Unit 8_Pharm

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Thyroid/Pancreas/Antibiotics:

Thyroid/Pancreas/Antibiotics

Endocrine Medications: :

Endocrine Medications: Thyroid and Parathyroid Hormones Thyroid Hormone (- feedback) Hypothalamus TRH Pituitary TSH Thyroid gland T3/T4 Target Organ Target Organ Response

Endocrine Medications: :

Endocrine Medications:

Endocrine Medications: :

Endocrine Medications: T4 converted to T3 T3/T4 enter cell T3

Endocrine Medications:

Endocrine Medications Physiological Effects of Thyroid Hormone Thermogenesis Growth and development Increased Cardiac activity Carbohydrate, lipid metabolism

Endocrine Disorders:

Endocrine Disorders Hyperthyroidism (Goiter, Graves Disease) Tumor Imbalance in regulation (excess TSH) Graves is autoimmune increase in T3/T4 Exophthalmus Digital clubbing Muscle wasting Tachycardia Diarrhea Weight loss

Endocrine Disorders:

Endocrine Disorders Hypothyroidism (Myxedema) Autoimmune destruction Low iodine Genetic causes Lethargic Wt. gain Facial edema Cold Sleepiness Anorexia Menorrhagia Dry, coarse skin Tx with T3/T4 or both

Childhood Hypothyroidism Cretinism- failure to grow:

Childhood Hypothyroidism Cretinism- failure to grow Growth hormone needs Thyroid to function properly

Endocrine Medications Thyroid and Parathyroid hormones:

Endocrine Medications Thyroid and Parathyroid hormones 2. Parathyroid Hormone (PTH) and bone metabolism - turns on osteoclasts - increases active form Vitamin D - increases renal Ca++ absorption - increases GI absorption of Ca ++

Endocrine Medications Thyroid and Parathyroid hormones:

Endocrine Medications Thyroid and Parathyroid hormones 3. Calcitonin - secreted by thyroid (parafollicular) cells - antithesis of PTH - increases Ca++ deposition 4. Vitamin D - increases GI absorption of Ca++/P - some forms promote bone resorption, others bone formation - decreases renal excretion of Ca++/P

Endocrine Medications Thyroid and Parathyroid hormones:

Endocrine Medications Thyroid and Parathyroid hormones Disorders of Bone Metabolism: Osteoporosis - estrogen replacement - calcium supplements - calcitonin supplements - Vitamin D supplements - Bisphosphonates -alendronate (Fosamax) - inhibit osteoclasts

Endocrine Medications: :

Endocrine Medications: Insulin Beta cells of Islets of Langerhans - promotes uptake of glucose, fats, amino acids Effects: A. Liver - stimulates glucokinase - promotes glycogen synthesis B. Other tissues - increases glucose transport proteins

Endocrine Medications: :

Endocrine Medications: Diabetes Mellitus - Lack of production or release - Lack of receptor stimulation Consequences: - Small vessel disease (thickening of basement membrane) - blindness - renal failure - poor wound healing - Large vessel disease - hypertension - atherosclerosis - MI - CVA - neuropathies- sorbitol

Endocrine Medications: :

Endocrine Medications: Diabetes Mellitus Type I diabetes mellitus (IDDM) - don’t make adequate amounts - early onset (juvenile diabetes) - require insulin injections Type II diabetes mellitus (NIDDM) - decreased release or post-receptor signaling sensitivity - late onset (adult diabetes) - metabolic syndrome? - HBP, diabetes, high cholesterol, abdominal fat

Endocrine Medications: :

Endocrine Medications: Tx of diabetes mellitus - medication - diet triad of treatment - exercise Type I diabetes ( Humulin , Lente , Novolin , etc) Insulin injection (beef, pork, human, synthetic) rapid, intermediate, long-acting altering aa or adding zinc or other things changes absorption rates combination insulins ADVERSE EFFECTS: hypoglycemia ( esp w /exercise), immune response (allergic rxn )

Endocrine Medications: :

Endocrine Medications: Symptoms of Hypoglycemia Headache Fatigue Hunger Tachycardia Diaphoresis Anxiety Confusion Muscle spasms Loss of consciousness

Endocrine Medications: :

Endocrine Medications: Treatment of Type II Diabetes Sulfonylureas - stimulate insulin release - Glipizide ( Glucotrol ) - hypoglycemia, GI 2. Biguanides - Metformin ( Glucophage ) - inhibits gluconeogenesis - increases tissue sensitivity - hypoglycemia, GI 3. Others - either inhibit glu absorption or increase tissue sensitivity

Antibiotics:

Antibiotics Inhibit Cell Wall Synthesis - Penicillins 2. Inhibit Protein Synthesis - Tetracyclines 3. Inhibit DNA/RNA Synthesis - Sulfonamides

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