A.

HYPOTHALMIC AND PITUITARY AGENTS

(a) DRUGS AFFECTING HYPOTHALAMIC HORMONES

Agonist
corticotropin-releasing Antagonists
hormone abarelix
gonadorelin ganirelix
goserelin leuprolide
sermorelin nafarelin

(b) DRUGS AFFECTING ANTERIOR PITUITARY HORMONES

Growth Hormone Agonist
somatropin
somatropin rDNA origin

Nursing Assessment
o Assess history of allergy to any GH or binder, presence of closed epiphyses or underlying cranial
lesions, serious infection following open-heart surgery, abdominal surgery, and pregnancy or
lactation status to determine contraindications to the use of the drug.
o Assess height, weight, thyroid function tests, glucose tolerance tests, and GH levels to determine
baseline status before beginning therapy and for any p otential adverse effects.
Nursing Diagnoses
o Imbalanced Nutrition: Less Than Body Requirements related to metabolic changes
o Acute Pain related to need for injections
o Deficient Knowledge regarding drug therapy
Implementation
o Reconstitute the drug following manufacturer’s directions
o Monitor response carefully when beginning therapy to allow appropriate dose adjustments as
needed.
o Monitor thyroid function, glucose tolerance, and GH levels periodically
o Provide thorough patient teaching, including measures to take to avoid adverse effects, warning
signs of problems, and the need for regular evaluation.
Evaluation
o Monitor patient response to the drug (return of GH levels to n ormal; growth and development).
o Monitor for adverse effects (hypothyroidism, glucose intolerance, nutritional imbalance).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to
watch for, and specific measures to avoid them; family member can demonstrate proper technique
for preparation and administration of the drug).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

Growth Hormone Antagonist

bromocriptine mesylate
octreotide acetate
pegvisomant
 Nursing Assessment
o Assess for history of allergy to any GH antagonist or binder to prevent hypersensitivity reactions;
other endocrine disturbances, which could be exacerbated when blocking GH; and pregnancy and
lactation because of the potential for adverse effects to the fetus and the blocking of lactation.
o Assess orientation, affect, and reflexes; blood pressure, pulse, and orthostatic blood pressure;
abdominal examination; glucose tolerance tests and GH levels , to determine baseline status before
beginning therapy and for any potential adverse effects,
Nursing Diagnoses
o Imbalanced Nutrition: More Than Body Requirements related to metabolic changes
o Acute Pain related to need for injections (octreotide, pegvisomant)
o Deficient Knowledge regarding drug therapy
Implementation
o Reconstitute octreotide and pegvisomant following manufacturer’s directions; administer these
drugs subcutaneously and rotate injection sites regularly to prevent skin breakdown and to ensure
proper delivery of the drug.
o Monitor thyroid function, glucose tolerance, and GH levels periodically to detect problems and to
institute treatment as needed.
o Arrange for baseline and periodic ultrasound evaluation of the gallbladder if using octreot ide to
detect any gallstone development and to arrange for appropriate treatment.

Drugs affecting other Anterior Pituitary Hormones

chorionic gonadotropin corticotropin menotropins
chorionic gonadotropin alfa cosyntropin thyrotropin alfa
(c) DRUGS AFFECTING POSTERIOR PITUITARY HORMONES
desmopressin

Nursing Assessment
o Assess for history of allergy to any ADH preparation or components to avoid hypersensitivity
reactions; vascular diseases; epilepsy; renal dysfunction; pregna ncy; and lactation, which could be
cautions or contraindications to use of the drug.
o Assess for skin and lesions; orientation, affect, and reflexes; blood pressure and pulse; respiration
and adventitious sounds; abdominal examination; renal function tests; and serum electrolytes, to
determine baseline status before beginning therapy and fo r any potential adverse effects
Nursing Diagnoses
o Impaired Urinary Elimination
o Excess Fluid Volume related to water retention
o Deficient Knowledge regarding drug therapy
Implementation
o Monitor patient fluid volume to watch for signs of water intoxication an d fluid excess; arrange to
decrease dose as needed.
o Monitor patients with vascular disease for any sign of exacerbation to provide for immediate
treatment.
o Monitor condition of nasal passages if given intranasally to observe for nasal ulceration, which can
occur and could affect absorption of the drug.
 o Provide thorough patient teaching, including measures to avoid adverse effects, warning signs of
problems, and the need for regular evaluation, including blood tests, to enhance patient knowledge
about drug therapy and promote compliance.

B. ADRENOCORTICOL AGENTS
(a) GLUCOCORTICOIDS
beclomethasone dexamethasone prednisolone
betamethasone flunisolide prednisone
budesonide hydrocortisone triamcinolone
cortisone methylprednisolone

Nursing Assessment
o Assess for history of allergy to any steroid preparations, acute infections, peptic ulcer disease,
pregnancy, lactation, endocrine disturbances, and renal dysfunction, which could be cautions or
contraindications to use of the drug.
o Assess weight; temperature; orientation and affect; grip strength; eye examination; blood pressure,
pulse, peripheral perfusion, and vessel evaluation; respiration and adventitious breath sounds;
glucose tolerance, renal function, serum electrol ytes, and endocrine function tests as appropriate,
to determine baseline status before beginning therapy and for any potential adverse effects.
Nursing Diagnoses
o Decreased Cardiac Output related to fluid retention
o Excess Fluid Volume related to water retention
o Disturbed Sensory Perception (Visual, Kinesthetic)
o Risk for Infection related to immunosuppression
o Ineffective Coping related to body changes caused by the drug
o Deficient Knowledge regarding drug therapy
o Imbalanced Nutrition: More Than Body Requirements related to metabolic changes
Implementation
o Administer drug daily at 8 to 9 AM to mimic normal peak diurnal concentration levels and thereby
minimize suppression of the hypothalamic–pituitary axis.
o Space multiple doses evenly throughout the day to try to achieve homeostasis.
o Use the minimal dose for the minimal amount of time to minimize adverse effects.
o Taper doses when discontinuing from high doses or from long -term therapy to give the adrenal
glands a chance to recover and produce adrenocorticoid s.
o Arrange for increased dose when the patient is under stress to supply the increased demand for
corticosteroids associated with the stress reaction.
o Use alternate-day maintenance therapy with short-acting drugs whenever possible to decrease the
risk of adrenal suppression.
o Do not give live virus vaccines when the patient is immunosuppressed because there is an increased
risk of infection.
o Protect the patient from unnecessary exposure to infection and invasive procedures because the
steroids suppress the immune system, and the patient is at increased risk for infection.
o Assess the patient carefully for any potential drug –drug interactions to avoid adverse effects.
Evaluation
o Monitor patient response to the drug (relief of signs and symptoms of inflammatio n, return of
adrenal function to within normal limits).
o Monitor for adverse effects (increased susceptibility to infections, skin changes, endocrine
dysfunctions, fatigue, fluid retention, peptic ulcer, psychological changes).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to
watch for, and specific measures to avoid them).

(b) MINERALOCORTICOIDS
cortisone fludrocortisone hydrocortisone

Nursing Assessment
o Assess for allergy to these drugs to avoid hypersensitivity reactions; history of heart failure,
hypertension, or infections; high sodium intake; lactation; and pregnancy, which could be cautions or
contraindications to use of the drug.
o Assess blood pressure, pulse, and adventitious breath sounds; weight and temperature; tissue
turgor; reflexes and bilateral grip strength; and serum electrolyte levels,
Nursing Diagnoses
o Imbalanced Nutrition: More Than Body Requirements related to metabolic changes
o Excess Fluid Volume related to sodium retention
o Impaired Urinary Elimination related to sodium retention
o Deficient Knowledge regarding drug therapy
 Implementation
o Use only in conjunction with appropriate glucocor ticoids to maintain control of electrolyte bal ance.
o Increase dose in times of stress to prevent adrenal insufficiency and to meet increased demands
for corticosteroids under stress.
o Monitor for hypokalemia (weakness, serum electrolytes) to detect the loss early and treat
appropriately.
o Discontinue if signs of overdose (excessive weight gain, edema, hypertension, cardiomegaly) occur
Evaluation
o Monitor patient response to the drug (maintenance of electrolyte balance).
o Monitor for adverse effects (fluid retention , edema, hypokalemia, headache).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to
watch for, and specific measures to avoid them).
o Monitor effectiveness of comfort measures and compliance with the regimen.

C. THYROID AND PARATHYROID AGENTS

(a) THYROID AGENTS
Thyroid Hormone
liothyronine
levothyroxine liotrix thyroid desiccated

Nursing Assessment
o Assess for history of allergy to any thyroid hormone or binder, lactation, Addison disease, acute
myocardial infarction not complicated by hypothyroidism, and thyrotoxicosis
o Assess for the presence of any skin lesions; orientation and affect; baseline pulse, blood pressure,
and electrocardiogram (ECG); respiration and adventitious sounds; and thy roid function tests
Nursing Diagnoses
o Decreased Cardiac Output related to cardiac effects
o Imbalanced Nutrition: Less Than Body Requirements related to changes in metabolism
o Ineffective Tissue Perfusion related to thyroid activity
o Deficient Knowledge regarding drug therapy
Implementation
o Administer a single daily dose before breakfast each day
o Administer with a full glass of water
o Monitor response carefully when beginning therapy
o Monitor cardiac response
o Assess patient carefully
o Arrange for periodic blood tests of thyroid function
o Provide thorough patient teaching
Evaluation
o Monitor patient response to the drug (return of metabolism to normal, prevention of goiter).
o Monitor for adverse effects (tachycardia, hypertension, anxiety, skin rash).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to
watch for, and specific measures to avoid them).
 Antithyroid Hormone
Thioamides Iodine Solutions
methimazole sodium iodide I 131
propylthiouracil strong iodine solution,
potassium iodide

Nursing Assessment
o Assess for history of allergy to any antithyroid drug; pregnancy and lactation status; and
pulmonary edema or pulmonary tuberculosis if using strong iodine solutio ns, which could be cautions
or contraindications to use of the drug.
o Assess for skin lesions; orientation and affect; baseline pulse, blood pressure, and ECG; respiration
and adventitious sounds; and thyroid function tests, to determine baseline status bef ore beginning
therapy and for any potential adverse effects.
Nursing Diagnoses
o Decreased Cardiac Output related to cardiac effects
o Imbalanced Nutrition: More Than Body Requirements related to changes in metabolism
o Risk for Injury related to bone marrow sup pression
o Deficient Knowledge regarding drug therapy
Implementation
o Administer propylthiouracil three times a day, around the clock
o Give iodine solution through a straw
o Monitor response carefully and arrange for periodic blood tests
o Monitor patients receiving iodine solution for any sign of iodism
(b) Parathyroid Agents
Antihypocalcemic Agents
calcitriol dihydrotachysterol teriparatide

Nursing Assessment
o Assess for history of allergy to any component of the drugs, hypercalcemia, vitamin toxicity, renal
stone, and pregnancy or lactation
o Assess for the presence of any skin lesions; orientation and affect; liver evaluation; serum calcium,
magnesium, and alkaline phosphate levels; and radiographs of bones as appropriate
Nursing Diagnoses
o Acute Pain related to GI or CNS effects
o Imbalanced Nutrition: Less Than Body Requirements related to GI effects
o Deficient Knowledge regarding drug therapy
Implementation
o Monitor serum calcium concentration before and periodically during treatment to allow for
adjustment of dose to maintain calcium levels within normal limits.
o Provide supportive measures to help the patient deal with GI and CNS effects of the drug
(analgesics, small and frequent meals, help with activities of daily living) .
o Arrange for a nutritional consultation if GI effects are severe to ensure nutritional balance.
o Provide thorough patient teaching, including measures to avoid adverse effects, warning signs of
problems, and the need for regular evaluation.
 Evaluation
o Monitor patient response to the drug (return of serum calcium levels to normal).
o Monitor for adverse effects (weakness, headache, GI effects).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to
watch for, and specific measures to avoid them).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

Antihypercalcemic Agents
Bisphosphonates
alendronate pamidronate zoledronic acid
etidronate risedronate
ibandronate tiludronate
Calcitonins
calcitonin salmon
Nursing Assessment
o Assess for history of allergy to any of these products or to fish products with salmon calcitonin to
avoid hypersensitivity reaction; pregnancy or lactation; hypocalcemia; and renal dysfunction.
o Assess for the presence of any skin lesions; orientation and affect; abdominal examination; serum
electrolytes; and renal function tests.
Nursing Diagnoses
o Acute Pain related to GI or skin effects
o Imbalanced Nutrition: Less Than Body Requirements related to GI effects
 o Anxiety related to the need for parenteral injections (specific drugs)
o Deficient Knowledge regarding drug therapy
Implementation
o Ensure adequate hydration with any of these agents
o Arrange for concomitant vitamin D, calcium supplements, and hormone replacement therapy
o Rotate injection sites and monitor for inflammation if using calcitonins
o Monitor serum calcium regularly
o Assess the patient carefully for any potential drug –drug interactions if giving in combination with
other drugs
o Arrange for periodic blood tests of renal function if using gallium
o Provide comfort measures and analgesics
Evaluation
o Monitor patient response to the drug (return of calcium levels to normal; prevention of
complications of osteoporosis; control of Paget disease).
o Monitor for adverse effects (skin rash; nausea and vomiting; hypocalcemia; renal dysfunction).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to
watch for, and specific measures to avoid them).
o Monitor the effectiveness of comfort measures and compliance with the regimen.

D. AGENTS TO CONTROL BLOOD GLUCOSE LEVELS

(a) INSULIN
Nursing Assessment
o Assess for contraindications or cautions: any known allergy to any insulin and current status of
pregnancy or lactation
o Perform a physical assessment
o Assess for presence of any skin lesions; orientation and reflexes; baseline pulse and blood
pressure; respiration or adventitious breath sounds
o Assess body systems
o Investigate nutritional intake
o Assess activity level, including amount and degree of exercise
o Inspect skin areas that will be used for injection of insulin
o Obtain blood glucose levels
Nursing Diagnoses
o Risk for Unstable Blood Glucose related to the use of insulin and underlyin g disease processes
o Imbalanced Nutrition: Less Than Body Requirements related to metabolic effects of the drug
o Disturbed Sensory Perception (Kinesthetic, Visual, Auditory, Tactile) related to glucose levels
o Risk for Infection related to injections and dise ase processes
o Risk for Injury related to potential hyper- or hypoglycaemia and injection technique
o Ineffective Coping related to diagnosis and the need for injection therapy
o Deficient Knowledge regarding drug therapy
Implementation
o Ensure that the patient is following a dietary and exercise regimen and using good hygiene practices
o Gently rotate the vial containing the agent and avoid vigorous shaking
o Select a site that is free of bruising and scarring
o Give maintenance doses by the subcutaneous route only an d rotate injection sites
o Monitor response carefully to avoid adverse effects; blood glucose monitoring is the most effective
way to evaluate insulin dose
o Monitor the patient for signs and symptoms of hypoglycemia, especially during peak insulin times,
when these signs and symptoms would be most likely to appear
o Always verify the name of the insulin being given
o Use caution when mixing types of insulin; administer mixtures of regular and NPH or regular and
lente insulins within 15 minutes after combining them
o Store insulin in a cool place away from direct sunlight to ensure effectiveness
o Monitor the patient during times of trauma or severe stress
o Monitor the patient’s food intake; ensure that the patient eats when using insulin
o Monitor the patient’s exercise and activities; ensure that the patient considers the effects of
exercise in relationship to eating and insulin dose
o Protect the patient from infection, including good skin care and foot care
o Monitor the patient’s sensory losses
o Help the patient to deal with necessary lifestyle changes, including diet and exercise needs, sensory
loss, and the impact of a drug regimen
o Instruct patients who are also receiving beta -blockers about ways to monitor glucose levels and
signs and symptoms of glucose abnormalities
(b) SULFONYLUREAS AND OTHER ANTIDIABETIC AGENTS
Sulfonylureas glyburide Human Amylin
First-Generation Other antidiabetic agents pramlintide
Sulfonylureas Alpha-Glucosidase Inhibitors Incretin Mimetic
chlorpropamide acarbose exenatide
tolazamide miglitol Meglitinides
tolbutamide Biguanide nateglinide
Second Generation metformin repaglinide
Sulfonylureas Dipeptidyl Peptidase-4 Thiazolidinediones
glimepiride Inhibitor pioglitazone
glipizide sitagliptin rosiglitazone

Nursing Assessment
o Assess for contraindications or cautions: history of allergy to any of these agents to avoid
hypersensitivity reactions; severe renal or hepatic dysfunction
o Perform a complete physical assessing to establish baseline status
o Assess for the presence of any skin lesions for indication of possible infection
o Assess body systems
o Investigate nutritional intake, noting any problems with intake and adherence to prescribed diet.
o Assess activity level, including amount and degree of exercise.
o Monitor blood glucose levels as ordered.
Nursing Diagnoses
o Risk for Unstable Blood Glucose related to ineffective dosing of antidiabetic agents
o Imbalanced Nutrition: Less Than Body Requirements related to metabolic effects
o Disturbed Sensory Perception (Kinesthetic, Visual,
o Auditory, Tactile) related to glucose levels
o Ineffective Coping related to diagnosis and therapy
o Deficient Knowledge regarding drug therapy
Implementation
o Administer the drug as prescribed in the appropriate relationship to meal s
o Ensure that the patient is following diet and exercise modifications
o Monitor nutritional status to provide nutritional consultation as needed.
o Monitor response carefully; blood glucose monitoring is the most effective way
o Monitor liver enzymes of patients receiving pioglitazone or rosiglitazone very carefully to avoid
liver toxicity; arrange to discontinue the drug to avert serious liver damage if liver toxicity
develops.
o Monitor patients during times of trauma, pregnancy, or severe stress, and arrange to switch to
insulin coverage as needed.
Evaluation
o Monitor patient response to the drug (stabilization of blood glucose levels).
o Monitor for adverse effects (hypoglycemia, GI distress).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to
watch for, and specific measures to avoid them).
o Monitor the effectiveness of comfort measures and compliance with the regimen.
(c) GLUCOSE ELEVATING AGENTS
diazoxide glucagon
Nursing Assessment
o Assess for contraindications and cautions: history of allergy to thiazides if using diazoxide, to avoid
hypersensitivity reactions; severe renal or hepatic dysfunction
o Perform a complete physical assessment
o Assess orientation and reflexes and baseline pulse, blood pressure, and adventitious sounds
o Monitor blood glucose levels as ordered
o Monitor the results of laboratory tests, including urinalysis, to evaluate for glucosuria
Nursing Diagnoses
o Risk for Unstable Blood Glucose related to ineffective dosing of the drug
o Imbalanced Nutrition: More Than Body Requirements related to metabolic effects, and Less Than
Body Requirements related to GI upset
o Disturbed Sensory Perception (Kinesthetic, Visual, Auditory, Tactile) related to glucose levels
o Deficient Knowledge regarding drug therapy
Implementation
o Monitor blood glucose levels to evaluate the effectiveness of the drug.
o Have insulin on standby during emergency use to treat severe hyperglycemia if it occurs as a
result of overdose.
o Monitor nutritional status to provide nutritional consultation as needed.
o Monitor patients receiving diazoxide for potential cardiovascular effects, including blood pressure,
heart rhythm and output, and weight changes, to avert serious adverse reactions.
Evaluation
o Monitor patient response to the drug (stabilization of blood glucose levels).
o Monitor for adverse effects (hyperglycemia, GI distress).
o Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to
watch for, and specific measures to avoid them).
o Monitor the effectiveness of comfort measures and compliance to the regimen.