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Hormones are?
Chemical messengers
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Hormones are released in response to what?
A change in the body's internal environment
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Parts of the endocrine system are?
- Pineal gland
- Hypothalamus
- Pituitary gland
- Parathyroid gland
- Thyroid gland
- Thymus
- Adrenal glands
- Pancreas
- Gonad (ovaries)
- Gonad (testes)
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Goals of hormone pharmacotherapy are?
Replacement Therapy- for those who aren't able to secrete sufficient quantities of their own endogenous hormones
Cancer Chemotherapy- testosterone for breast cancer & estrogen for testicular cancer
To produce exaggerated response taht is part of the normal action of the drug to achieve some therapeutic advantage.
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Adrenal Cortex secretes what hormone?
Its endocrine disorders & drug treatment for it are?
Glucocorticoids
Hypersecretion: Cushing's Syndrome -- NO DRUGS
Hyposecretion -- GLUCOCORTICOIDS
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Pancreas (Islets of Langerhans) secretes what hormone?
Its endocrine disorders and drug treatment for it are?
Insulin
Hyposecretion: diabetes mellitus -- INSULIN
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Pituitary secretes what hormones?
Its endocrine disorders & drug treatment for it are?
- Growth Hormone
- Antidiuretic Hormone
Hyposecretion: dwarfism -- SOMATREM (PROTROPIN) & SOMATROPIN (HUMATROPE & OTHERS)
Hyposecretion: diabetes insipidus -- VASOPRESSIN DESMOPRESSIN (DDAVP, STIMATE)
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Thyroid secretes what hormones?
Its endocrine disorders & drug treatment for it are?
Thyroid Hormone (T3 & T4)
Hypersecretion: Graves' Disease -- PROPHYLTHIOURACIL (PTU)
Hyposecretion: myxedema (adults) & cretinism (children) -- THYROID HORMONE (SYNTHROID)
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The hypothalamus secretes chemicals called?
Releasing factors or releasing hormones that travel via blood vessels a short distance to the anterior pituitary gland.
Hypothalamus > releasing factors > anterior pituitary gland > target organ
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The pancreas is a gland that is essential to?
The digestive & endocrine system
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Function of the pancreas cells, Islets of Langerhans, are?
Pancreas' endocrine function: secretion of glucagon & insulin.
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The prancreas secretes these hormones directly where?
Into blood capillaries, where they are available for transport to body tissues.
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Insulin is regulated by various...?
1 of the most important regulators is the level of...?
Chemical, hormonal, & neural regulators
Level of glucose in blood stream
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Action of the pancreas after a meal, blood glucose rise (hyperglycemia) & when blood glucose levels fall (hypoglucemia)?
Pancreas stimulated to secrete insulin.
Islet cells sends pancreas a message to STOP screting insulin when blood glucose levels fall (hypoglycemia)
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Insulin affects which 3 metabolisms in most cells of the body?
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Insulin's most important actions is?
to assist in glucose transport.
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Primary function of glucagon is?
To maintain adequate levels of glucose in the blood between meals.
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Glucagon has what kind of an effect?
Hyperglycemic effect: its presence moves glucose from cells, primarily in the liver to bloodstream.
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Type 1 Diabetes Mellitus is also called?
Juvenile-onset diabetes; most common diseases of childhood (ages 11-13)
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Type 1 diabetes mellitus is a result from a lack of?
Insulin secretion by the pancreas
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Who has a higher risk of acquiring type 1 diabetes mellitus?
Genetic component; children & siblings of people w/ disease have higher risk
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Most diagnostic sign of Type 1 diabetes?
Sustained hyperglycemia; Fasting plasma glucose levels of 126mg/dL or greater on 2 separate occasions
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Typical s/s of type 1 diabetes
- Hyperglycemia-fasting blood glucose greater than 126mg/dL
- Polyuria-excessive urination
- Polyphagia-increase in hunger
- Glucosuria-high levels of glucose in the urine
- Weight loss
- Fatigue
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Untreated type 1 & type 2 diabetes produces?
Serious long-term damage to arteries leading to Heart Disease, Stroke, Kidney Disease, & Blindness.
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Ketoacids
- Produced in type 1 diabetes when glucose can't enter cells & lipids are used as energy source.
- Ketoacids are producd as waste products.
- Gives breath an acetone-like, fruity odor.
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High levels of ketoacids changes what?
pH of the blood, producing acidosis & possibly coma.
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Type 1 diabetes requires drug therapy w/?
- Insulin - reserved for more severe deficiency states
- hypoglycemics - given for milder forms of diabetes
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Type 1 is treated with?
A combination of prper meal planning, exercise (regular moderate), & insulin.
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Insulin therapy goal?
Maintain blood glucose levels within strict, normal limits.
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Type 2 diabetes cause?
- Secretion of insulin amounts too small.
- Insulin receptors in target tissues have become insensitive/ resistant to hormone.
- Small amounts present does not bind effectively to receptor = no effect achieved.
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Type 2 diabetics usually controlled w/?
Oral hypoglycemic agents.
Insulin given in severe cases.
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Many type 2 diabetics are?
Obese & need medically supervised plan to reduce weight gradually & exercise safely.
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6 General classes of oral hypoglycemic medications for Type 2 diabetes?
- Sulfonylureas
- Biguanides
- Thiazolidinediones
- Alpha-Glucosidase Inhibitors
- Meglitinides
- Dipeptidyl-Peptase 4 Inhibitors
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Therapy with oral hypoglycemics is usually initiated w/?
- A single agent
- If therapeutic goals not achieved, 2 agents may be administered
- Failure to achieve normal blood glucose w/ 2 oral hypoglucemics indicates need for insulin
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Insulin Analogs (Rapid Acting)
- Insulin aspart (NovoLog) - 5-10min before meals
- Insulin glulisine (Apidra) - 5-10min before meals
- Insulin lispro (Humalog) - 0-15min before meals
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Insulin Analog (Longer Acting)
Insulin glargine (Lantus) - For type 1 diabetes; Given same time each day (usualy @ bedtime)
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Insulin Mixtures (Short To Intermediate Acting)
- NPH 70%
- Regular 30%
- (Humulin 70/30, Novolin 70/30) - appear cloudy/milky
- NPH 50%
- Regular 50% - applear cloudy/milky
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Short-Acting Insulin (Peak Activity is Usually Between 2 & 4 Hours)
Regular insulin (Humylin R, Novolin R, Pork Regular Iletin II, Reualr Purified Pork Insulin) - 30min before meal.
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Intermediate-Acting Insulin (Peak Activity Usually Between 4-12 Hours)
Isophane insulin suspension (NPH, NPH Iletin II, Humulin N, Novolin N) - 30min before 1st meal of day. 2nd smaller dose may be prescribed 30min before supper/ @ bedtime.
Insulin zinc suspension (Lente Iletin II, Lente L, Humulin L, Novolin N) - 30min before breakfast. Some require another 30min for supper/bedtime.
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Longer-Acting Insulin (Peak Activity Usually 6-20 Hours)
Extended insulin zinc suspension (Humulin U, Ultralente) - 30min before breakfast by deep subQ. May be mixed w/ Semilente but not others.
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NPH means?
Neutral Protamine Hagedorn
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Alpha-Glucosidase Inhibitors (Oral Hypoglycemics)
Acarbose (Precose) - avoid use w/ chronic intestinal disease
Miglitol (Glyset) - Cautiously used w/ renal impairment
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Biguanides (Oral Hypoglycemics)
Metformin HCL (Glucophage) - Lactic acidosis may be a complication
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Meglitinides (Oral Hyperglycemics)
Nateglinide (Starlix) - cautiously used in hepatic/ renal impairment.
Repaglinide (Prandin) - Glitazone type. Cautiously used in hepatic/ renal impairment.
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Sulfonylureas, 1st generation (Oral Hyperglycemics)
Chlorpropamide (Diabinese, Novopropamide) - Known sensitivity to sulfonylureas & sulfonamides.
Tolazamide (Tolamide, Tolinase) - Short-acting, older drug used when others fail to control blood glucose.
Tolbutamide (Orinase) - Similar to tolazamide, used when others fail to control.
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Sulfonylureas, 2nd Generation (Oral Hypoglycemics)
Glimepiride (Amaryl) - Not recommended during pregnancy
Glipizide (Glucotrol)
Glyburide (DiaBeta, Micronase, Glynase) - Combination drug containing glyburide & metformin.
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Thiazolidinediones (Oral Hypoglycemics)
Pioglitazone (Actos) - Given w/out regart to meals
Rosiglitazone (Avandia) - Often combination w/ metformin or insulin to control blood glucose
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Dipeptidyl-Peptidase 4 Inhibitors (Oral Hypoglycemics)
AKA DDP-4 inhibitors
Saxaglipton (Onglyza) - May be used in combination w/ antidiabetics
Sitagliptin (Januvia) - Actions occur only in presence of rising serum glucose levels; type of incretin enhancement therapy
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Combinatin Drugs (oral hypoglycemics)
- Glipizide/metformin (Metaglip)
- Glyburide/metformin (Glucovance)
- Rosiglitazone/metformin (Avandamet)
Lactic Acidosis is a complication in many cases if meds no taken properly.
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Dipeptidylpeptidase 4 (DDP-4) inhibitors or incretin enhancers are effective at what when taken within proper parameter?
Effective at lowering blood glucose without causing extreme hypoglycemia.
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DDP-4 inhibitors are for type 2 diabetics that is responsible for?
Breaking down gastric hormones called incretins.
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Incretin's action
In response to food presence in small intestine, incretins normally inhibit release of glucagon, stimulating release of insulin from pancreas.
Also delays gastric emptying & convey impulses to brain about satiety (Feeling of being full)
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Inhancement of incretin results in?
A decreased glucagon secretion, increaed insulin secretion, & stabilization of hormone fluctuations after a meal.
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