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

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Pituitary Gland (cont’d)

Anterior pituitary gland
 Growth hormone • Drugs for growth hormone deficiency: somatrem (Protropin), somatropin (Humatrope) • Drugs for growth hormone excess: bromocriptine (Parlodel), octreotide (Sandostatin)
 Thyroid-stimulating hormone • Thyrotropin (Thytropar)  Adrenocorticotropic hormone • Corticotropin (Acthar)

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Pituitary Gland (cont’d)

Adrenocorticotropic hormone
 Corticotropin

(Acthar, ACTH)

Action
 Stimulates

adrenal cortex to secrete cortisol

Use
 Antiinflammatory,

diagnose adrenocortical disorders, treat acute multiple sclerosis

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Pituitary Gland (cont’d)

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 (cont’d)

Adrenocorticotropic hormone
 Corticotropin

(Acthar, ACTH)

Side effects

Mood swings, increased appetite, edema, water and Na retention, GI distress, hypokalemia, hypocalcemia, petechiae, ecchymosis, menstrual irregularities Osteoporosis, muscle atrophy, decreased wound healing, glaucoma, cataracts, ulcer perforation

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Pituitary Gland (cont’d)

Nursing interventions
 ACTH

• • • • •

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 (cont’d)

Posterior pituitary gland
 Antidiuretic hormone • Vasopressin (Pitressin) • Desmopressin acetate (DDAVP)

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Pituitary Gland (cont’d)

Nursing interventions
 ADH

•  GH • • •

Monitor vital signs, urinary output Advise athletes not to take GH Administer when needed GH subQ, IM Monitor growth rate

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Thyroid Gland

Thyroid gland hormones
 Thyroxine (T4)  Triiodothyronine

(T3)

Functions
 Regulate

protein synthesis, enzyme activity  Stimulate mitochondrial oxidation

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Thyroid Gland (cont’d)

Hypothyroidism
 Decrease in thyroid hormone secretion  Etiology • Primary: thyroid gland disorder, more common

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 (cont’d)

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 (cont’d)

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 (cont’d)

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 (cont’d)

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 (cont’d)

Hyperthyroidism
 Propylthioruacil  Action

(PTU), methimazole (Tapazole)


 Use

Reduce excess secretion of T4, T3 by inhibiting thyroid secretion Treat thyrotoxic crisis, preparation for subtotal thyroidectomy

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Thyroid Gland (cont’d)

Hyperthyroidism
 Propylthioruacil  Interactions

(PTU), methimazole (Tapazole)

• • • •

Increase effect of anticoagulants Decrease effect of antidiabetics Digoxin and lithium increase action of thyroid drugs Phenytoin increases T3 level

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Thyroid Gland (cont’d)

Nursing interventions
 Monitor

vital signs, weight  Administer thyroid replacement drug before breakfast  Check labels prior to using OTCs  Advise reporting of symptoms of hyperthyroidism  Encourage medic-alert tag  Warn of foods that inhibit thyroid secretion

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Thyroid Gland (cont’d)

Nursing interventions
 Administer antithyroid drugs with meals  Warn of iodine effects and presence in iodized

salt, shellfish, OTC cough medications  Do not abruptly stop antithyroid drugs  Advise reporting of symptoms of hypothyroidism

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Parathyroid Glands

Parathyroid hormone
 Action

•  Use •

Corrects blood calcium deficit Treat hypoparathyroidism, hypocalcemia in chronic renal failure

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Parathyroid Glands (cont’d)

Calcitriol (Rocaltrol)
 Action


 Use

Promotes calcium absorption from GI tract and renal tubules

• Treat hypoparathyroidism, hypocalcemia  Contraindications • Hypercalcemia, hyperphosphatemia, excess
vitamin D, malabsorption syndrome

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Parathyroid Glands (cont’d)

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 (cont’d)

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 Adrenal cortex • Produces glucocorticoids (cortisol)  Promote sodium retention, K excretion  Adrenal hyposecretion (Addison’s disease)  Levels controlled by negative feedback • Mineralocorticoids (aldosterone)  Secretes aldosterone  Promotes sodium and water retention  Controlled by RAAS
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Adrenal Glands (cont’d)

Glucocorticoids

Prednisone ((Deltasone) • Action

• Use

 

Suppresses inflammation, immunosuppression

• Interactions

Decrease inflammation
Increased effect with barbiturates, phenytoin, rifampin, ephedrine, theophylline Decreased effects of aspirin, anticonvulsants, INH, antidiabetics

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Adrenal Glands (cont’d)

Glucocorticoids

Prednisone (Deltasone) • Side effects/adverse reactions  Increased appetite, sweating, headache, flushing  Mood changes, depression, psychosis  Tachycardia, hypertension  Hyperglycemia, abnormal fat deposits, muscle wasting, edema  Glaucoma, peptic ulcers

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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-acting glucocorticoids.

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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 (cont’d)
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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