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NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2
Adrenal Gland, GH, and ADHGROWTH HORMONE DISORDERS (Deficiency: small stature; Excess: Gigantism or Acromegaly)
Growth Hormone Agents
Deficiency
o GH replacement: somatropin
Somatropin= synthetic growth hormone that can be given for growth hormone
insufficiency
Somatotropin= natural growth hormone
o Therapy for small stature r/t GH
Children who are not growing properly
Can have growth hormone injections even if not documented deficiency
This is expensive though
Educate parents
For kids without hormone deficiency, maybe will only add an inch or two
With deficiency, could add 6+ inches, however side effects (increased risk of
diabetes)
Excess
o GH antagonist: octreotide
Can not be administered after a certain age, usually teen years, bc when apephyses seal
you won’t get added height, you will get acromegaly
Decreases GI motility (used for severe diarrhea)
One of the most common uses for this drug
o Therapy for acromegaly
Can give GH antagonist
Side effects of GH
o Hyperglycemia & DM
Diabetes in children is harder to manage bc they have more GH since they are growing
Revised 8/20117
NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2
Adrenal Gland, GH, and ADHo Acromegaly
Nursing implications & Patient Teaching
o Growth plates must not be sealed
o Monitor blood glucose
o Monitor height and weight through growth charts
ADRENAL CORTEX DISORDERS: Addison’s (Adrenal Insufficiency) and Cushing’s
Adrenal medulla is hard wired via nerves; Related to fight or flight response
Adrenal cortex is hormonal connection to sustain fight or flight response
Replacement therapy for endocrine disorders bc gland isn’t making any
Glucocorticosteroids
Mechanism of Action: Multiple actions and effects on metabolic processes
Indications
o Inflammatory processes, Cerebral edema, Cancer, Prevent organ transplant rejection
o Replacement therapy (cortisol & Addison’s disease)
Typical Examples (systemic) review
o Short Acting: Cortisone, hydrocortisone
o Intermediate Acting: Prednisone, methylprednisolone (most common)
o Long Acting: Bethamethasone, dexamethasone
Cushingoid Side Effects
Cataracts
Ulcers and gastric bleeding
Skin: striae, thinning, bruising, tears
HTN/ Hirsutism
Ingection
Necrosis of femoral head
Glycosuria
Revised 8/20117
NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2
Adrenal Gland, GH, and ADHObesity/Osteoporosis
Immunosuppression
Diabetes
More likely when taking exogenous glucocorticosteroids and already functioning adrenal gland(affects immune
system, skin, etc.)
Nursing Implications
o Give in the morning with food bc this is when normal cortisol levels rise
o Monitor labs
CBC- look at white count bc suppression of immune system
Blood Glucose bc they are linked with action of glucocorticosteroids
o Monitor V/S
BP
Weight particularly at start of therapy
Temp
o Dose adjustments and taper
o When we are under stress, adrenal gland responds to reduce this. With addison’s, be aware of
dose tapering (increase when sick to get over illness, etc.)
Patient Teaching
o Take exactly as prescribed bc if abrupt stopping Addison’s crisis (looks like CVD collapse)
Nothing activating BP, no mineralcorticosteroids (fluid retention), no reserve system
o Signs of infection may be masked w/ long term therapy
o Report increased stress (dose adjustment)
o Monitor blood sugar with long term therapy
o Report black tarry stools
Very hard on GI system
Take with food!! Significantly reduces risk of this
Revised 8/20117
NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2
Adrenal Gland, GH, and ADH See Corticosteroid slide
Mineralocorticoids
Typical Examples: fludrocortisone (basically synthetic aldosterone)
Mechanism of Action
o Reabsorb Na in kidney tubule
o K+ excretion
o Basically concentrate minerals in body (Na, hold onto water)
Not enough like with addison’s, do not hold onto sodium, CVD collapse
Indications: Replacement therapy for adrenal insufficiency (Addison’s)
o Take regularly
Side Effects: Fluid and electrolyte imbalances
o If we are conserving sodium, water follows, also exchanging for potassium
o Watch sodium and potassium levels of patient and signs of fluid imbalance (weight, I/O)
Nursing Implications
o Assess for s/sx of fluid retention
Body weight
Edema
SOB
BP increasing
o Labs
Monitor electrolytes
Hyper and hypo stiuations (REVIEW FROM UNIT 1)
Patient Teaching
o S/Sx inadequate dose
o Report signs of edema (increasing BP)
o Eat high potassium foods and avoid high-sodium foods
Revised 8/20117
NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2
Adrenal Gland, GH, and ADH Due to fact that we hold onto sodium and are losing potassium
o Dosage adjustment when under stress
Naturally aldosterone would come into play increasing BP, but does not occur here
POSTERIOR PITUITARY DISORDERS: Diabetes Insipidus and SIADH
Too little or too much water concentration
Affects electrolyte concentrations by diluting or not diluting body fluids
Diabetes insipidus
Typical examples
o desmopressin (DDAVP)
used with reduced or absent ADH
basically prevents copious amounts of urine output associated with this
synthetic
conserves water like normal ADH
nasal spray, but comes SubQ and oral (used less often)
o vasopressin
IV used critical care bc ability to raise BP very quickly
Ability to raise BP via -pressin affect (vasoconstriction to increase BP when not enough
fluid)
Mechanism of action
o Enhances water re-absorption
Indications
o Treatment of DI
Temporarily due to head trauma or due to life long deficiency
o Bedwetting
Preschool kids
If we give nasal spray, helps children retain fluid longer and stay dry during the night
Revised 8/20117
NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2
Adrenal Gland, GH, and ADHo VonWillbrand disease
Clotting factor disorder
When not enough vonwillebrand factor, bleeding results
This is used for this bc it activates and increases action of specific clotting factors
o CV collapse (vasopressin)
In ICU
Side effects: Too much medication = SIADH
o Increase BP too much
o Conserve too much water hyponatremia
o S/Sx of SIADH
o Managed by looking at specific gravity (how much stuff is in urine)
Concentration of stuff in urine compared to water
Teach patients to do this
Nursing Implications
o Intranasal form
Don’t inhale
Alternate nares to prevent irritation
Just want it to be absorbed, not
inhaled into respiratory tree
If highly congested (sinus infection/cold), this
interferes with absorption
Might be converted to SubQ injection for a short period of time
o Monitor effectiveness
Urine specific gravity
Should be 1.01-1.04
Digital machine
Revised 8/20117
NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2
Adrenal Gland, GH, and ADH I/O
BP
o Patient Teaching
Report nasal congestion
Monitor voiding pattern (I/O)
Should void 6-8 times per day minimum
Each void should be about 300 mL
Check urine specific gravity
Report <1.01 and >1.04
SIADH- a little more problematic
Holding onto fluid, too much water conservation, too much ADH
Treatment
o Fluid restriction and DDAVP dose adjustment to make sure you are not holding onto too much
o Demeclocycline (tetracycline antibiotic)
ADH receptor antagonist
Off label use for SIADH bc it has ability to antagonize receptors for ADH
Potentially a drug used in these circumstances
Revised 8/20117