Endocrine Meds: pituitary hormone thru thyroid replacement
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What does the endocrine system consist of?
ductless glands that secrete hormones into the bloodstream.
What are hormones?
- Chemical substances synthesized from amino acids & cholesterol that act on body tissues & organs & affect cellular activity.
- *affect metabolism
- *negative feedback system
Hormones can be divided into two catagories, what are they?
- Proteins or small peptides
Where do the steroid hormones come from?
Adrenal glands & gonads
Which glands are included in the Endocrine system?
What are the two ways Endocrine medications work?
Mimic or Block the effects of natural hormones
Why are Endocrine medications needed?
- The body is making to much hormone
- The body is not making enough hormone
What does the posterior pituitary gland do?
Secretes ADH (vasopressin) & oxytocin
Where are ADH & Oxytocin manufactured?
Hypothalamus & stored in the posterior pituitary
What does ADH hormone do?
^reabsorption of water from the renal tubules, returning it to the systemic circulation.
What does Oxytocin do?
stimulates contraction of the smooth muscle of the uterus & mammary glands
What hormones are secreted by the Anterior Pituitary Gland?
- Growth hormone (GH)
- Thyroid-stimilating hormone (TSH)
- Adrenocorticotropic hormone (ACTH)
- Gonadotropins (FSH), (LH)
What does Growth hormone (GH) do?
Stimulates growth in tissue & bone
What is the actions of Thyroid-stimulating hormone (TSH)?
Acts on thyroid gland
What does the Adrenocorticotropic hormone (ACTH) do?
Stimulates adrenal glands to release Glucocorticoids (cortisol), Mineralcorticoids (Aldosterone), & Androgen.
What is the action of Gondadotropins (FSH), (LH)?
Regulate hormone secretion from the ovaries & testes
Explain how Growth Hormones work.
Act directly on bones. Stimulate tissue & bone growth, mobilize glucose & free fatty acids.
What can happen if there are alterations in secretion of Growth Hormones?
- Gigantism: excess prior to closure of epiphyseal shafts.
- Acromegaly: excess after closures.
- Dwarfism: deficiency during childhood
- *inadequate secretion of GH
- *or Genetics
How do replacement Growth hormones effect a body?
Promote growth both skeletal (at epiphyseal plates) & cellular.
Given: SQ or IM
Name the Growth Hormone drugs.
- Mimic natural hormone that is lacking.
- Somatrem (Protropin)
- Somatropin (Genotropin, Nutropin)
What are the s/e of Somatrem & Somatropin?
Hyperglycemia, Insuline resistance, Hypothyroidism
What are the nursing considerations with the GH Somatropin & Somatrem?
- Montior: Growth rate
- Blood sugars
- Athletes are advised NOT to take GH
What is the Tx for excess GH secretion?
- Drugs that inhibit the release of natural GH
- Mimic the effect of somatostatin (stops growth)
Name the drugs that inhibit the release of GH.
- Bromocriptine (Parlodel)
- Octreotide (Sandostatin) = inhibits GH, Insulin & glucagon
Drugs that inhibit GH are used for what diagnosis?
- Metastatic Carcinoid
- Other Tumors
What are the s/e of drugs that inhibit GH like Sandostatin or Parlodel?
- Abdominal pain
- rare: hyperglycemia
Sandostantin acts on Exess GH how?
by mimicking the natural hormone somastatin that blocks somatropin
What is the action of ACTH (Adrenocorticotropic hormone)?
Stimulates adrenal cortex to secrete cortisol (glucocorticoid)
The hypothalamus releases Corticotropin-releasing Factor, which stimulates the pituitary corticotrophs to secrete what hormone?
Adrenocorticotropic Homone (ACTH)
The ACTH drug Corticotropin (Acthar) is used for what purpose?
- In diagnosis of adrenal gland disorders.
- Helps differentiates between pituitary & adrenal causes of Adrenocortical insufficiency
What are the s/e of the ACTH drug Corticotropin (Acthar)?
- Mood swings, ^appetite, edema, water & Na retention, GI distress, hypokalemia, hypocalcemia, petechiae, ecchymosis, menstrual irregularities
- Osteoporosis, muscle atrophy, <wound healing, glaucoma, cataracts, ulcer perforation, sweating, acne
What are the nursing interventions for the ACTH drug Corticotropin (Acthar)?
- Monitor: G&D in children, weight, edema, electrolytes
- Do NOT stop drug therapy (taper dose)
- Warn client to <salt intake
- s/s that need reporting
Where is the antidiuretic hormone Vasopressin secreted from & where is it produced?
- Stored & secreted from Posterior Pituitary gland
- Produced in hypothalamus
What does ADH (antidiuretic hormone) do?
- promotes water reabsorption from the renal tubules to maintain water balance in the body fluids.
- Vasoconstriction of arterioles
What patients are deficient in ADH?
What are the factors of Diabetes Insipidus?
- Deficiency of ADH
- Urinary excretion of excessive amts of very dilute urine (5-20 liter/day!!)
- Polydipsia: incredible thirst
- General weakness, altered CNS
- ^serum sodium & osmolaity
- Severe FVD: wt loss, poor tissue turgor, hypotention, tachycardia, shock
- Fatigue from nocturia
Hormone replacement therapy for ADN promotes what?
Water reabsorption from the renal tubules
What is ADH replacement therapy used to Tx?
- Diabetes Insipidus
- Hemophilia A
- Von Willebrand disease
What are the drugs used as ADH replacement therapy?
- Desmopressin (DDAVP, Stimate); PO, IV, nasal
- Vasopressin (Pitressin); IM, SQ
What are the s/e of the ADH replacement drugs Desmpressin & Vasopressin (Pitressin)?
HA, fluid retention, ^BP, nasal congestion, chest pain, MI, abdominal cramps, N/V/D
What are the nursing implications for ADH replacement meds?
- Monitor: Electrolytes, BP, Vitals, Wt, fluid imbalances, I&O
- Assess ability to utilize nasal sparys & discurss URI's
- Do NOT take OTC meds for colds, cough or allergies (NO decongestants while on vasopressin d/t ^BP)
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