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1. Pharmacology
Drugs that Affect the
Endocrine System

2. INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

3. Topics
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Pituitary Drugs
Parathyroid/Thyroid Drugs
Adrenal Drugs
Pancreatic Drugs
Reproductive Drugs
Sexual Behavior Drugs

4. Functions
• Regulation
• Control

5. Glands
Exocrine
Endocrine
• Secrete enzymes
• Close to organs
• Secrete hormones
• Transport via
bloodstream
• Require receptors

6. Nervous
Endocrine
Wired
Wireless
Neurotransmitters
Hormones
Short Distance
Long Distance
Closeness
Receptor Specificity
Rapid Onset
Delayed Onset
Short Duration
Prolonged Duration
Rapid Response
Regulation

7. Mechanism of Action

8. Hypothalamus

9. Hypothalamic Control Pituitary

10. Posterior Pituitary
Target
Actions
Oxytocin
Uterus
Mammary
ADH
Kidneys
Contraction
Milk
let-down
Water
reabsorption

11. Anterior Pituitary
Target
GH
Most tissue
TSH
Thyroid
ACTH
Adrenal
Cortex
Action
Growth
TH
secretion
Cortisol
secretion

12. Anterior Pituitary
Target
Action
FSH
Ovaries
Testes
LH
Ovaries
Testes
Follicles
Estrogen
Sperm
Ovulation
Progesterone
Testosterone

13. Anterior Pituitary
Target
Prolactin
Action
Mammary
Gland
Milk
production

14. Pituitary Hormones

15. Thyroid

16. Thyroid
Target
Action
Thyroxine
Most cells
Triiodothyronine
BMR
Calcitonin
Calcium
Mostly bone

17. Hypothyroidism

18. Hyperthyroidism

19. Parathyroid

20. Parathyroid
Target
Parathyroid
(PTH)
Bone
Kidney
GI Tract
Action
Calcium

21. Calcium Regulation

22. Pancreas

23. Pancreas
• Alpha cells: glucagon
• Beta cells: insulin

24. Pancreas
Target
Action
Glucagon
Liver
Glucose
Insulin
General
Glucose

25. Glucose Regulation

26. Adrenal

29. Adrenal Medulla
Target
Norepi
Epi
Action
Heart
Blood
vessels
Liver
Prolongs
SNS Effects

30. Adrenal Cortex
Target
Aldosterone Kidney
Cortisol
Most Tissue
Action
Na
reabsobtion
Water
retention
Glucose
inflammation

31. Anterior Pituitary Drugs
Inadequate Growth
Hormone
• Dwarfism
• somatrem (Protropin®)
• homatropin
(Humatrope®)
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Excessive Growth
Hormone
Acromegaly
Gigantism
Surgical removal 1º
octreotide
(Sandostatin®)

32. Posterior Pituitary Drugs
• Oxytocin
• ADH
– Diabetes insipidus
– Nocturnal enuresis
• vasopressin (Pitressin®)
• desmopressin (Stimate®)
• lypressin (Diapid®)

33. Parathyroid Diseases
• Hypoparathyroidism
– Inadequate calcium levels
• TX: increased dietary calcium
• Hyperparathyroidism
– Excessive calcium levels
• TX: surgical removal

34. Thyroid Disease
• Hypothyroidism
– Hormone replacement
– levothyroxine (Synthroid®)
• Hyperthyroidism
– Thyrotoxicosis
– Surgical removal
– propylthiouracil (PTU)

35. Adrenal Cortex
ACTH Hypersecretion
Cushing’s Disease
• Surgical removal
• Inhibit adrenal
secretion
–
•
•
•
•
ketoconazol (Nizoral ®)
Symptomatic tx:
– Antihypertensives
•
ACTH Hyposecretion
Addison’s Disease
Replacement therapy
Cortisone (Cortistan®)
Hydrocortisone
(SoluCortef®)
Fludrocortisone
(Florinef Acetate®)

36. Pancreas
Blood
Potassium
Blood
Glucose

37. Insulin Preparations
• Regular Insulin
– Natural insulin
• Modified Insulin
– Increased duration of action
– NPH (neutral protamin Hagedorn)
• Natural plus protamin
– Lente
• Attached to zinc to prolong absorption

38. Oral Hypoglycemic Agents
Sulfonylureas
insulin secretion
tolbutamide (Orinase®)
chlorpropamide (Diabinese®)
glipizide (Glucotrol®)
glyburide (Micronase®)
Biguanides
metformin (Glucophage®)
Glucose synthesis
Glucose uptake
Alpha-glucosidase
inhibitors
• Delay carbohydrate
metabolism
acarbose (Precose®)
miglitol (Glyset®)
Thiazolidinediones
Insulin effectiveness
troglitazone (Rezulin®)

39. Hyperglycemic Agents
• Glucagon
–
gluconeogenesis
• diazoxide
(Proglycem®)
– Inhibits insulin release
• D50W

40. Estrogens & Progestins
• Estrogens used for
post-menopausal
hormone replacement
therapy.
– estradiol (Estrace®)
– conjugated estrogens
(Premarin®)
– estropipate (Ogen®)
• Progestin
– Diminish side effects
of estrogen therapy
– Nausea, fluid retention,
breast tenderness
– medroxyprogesterone
acetate (Provera®)
– norethindrone acetate
(Aygestin®)

41. Oral Contraceptives
• Combination of estrogen and progestin
– Loestrin®, Levora®, Nordette®, Ovocon®,
Norinyl® plus many others
• Minipill: progestin only
– Micronor®, Nor-Q.D.®, Orvette®
• Prime side effect: risk of
thromboembolism

42. Uterine Stimulants &
Relaxants
• Stimulants (Oxytocics)
•
uterine contraction
• Indication:
– Induce labor
– Postpartum
hemorrhage
• oxytocin (Pitocin®)
• ergonovine
(Ergotrate®)
• Relaxants (tocolytics)
• Relax uterine smooth
muscle
• Beta2 agonists
– terbutaline (Brethine®)
– ritodrine (Yuptopar®)

43. Infertility Agents
• Promote maturation of ovarian follicles
• clomiphene (Clomid®)
• urofollitropin (Metrodin®)

44. Male Reproductive Agents
• Testosterone Replacement
– methyltestosterone (Metandren®)
– fluoxymesterone (Halotestin®)
• Benign Prostatic Hypertrophy
– Surgery
– finasteride (Proscar®)

45. Sexual Behavior
• Most are side effects from other
medications
– Antihypertensives & psychoactive drugs
• sildenafil (Viagra®)

46. Thank you
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