Two parts of the Adrenal Gland
Cortex and Medulla
What does the Adrenal Medulla do?
stimulated the sympathetic nervous system
secretes norepinephrine and epinephrine
What does the Adrenal Cortex do?
Produces and secretes steroid hormones:
Corticosteroids (glucocorticoids, mineralocorticoids)
Gonadocorticoids
two types of corticosteroids
Glucocorticoids (cortisol, metabolism, infl. process, cardiovasular, immune system, stress**) and Mineralcorticoids (aldosterone, maintain Na+/K+)
Increased release of cortisol can be reduced by
morphine, benzodiasepines (valium
), local anesthetic
, N2O
what do mineralocorticoids do?
Aldosterone*
Essential for sodium/potassium balance
responsible for fluid/water maintenance in blood
Addisons Disease cause
Chronic Adrenal insufficiency
decreased glucocorticoids ( cortisol*)
decreased mineralcorticoids (aldosterone*)
Addisons Disease symptoms
spots in the mouth (abnormal pigmentation)*
decreases glucose fat
, protein metabolism
inability to tolerate stress -> adrenal crisis*
Inability to conserve sodium and eliminate potassium*
Secondary adrenocortical insufficiency
more common
from exogenous corticosteroids*
When MD prescribes excess cortisol for autoimmune.
Cushing's Syndrome
Hyperadrenalism*
weight gain*
Round or moon shaped face*
Buffalo hump*
hypertension
bone fractures
mental depression
patients who take corticosteroids should...
not have any additional supplementation
MD consult
patients with hyperadrenalism have...
increased possibility of hyper tension ( due to increased Aldosterone*)
increased likelihood of osteoporosis (due to increased Corticosteroids*)
decreased connective tissue growth
inhibits osteoblasts and chondrocytes
compromises muscles integrity
Define Diabetes Mellitus
disorder of Pancreas/cells (decrease or lack of insulin)
Metabolic and vascular components*
Blood glucose levels overwhelm the kidneys
hyperglycemia
excess glucose in the blood* (increase vascular thickness, loss of elasticity)
neuropathy*
retinopathy*
the most important stimulant of insulin secretion is...
glucose*
Type 1 Diabetes
insulin dependent or juvenile *
autoimmune
genetic
environmental
absolute insulin deficiency*
Before age 25*
Idopathic
Type 2 Diabetes
Adult, non-insulin dependent
gradual onset
middle age
obesity
resistance to insulin (receptor sites)
tx: diet, exercise, oral hypoglycemics (diabinese-Orinese, Tolinese) *
Gestational Diabetes
Temporary disorder of glucose metabolism
Occurs only during pregnancy*
Body increased production of glucose from...
glycogen, fat and protein
Glucose accumulates where
tissue fluids and blood
Ketoacidosis
type of hyperglycemia
formation of ketone bodies
sweet smell
If fat metabolism continues the body develops metabolic acidosis*
Glucose, Fats, Proteins *
Diabetic Acidosis
Acidosis inhibits migration of cells to injured areas and decreases phagocytic activity
increased susceptibility to infection
Gangrene
complication of diabetes
loss of blood supply/no oxygen in fingers/toes
does not cause sepsis
untreated: may lead to sepsis
Cataract
complication of diabetes
clouding of lens
symptoms of diabetes
polydipsia ( thirst)
polyuria (urination )
polyphagia ( appetite )
weight loss
loss of strength
Function of the thyroid
basic metabolic rate
influences growth and maturation of tissues*
cell respiration
energy expenditure
essential for metabolism of carbohydrates, fats, proteins.
Thyroxine
Hormone secreted by thyroid
T4 Levothyroxine
converted to active form - T3 at target sites
Triiodothyronine
Hormone secreted by thyroid
T3
Calcitonin
Hormone secreted by thyroid
Thyroid hormones...
affect the metabolic process throughout the body (how fast you metabolize carbohydrates)
Graves Disease
most common cause of hyperthyroidism in children and adolescents
autoimmune disease
overactive thyroid
Exophythalmos** ( eye muscles swell)
Hyperthyroidism
condition due to excessive production of thyroid hormone
Thyrotoxicosis
occurs due to excessive thyroid hormone of any cause, including hyperthyroidism
Signs and Symptoms of Hyperthyroidism
increased cardiovascular
increased gastro
increased CNS
thin hair
etc
Signs and Symptoms of Hypothyroidism
decreased gastro
slower CNS
arthritis
dry hair
etc
Uncontrolled hyperthyroidism
requires a medical consult before tx *
adverse affects with epi*
controlled hyperthyroidism
conservative amounts of epinephrine*
Hypothyroidism
a condition of decreased activity of the thyroid gland
fails to secrete T4 and T3
Hashimoto's Disease
primary hypothyroidism
most common type of hypothyroidism
autoimmune disease
atrophy of the thyroid gland
diffuse goiter
neonatal cretinism
type of hypothyroidism
dwarfism
broad flat nose
wide set eyes
delayed eruption of teeth
malocclusion
Myxedema
type of hypothyroidism
accumulation of intracellular and extracellular fluid
body retains water
high BP
bradycardia
low body temp
weakness
weight gain
tx alterations for hypothyroidism
mild symptoms: no changes
avoid CNS depressant drugs, sedatives, narcotics
Drugs affecting the endocrine system include
synthetic hormone agonist/antagonists
drugs that affect the synthesis and secretion of hormones
The most important application of these drugs of Replacement Therapy*
Initial treatment for hyperthyroid
Beta Blockers*
do not reduce thyroid levels
decrease rapid heartbeat/nervousness
prevent palpations
Radioactive iodine (RAI)
hyperthyroid drug
destroys part of gland *
will become hypothyroid and need synthroid
Methimazone (tapazole)
hyperthyroid drug
more potent
fewer side effects
interfere with iodine uptake
Synthroid ( levothyroxine, levothyroid)
hypothyroid drug
A synthetic T4
drug of choice
daily dosing
Cytomel (L-triiodothyronine)
hypothyroid drug
synthetic T3
daily multiple dosing- difficult to monitor
Thyrolar (Iiotrix)
hypothyroid drug
synthetic T3/T4
controversial
expensive
thyroid hormone ( armour thyroid )
hypothyroid drug
contains iodine
difficult to monitor
Unpredictable
Victoza
injectible drug
improve blood glucose in Type 2 diabetes
used with diet/exercise
oral hypoglycemics...
stimulate the beta cells of the pancreas to release insulin
effective only when pancrease has some functional beta cells ( type II only*)
used with diet/weight control/exercise
Sulfonylureas
oral hypoglycemic drug
first oral agent
stimulate exiting B cells*
increase sensitivity of insulin receptors*
increase glucose transport in the tissues*
first generation oral hypoglycemic drugs
Diabinese* Prototype
Tolinase
Orinase*
decreased use with development of 2nd generation
second generation oral hypoglycemic drugs
more potent (smaller doses)
can be given daily
Glucotrol extended release*
Micronase
Amaryl extended release*
lower risk of hypoglycemia and wight gain
Prandin (repaglinide)
oral hypoglycemic
newer class
is a glinide
low risk of hypoglycemia and weight gain
Subcutaneous Antidiabetics
rapid: Novolog
Short-acting: Humulin-R
Intermediate acting: Humulin-N
Long-acting: Lantus
Adrenocortical Hormones
All are agents secreted by adrenal cortex
Hyposecretion of glucocorticoids and aldosterone by the adrenal cortex
Addison's*
Excessive corticosteroid secretion by the adrenal glands or by corticosteroid therapy
Cushing's*
what do glucocorticoids do?
potent anti-inflammatory
suppress immune system
are pallative rather than curative *
Corticoid (hydrocortisone)
type of corticosteroid drug
topical appilcation
skin inflammation
Decadron
type of corticosteroid drug
immunosupression- IV, IM
Deltasone
type of corticosteroid drug
oral form only
neoplasia
Kenalog
type of corticosteroid drug
IM, SC, Intradermal, Aerosol
oral side effects of steroids
mucosal heals slower
more susceptible to infection
side effects of inhalers
possible candidiasis
xerostomia
define seizure
disorders characterized by chronic recurrent, paroxysmal changes in neurologic function
altered consciousness
involuntary movements
T/F all seizures imply epilepsy?
false
Grand Mal
tonic/clonic
Aura
sudden epileptic cry**
more than 5 min -> emergency
tonic part of grand mal
generalized muscle rigidity
mydriasis
eye roll up or to the side
loss of conciousness
clonic part of grand mal
uncoordinated movements
rhythmic contractions of limbs
forced musculature closure of mouth
status epilepticus
repeated seizures in a short period of time without recovery
T/F does Valium inhibit/stop a seizure?
true
Dilantin
anticonvulsant drug
blocks sodium channels
gingival hyperplasia
anticonvulsant drugs
first line agents used
can cause an allergic response
Steven-Johnson Syndrome
toxic
T/F aspirin does not interfere with Coumadin drug for a stroke
false
Parkinsons
Chronic neurodegenerative disease of CNS
Degenerative disease of the basal ganglia involving the Dopamine* -secreting pathway
Signs and Symptoms of Parkinsons
muscle rigidity
facial impassiveness
tremors (extremities at rest, Cogwheel-type rigidity*)
stooped posture
pain
bowel/bladder dysfunction
treatment for Parkinsons
no treatment/cure
therapy with increasing dopamine levels in the CNS
L-dopa
most common prescribed med for parkinsons
Requip
drug for parkinsons
relives stiffness, tremors, muscle spasm, restless leg syndrome
Azilect
drug for parkinsons
MAO-B-Inhibitor
reduce the breakdown of dopamine which increased the level
Alzheimer's/Dementia
degeneration of cholinergic neurons that utilize neurotransmitters Ach and glutamate
impaired learning and memory
MS (multiple sclerosis)
chronic and continuous demyelination of the corticospinal and tract neurons
dry or burning mouth
ALS (Lou-Gehrig's)
chronic, progressive, fatal disease
50% die within 18 mo.
Difficult to Diagnose
Rilutek
Drug for ALS
reduce damage to motor neurons by decreasing release of glutamate