Ime Pharmacology (Chapter 27-The Endocrine Glands And Hormones)

Front 1

Any of various glands producing hormonal secretions that pass directly into the bloodstream. Also called the ductless gland

Back 1

Endocrine glands

Front 2

What are the glands that make up the Endocrine system?

Back 2

Thyroid
Parathyroids
Ant. & Pos. Pituitary
Pancreas
Adrenals
Gonads
Mammary

Front 3

Is called the “master gland” of the endocrine system, located at the base of the brain

Back 3

Pituitary gland

Front 4

How may lobes does Pituitary gland have?

Back 4

Two (Anterior & Posterior)

Front 5

A Pituitary gland lobe that secretes regulating hormone (tropic hormone) that control the actions of other endocrine glands

Back 5

Anterior lobe

Front 6

A Pituitary gland lobe that releases antidiuretic hormone (ADH) and oxytocin

Back 6

Posterior lobe

Front 7

Regulating hormones that is secreted by the Anterior lobe of the Pituitary gland and are named according to the gland they affect

Back 7

Tropic hormones

Front 8

A tropic hormone that affects the Thyroid gland

Back 8

Thyrotropic

Front 9

A tropic hormone that affects the cortex of the Adrenal gland

Back 9

Adrenocorticotropic

Front 10

A gland that is composed of two lobes located on either side of the larynx

Back 10

Thyroid gland

Front 11

Hormone that is secreted by the Thyroid gland which causes all cells to accelerate the rate of their metabolism

Back 11

Thyroxine

Front 12

A condition caused by a reduced activity of the Thyroid gland

Back 12

Hypothyroidism

Note:
↑ TSH, ↓ T4 (thyroxine)

Front 13

A disorder in children where the Thyroid gland fails to function properly during the formative years of a child's development

Back 13

Cretinism

Note:
Child is called "Cretin"

Front 14

Characteristics of Cretinism

Back 14

·Occurs mostly in regions having iodine defficiency in water & food
·The child fails to develop normally
·Has pronounced mental retardation
·Slow development
·Skin is thickened, dry, & wrinkled
·Tongue is thick & protrudes from mouth
·Abdomen protrudes
·Legs are short
·Body musculature is weak

Front 15

Treatment for Cretinism

Back 15

Thyroid hormone therapy. Maybe corrected if given early in infancy

Front 16

A type of hypothyroidism in adult that is characterized by a gradual slowing of mental & physical functions

Back 16

Myxedema

Front 17

Signs & Symptoms of Myxedema

Back 17

Hands & feet are puffy
Skin is thick & leathery
Is hypersensitive to cold

Front 18

A condition caused by an overproduction of the thyroid gland

Back 18

Hyperthyroidism

Note:
↓ TSH, ↑ T4 (thyroxine)

Front 19

Signs & Symptoms of Hyperthyroidism

Back 19

Protruding eyes
Weight loss
Increased appetite
Tachycardia & Palpitations
Nervousness
Diarrhea
Abdominal cramps
↑pulse & bp
Headache
Intolerance to heat
Fever
Menstrual irregularities

Front 20

Treatments for Hyperthyroidism

Back 20

May be treated with an antithyroid drug:
propylthiouracil (dose: 100 mg)
methimazole (10 mg)
radioactive iodine
gland may be removed surgically

Front 21

Also known as “chronic lymphocytic thyroiditis – is considered to be caused by an autoimmune process

Back 21

Hashimoto's disease

Front 22

Treatment for Hashimoto's disease

Back 22

Thyroid treatment should be started based on the thyroid studies as soon as the disease is diagnosed

Front 23

An enlarged thyroid gland.May be caused by hyperthyroidism or hypothyroidism. The growth resulting from a body “reflex” to compensate for the inefficiency of the gland

Back 23

Goiter

Front 24

Thyroid Preparations

Back 24

Either natural or synthetic preparations.
Naturally produced in the thyroid gland.
Synthetic permits greater accuracy & predictability when treating thyroid dysfunction

Ex: thyroid
Obtained primarily from hogs.
May be used in varied dosage as neccessary to attain thyroid function

Front 25

Antithyroid agents

Back 25

methimazole (Tapazole)

propylthiouracil


Note: These agents should not be taken by pregnant women because these can induce goiter & hypothyroidism in the developing fetus

Front 26

An antithyroid agent which:
Inhibits synthesis of thyroid hormone by preventing incorporation of iodine into the hormone.

It is used for palliative treatment of hyperthyroidism & preoperatively before surgical or radiation procedures

Back 26

methimazole (Tapazole)

Front 27

Glands that are located directly above the kidneys and are composed of two parts: cortex (outer portion), & medulla (inner portion)

Back 27

Adrenal glands

Front 28

The outer portion of the Adrenal glands that secretes number of hormones that are essential to life

Back 28

Cortex

Front 29

The inner portion of the Adrenal glands that secretes epinephrine & norepinephrine

Back 29

Medulla

Front 30

Name four hormones secreted by the Cortex

Back 30

cortisone

hydrocortisone

aldosterone

deoxycorticosterone

Front 31

Three important functions of the hormones secreted by the Cortex

Back 31

1.Regulation of water & salt metabolism
2.Regulation of carbohydrate metabolism
3.Production of anti-inflammatory effects

Front 32

Uses of Cortisone & Hydrocortisone

Back 32

Suppression of the symptoms of rheumatoid arthritis, bursitis, various types of skin diseases

Tx of multiple sclerosis

Note:
Neither of the two drugs cure the disease or causes any real improvement. They only suppress the symptoms

Front 33

Adrenocorticoid agent side effects

Back 33

Salt & Water retention
"Moon facies"
Muscular weakness
Hirsutism
Acne
Occasional mental disturbances

Front 34

Some precautions when using adrenocorticoid agents

Back 34

In patient with peptic ulcer

They are contraindicated for individuals suffering from tubercolosis or other infectious diseases

Front 35

A destructive disease of the adrenal cortex

Back 35

Addison's disease

Note: If untreated, it is gradually progressive, and death occurs within 2 or 3 years

Front 36

Signs & Symptoms of Addison's disease

Back 36

Weight loss
Weakness
Disturbed carbohydrate & mineral metabolism
Increased bronzing pigmentation of the skin

Front 37

Synthetic compounds similar in action to Cortisone & Hydrocortisone

Back 37

cortisone acetate, (Cortogen, Cortone), (Oral, IM)
hydrcortisone, (Hydrocortone, Cortef, Solu-Cortef), (Oral, IM, IV, Intrathecal)
predisone, (Deltasone, Sterapred), (Oral)
prednisolone, (Prelone, Cotolone), (Oral)
methylprednisolone, (Medrol, Solu-Medrol), (Oral, IM, IV)
triamcinolone acetonide, (Aristocort, Kenalog), (Oral, Intralesional, Intraarticular)
dexamethasone, (Decadron), (Oral, IM, IV, Intraarticular)
betamethasone, (Celestone), (Oral, IM, IV, Intraarticular)
fludrocortisone acetate, (Florinef), (Oral)
fluocinolone, (Synalar), (Topical)
fluradrenolide, (Cordan), (Topical)

Front 38

This is where the clusters of cells known as the islets of Langerhans are found & are the sources of the hormone known as insulin

Back 38

Pancreas

Front 39

Three purpose of insulin

Back 39

1. Aids in the utilization of glucose as energy

2. Stores excess glucose as glycogen in the liver

3. Responsible for the conversion of glucose to fat

Front 40

Important things to remember when giving insuling therapy

Back 40

Be accurate in the dosage of insulin
Overdose can lead to insulin shock
Too small a dose can result in diabetic coma
For mild cases, diet therapy alone may be sufficient, along with regulated exercise to maintain blood sugar level
In more severe cases, oral hypoglycemics or insulin must be given

Front 41

A condition where the glucose level in the blood becomes quite high after the ingestion of carbohydrates

Back 41

Diabetes Mellitus

Note:
If diabetes is not treated, sugar spills over into the urine, & acidosis & ketosis occur as a result of the metabolism of fat for energy, resulting in the creation of ketones as by-products
If untreated, , the patient in ketosis eventually becomes comatose & dies

Front 42

Four factors needed to determine the dose of insulin required to treat Diabetes Mellitus

Back 42

1. Weight of the patient

2. Metabolic rate

3. Physical activity

4. Any residual function of the pancreas

Front 43

Examples of Individual Insulin Products

Back 43

human insulin
human insulin injection, regular (Humulin R, Novolin R)
human insulin injection, isophane (Humulin N, Novolin N)
lente human insulin zinc injection (Humulin L, Novolin L)
ultralente human insulin injection (Humulin U)

Note:
Regular insulin is the only insulin form that may be given IV.
The effect of regular insulin, regardless of the mode of administration last only a few hours

Front 44

An individual insulin product than can be prepared in various forms to lower blood sugar rapidly or over a prlonged period time

Back 44

human insulin

Front 45

An individual insulin product that consists of zinc-insulin crystal that are dissolved in a clear fluid

Back 45

human insulin injection, regular (Humulin R, Novolin R)

Route(s):
subQ, IV

Takes effect rapidly & last 4 to 6 hours

Front 46

An individual insulin product also known as isophane insulin, or NPH containing a suspension of zinc-insulin crystals & protamine sulfate

Back 46

human insulin injection, isophane (Humulin N, Novolin N)

Route(s):
subQ only

A intermediate-acting isulin
Onset of action is in 1 1/2 hours
Peak activity is from 4 to 6 hours

Front 47

An individual insulin product is a mixture of crystalline & amorphous insulin

Back 47

lente human insulin zinc injection (Humulin L, Novolin L)

Route(s):
subQ only

An intermediate-acting insulin
Onset of action in 2 1/2 hours
Peak from 7 to 15 hours
Duration is up to 24 hours

Front 48

An individual insulin product that is a crystalline suspension of human insulin with zinc that provides a slower onset of action & longer duration of activity

Back 48

ultralente human insulin injection(Humulin U)

Route(s):
subQ only

A long-acting insulin
Onset of activity in 4 to 8 hours
Peak of activity in 12 to 18 hours
Duration of action up to 28 hours

Front 49

Example of Insulin Analog

Back 49

insulin lispro (Humalog)

Route(s):
subQ, IV

Note:
There is also a Humalog Pen for self-injection

Front 50

Example of Combination Insulin Products

Back 50

Humulin 50/50 - a combination of 50% regular & 50% isophane insulin

Humulin 70/30 & Novalin 70/30 - combinations of 70% isophane & 30% regular insulin

Front 51

What is Insulin Pump Therapy?

Back 51

Also called continous subcutaneous insulin infusion, is designed to simulate normal pancreatic beta-cell function & deliver both basal & bolus insulin doses in patients with type 1 diabetes

Front 52

Several factors that are key to successful treatment with insulin pumps

Back 52

Blood glucose monitoring

Logbook recording of insulin doses & blood glucose results

Counting of carbohydrates

Use of the long-acting insulin lispro with regular insulin

Front 53

The most serious adverse effect of intensive insulin therapy

Back 53

Severe Hypoglycemia

Front 54

A commonly develop conditon in which a patient who have had a type 1 diabetes for more than 5 years no longer recognize the symptoms of low blood glucose levels, such as fatigue, sweating, dizziness, palpitations, & impaired cognition

Back 54

Hypoglycemic awaremess

Front 55

Name one strategy for preventing hypoglycemia

Back 55

Set a higher target blood glucose level, using a lower basal insulin delivery rate & eliminating the wilde glycemic swings

Front 56

Examples of Oral Hypoglycemic Agents

Back 56

chlorpropamide, (Diabinese)

tolbutamide, (Orinase)

glipizide, (Glucotrol)

glyburide, (Diabeta, Micronase, Glynase)

acarbose, (Precose)

metformin hcl, (Glucophage)

Front 57

A potent oral hypoglycemic agent that acts on pancreatic cells to cause them to release residual insulin

Back 57

chlorprapamide, (Diabinese)

Route(s):
Oral

Note:
Not all patients with diabetes are suitable candidates for chloroprapamide therapy

Front 58

An oral hypoglycemic agent that its recommended use has been restricted to those cases in which diet & insulin are ineffective

Back 58

tolbutamide, (Orinase)

Route(s):
Oral

Front 59

An oral hypoglycemic agent that lowers blood glucose levels in diabetic & non-diabetic patients

Back 59

glipizide, (Glutorol)

Route(s):
Oral

Note:
It is used as an adjunct to dietary control in the management of non-insulin-dependent (type 2 diabetes)

Front 60

An oral hypoglycemic agent that lowers blood sugar & produces a mild diuresis

Back 60

glyburide, (Diabeta, Micronase, Glynase)

Route(s):
Oral

Front 61

An oral hypoglycemic agent that inhibits enzymes known as the alpha-glucoside enzymes that break down complex carbohydrates into glucose & other monosacchardies

Back 61

acarbose, (Precose)

Front 62

An oral hypoglycemic agent that is believe to improve sensitivity to insulin at the receptor sites

Back 62

metformin hcl, (Glucophage)

Front 63

Examples of other Oral Hypoglycemic agents

Back 63

glimepiride, (Amaryl)

pioglitazone, (Actos)

repaglinide, (Prandin)

miglitol, (Glyset)

Front 64

Examples of Combination Oral Hypoglycemic agents

Back 64

metformin plus glyburide, (Glucovance)

rosiglitazone plus metformin, (Avandamet)

glipizide plus metformin, (Metaglip)

Front 65

Sex glands of the female (ovaries ) & those of the male (testes) are called?

Back 65

gonads

Front 66

Hormone secreted by the Anterior Pituitary gland that affect the Gonads

Back 66

gonadotropic hormones

Front 67

Name the two gonadotropic hormones

Back 67

follicle-stimulating hormone (FSH)

luteinizing hormone (LH)

Front 68

A gonadotropic hormone that stimulates the maturation of the graafian follicles in the ovaries

Back 68

follicle-stimulating hormone (FSH)

Front 69

A female hormone produced by the cells around the ovum is responsible for the changes in the accessory organs of reproduction during the first part of the menstrual cyle & the development of the secondary sex characteristics

Back 69

Estradiol

Note:
Is the naturally occuring female hormone in humans & animals

Front 70

A female hormone that prepares the uterus for the reception of the ovum

Back 70

Progesterone

Front 71

Responsibilities of Progesterone

Back 71

1. The uterine changes characteristics of the first half of the menstrual cycle.

2. The development of the placenta (organ that enables the embryo to receive nourishment from the mother during pregnancy).

3. The maturation of the mammary glands
4. The multipication of the uterine muscle fibers.

5. The inhibition of uterine contraction.

Front 72

Is the generic term referring to natural & synthetic agents that exert the biologic effect of estradiol

Back 72

Estrogen

Note:
Is used to treat conditions such as sexual infantilism & senile vaginitis in perimenopausal women to provide a smooth transition during perimenopause

Front 73

Examples of agents used to suppress lactation

Back 73

estradiol suspension, (IM)

estrone (Theelin), (IM)

Front 74

A type of therapy that has been used for the treatment of menopausal symptoms, urogenital dryness, & the prevention & treatment of osteoporosis

Back 74

Estrogen Replacement Therapy (ERT)

Note:
Recent studies have shown some increase in breast cancer & cardiovascular complications with the use of this therapy

Front 75

Examples of Estrogen Replacement Therapy agents

Back 75

estrogens, conjugated (Premarin), (Oral, Vaginal)

esterified estrogen tablets, (Estratab), (Oral)

Front 76

Example of Estrogen Agonist-Antagonist agent

Back 76

raloxifene hcl, (Evista)

Route(s):
Oral

Tx:
For postmenopausal women

Front 77

Agents that prevent pregnancy by virtue of their estrogen content

Back 77

Oral contraceptives

Note:
Are contraindicated in patients with a history of:
-Breast or genital cancer
-Thrombophlebitis
-MI or coronary artery disease
-Pre-existing liver, kidney, or heart dysfuntion

Front 78

Side effects of oral contraceptives

Back 78

Breast changes
Loss of scalp hair
Dermatoses
Headache
Nervousness
Thromboembolic disorders
Emotional instability

* An important side effect to remember:
Oral contraceptive drugs are LESS EFFECTIVE when taken with ANTIBIOTICS.

Front 79

Examples of oral contraceptives

Back 79

levonorgestrel plus ethinyl estradiol, (Triphasil)

levonorgestrel plus ethinyl estradiol, (Seasonale)

Front 80

Examples of injectable & transdermal contraceptives

Back 80

medroxyprogesterone acetate, (Depo-Provera), (IM)

norelgestromin plus ethinyl estradiol , (Ortho Evra), (Transdermal)

Front 81

Side effect of medroxyprogesterone acetate

Back 81

Menses may cease entirely or become irregular

Front 82

Disadvantage of using norelgestromin plus ethinyl estradiol

Back 82

Less satisfactory in warm, humid climates

Front 83

Example of emergency contraceptives

Back 83

ethinyl estradiol plus levonorgestrel (Preven)

levonorgestrel plus ethinyl plus estradiol (Ovral)

levonogestrel (Plan B) *Progestin-Only Regimen

Note:
High Doses of of a Combination Oral Contraceptive. The first dose should be taken within 72 hours of unprotected intercourse

Front 84

Example of a drug that promotes ovulation

Back 84

clomiphene citrate, (Clomid)

Front 85

Is a synthetic, nonsteroidal compound that may be administered orally to promote ovulation in women who have been anovulatory

Back 85

clomiphene citrate (Clomid)

Note:
This drug is contraindicated in patients with a history of liver disesase & those with abnormal uterine bleeding

Front 86

Agents that are used as a uterine stimulant

Back 86

Oxytocic agents

Front 87

Side effects of agents that promote ovulation

Back 87

Blurred vision
Hot Flashes
Abdominal discomfort
Nausea & Vomiting
Breast engorgement
Headache
Dizziness

Front 88

Example of oxytocic agents

Back 88

oxytocin injection (Pitocin, Syntocinon)
ergonovine maleate (Ergotrate)
methylergonovine maleate (Methergine)
sodium chloride 20 % injection
urea 40% to 50% injection(Carbamide)
dinoprostone (Prostin E2)
dinoprostone cervical gel (Prepidil)
mifepristone (RU-486, Mifeprex)

Front 89

An oxytocic agent that stimulates the uterine muscles & produces rhytmical contractions

Back 89

oxytocic injection(Pitocin, Syntocinon)

Route(s):
IM, IV

Note:
Overdose may produce tetany
It is contraindicated in the first stage of labor
Must be given with great caution to patients with a cardiovascular disease or previous cesarean section

Front 90

An oxytocic agent that is used for the tx of postpartum & postabortion hemmorhage

Back 90

ergonovine maleate (Ergotrate)

Route(s):
Oral, IM, IV

Side effect:
May produce ergotism (a prolonged constriction of the blood vessels in other parts of the body)

Front 91

An oxytocic agent that is preferred for patients with threatened eclampsia

Back 91

methylergonovine maleate(Prostin E2)

Route(s):
Oral, IM, IV

Front 92

An oxytocic agent that is useful in the induction of second trimester abortions

Back 92

sodium chloride 20% injection

Route(s):
IV

Side effects:
Sensation of heat
Thirst
Mental confusion
Urea Hypothermia

Front 93

An oxytocic agent that induces fetal death & abortion

Back 93

urea 40% to 50% injection(Carbamide)

Route(s):
IV

Note:
Pt should take fluids during the procedure to facilitate urea
Nurse should monitor for signs of fluid & electrolyte imbalance during procedure

Front 94

An oxytocic agent that is used intravaginally to induce abortion during second trimester of pregnancy

Back 94

dinoprostone (Prostin E2)

Route(s):
Intravaginally

Front 95

An oxytocic agent that is in pregnant women at or near term with a medical or obstetrical need for labor induction

Back 95

dinoprostone cervical gel (Prepidil)

Route(s):
Endocervically

Front 96

An oxytocic agent that is an oral abortifacient taken anytime before the eight week of pregnancy

Back 96

mifepristone (RU-486, Mifeprex)

Route(s):
Oral

Front 97

Is responsible for normal development of male reproductive tract and maintains the secondary sex characteristics

Back 97

testosterone

Note:
It plays a role in the development of the penis, the seminal vesicles, & prostate gland & in the descent of the testes from the abdominal cavity
It can also increase the resistance of the CNS to fatigue

Front 98

What are the accessory sexual characteristics affected by testosterone?

Back 98

Development of penis
Depth of voice
Distribution of facial and body hair
Development of the masculine skeletal muscles.
Confers sense of “well being”
Restores mental equilibrium and energy.

Front 99

What are the three therapeutic uses of testosterone?

Back 99

1. When a deficiency of the hormone is known
2. In females to treat certain ovarian dysfunctions
3. In females to treat breast engorgement & suppress lactation

Front 100

Examples of commercially prepared testosterone used as hormone replacement therapy

Back 100

testosterone gel (Androgel), (transdermal)

Testosterone transdermal system (Androderm), (transdermal)