NURS 3400 Chapter 44: Drugs for Endocrine Disorders Part 2 Adrenal Gland, GH, and ADH GROWTH 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 Revised 8/20117
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Weebly · Web viewReplacement therapy (cortisol & Addison’s disease) Typical Examples (systemic) review Short Acting: Cortisone, hydrocortisone Intermediate Acting: Prednisone,
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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