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Chapter 51

** This chapter covers the drugs that are used for hormone replacement Know what diseases need what meds to treat hypo and hyper and the side affects of the meds
Pituitary Gland

}Anterior pituitary gland ◦Growth hormone (GH) –Stimulates growth in tissue and bone ◦Thyroid-stimulating hormone (TSH) –Acts on thyroid gland ◦Adrenocorticotropic hormone (ACTH) –Stimulates adrenal gland ◦Gonadotropins (FSH), (LH) –Affects ovaries
Pituitary Gland (cont’d)

}Anterior pituitary gland ◦Growth hormone –Drugs for growth hormone deficiency: somatrem (Protropin), somatropin (Humatrope) –Drugs for growth hormone excess: bromocriptine (Parlodel), octreotide (Sandostatin)  ◦Thyroid-stimulating hormone –Thyrotropin (Thytropar) ◦Adrenocorticotropic hormone –Corticotropin (Acthar)
Growth hormones can not be given orally because they are inactivated by gastrointestinal enzymes (SQ or IV)-similar to insulin that can’t be given PO. Prolonged GH therapy can antagonize insulin secretion and eventually cause diabetes mellitus. Drugs for growth hormone excess: bromocriptine (Parlodel), octreotide (Sandostatin) --CAN ONLY BE GIVEN IV
Growth Hormone Deficiency

}Somatrem (Protropin) & Somatropin (Genotropin)
}Are two hormones used to treat growth failure in children
}Because of pituitary GH deficiency
}Somatropin is contraindicated in Pediatric clients who have Prader-Willi Syndrome and that are severely obese or respiratory impairment
Prader-Willi syndrome is a rare disorder present at birth that results in a number of physical, mental and behavioral problems. A key feature of Prader-Willi (prah-dur VIL-ee) syndrome is a constant sense of hunger that usually begins after the first year of life. Poor muscle tone, Distinct facial features  (almond-shaped eyes, a narrowing of the head at the temples, a turned-down mouth and a thin upper lip), Failure to thrive, Lack of eye coordination (strabismus), and Generally poor responsiveness.
Growth Hormone Excess

}Can occur with GH hypersecretion
}Frequently caused by a pituitary tumor
}Octreotide (Sandostatin) is used to suppress GH release.
}This drug is very expensive
Gigantism-excessive growth during childhood and Acromegaly-excessive growth after puberty, can occur w/ GH hypersecretion and are frequently caused by a pituitary tumor. If the tumor cannot be destroyed by radiation, the prolactin-release inhibitor bromocriptine can inhibit the release of GH from the pituitary gland.
Octreotide (Sandostatin) is a potent synthetic somatostatin used to suppress GH release. **Read over the signs and symptoms so that you can know… They will usually do intensive testing to diagnose pts w/ these
Pituitary Gland (cont’d)

}Adrenocorticotropic hormone ◦Corticotropin (Acthar, ACTH)
}Action ◦Stimulates adrenal cortex to secrete cortisol
}Use ◦Antiinflammatory, to diagnose adrenocortical disorders, to treat acute multiple sclerosis
Pituitary Gland (cont’d)

}Adrenocorticotropic hormone ◦Corticotropin (Acthar, ACTH)
}Contraindications ◦Severe fungal infections, CHF, peptic ulcer
}Interactions ◦Increase risk of ulcers with aspirin, increase effect of potassium-wasting diuretics, decrease effects of antidiabetics
Lasix…monitory potassium level b/c it drains all the potassium out.
Thyroid-Stimulating Hormone

The adenohypophysis secretes thyroid-stimulating hormone (TSH) in response to thyroid-releasing hormone (TRH) for the hypothalamus, and TSH stimulates the thyroid gland to release thyroxin (T4) and Triiodothyronine (T3, or liothyronine). Excess TSH secretion can cause hyperthyroidism, and TSH deficit can cause hypothyroidism.  Hypothyroidism  may be caused by a thyroid gland disorder (primary cause) or a decrease in TSH secretion (secondary cause). Thyrotropin (Thytropar), a purified extract of TSH, is used as a diagnostic agent to differentiate between primary and secondary hypothyroidism.
Pituitary Gland (cont’d)

}Adrenocorticotropic hormone ◦Corticotropin (Acthar, ACTH)
}Side effects ◦Mood swings, increased appetite, edema, water and Na retention, GI distress, hypokalemia, hypocalcemia, petechiae, ecchymosis, menstrual irregularities ◦Osteoporosis, muscle atrophy, decreased wound healing, glaucoma, cataracts, ulcer perforation
Petechia- small pinpoint spots/bruises Ecchymosis- big bruise
Pituitary Gland (cont’d)

}Nursing interventions ◦ACTH –Monitor G&D in children. –Monitor weight, edema, electrolytes. –Do not stop drug abruptly; taper doses. –Warn client to decrease salt intake. –Instruct clients about symptoms to report.
If you stop all of the sudden, it can cause a hypo function of the gland and cause problems
Pituitary Gland (cont’d)

}Posterior pituitary gland ◦Secetes Antidiuretic hormone –Vasopressin (Pitressin) –Desmopressin acetate (DDAVP) –Deficiency – large amount of water are excreted by the kidneys –This condition is called Diabetes Insipdus (DI) – (polyuria) –Can lead to severe fluid volume deficit and electrolyte imbalance
Fluid and electolyte balance must be closely monitored in these clients, and ADH replacement may be needed. The ADH preparations vasopressin (Pitressin) and desmopressin acetate (DDAVP) can be administered intranasally or by injection.

Pituitary Gland (cont’d)

}Posterior pituitary gland }Head injury and brain tumors resulting in trauma to the hypothalamus and pituitary gland can also cause DI.  Fluid and electrolyte balance must be closely monitored in these clients, and ADH replacement may be needed.  The ADH preparations vasopressin and desmopressin acetate can be administered intranasally or by injection.
Intranasally-Within the nose
Pituitary Gland (cont’d)

}Nursing interventions ◦ADH –Monitor vital signs, urinary output ◦GH –Advise athletes not to take GH –Administer when needed GH subQ, IM –Monitor growth rate
* Monitor vital signs. Increased heart rate and decrease systolic pressure can indicate fluid volume loss resulting from decreased ADH production. With less ADH secretion, more water is excreted, decreasing vascular fluid (hypovolemia)
*record urinary output. Increased output can indicate fluid loss caused by decrease in ADH
Thyroid Gland

}Thyroid gland hormones ◦Thyroxine (T4) ◦Triiodothyronine (T3)
}Functions ◦Regulate protein synthesis, enzyme activity ◦Stimulate mitochondrial oxidation
Thyroid Gland (cont’d)

}Hypothyroidism ◦Decrease in thyroid hormone secretion ◦Etiology –Primary: thyroid gland disorder, more common –Due to thyroid gland inflammation, radioiodine therapy, excess intake of antithyroid drugs, surgery –Myxedema-hypothyroidism (adult), cretinism hypothyroidism (child) –Secondary: lack of TSH secretion –Weight gain occurs with hypothyroidism –Administer thyroid replacement drug at the same time each day preferably before breakfast.
Hypothyroidism (cont)

}Avoid foods that can inhibit thyroid secretion: strawberries, peaches, pears, cabbage, turnips, spinach, brussels sprouts, cauliflower, radishes, and peas
Thyroid Gland (cont’d)

}Levothyroxine (T4, Synthroid) ◦Action –Increase metabolism, body growth ◦Use –Treat hypothyroidism, myxedema, cretinism ◦Contraindications –Thyrotoxicosis (hyperthyroidism), MI, severe renal disease
**give synthroid alot in the hospital.
Thyroid Gland (cont’d)

}Levothyroxine (T4, Synthroid) ◦Interactions –Increased cardiac insufficiency with epinephrine –Increased effects of anticoagulants, TCAs, vasopressors, decongestants –Decreased effects of antidiabetics, digitalis (digoxin, lenoxin, interferes w/ pulse rate) –Decreased absorption with cholestyramine, colestipol
Thyroid Gland (cont’d)

}Levothyroxine (T4, Synthroid) ◦Side effects/adverse reactions –Nervousness, insomnia, weight loss –Tremors, headache –Nausea, vomiting, diarrhea, cramps –Tachycardia, palpitations, hypertension –Dysrhythmias, chest pain, excessive sweating, angina –Thyroid crisis –Report any S/S
Hypothyroidism Drug (Cont)

}Cytomel – can be administered for a child or an adult.
}Use to treat hypothyroidism
}Faster acting than other thyroid medications
}Effects seen is 24 to 72 hours
Liothyronine (Cytomel) is a synthetic T3 that has a short half-life and duration of action. it is not recommended for maintenance therapy.
Thyroid Gland (cont’d)

}Hyperthyroidism ◦Increase in T4 and T3 ◦Etiology –Hyperfunction of thyroid gland –Excessive release of thyroid hormones ◦Symptoms:  Graves Disease (hyperthyroidism) tachycardia, palpitations, excess sweating, heat intolerance, nervousness, irritability, exophthalmos (bulging eyes), weight loss
Propranolol (Inderal) can control cardiac symptoms like palpitations and tachycardia that result from hyperthyroidism. It does not lower T4 and T3.
Thyroid Gland (cont’d)

}Hyperthyroidism ◦Propylthioruacil (PTU), methimazole (Tapazole) ◦Action –Reduce excess secretion of T4, T3 by inhibiting thyroid secretion ◦Use –Treat thyrotoxic crisis, preparation for subtotal thyroidectomy (they will partially remove it)
Thyroid Gland (cont’d)

}Hyperthyroidism ◦Propylthioruacil (PTU), methimazole (Tapazole) ◦Interactions –Increase effect of anticoagulants –Decrease effect of antidiabetics –Digoxin and lithium increase action of thyroid drugs –Phenytoin increases T3 level
Thyroid Gland (cont’d)

}Nursing interventions ◦Monitor vital signs, weight. (always get the baseline) ◦Instruct client to take the drug with meals to decrease GI symptoms. ◦Check labels before using OTCs. ◦Encourage medical alert tag.
Thyroid Gland (cont’d)

}Nursing interventions ◦Warn of iodine effects and presence in iodized salt, shellfish, and over-the-counter cough medications. ◦Do not abruptly stop antithyroid drugs. ◦Advise reporting of symptoms of hypothyroidism.
Parathyroid Glands

}Parathyroid hormone ◦Action –Corrects blood calcium deficit ◦Use –Treats hypoparathyroidism, hypocalcemia in chronic renal failure
Parathyroid Glands (cont’d)

}Calcitriol (Rocaltrol) ◦Action –Promotes calcium absorption from GI tract and renal tubules ◦Use –Treats hypoparathyroidism, hypocalcemia ◦Contraindications –Hypercalcemia, hyperphosphatemia, excess vitamin D, malabsorption syndrome
Parathyroid Glands (cont’d)

}Calcitriol (Rocaltrol) ◦Interactions –Increased dysrhythmias with digoxin, verapamil –Decreased calcitriol absorption with cholestyramine ◦Side effects/adverse reactions –Drowsiness, headache, dizziness, lethargy, photophobia, GI distress, hypercalciuria, hyperphosphatemia, hematuria (blood in the urine)
Parathyroid Glands (cont’d)

}Calcitriol (Rocaltrol) ◦Nursing interventions –Monitor calcium levels. –Advise reporting of symptoms of hypocalcemia. –Tetany, twitching of mouth, tingling, numbness of fingers, spasmodic contractions, laryngeal spasms –Warn about checking OTC drugs for calcium content.
Adrenal Glands

}Adrenal glands ◦Adrenal medulla ◦Adrenal cortex –Produces glucocorticoids (cortisol) –Promote Na (sodium) retention, K (potassium) excretion –Mineralocorticoids (aldosterone) –Secretes aldosterone –Promotes sodium and water retention

}Addison Disease – a decrease in corticosteroid (adrenal insufficiency)
}Cushing Syndrome – an increase corticosteroid (adrenal hypersecretion)
}Corticosteroid can cause sodium absorption from the kidney, resulting in water retention and potassium loss which will increase blood pressure.
Adrenal Glands (cont’d)

}Glucocorticoids ◦Prednisone (Deltasone) –Action –Suppresses inflammation, immunosuppression –Use –Decreases inflammation –Interactions –Increased effect with estrogens, barbiturates, phenytoin, rifampin, ephedrine, theophylline –Decreased effects of anticonvulsants, INH, antidiabetics –Concurrent use of aspirin and NSAIDS increase GI toxicity.
Glucocorticoids are influenced by ACTH, which is released from the anterior pituitary gland. They affect carbohydrate, protein, and fat metabolism and muscle and blood cell activity. B/c of their many mineralocorticoid effects, glucocorticoids can cause sodium absorption from the kidney, resulting in water retention, potassium loss, and increased B/P.
Adrenal Glands (cont’d)

}Glucocorticoids ◦Prednisone (Deltasone) –Side effects/adverse reactions –Increased appetite, sweating, headache, flushing –Mood changes, depression, psychosis –Tachycardia, hypertension –Hyperglycemia, abnormal fat deposits, muscle wasting, edema –Glaucoma, peptic ulcers

}Mineralocorticoids (second type of corticosteroid)
}A severe decrease in the Mineralocorticoid aldosterone leads hypotension and vascular collapse (shock), as seen Addison Disease.
Vascular collapse is commonly referred to as shock.
Adrenal Hormone: Glucocorticoids

}Note baseline vital signs for future comparison (hypertension)
}A nursing diagnosis: Excess fluid volume related to fluid retention
}The client’s inflammatory process will decrease
}Determine vital signs.  Glucocorticoids such as Prednisone can increase blood pressure and sodium and water retention.
Adrenal Hormone: Glucocorticoids (Cont)

}Record weight.  Report weight gain of 5 pounds in several days; this would most likely be caused by water retention
}The medication should not be abruptly stopped, because adrenal crisis can result
}Advise client to take drug as prescribed
}When drug is discontinued, dose is tapered over 1 to 2 weeks
Adrenal Hormone: Glucocorticoids (Cont)

}Teach client to report S/S of drug over dose or Cushing Syndrome: moon face, puffy eyelids, edema in the feet, increased bruising, dizziness, bleeding, and menstrual irregularity.
}Instruct client to take cortisone preparations at mealtime or with food.  Glucocorticoid drugs can irritate gastric mucosa and cause peptic ulcers.
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