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Medication Review
Local Hormones
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Medication Review, Local Hormones
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Definitions
Therapeutic Classes
Systemic Hormones
Antihistamines (Histamine
Antagonists)
Prostaglandin Antagonists
Prostaglandins
Systemic Hormones
Androgens
Estrogens
Progestins
Corticosteroids
Insulin Oral
Hypoglycemics
Oxytocics
Thyroid hormones (Thyroxine)
AntiThyroid Hormones
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Definitions
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Definitions
Local Hormones vs. Systemic Hormones
Local hormones are synthesized in various tissue types.
Systemic hormones are produced by one specific tissue (gland)
Local hormones are released and act locally
Systemic hormones act throughout the body
Local hormones exert profound changes in the body
Systemic hormones have a regulatory effect
Histamine
Local hormone found in all tissues of the body
Causes bronchial constriction, stomach acid secretion, blood vessel dilation, and local
edema (swelling), pain, and itching.
Prostaglandins
A group of local hormones that cause a variety of local reactions
Causes uterine and bronchial contractions and relaxation, decreased gastric secretions,
pain, and inflammation.
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Therapeutic Classes
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Therapeutic Classes
Antihistamines (Histamine Antagonists)
Uses
Treatment of allergies, rashes, and hay fever
Motion sickness, nausea, and dizziness
H2 antagonist is used to treat ulcers and reflux disease
Mechanism of Action
Inhibits the action of histamine
Side Effects
Drowsiness
CNC depression
Anticholinergic effects
Examples
Sedating Antihistamines - Type 1, competitively antagonize histamine at the H1 receptor
(block histamine). They cross the blood brain barrier making them a CNS drug
Diphenhydramine (Benedryl)
Chlorpheniramine (Chlor-Trimeton)
Hydroxyzine (Atarax, Vistaril)
Brompheniramine (Dimetane)
Dimenhydrinate (Dramamine)
Meclizine (Antivert, Bonine, Dramamine II) used to treat vertigo
Clemastine (Tavist)
Cyclizine (Marezine)
Cyproheptadine (Periactin)
Dexchlorpheniramine (Polaramine)
Cyproheptadine (also used for appetite stimulation)
Promethazine (Phenergan) is used to treat nausea (antiemetic).
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IProchlorperazine (Compazine) is used to treat nausea (antiemetic).
Non-Sedating Antihistamines - Type I, do not cross blood brain barrier, no sedation
Loratadine (Claritin)
Astemizole (Hismanal)
Fexofenadine (Allegra)
Cetirizine (Zyrtec)
Desloratadine (Clarinex)
Medpointe (Astelin) nasal spray used for seasonal allergic
Claritin-D
Allegra-D
The "D" is for decongestant (Pseudoephedrine) - may cause heart palpitations.
Antihistamine - Type II, competitive blockers of histamine at the H2 receptors, those in the
stomach
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)
Prostaglandin Antagonists
Uses
Arthritis
Minor pain
Fever
Inflammation
Mechanism of Action
Inhibit or reverse the actions of prostaglandins by blocking Cox-1 and Cox-2 enzymes
Side Effects
Ulcers
Kidney damage
Examples
Non-steroidal anti-inflammatory drugs (NSAID's):
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Aspirin (Anacin, Ascriptin, Bayer, Bufferin, Ecotrin)
Ibuprofen (Motrin)
Naproxen (Anaprox, Naprosyn)
Indomethacin (Indocin)
Diclofenac (Voltaren)
Nabumetone (Relafen)
Oxaprozin (Daypro)
Piroxicam (Feldene)
Sulindac (Clinoril)
Fenoprofen (Nalfon)
Flurbiprofen (Ansaid)
Etodolac (Lodine)
Diflunisal (Dolobid)
Ketoprofen (Orudis, Oruvail)
Ketorolac Tromethamine (Toradol)
Meclofenamate (Meclomen)
Salsalate (Disalcid)
Tolmetin (Tolectin)
Cox-2 selective drugs
Side Effects
Kidney damage
Celecoxib (Celebrex)
Rofecoxb (Vioxx) no longer available in the US
Prostaglandins
Uses
NSAID ulcer prevention
Abortifacient (abortion)
Examples
Misoprostol (Cytotec)
Dinoprostone (Prostin E2)
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Alprostadil (MUSE)
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Systemic Hormones
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Definitions
Systemic Hormones
Hormones produced by one specific tissue (gland)
Generally, act systemically
Have a regulatory function on the body
Therapeutic Classes
Androgens
Male hormones, which are secreted by the testes, are responsible for the characteristic
sexual changes in men (sexual organ development, hair growth, muscle development, and
deepening of the voice)
Uses
Testosterone deficiency (hormone replacement)
Muscle wasting (severely anemic and cancer patients)
Side effects
Masculinizing effects
Examples
Fluoxymesterone (Halotestin)
Nandrolone (Durabolin)
Testosterone (Androderm, Depotest)
Methyltestosterone
Estrogens
Female hormones, which are secreted by the ovaries and are responsible for development
of female sexual characteristics (breast development, body fat distribution, sexual organ
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development, and menstruation)
Uses
Hormone replacement (menopause):
Decrease heart problems
Prevent osteoporosis
Contraception
Cancer chemotherapy
Side effects
Headaches
Blood clots
Examples
Hormone replacement:
Conjugated Estrogens (Premarin)
Ethinyl Estradiol (Estinyl)
Estropipate (Ogen)
Oral contraceptives:
Monophasic (combination products) - fixed dosage of estrogen to progestin throughout the
cycle.
Lo-Ovral
Demulen
Loestrin
Ovcon
Levlen
Nordette
Yasmin
Biphasic - Estrogen is same for 21 days, increased progestin for first half of cycle and
decreased progestin during second half of cycle
Ortho Novum 10/11
Necon 10/11
Triphasic - Estrogen remains the same or varies throughout cycle and progestin varies
Ortho Novum 7/7/7
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Triphasil
Tri-Norinyl
Tri-Levlen
Ortho Tri-Cyclen
Progestins
Female hormones secreted by the corpus luteum, which cause growth of mammary ducts
and prevention of uterine bleeding during pregnancy
Uses
Hormone replacement (menopause)
Contraception
Side Effects
Breast changes
Changes in weight
Examples
Hormone replacement:
Medroxyprogesterone (Cycrin, Provera)
Oral contraceptives: Progestin only products
Norethindrone (Nor-QD)
Norgestrel (Ovrette)
Corticosteroids
Hormones secreted by the adrenal gland
Uses
Inflammation
Asthma
Cancer
Hypoadrenalism
Side Effects
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Stomach upset (take with food or milk to decrease upset)
Water retention
Increased appetite
Agitation
Suppression of the body's production of Cortisol
Examples
Prednisone (Deltasone, Orasone)
Methylprednisolone (Medrol)
Prednisolone (Prelone)
Dexamethasone (Decadron)
Hydrocortisone (Anucort - HC, Cortaid, Gynecort, Hytone, Locoid, ProctoCream, Cortifoam,
Westcort)
Triamcinolone (Aristocort, Azmacort, Kenalog)
Betamethasone (Alphatrex, Diprolene, Diprosone, Valisone)
Cortisone (Cortone)
Insulin
Hormone produced by pancreas by the Beta cells
Use
To replace insulin in patients with Type I or Type II diabetes
Mechanism of Action
Facilitates the utilization and storage of glucose
Type I (IDDM):
Patient who does not produce any insulin and requires daily insulin injections for survival
Type II (NIDDM):
Patient who produces some insulin, but generally not enough to allow proper glucose
utilization
Side Effects
Hypoglycemia
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Examples
Regular - fast acting
NPH - Intermediate acting
Semilente - Rapid acting
Ultralente - Long acting
Lente - Intermediate acting
Humalog - fast acting
Lantus- long acting (once daily dose)
Oral Hypoglycemics
Use
Manage patients with Type II diabetes
Mechanism of Action
Promote insulin release from the beta cells of the pancreas
Increases insulin sensitivity
Side Effects
Hypoglycemia
Photosensitivity
Skin rash
AVOID ALCOHOL
Examples
Glyburide (Micronase, Diabeta) (Sulfonylurea) - second generation oral hypoglycemic agent
Glipizide (Glucotrol) - Mechanism of Action - decrease blood glucose by stimulating the
release of insulin from pancreas
Metformin (Glucophage) - does not stimulate insulin secretion - Mechanism of Action decrease hepatic (liver) glucose production and increases peripheral glucose utilization
(muscle sensitivity to insulin)
Troglitazone (Rezulin) - Mechanism of Action - stimulates peripheral glucose utilization, high
doses decrease hepatic glucose production
Chlorpropamide (Diabinese) - first generation
Glimepiride (Amaryl) - second generation
Tolazamide (Tolinase) - first generation
Tolbutamide (Orinase) - first generation
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Oxytocics
Hormones secreted by the pituitary, which stimulate the contraction of uterine smooth
muscle
Uses
Relief from breast enlargement during lactation and control of postpartum uterine bleeding
Some Ergot Alkaloids are also used to treat migraine headaches e.g. Ergotamine (Ergostat)
Side Effects
Nausea/vomiting
Dizziness
Increased blood pressure
Chest pain
Examples
Oxytocin (Pitocin)
Ergonovine (Ergotrate)
Methylergonovine (Methergine)
Thyroid hormones (Thyroxine T4)
Regulate the rate of many physiological processes including protein synthesis, glucose and
carbohydrate metabolism, energy storage, lipid metabolism, nervous system development,
and body temperature regulation
Uses
Treat thyroid hormone deficiency (hypothyroidism)
Side Effects
Various
Examples
Levothyroxine (Synthroid, Levothroid)
Thyroglobulin (Proloid)
Thyroid Tablets
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Anti-Thyroid Hormones
Uses
To treat over secretion of thyroid hormones (hyperthyroidism)
Mechanism of Action
Interfere with thyroid hormone production
Examples
Methimazole (Tapazole)
Propylthiouracil (PTU)
Potassium Iodide (SSKI)
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