this is Professor Hoffman and this will be the first in three videos uh to cover the content for topic nine where we're looking at uh drug classes that affect the endocrine system uh we'll be looking at the corticosteroids uh we'll also be looking at uh medications to control glucose so the diabetic medications and then we'll look at a couple thyroid medications in the three videos that are coming up so again this video we're going to look at some background information on the endrant system uh just some basic A&P review Concepts and then we'll look at the corticosteroid uh drug class so again the endocrine system is a communication system in our body it complements the neurological system um when we talked about the talked about the neurological system and when we were looking at sympathetic and parasympathetic nervous systems and the drugs that were related to that we talked about the role of neurotransmitters as the chemicals that were served as communicators in the endocrine system those communicators are the hormones now specific glands um uh in the bodies are endocrine glands that means they excrete specific hormones into the bloodstream uh those hormones then circulate through the body until they locate the receptor sites that are specific to them so again we're using the same kind of theory here for receptor site Theory with hormones um as we would with the neurotransmitters when we were talking about the neuros neuros system and the autonomic nervous system um our content Focus uh for this course in terms of endocrine in this section of videos as you look at the different um glands and hormones are involved are going to be the adrenal gland and specifically the ones in terms of the adrenal core cortex so these are going to be the C corticosteroids there's a couple other aspects of the adrenal gland that we'll talk about and we've already looked at some of the hormonal effect um for those areas in the next video we'll look at the hormones released by the pancreas for glucose control and drugs that we can use to help um augment that um that process and then the final video in this series we'll be looking at the thyroid medic ations so along with remembering that the hormones are communicating um chemicals uh and that when we were doing endocrine related medication classes we're usually looking at replacing the hormones so we're increasing circulation but um we need to keep in mind that how the body normally works in determining when to release the hormones uh when to stop releasing the them is again the negative feedback loop uh We've looked at this concept in uh other drug classes as well but the idea is uh the glands will receive a stimulus or a signal that a hormone is needed to be um produced and secreted into the bloodstream so it can go to the Target organs or target cells produce the effect once that effect is produced the signal will come back to the gland and tell it to stop stop production and that's our normal process to keep us from accumulating too much of a hormone in our system at any one time now when we're looking at types of stimuli that will activate a an endocrine gland um there can be a hormonal stimulus so we see that with a lot of the hormones that Rel released from the pituitary gland and go out to various parts of the body including the ad um adrenal gland that we'll be looking at here shortly so those hormones go out and they find another endocrine gland and they trigger uh response in that gland which then produces that specific hormone which goes out to the body and produces the results that we're looking for uh the Target or the triggers can also be uh bloodborne her blood level changes so that can be chemicals electrolytes that type thing and Al or also the osmolarity so any discussions you've had in anatomy and physiology and pathophysiology um when we're looking at blood pressure control uh related to drugs as well you'll remember conversations about Barrow receptors and osmo receptors um again these will sense a lack of a certain chemical trigger the hormones to be released to do that glucose is the prime example we'll be looking at in uh the next video when gluc glucose levels um are high um it's going to trigger the pancreas to release insulin so that can enable that glucose to leave the bloodstream get to the cells where it's needed and again it's all going to operate off of a negative feedback loop once the glucose levels go down the stimulus to produce insulin will also decrease we can also have a neuros uh stimuli uh and we looked at that when we were looking at the autonomic nervous system drugs the sympathetic fight ORF flight response and release of epinephrine nor epinephrine those are actually two hormones that are being released by part of the adrenal gland and again it's response to neuros neuros signals that uh will activate that release so the first one we're going to look at are the corticosteroids the corticosteroids mimic the hormones that are released by the adrenal glands the adrenal glands are located on top of the kidneys and they're made up of the cortex Tex which is the um outer layer mid to outer layer and then the medulla which is the interior section the medulla produces norepinephrine and epinephrine so again when we were talking about autonomic nervous system and the adrenergic or sympathomimetic type response we were looking at in um normal functioning the medulla of the adrenal gland being triggered to release norepinephrine and epinephrine so they could go out and they then were the neurotransmitters for the sympathetic nervous system so the whole fight ORF flight process is going there when we talk about corticosteroids though we're talking about the uh hormones that are released by The cortex that mid to outer layer of the adrenal glands and there's two classes one we've talked about uh without talking specifically about it um being a hormone necessarily but aldosterone that's a mineral Cor covid it is really involved in the maintaining proper levels of sodium and potassium when we talked about blood pressure control and we talked about the renan Angiotensin aldosterone system that's where that one came into play and the idea of the aldosterone is when it was released U by the cortex of the adrenal gland went into circulation found its way to the kidneys um and uh directed the kidneys then to hold on to sodium so it would hold on to water and in the process it also allowed for the depletion of potassium so the aldosterone is a mineral corticoid it's one of the corticosteroid groupings uh and it's really responsible for sodium potassium levels and fluid balance so that's where we see that uh the class when we when you normally talk about steroids in patient use we're normally going to be looking at the glucose corticoids now the glucocorticoids are also produced by the cortex and the main natural glucocorticoid is cortisol and the purpose of cortisol it's released uh at times of prolonged stress and if we have that immediate stress we're going to get activation as a medulla we're going to go into fight or flight to get an immediate response um to deal with stress when stress becomes prolonged and we start involving inflammatory process uh the immune process things like that then the cortex is stimulated and the glucocorticoids cortisol goes out corticos Sol's main job is to make sure there's plenty of glucose available for energy for this prolonged stress situation so it is going to um communicate with the liver to take um produce glucose out of stored glycogen it's going to start converting fat um molecules fatty molecules into fatty acids and ketones that can be used for energy it's going to start breaking down um muscle cells into their basic amino acids which then also can be converted into possible energy sources so they do this as a protective measure so by increasing this amount of glucose that's available they're also going to suppress those other activities and again that's our normal functioning as we get through the stress so everything returns back to normal and um we don't see any really long-term effects um we will see the long-term effects when we start using medications that mimic this though because again normally we're going to have that negative feedback loop that once the stress has decreased the signal is going to go back down to the adrenal glands to stop making the excess cortisol so it's just going to taper it off and we it back to normal levels so that's the basic &p review for those uh so when we look at the corticosteroids then that specific group and we're looking at glucocorticoids primarily uh these are going in in sewn and Loan uh quite often so predisone methyl prednisolone um are ones that you're going to commonly see they can be given orally they can be given by injection now what we can give the is if we have a situation of adrenal insufficiency where the adrenal glands aren't working we can do them as a hormone replacement so that would be one possibility most often we're going to be seeing them used for their anti-inflammatory action again they're mimicking cortisol so the main natural reason for the cortisol is to increase glucose availability but to do that it slows down the inflammatory process immune process other things that would make take um take glucose out of circulation to be able to use for those activities and keep it available for the muscle cells that type of thing so by using introducing the corticosteroids again we act like cortisol and we block those inflammatory processes block that need but also block what those processes will do uh we block any impact of inflammation uh which in respiratory situation will be Broncos constriction we're going to produce Bronco dilation because again we're dis erupting that inflammatory response in the Airways uh for arthritis for chronic inflammatory uh pain so that could be arthritis autoimmune diseases those types of things where there's an inflammatory process going on somewhere in the body we're going to block that process uh with the corticosteroids and for the side effect or the secondary effect of decreasing pain because we decrease that work of prostate Landings those other things that we talked about in pain management earlier so again we're getting um what in the body would be a secondary or um side effect type response in uh our natural day-to-day activity of our body we're using that as the primary purpose of the drug so we're corticosteroids or the glucocorticoids again primarily we're going to use them as anti-inflammatories um and for pain management for inflammatory pain so again we're introducing these drugs and they mimic the action of cortisol so we're going to see the same issues with prolonged corticosteroid glucocorticoid use as we would see if we had over production of cortisol we're going to get fluid and elect electrolyte imbalances we're going to be particularly watchful for hypokalemia because the glucocorticoid drugs also have some mineral corticoid effects so they're going to U mimic aldosterone to some degree as well again the glucocorticoids just like cortisol they're going to cause an increase of blood glucose from stored uh energy sources uh we're going to have muscle weakness because there's going to be some muscle breakdown and not the time for muscle rebuilding or have the resources for it and just going on through Cushing's the syndrome is a syndrome of overactive adrenal gland so over production of cortisol we can mimic that or reproduce that with the prolonged juice of the glucocorticoid so we're going to watch for that again the anti-inflammatory process also blocks the immune process so we're going to have an increased risk for infection uh by relieving those symptoms of pain in certain areas we may mask some symptoms of a disease or infection or injury going on so again those all become reactions and po potential risks of the corticosteroids from a nursing perspective then uh we want to monitor uh for those side effects particularly elevated BL uh elevated blood glucose levels um we're going to look for the early signs of Cushing syndrome uh we're going to be aware of any systemic infections um that may be developing and realizing that patients is going to have difficulty combating those in terms of tapering um the dose to discontinue or weaning it off remember normally the body would use its negative feedback loop to handle an excess of in this case a cortisol or cortisol likee substance and it would tell this adrenal gland when to produce more and then we told when it to stop producing so levels could come back down we're giving the medication or we're giving that chemical um through the medication that short circuits or bypasses that negative feedback loop and it's and actually what's happening is as we do routine long-term doses with the glucocorticoids the message is going to be received by the sensors that we have plenty of this cortisol type substance here so the adrenal plants are going to quit producing any they're going get very quiet now if we stop abruptly the adrenal glands are not going to have time to start producing natural cortisol this takes a um this is not immediate response the epinephrine nor epinephrine the medulla of the adrenal glands are really immediate in their um production and they stopping on the cortex side the corticosteroids um take time to build up and also time to uh phase out so if we stop abruptly we're going to go from this high level cor corticosteroids to putting them in the opposite place where they're going to be deprived of the corticosteroid effects so that's what we want to watch for in those cases um that's really the main characteristics of the corticosteroids um that we want to look at so uh we'll in the next video we'll move on to the pancreas and look at insulin control and blood glucose control