endocrine gland drugs
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Chapter 50
ENDOCRINE DRUGS: PITUITARY, THYROID,
PARATHYROID, AND ADRENAL DISORDERS
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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
Melanocyte-stimulating hormones (MSH) Affects skin pigmentation
Prolactin Affects mammary glands to produce milk
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Pituitary Gland
Posterior pituitary glandOxytocin
Stimulates uterine contractions
Vasopressin, antidiuretic hormone Regulation of fluid balance
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Pituitary Gland (contd)
Anterior pituitary glandGrowth hormone
Drugs for growth hormone deficiency-Growth failure: somatrem (Protropin),somatropin (Humatrope)
Drugs for growth hormone excess-Acromegaly: bromocriptine (Parlodel),octreotide (Sandostatin)
Thyroid-stimulating hormone Thyrotropin (Thytropar)
Adrenocorticotropic hormone Corticotropin (Acthar)
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Pituitary Gland (contd)
Adrenocorticotropic hormone
Corticotropin (Acthar, ACTH)
Cosyntropin (Cortrosyn) Action
Stimulates adrenal cortex to secrete cortisol
UseAntiinflammatory, diagnose adrenocortical
disorders, treat acute multiple sclerosis
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Pituitary Gland (contd)
Adrenocorticotropic hormone
Corticotropin (Acthar, ACTH)
Contraindications Severe fungal infections, CHF, peptic ulcer
Interactions Increase risk of ulcers with aspirin, effect of K-wasting
diuretics, decrease effects of antidiabetics
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Pituitary Gland (contd)
Nursing interventionsACTH
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
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Pituitary Gland (contd)
Posterior pituitary glandAntidiuretic hormone
Vasopressin (Pitressin)
Desmopressin acetate (DDAVP)
Uses Enhance reabsorption of water in the
kidneys Used in diabetes insipidus
Side effects
Flushing, nausea, abdominal cramps
Water intoxication drowsiness, headache
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Pituitary Gland (contd)
Nursing interventionsADH
Monitor vital signs-BP, urinary output
Monitor weight and serum electrolytes
Restrict fluid intake as prescribed
Instruct client to report signs of water
intoxication
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Thyroid Gland
Thyroid gland hormonesThyroxine (T4)
Triiodothyronine (T3)
FunctionsRegulate protein synthesis, enzyme activity
Stimulate mitochondrial oxidation
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Thyroid Gland (contd)
HypothyroidismDecrease in thyroid hormone secretion
Etiology
Primary: thyroid gland disorder, morecommon Due to thyroid gland inflammation, radioiodine
therapy, excess intake of antithyroid drugs, surgery
Myxedema (adult), cretinism (child)
Secondary: lack of TSH secretion
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Thyroid Gland (contd)
Levothyroxine (T4, Synthroid)Action
Increase metabolism, body growth
Use Treat hypothyroidism, myxedema, cretinism
Contraindications Thyrotoxicosis, MI, severe renal disease
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Thyroid Gland (contd)
Levothyroxine (T4, Synthroid) Interactions
Increased cardiac insufficiency with
epinephrine Increased effects of anticoagulants, TCAs,
vasopressors, decongestants
Decreased effects of antidiabetics, digitalis
Decreased absorption with cholestyramine,
colestipol
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Thyroid Gland (contd)
Levothyroxine (T4, Synthroid)
Side effects/adverse reactions
Nervousness, insomnia, weight loss
Tremors, headache
Nausea, vomiting, diarrhea, cramps
Tachycardia, palpitations, hypertension
Dysrhythmias, angina Thyroid crisis
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Thyroid Gland (contd)
Nursing interventions
Monitor vital signs, weight
Administer thyroid replacement drug before
breakfastCheck labels prior to using OTCs
Advise reporting of symptoms ofhyperthyroidism
Encourage medic-alert tag
Warn of foods that inhibit thyroid secretion
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Thyroid Gland (contd)
Hyperthyroidism Increase in T4 and T3
Etiology
Hyperfunction of thyroid gland Excess release of thyroid hormones
Symptoms Tachycardia, palpitations, excess sweating,
heat intolerance, nervousness, irritability,exophthalmos, weight loss
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Thyroid Gland (contd)
Hyperthyroidism
Propylthioruacil (PTU), methimazole
(Tapazole)
Action
Reduce excess secretion of T4, T3 by
inhibiting thyroid secretion
Use Treat thyrotoxic crisis, preparation for
subtotal thyroidectomy, hyperthyroidism, or
Gravess disease
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Elsevier items and derived items 2009, 2006,2003 by Saunders, an imprint of Elsevier Inc.
Thyroid Gland (contd)
Hyperthyroidism
Propylthioruacil (PTU), methimazole
(Tapazole)
Side effects
Nausea and vomiting; diarrhea
Agranulocytosis with leukopenia
Hypothyroidism
Hypersensitivity with skin rash
Iodism vomiting, abdominal pain, metallic
or brassy taste in mouth, sore gums
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Elsevier items and derived items 2009, 2006,2003 by Saunders, an imprint of Elsevier Inc.
Thyroid Gland (contd)
Hyperthyroidism
Propylthioruacil (PTU), methimazole
(Tapazole)
Interactions
Increase effect of anticoagulants
Decrease effect of antidiabetics
Digoxin and lithium increase action ofthyroid drugs
Phenytoin increases T3 level
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Thyroid Gland (contd)
Nursing interventionsAdminister antithyroid drugs with meals
Warn of iodine effects and presence in
iodized salt, shellfish, OTC coughmedications
Do not abruptly stop antithyroid drugs
Advise reporting of symptoms of
hypothyroidism
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Parathyroid Glands
Parathyroid hormone
Action
Corrects blood calcium deficit
Use
Treat hypoparathyroidism, hypocalcemia in
chronic renal failure
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Parathyroid Glands (contd)
Calcitriol (Rocaltrol)
Action
Promotes calcium absorption from GI tract
and renal tubules
Use
Treat hypoparathyroidism, hypocalcemia
Contraindications Hypercalcemia, hyperphosphatemia, excess
vitamin D, malabsorption syndrome
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Parathyroid Glands (contd)
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
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Parathyroid Glands (contd)
Calcitriol (Rocaltrol)
Nursing interventions
Monitor calcium levels
Advise reporting of symptoms of
hypocalcemia
Tetany, twitching of mouth, tingling, numbness
of fingers, carpopedal spasm, spasmodic
contractions, laryngeal spasms Warn about checking OTC drugs for calcium
content
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Adrenal Glands
Adrenal glands Adrenal medulla
Produces epinephrine and norepinephrine
Adrenal cortex Produces glucocorticoids (cortisol)
Promote sodium retention, K and Ca
excretion
Adrenal hyposecretion (Addisons disease) Mineralocorticoids (aldosterone)
Secretes aldosterone
Promotes sodium and water retention
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Adrenal Glands (contd)
Glucocorticoids Prednisone ((Deltasone)
Action Suppresses inflammation, immunosuppression
Use Decrease inflammation and allergic reactions and antistress
effects,
Produce metabolic effects
Promote sodium and water retention, K excretion
Interactions Increased effect with barbiturates, phenytoin, rifampin,
ephedrine, theophylline
Decreased effects of aspirin, anticonvulsants, INH,
antidiabetics
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Adrenal Glands (contd)
Glucocorticoids Prednisone (Deltasone)
Side effects/adverse reactions
Increased appetite, sweating, headache,flushing
Mood changes, depression, psychosis
Hyperglycemia, abnormal fat deposits,muscle wasting, edema
Glaucoma, peptic ulcers Hypokalemia and Na & water retention;
Tachycardia, hypertension
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Adrenal Glands (contd)
Glucocorticoids Prednisone (Deltasone)
Nursing interventions Monitor VS, serum electrolytes and CBG
Monitor I & O, weight & signs of edema
Taper doses when discontinuing the drug therapy
Advise client to take at mealtime or with food
Advise to eat foods high in potassium
Instruct to report signs of overdose or Cushings
syndrome-moon face, puffy eyelids, edema in feet,easy bruising, dizziness, bleeding and menstrualirregularities
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Adrenal Glands (contd)
Mineralocorticoids Fludrocortisone (Florinef)
Uses Enhance reabsoprtion of Na and Cl and promote
the excretion of K and H from the renal tubules
Side effects Na and water retention, hypertension
Hypokalemia; hypocalcemia
Increased susceptibility to infection; delayed woundhealing
Increased appetite, weight gain
GI distress-peptic ulcer; abdominal distention
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Adrenal Glands (contd)
Mineralocorticoids Fludrocortisone (Florinef)
Nursing interventions Monitor VS, serum electrolytes and CBG
Monitor I & O, weight & signs of edema
Instruct not to stop drug abruptly
Advise client to take at mealtime or with food
Advise to eat foods high in potassium
Instruct to report signs of infection, muscle aches,
sudden weight gain, headaches Instruct not to take aspirin
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Case Study
A client has adrenocortical insufficiency
and
is taking hydrocortisone (Solu-Cortef).
Critical Thinking
Give examples of short-acting,
intermediate-acting, and long-actingglucocorticoids.
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Practice Question #1
A client has adrenocortical insufficiency and was
taking hydrocortisone (Solu-Cortef) 240 mg every 12
hours IV. Before discharge the drug was switched to
prednisone (Deltasone). Which is appropriate
teaching for discharging a client with oral cortisone?
A. Stop the drug when feeling better.
B. Prednisone is always given by injection.
C. The dose needs to be tapered off over 5 to 10 days.
D. Weight loss and hypoglycemia are common.
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Practice Question #1 (contd)
Answer: C. Rationale: Glucocorticoids must
be tapered off gradually to avoid adrenal
crisis. Never stop the drug abruptly.
Prednisone is an oral preparation. Weight
gain and hyperglycemia are side effects of
cortisone.
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