in the blood
• CORTISOL


  A glucocorticoid that helps the body respond to stress, including the stress of illness, injury, or surgery, Helps maintain BP, heart function, the immune response, and blood glucose
• ADDISON'S DISEASE


  • A rare genetic disorder that lacks two (2) essential steroid hormones (Aldosterone and Cortisol)
• Manifestations of Addison's Disease

  • Pigmentation + Potassium ("Bronze Pigmentation" "Hyperkalemia")
  • Weight (Water Loss = weight loss)
  • Decreased BP, hair, sugar & energy ("fatigue" "alopecia" "hypoglycemia" "hypotension")
  • Sodium loss 135 or LESS
  • Salt craving
• CUSHING'S DISEASE

  Can be caused by a somatic gene defect or long-term use of corticosteroids
• Manifestations of Cushing's Disease

  • Truncal Obesity + Moon Face + Buffalo Hump
  • Unusual Hair Growth ("Hirsutism")
  • Skin ("Purple Striae" "Butterfly Mark")
  • High Sugar, BP, Weight
• Hydrocortisone


  Mimic effect of natural steroid hormones
• Diabetes Mellitus


  The body is unable to move sugar from the blood to the cells (the cells of the body need sugar to run), There are two hormones that bring sugar in or out of the cells: Insulin brings glucose from the blood to the cells (This reduces blood glucose levels), Glucagon brings glucose from the cells to the blood (This increases blood glucose)
• Vaccines and toxoids

  Can reduce the antibody response
• Adrenal hormone replacement - Contraindications and Precautions

  • Prednisone is a Pregnancy Risk Category B
  • Hydrocortisone and Dexamethasone is a Pregnancy Risk Category C
  • Use is contraindicated in clients who have an active infection not controlled by antibiotics
• Adrenal hormone replacement - Nursing Administration

  • Monitor weight gain, blood pressure, and electrolytes
  • Monitor glucose levels in clients who have diabetes mellitus or prediabetes
  • DO NOT stop the medication suddenly. Taper dosage if discontinued
• Medications affecting the endocrine system – diabetes mellitus
• Diabetes


  The body is unable to move sugar from the blood to the cells (the cells of the body need sugar to run)
• Hormones that bring sugar in or out of the cells

  • Insulin
  • Glucagon
• Insulin


  Brings glucose from the blood to the cells, reducing blood glucose levels
• Glucagon


  Brings glucose from the cells to the blood, increasing blood glucose levels
• Islets of Langerhans, beta cells, and alpha cells

  • Insulin is secreted in Beta Cells in the center of these islets
  • Glucagon is secreted in Alpha Cells in the periphery of the islets
• Types of Diabetes

  • Type I
  • Type II
• Type 1 Diabetes

  Can't make enough insulin or insulin is not made at all
• Genetic abnormality in chromosome 6 in a group of genes known as Human Leukocyte Antigen (HLA) in Type 1 Diabetes
• In Type 1 Diabetes, beta cells are destroyed early on in life – usually 90% before the first s/s present
• Type 1 Diabetes - Signs and Symptoms

  • Polyphagia (excessive hunger)
  • Glycosuria (glucose in the urine)
  • Polyuria (where glucose goes, water follows)
  • Polydipsia (excessive thirst)
• Type 2 Diabetes

  Makes insulin but tissue doesn't respond well to it
• Type 2 Diabetes

  1. Cells become insulin resistant

  2. Beta cells produce more insulin (hyperplasia) to overcome insulin resistance. This hyperplasia causes more beta cells to be created (hypertrophy) in an attempt to pump out more insulin

  3. Eventually hypoplasia and hypotrophy occur as a result of beta cells burning out from excessive overuse
• Type 2 Diabetes - Risk Factors

  • HTN
  • Obesity
  • Lack of exercise
  • Genetics