Chapter 50

ENDOCRINE DRUGS: PITUITARY, THYROID, PARATHYROID, AND ADRENAL DISORDERS

Pituitary Gland
• Anterior pituitary gland
– Growth hormone (GH)
• • • • • • Stimulates growth in tissue and bone Acts on thyroid gland

– Thyroid-stimulating hormone (TSH)
Stimulates adrenal gland Affects ovaries

– Adrenocorticotropic hormone (ACTH)
– Gonadotropins (FSH), (LH)

– Melanocyte-stimulating hormones (MSH) – Prolactin
Affects skin pigmentation Affects mammary glands to produce milk

Pituitary Gland
• Posterior pituitary gland
– Oxytocin
• Stimulates uterine contractions

– Vasopressin, antidiuretic hormone
• Regulation of fluid balance

Pituitary Gland (cont’d)
• Anterior pituitary gland
– Growth hormone
• Drugs for growth hormone deficiencyGrowth failure: somatrem (Protropin), somatropin (Humatrope) Drugs for growth hormone excessAcromegaly: bromocriptine (Parlodel), octreotide (Sandostatin)

– Thyroid-stimulating hormone

Thyrotropin (Thytropar)
Corticotropin (Acthar)

– Adrenocorticotropic hormone

Pituitary Gland (cont’d)
• Adrenocorticotropic hormone
– Corticotropin (Acthar, ACTH) – Cosyntropin (Cortrosyn)

• Action
– Stimulates adrenal cortex to secrete cortisol

• Use
– Antiinflammatory, diagnose adrenocortical disorders, treat acute multiple sclerosis

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

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

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

Pituitary Gland (cont’d)
• Posterior pituitary gland
– Antidiuretic 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

Pituitary Gland (cont’d)
• Nursing interventions
– ADH
• • • • Monitor vital signs-BP, urinary output Monitor weight and serum electrolytes Restrict fluid intake as prescribed Instruct client to report signs of water intoxication

Thyroid Gland
• Thyroid gland hormones
– Thyroxine (T4) – Triiodothyronine (T3)

• Functions
– Regulate protein synthesis, enzyme activity – Stimulate mitochondrial oxidation

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

Thyroid Gland (cont’d)
• Levothyroxine (T4, Synthroid)
– Action
• Increase metabolism, body growth

– Use

Treat hypothyroidism, myxedema, cretinism
Thyrotoxicosis, MI, severe renal disease

– Contraindications

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


• •

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

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

Thyroid Gland (cont’d)
• Hyperthyroidism
– Increase in T4 and T3 – Etiology
• • • Hyperfunction of thyroid gland Excess release of thyroid hormones Tachycardia, palpitations, excess sweating, heat intolerance, nervousness, irritability, exophthalmos, weight loss

– Symptoms

Thyroid Gland (cont’d)
• 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 Graves’s disease

Thyroid Gland (cont’d)
• Hyperthyroidism
– Propylthioruacil (PTU), methimazole (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
Elsevier items and derived items © 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

Thyroid Gland (cont’d)
• Hyperthyroidism
– Propylthioruacil (PTU), methimazole (Tapazole) – Interactions
• • • • Increase effect of anticoagulants Decrease effect of antidiabetics Digoxin and lithium increase action of thyroid drugs Phenytoin increases T3 level
Elsevier items and derived items © 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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

Parathyroid Glands
• Parathyroid hormone
– Action
• Corrects blood calcium deficit Treat hypoparathyroidism, hypocalcemia in chronic renal failure

– Use

Parathyroid Glands (cont’d)
• Calcitriol (Rocaltrol)
– Action
• Promotes calcium absorption from GI tract and renal tubules Treat hypoparathyroidism, hypocalcemia

– Use

– Contraindications
• Hypercalcemia, hyperphosphatemia, excess vitamin D, malabsorption syndrome

Parathyroid Glands (cont’d)
• Calcitriol (Rocaltrol)
– Interactions
• Increased dysrhythmias with digoxin, verapamil Decreased calcitriol absorption with cholestyramine Drowsiness, headache, dizziness, lethargy, photophobia, GI distress, hypercalciuria, hyperphosphatemia, hematuria

– Side effects/adverse reactions

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

Adrenal Glands
• Adrenal glands
– Adrenal medulla
• Produces epinephrine and norepinephrine

– Adrenal cortex
• Produces glucocorticoids (cortisol) – Promote sodium retention, K and Ca excretion – Adrenal hyposecretion (Addison’s disease) • Mineralocorticoids (aldosterone) – Secretes aldosterone – Promotes sodium and water retention

Adrenal Glands (cont’d)
• 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

Adrenal Glands (cont’d)
• Glucocorticoids
– Prednisone (Deltasone)
• Side effects/adverse reactions – 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

Adrenal Glands (cont’d)
• 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 Cushing’s syndrome-moon face, puffy eyelids, edema in feet, easy bruising, dizziness, bleeding and menstrual irregularities

Adrenal Glands (cont’d)
• Mineralocorticoids
• Uses

– Fludrocortisone (Florinef)
– Enhance reabsoprtion of Na and Cl and promote the excretion of K and H from the renal tubules – Na and water retention, hypertension – Hypokalemia; hypocalcemia – Increased susceptibility to infection; delayed wound healing – Increased appetite, weight gain – GI distress-peptic ulcer; abdominal distention

• Side effects

Adrenal Glands (cont’d)
• 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

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.

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.

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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