Pharm7e-Ch13-Presentation

[Audio] Welcome to the Pharmacology for Technicians Seventh Edition Watch and Learn Lessons!.

[Audio] Chapter 13, The Endocrine System and Drug Therapy..

[Audio] In the anatomy and physiology section of this chapter, you will learn about the physiologic processes of the endocrine system. You will also learn about hormones and how they regulate the body. In the thyroid disorders and drug treatments section, you will develop an awareness of the treatments for disorders of the thyroid. As you progress through the adrenal glands and drug treatments section, you will discover commonly used corticosteroids. In the diabetes and drugs treatments section of this chapter, you will learn about diabetes along with the proper treatment and care of patients with diabetes. You will also learn about the classes of drugs used to treat diabetes. In addition, you will develop an understanding of how the medications used to treat diabetes work..

[Audio] Chapter 13, Section 1, Anatomy and Physiology of the Endocrine System..

[Audio] The endocrine system consists of glands that secrete hormones into the bloodstream. A hormone has a specific regulatory effect on organs and other tissues. The cell, tissue, or organ affected by a hormone is called a target..

[Audio] A feedback mechanism is the continuous feedback process that allows the endocrine system to secrete hormones at a constant rate. This keeps the hormone levels in the blood stable. Negative feedback occurs when the level of hormone in the blood moves above or below a certain range, and hormone production changes in the opposite direction to keep it in range. Positive feedback occurs when the presence of hormone promotes production of more of that hormone until some other input stops it. With this type of feedback, the hormone is not kept within a particular range. This type of feedback is rare..

[Audio] The pituitary gland plays a leading role in the endocrine system. The pituitary gland produces hormones that regulate several other endocrine glands. The thyroid gland, adrenal glands, and the hormones within the kidney are all regulated by the pituitary gland..

[Audio] The thyroid gland produces hormones that stimulate body tissues to increase their metabolic activity. The thyroid gland produces two hormones. The first hormone is called tri-iodothyronine, known as T3, and the second hormone is called thyroxine, known as T4. Thyroid stimulating hormone, TSH, regulates the secretion of T3 and T4. A high TSH test result means that T3 and T4 levels are low, which is consistent with hypothyroidism. The hypothalamic-pituitary axis is shown in Figure 13.4..

[Audio] The adrenal glands are located on top of the kidneys. The inner portion is called the adrenal medulla, and it produces catecholamines such as epinephrine and norepinephrine. The outer portion is called the adrenal cortex, and it produces several types of steroid hormones. Each such hormone, known as a corticosteroid, has its own combination of glucocorticoid and mineralocorticoid activity. Glucocorticoid activity includes regulating cholesterol, fat, and protein metabolism. Mineralocorticoid activity includes regulating electrolyte and water balance. The principal adrenal steroid hormone is cortisol..

[Audio] As with the thyroid hormones, the production of cortisol and other steroids begins in the hypothalamic-pituitary axis. The feedback mechanisms regulating production of hormones in the adrenal cortex are corticotropin-releasing factor produced by the hypothalamus, and adrenocorticotropic hormone produced by the pituitary..

[Audio] The pancreas produces insulin. Insulin helps cells burn glucose for energy, binds with cell membrane receptors to allow glucose uptake, enhances amino acid transport and incorporation into proteins, increases ion transport into tissues, inhibits fat breakdown, and maintains blood glucose levels..

[Audio] Chapter 13, Section 2, Thyroid Disorders and Drug Treatments..

[Audio] Hypothyroidism refers to conditions where the production of thyroid hormones is lower than normal. Causes of hypothyroidism include surgical removal of the thyroid, defects in thyroid function due to autoimmune disorders or radioactive iodine therapy, and pituitary or hypothalamus dysfunction. Symptoms of hypothyroidism include tiredness, lethargy, hair loss, weight gain, changes in sleep, depressed mood, and increased appetite..

[Audio] Thyroid replacement agents are used in the treatment of hypothyroidism. Levothyroxine is synthetic T4 and replaces the body's natural hormone. Levothyroxine is used in chronic hypothyroidism and is available in various oral dosage forms as well as injection. Side effects of levothyroxine include palpitations, arrythmias, increased blood pressure, flushing, anxiety, irritability, and heat intolerance. Levothyroxine should not be used for weight loss, and the patient's hormone levels should be monitored. Levothyroxine should be refilled with a consistent brand. Liothyronine, which is synthetic T3, replaces the body's natural hormone. Liothyronine is used in hypothyroidism and goiter. Side effects and cautions of liothyronine are the same as those of levothyroxine..

[Audio] Hyperthyroidism describes an excessive level of thyroid hormones. Causes include Graves disease, thyroid nodules or tumors, and pituitary nodules or tumors. The symptoms of hyperthyroidism include weight loss, hair loss, and exophthalmos. Exophthalmos is a condition in which fat collects behind the eyeballs and causes them to protrude..

[Audio] Treatment options for hyperthyroidism include surgery to remove or reduce the gland, radioiodine ablation to destroy the thyroid gland, thyroid hormone replacement to artificially provide adequate hormone after surgery or ablation, medications to suppress thyroid hormones..

[Audio] Methimazole is used for the treatment of hyperthyroidism when surgery or radioactive iodine are not appropriate. Methimazole is also used for the adjunctive treatment in preparation for surgery or radioactive iodine therapy. Side effects of methimazole include altered taste, mild alopecia, bone marrow depression, an autoimmune reaction, and a warfarin-like anticoagulant reaction. Methimazole is associated with liver toxicity, increased bleeding, bone marrow suppression, and dermatitis. Propylthiouracil is used in the palliative treatment of hyperthyroidism, as adjunctive treatment in preparation for surgery, and in thyroid storm. Side effects of propylthiouracil are the same as methimazole's. Propylthiouracil carries a boxed warning for liver toxicity. In addition, propylthiouracil is associated with increased bleeding, bone marrow suppression, and dermatitis..

[Audio] Chapter 13, Section 3, Adrenal Glands and Drug Treatments..

[Audio] Cushing's syndrome is an excess of cortisol production. Causes of Cushing's syndrome include overproduction of cortisol, excessive administration of corticosteroids, and adrenal gland tumors. The symptoms of Cushing's syndrome include protruding abdomen; round, puffy face; and fat deposits over the shoulder blades. Treatment consists of surgery or chemotherapy drugs to treat the tumor and suppress corticosteroid production..

[Audio] Addison's disease is a life-threatening deficiency of glucocorticoids and mineralocorticoids. Symptoms of Addison's disease include debilitating weakness, hyperkalemia, hyperpigmentation of skin, low sodium and glucose levels, low blood pressure, and weight loss. Treatment consists of IV fluids and systemic corticosteroids..

[Audio] The generic names of systemic corticosteroids are listed on this slide. See Table 13.2 for the brand names and dispensing status of commonly used corticosteroids. Systemic corticosteroids are used in acute adrenal deficiency, asthma, autoimmune disorders, hypersensitivity, and allergic reactions. Common side effects of systematic corticosteroids include headache, dizziness, insomnia, and hunger. Corticosteroids are associated with more severe side effects such as high blood pressure, osteoporosis, bone loss, electrolyte imbalance, cataracts or glaucoma, and insulin resistance. Corticosteroids should not be stopped abruptly due to the risk for life-threatening effects. Cautions include the risk of infections, the potential for growth stunting, and the risk of GI events. These potential events include gastritis, ulcer formation, and GI bleeding..

[Audio] Chapter 13, Section 4, Diabetes and Drug Treatments..

[Audio] Diabetes is characterized by elevated blood glucose due to insufficient levels of insulin. Diabetes is caused by inadequate secretion of insulin or by inadequate use of insulin within in the body. Deficiencies in either of these processes lead to elevated blood glucose levels. The normal blood glucose level is about 100 milligrams per deciliter. Levels consistently above 140 to 160 milligrams per deciliter are associated with the long-term effects of diabetes. Hyperglycemia is defined as an elevated blood sugar level. Diabetes can damage all major organ systems and can be devastating if left untreated. Over time, diabetes can destroy eyesight, kidney function, and peripheral circulation..

[Audio] Symptoms of diabetes include frequent infections, presence of glucose in the urine known as glycosuria, hunger and thirst, increased urination known as polyuria, excessive urination at night known as nocturia, numbness and tingling, slow wound healing, visual changes such as blurry vision, nausea and vomiting, weight loss, irritability, and ketoacidosis, and fatigue..

[Audio] Chronic hyperglycemia can result in long-term complications that can destroy quality of life. If diabetes goes unchecked, the risk of several complications increases. Retinopathy is a complication of diabetes and is the leading cause of blindness in the United States. In diabetic retinopathy, the blood vessels of the retina become damaged. Diabetic neuropathy is another complication of diabetes and results in a lack of blood flow to nerves, leaving them unable to function. The next complication of diabetes is vascular problems, which lead to atherosclerosis of blood vessels all over the body. The decreased blood flow causes neuropathy and slows the healing of wounds, especially in the feet and legs. Dermatologic issues may include boils, acne, or fungal infections. The last complication is nephropathy, or kidney damage, and it is the primary cause of end-stage renal disease..

[Audio] The four types of diabetes are type 1, type 2, gestational, and secondary diabetes. Type 1 diabetes occurs most commonly in children and young adults. Type 1 patients are not able to produce insulin and are insulin dependent. Type 1 diabetes is only treatable with insulin. Type 2 diabetes comprises 80% to 90% of diabetes cases. Most patients diagnosed with this type of diabetes are over 40 years old. The main issue in Type 2 diabetes is insulin resistance. This means that tissue cells are less sensitive to the effects of insulin. Gestational diabetes occurs during the second and third trimesters of pregnancy. Insulin resistance is caused by elevated hormones. Drugs such as oral contraceptives, beta-blockers, diuretics, calcium channel blockers, glucocorticoids, and phenytoin cause secondary diabetes. Secondary diabetes may cease when the drug causing it is discontinued..

[Audio] The goal of diabetes treatment is to approximate nondiabetic physiology as close as possible. Treatment consists of healthy eating, exercise, and medications. It is important to monitor blood glucose to prevent complications and to guide treatment. Patients should aim for a blood glucose goal between 80 and 130 milligrams per deciliter..

[Audio] Insulin is used in the treatment of diabetes and is available in various injectable forms including vials, self-injector pens, and within a pump. Insulin is also available in an inhaled form. The most common side effect of insulin is hypoglycemia. Although hypoglycemia is the intended effect, serious hypoglycemia can occur when doses are too high or meals are skipped. If blood glucose drops to 40 milligrams per deciliter or less, loss of consciousness and brain damage can occur. Other side effects of insulin include lipodystrophy, which is can be either fat accumulation or depletion at injection sites. One of the important considerations in the use of insulin is hypoglycemia management. The patient and family should be provided education on how to recognize and treat low blood sugar. Another important consideration is the potential for confusion among the different types of insulin available. Insulin carries a boxed warning for the risk of acute bronchospasm in chronic lung disease. Concentrated insulin products are available. Pharmacy technicians should be cautious and ensure that the concentrated products are not dispensed instead of the 100 unit per milliliter products. Insulin storage is another point of consideration. Vials and pens should be refrigerated until used. Once opened, they are given an expiration date specific to the product. Insulin should also be protected from heat or freezing temperatures. Insulin should be discarded if it contains clumps or appears frosty..

[Audio] Insulin products vary in their onset of action which is how soon their effects take place. The rapid-acting insulins include inhaled human insulin, insulin aspart, insulin glulisine, and insulin lispro. The only short-acting insulin product that is available is regular insulin U-100. There are two products available that are considered intermediate-acting. They are neutral protamine Hagedorn or NPH and regular insulin as the U-500 concentration. The long-acting insulin products include the following: insulin degludec, insulin detemir, and insulin glargine..

[Audio] The glucagon-like peptide 1 receptor agonists mimic endogenous incretin hormones and glucose-dependent insulinotropic polypeptide, which are produced in response to the arrival of glucose from the intestines. Incretin and incretin mimetics increase insulin release, inhibit glucose production, and produce satiety, the sensation of fullness. These medications are used in the treatment of type 2 diabetes in combination with other medications and are available as injectable products only. Their side effects include nausea, vomiting, diarrhea, dizziness, fatigue, and headache. Important considerations with some of the individual agents in this class are that exenatide carries a risk of pancreatitis, while liraglutide and semaglutide carry the risk of thyroid tumor. Pramlintide mimics amylin, which is a hormone that reduces glucagon production, slows gastric emptying, and produces satiety. Pramlintide is used as a supplement to insulin in type 1 diabetes and is given by injection. A point of caution is the risk of low blood sugar if pramlintide is given with insulin. GLP-1 agonists are also called the incretin mimetics..

[Audio] The dipeptidyl peptidase-4 inhibitors include alogliptin, linagliptin, saxagliptin, and sitagliptin. These medications work by slowing inactivation of incretin hormones, which allows them to persist longer and produce beneficial effects. Incretin increases insulin release, inhibits glucose production, and produces satiety. These medications are all available as tablets. Their main side effects include headache, nasopharyngitis, and upper respiratory infection. Doses should be adjusted for patients with reduced renal function..

[Audio] Metformin inhibits excess hepatic glucose production and increases insulin sensitivity in muscle and other body tissues. Metformin is available in oral dosage forms. The side effects of metformin include stomach upset, abdominal cramps, nausea, diarrhea, flatulence, and metallic taste. Metformin has a boxed warning for increased risk for lactic acidosis. Lactic acidosis is a rare but serious side effect that is potentially fatal. Patients should temporarily discontinue metformin when having procedures using contrast dye or iodine substances as they can interact and cause kidney failure and lactic acidosis..

[Audio] The sodium-glucose linked transporter-2 inhibitors block the reabsorption of glucose that the kidney filters out of the bloodstream. This increases the excretion of glucose in the urine. The side effects of this class of medication include urinary tract infections, genital fungal infections, low blood pressure, and high blood potassium levels. The SGLT-2 inhibitors are not to be used in type 1 diabetes. They may cause hypotension, which may be particularly pronounced in older adults, patients with kidney dysfunction, and in patients using antihypertensive drugs. Kidney toxicity is a concern with the use of the SGLT-2 inhibitors, as well as the risk of hyperkalemia. These medications also increase the risk of fungal infections. They should be used with caution in kidney or liver impairment..

[Audio] The insulin secretagogues include the sulfonylureas glimepiride, glipizide, and glyburide and the meglitinide, nateglinide. These medications stimulate insulin production from the pancreas. Hypoglycemia, nausea, diarrhea, and constipation are side effects common to these agents. Patients taking insulin secretagogues and their families require education on hypoglycemia management. Sulfonylureas should be avoided in liver or kidney disease..

[Audio] Pioglitazine and rosiglitazone are in a medication class called the thiazolidinediones. TZDs work by directly increasing insulin sensitivity in tissue cells. They are available in tablet form. Their main side effects are fluid accumulation and weight gain. Rare but serious effects include liver toxicity and macular edema. Important points of consideration with pioglitazine and rosiglitazone are their potential for worsening heart failure and for increasing ovulation and pregnancy rates..

[Audio] Chapter 13, Section 5, Complementary and Alternative Therapies..

[Audio] Chromium is an essential trace element that some people have used for diabetes prevention and treatment. Although chromium deficiency has been found in patients with diabetes, there is little evidence that correcting this deficiency improves blood glucose levels. Side effects of chromium may include headache, insomnia, diarrhea, and hemorrhage. Patients with kidney or liver disease should not take chromium..

[Audio] Cinnamon is often taken for type 2 diabetes. A potential benefit was shown in one study, but little benefit was demonstrated in later studies. Cinnamon should not be taken by patients with liver disease..