Endocrine pharmacology - lecture notes PDF

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All lecture notes and additional learning notes from my Pharmacology Module in my BSC Adult Nursing Degree at Kings College London (2014-2017)....

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Endocrine pharmacology – lecture notes Insulin Insulin was first isolated in 1922 and was the first protein to be fully sequenced in 1950. Insulin can be genetically engineered human insulin or porcine insulin. The USA use human insulin. Porcine insulin is insulin from a pig – they only differ by one amino acid and is weakly antigenic. What does insulin do? Increased glucose levels signal the beta cell to secrete insulin Insulin also promotes the exit of glucose from the blood stream Insulin replacement therapy is given once or twice a day. It may be slow or slow acting or a mixture. Insulin can be available as pre-filled pen dispensing systems or in vials that need to be drawn up & injected. If insulin is given frequent blood glucose check need to be done – risk of hypoglycaemia Diabetes Type 1 – Insulin secretion is not enough therefore exogenous insulin is needed. Exogenous insulin = not naturally produced by the pancreas. Type 2 - Insulin resistant. Insulin is produced but the number of insulin receptors is low. The fewer receptors reduces the probability of insulin binding. Reduce resistance and secretion improvement is needed. Treatment for type 2 diabetes Initial treatment for type 2 diabetes is to reduce BMI as the reduction of BMI leads to an increases in insulin receptors. Medication is often also given to type 2 diabetics to try and increase insulin secretion. Sulfonylureas are a class of medications that are used to try and increase insulin secretion. Tolbutamide and glibenclamide are common types of sulfonylureas used. Sulphonylureas Promote insulin secretion from beta cells Sensitises beta cells to glucose Limits glucose production in the liver Decreases liver insulin clearance

Metformin Metformin can also be known as Glucophage It reduces insulin insensitivity Decreases intestinal absorption of glucose Reduces production of glucose by the liver Is NOT metabolised. Is excreted via renal system. The half-life is 6 hours. Reduced risk of hypoglycaemia as it does not increase insulin secretion Should not be used in Kidney disease. Hypoglycaemia nursing considerations Hypoglycaemia is more common with insulin replacement therapy A hypo can be indicated by the patient feeling dizzy, confused or angry Ensure medication is taken just before food Ensure patients on diabetic medications have a source of readily available glucose at all times

Hyperglycaemia considerations Patients pass large amounts of volume if hyperglycaemic therefore they get hydrated Patients need careful re-hydration and correction of their blood glucose levels Their breath smells like pear drops Thyroid What does the thyroid do? Thyroid hormones

Thyroid diseases Hyperthyroidism – Too much thyroid hormone. Often anxious. Heart rate is frequently rapid and suffers from muscle twitch and weight loss. Hypothyroidism – Too little thyroid hormone. Frequently depressed. Frequently has issues with being overweight. Goitre (swelling of the thyroid gland). Thyroid treatment Hyperthyroidism treatment is to surgically remove abnormal tissue and irradiate abnormal tissue. Propylthiouracil administration reduces the incorporation of Iodine into thyroid hormones. Hypothyroidism treatment is to improve thyroxine levels. Must make sure that it is safe to give levothyroxine – check blood levels. Levothyroxine can have adverse effects such as abnormal heart rhythms and increased risk of frail bones especially post-menopausal....