Steroid Hormones Contraceptive agents Hormones I Proteinpeptide 1

Steroid Hormones. Contraceptive agents

Hormones I Protein-peptide: 1. Hypothalamus 2. Pituitary gland 3. Parathyroid glands 4. Pancreas 5. Intestinal II Derivatives of amine acids: 1. Thyroid gland – derivatives of thyronin 2. Medulla of adrenal glands – catecholamines III Steroid: 1. Adrenal cortex 2. Sex glands

Hormonal preparations of steroid structure

Natural hormones of adrenal cortex Mineral corticosteroids Glucocorticosteroids hydrocortisone (cortisole) corticosterone cortisone 11 -dehydrocorticosterone aldosterone desoxycorticosterone 11 -desoxy-17 -oxycorticosterone Hormones with sexual activity androsterone androstendione estrone progesterone

Hypothalamus-adrenal axis Hypothalamus-hypophysis-epinephral system Hypothalamus CRH Somatostatin GRH TRH PIH Gn. RH Anterior pituitary Growth hormone ACTH TSH FSH LH (male) LH (female) Prolactin Peripheral endocrine glands Adrenal cortex Thyroid Gonads Liver Feed-back mechanism

Properties of glucocorticosteroides used in clinics • Anti-inflammatory • Immune-suppressive • Anti-allergic • Anti-shock • Anti-toxic

Anti-inflammatory action of GCS • Nonspecific inflammation • Auto-immune component • Hyperergic character • Therapy of despair

Mechanism of anti-inflammatory action of GCS activation of lipomoduline decreasing of activity of phospholipase А 2 slowing down of arachidonic acid metabolites production (prostaglandins, leucotriens, thromboxan А 2) stabilization of cellular and lyzosomal membranes depression of histamine, serotonin, bradykinine releasing decreasing of leucocytes’ migration processes, depression of phagocytes activity decreasing of capillaries’ wall permeability

Administration of GCS • Insufficiency of adrenal cortex • Rheumatoid illnesses (rheumatoid arthritis, rheumatism, system red lupus etc. ) • Chronic active hepatitis • Bronchial asthma • Ulcerative colitis • Nephritic syndrome • Auto-immune hemolytic anemia • Shock and collapse of any etiology • Brain, lungs, larynx edema • Acute allergic reactions • Transfusion reactions • Heavy infections (hiding behind the etiotropic drugs!) • Liver diseases

Doses and terms of GCS therapy Situation Daily dose Terms of treatment Acute cases (shock, collapse, brain, lungs edema, septic shock, asthmatic condition etc. ) 200 -5001 -3 days 800 -1000 mg i. v. Subacute and acute attacks of chronic processes (rheumatoid diseases, ulcerative colitis, bronchial asthma etc. ) 20 -50 mg (rarely till 200 mg) 4 -6 weeksseveral months Primary and secondary insufficiency of adrenal cortex 2, 5 -10 mg life-long

Hydrocortisone acetate

Prednisolone

Prednisolone

Prednisolone

Becotide = Beclometh (beclomethasone dipropionate)

Kenalog (triamcinolone acetonide)

Kenalog (triamcinolone acetonide)

Fluocinar – Sinaflan – Sinalar (Fluocinole acetonide)

Dexamethasone

Dexamethasone

Dexamethasone

Lorinden A: flumethasone pivalate (locacorten) + neomycin

Complications of GCS-therapy Steroid diabetes immune-suppression depression of resistance towards any infections atrophy of muscles hypopotassiumemia peptic ulcers disturbance of regeneration osteoporosis, delay of growth matronism (“buffalo hump”, “moonlike face” etc. ) retention of Na+ , H 2 o edema hypertension hypercoagulation of blood changes of psychical conditions disturbance of menstrual cycle hypothalamus-pituitary-epinephral insuffciency Izenko-Cushing’s syndrome

Controls and Actions of the Adrenal Glands

MINERALOCORTICOIDS Desoxycorticosterone acetate - DOXA • Mode of action Acts on kidney tubules: causes the reabsorption of sodium and water, decreases the reabsorption of potassium, regulates fluid-electrolyte metabolism, increases AP, enhances muscle work • Administration For chronic adrenal insufficiency (Addison’s disease), myasthenia, adynamia • Side effects edema, AP increasing, pulmonary edema, cardiac insufficiency

Drugs of female sex hormones Estrogens estron (oil solution of folliculin) estradiol ethynilestradiol (microfollin) synestrol Gestagens progesterone oxyprogesterone caproate alilestrenol (turinal)

Estrogens • Uses – Hormone replacement therapy (HRT) – Palliative and preventive therapy during menopause • Actions – Protecting the heart from atherosclerosis – Retaining calcium in the bones – Maintaining the secondary female sex characteristics

Sites of Action of the Estrogens

Administration of drugs of female sex hormones estrogens 1) Genital hypoplasia, primary and secondary amenorrhea 2) Sexual underdevelopment of women 3) After ovary-ectomia 4) Climacteric disorders 5) Lactation depression 6) Weak labor activity (estrogen background) 7) Prostate cancer of men, breast cancer of women after the age of 60 8) A part of contraceptive agents

Effects of Progesterone on the Body • Decreased uterine motility • Development of secretory endometrium • Thickened cervical mucus • Breast growth • Increased body temperature • Increased appetite • Depressed T-cell function • Anti-insulin effect

Administration of gestagens 1) miscarriage, habitual abortion 2) dysfunctional uterus bleedings, algomenorrhea 3) as component of contraceptives 4) Climacteric disorders 5) As part of fertility programs 6) Treat specific cancers with specific receptor site sensitivity

Hormonal contraceptives 1) combined estrogen-gestagen a) monophased (bisecurin, non-ovlon, rigevidon, marvelon, demulen) b) double-phased (anteovin, neo-eunomin) c) triple-phased (tri-regol, trisiston) 2) monohormonal gestagen (mini-pilli) exluton, ovret, continuin 3) postcoital hestagen (postinor) 4) depot-contraceptives - of prolonged action norplant (levonorgestrel) depot-provera (medroxyprogesterone acetate)

Complications in case of administration of hormonal contraceptives hypertension thrombo-embolia hypercoagulation dyspeptic disorders (nausea, vomiting) migraine depression obesity cholestatic jaundice breast cancer, cancer of uterus cervix ischemic heart disease myocardium infarction stroke embryotoxic and teratogenic action

Focus on the Fertility Drug Prototype: Clomiphene • Indications: Treat ovarian failure in patients with normal liver function and normal endogenous estrogens; unlabeled use: treat male sterility • Actions: Binds to estrogen receptors, decreasing the number of available estrogen receptors, which gives the hypothalamus the false signal to increase FSH and LH secretion, leading to ovarian stimulation • PO route: Onset 5– 8 days; duration 6 weeks • T½: 5 days, with hepatic metabolism and excretion in the feces

Abortifacients • Use – Evacuate the uterus by stimulating intense uterine contractions • Types – Carboprost (Hemabate) – Dinoprostone (Cervidil, Prepidil Gel, Prostin E 2) – Mifepristone (RU-486, Mifeprex)

Androgens and Their Indications • Testosterone (Duratest, Testoderm, others) – Hypogonadism; breast cancer • Danazol (Danocrine) – Block the release of FSH and LH in women • Fluoxymesterone (Halotestin) – Hypogonadism; breast cancer • Testolactone (Teslac) – Breast cancers

ANABOLIC STEROIDS Phenobolinum, Retabolil, Methandrostenolonum - PHARMACOLOGICAL EFFECTS Stimulation of protein synthesis Depression of phosphor and Ca++ excretion Increase of bones, muscles and parenchymatous organs mass Stimulation of regeneration ADMINISTRATION Aplastic anemia (bone marrow suppression) Osteoporosis, bone fractures Exhausted diseases Prolonged treatment with GCS COMPLICATIONS Hepatitis, sexual disorders (impotence), edemas, masculinization, nausea, vomiting