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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

Posterior pituitary gland

Antidiuretic hormone Vasopressin (Pitressin) Desmopressin acetate (DDAVP)

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Pituitary Gland (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (contd)

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 (Addisons disease) Levels controlled by negative feedback Mineralocorticoids (aldosterone) Secretes aldosterone Promotes sodium and water retention Controlled by RAAS
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Adrenal Glands (contd)

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 (contd)

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 (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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