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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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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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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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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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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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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Levothyroxine (T4, Synthroid)Action

Increase metabolism, body growth

Use Treat hypothyroidism, myxedema, cretinism

Contraindications Thyrotoxicosis, MI, severe renal disease


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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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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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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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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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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.


Hyperthyroidism


(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.


Hyperthyroidism


(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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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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Interactions

Increased dysrhythmias with digoxin,

verapamil Decreased calcitriol absorption with

cholestyramine


Drowsiness, headache, dizziness, lethargy,photophobia, GI distress, hypercalciuria,hyperphosphatemia, hematuria


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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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Glucocorticoids Prednisone (Deltasone)


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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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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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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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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