NUR 381 – Unit 5 Notes
Chapters 30-35
Chapter 30 – Pituitary Drugs
The pituitary gland is controlled by the central nervous system. Together with the hypothalamus, it essentially controls all bodily functions. The pituitary gland has 2 lobes, anterior and posterior
Anterior pituitary drugs – cosyntropin (Cortrosyn), somatropin (Nutropin), octreotide (Sandostatin)
Posterior pituitary drugs – vasopressin (Pitressin), desmopressin (DDAVP)
Mechanism of Action – all either augment or antagonize the natural effects of the pituitary hormones
Anterior pituitary drugs:
Cosyntropin (Cortrosyn) stimulates the secretion of cortisol. Cortisol has anti-inflammatory effects, and
promotes renal retention of sodium which can result in edema and HTN
Somatropin (Nutropin) mimics growth hormone. Basically, it promotes growth in children who lack normal levels of this hormone
Octreotide (Sandostatin) antagonizes the effects of natural growth hormone
Posterior pituitary drugs – mimic the actions of the naturally occurring antidiuretic hormone. They increase water reabsorption in the nephrons, they concentrate urine and reduce water excretion by up to
90%.
Vasopressin is a vasoconstrictor and can be used in hypotensive emergencies like shock. It can help stop
bleeding of esophageal varices.
Desmopressin can be used for certain blood disorders and management of nocturnal enuresis.
Indications
Cosyntropin is used to diagnosis adrenocortical insufficiency
Somatropin is used to treat growth failure. It can also be indicated for HIV patients with wasting or cachexia.
Octreotide us used to alleviate symptoms of carcinoid tumors (slow-growing tumors) stemming from the
secretion of VIP (vasoactive intestinal polypeptide which caused profuse watery diarrhea). So, it helps
control diarrhea, flushing, and life-threatening hypotension. It can be used to treat esophageal varices.
Vasopressin and desmopressin are used to prevent or control polydipsia (excessive thirst), polyuria, and
dehydration in patients with diabetes insipidus. Vasopressin can also be used to treat excessive bleeding
especially with GI hemorrhage.
Contraindications
All of these drugs need to be used with caution in patients with other illnesses, acute or chronic. Even
small amounts of these drugs can initiate major physiologic changes.
Somatropin is contraindicated in children with closed growth plates, patients with tumors, and patients
with acute illnesses.
Octreotide is used with caution in patients with renal impairment. It can impair gallbladder function. It
may affect glucose regulation and can cause severe hypoglycemia in type I diabetics and can cause severe
hyperglycemia in type II diabetics.
Adverse Effects
Somatropin – HA, hyperglycemia, flu-like symptoms, inflammation at injection site
Octreotide – fatigue, N/V/D, dyspnea, arthralgia, cardiac conduction abnormalities (*so the doctor may
order an EKG before taking because of this risk*)
Vasopressin and desmopressin – HTN, fever, HÁ, 2áusea, nasal congestion
Nursing things to remember
Do a thorough assessment before giving any of these drugs. Assess VS. Take complete medication history, note allergies. Assess baseline glucose levels, focus on respiratory status and liver and kidney functions (review lab work).
Chapter 31- Thyroid and Antithyroid Drugs
The thyroid gland regulates metabolism by secretion of 3 hormones – T4 (thyroxine, primary thyroid hormone that influences metabolic rate), T3 (triiodothyronine, secondary thyroid hormone the influences metabolic rate), and calcitonin.
T4 and T3 are produced in the thyroid gland with the help of iodine and the amino acid tyrosine. Through
a complex sequence of events, T4 and T3 are released into circulation after being triggered by TSH (thyroid stimulating hormone, which is housed in the pituitary gland). TSH stimulates the release of T4 and T3
when blood levels of each hormone is low.
Thyroid hormones regulate metabolic rate, lipid and carbohydrate metabolism, are essential for normal
growth and development, and control thermoregulation in the brain.
Hypothyroidism – decreased secretion of thyroid hormones
Hyperthyroidism – excessive secretion of thyroid hormones
Thyroid Replacement Drugs – treat hypothyroidism.
Levothyroxine (Synthroid, Levoxyl) – synthetic T4
Mechanism of Action – increase metabolic rate, increase oxygen consumption, body temperature, blood
volume, overall cellular growth and differentiation. Also stimulate the CV system which ultimately increases cardiac output and increases renal blood flow and GFR which results in diuresis.
Indications – thyroid hormone replacement
Contraindication – known drug allergy, recent MI, adrenal insufficiency, and hyperthyroidism
Adverse effects – usually the result of an overdose. Cardiac dysrhythmia, tachycardia, palpitations, angina, HTN, insomnia, anxiety, menstrual irregularities, weight loss, sweating, heat intolerance, fever.
Interactions – levothyroxine can increase the effect of warfarin (increased risk for bleeding)
*Note – switching levothyroxine brands can destabilize the course of treatment. Thyroid function tests
will need to be monitored closely when switching brands*
*Note – take levothyroxine at the same time each day, first thing in the morning, 30 minutes before eating* Remember what Barb Bancroft said – you can take levothyroxine anytime you want to, as long as it
is 4 hours after you eat!
Antithyroid Drugs – used to treat the underlying cause of hyperthyroidism, and beta-blockers are used to
treat the symptoms of hyperthyroidism.
Propylthiouracil (PTU) – antithyroid drug
Mechanism of Action – basically impede the formation of thyroid hormones. Overall effect is to decrease the thyroid hormone level which normalizes the overall metabolic rate.
Indications – hyperthyroidism
Contraindications – a known drug allergy
Adverse effects – most serious is liver and bone marrow toxicity
*Note – with antithyroid drugs, the patient needs to report any fever, sore throat, mouth ulcers or sores,
and any unusual bleeding or bruising to the prescriber immediately because these could be sighs of liver
toxicity or bone marrow toxicity. Monitor liver function tests and CBC as prescribed. Avoid the use of
foods high in iodine, like iodized salt, soy and shellfish because these could alter the drug’s effectiveness*
Chapter 32 – Antidiabetic Drugs – on PowerPoint
Chapter 33 – Adrenal Drugs
Quick Review:
The adrenal gland is an endocrine gland that sits atop the kidney like a cap. The adrenal gland functions
as two different endocrine glands, the adrenal cortex (outer layers of the gland, makes up 85% of the
gland) and the adrenal medulla (inner layers). The adrenal medulla secretes the hormones epinephrine and
norepinephrine. The adrenal cortex secretes the hormones that are broadly referred to as corticosteroids
(two types: glucocorticoids and mineralocorticoids).
Mineralocorticoids play an important role in regulating mineral salts, i.e. electrolytes, in the body. The
only physiologically important mineralocorticoid is aldosterone.
Aldosterone – maintains normal levels of sodium in the blood by causing sodium to be resorbed from the
urine back into the blood in exchange for potassium and hydrogen ions. It regulates blood sodium levels,
influences potassium levels in the blood, and influences blood pH.
Glucocorticoids affect the metabolism of carbohydrates, fats, and proteins. Cortisol is the major natural
glucocorticoid.
Corticosteroids are necessary for many vital bodily functions: anti-inflammatory actions, carbohydrate
and protein metabolism, fat metabolism, maintenance of normal blood pressure, handling stresses,
maintenance of serum potassium levels, maintenance of pH levels in the blood, sodium and water resorption.
Adrenal Drugs
fludrocortisone (Florinef), prednisone, methylprednisolone (Solu-Medrol) – read through these drug profiles.
Mechanism of Action
Mineralocorticoids (Aldosterone) – affects electrolyte and fluid balance by acting on the distal renal tubule.
Glucocorticoids (cortisol (natural)=hydrocortisone and cortisone (synthetic)) – inhibit inflammatory and
immune responses. Reduce swelling, itching, etc.
Indications
Glucocorticoids – very broad indications including, SCI, leukemias and lymphomas, ophthalmic inflammatory disorders, exacerbations of asthma and COPD, GI inflammatory diseases (colitis, enteritis), skin
diseases (dermatitis), cerebral edema, bacterial edema.
Contraindications
Glucocorticoids – known drug allergy, cataracts, glaucoma, PUD, mental health problems, and diabetes
mellitus. Adrenal drugs may intensify these diseases. Glucocorticoids increase blood glucose levels which
makes the patient often require insulin while in the hospital. Glucocorticoids also suppress the immune
system, so they should be avoided in the presence of serious infections.
Adverse Effects
All corticosteroids – heart failure, edema, HTN, weight gain, glaucoma, hyperglycemia, Cushing’s syndrome, nervousness, insomnia, poor wound healing. There are MANY!
Interactions – many
The Nursing Process
Assessment - perform a thorough physical assessment to determine the patient's baseline nutritional, hydration, and immune status. The patient's baseline weight, intake and output, vital signs (especially blood
pressure ranges), and the patient's skin condition (noting bruising, fragility, turgor, and color) also need to
be assessed and recorded. Baseline laboratory values that will most likely be ordered include serum sodium, serum potassium, and serum glucose. For adrenal drugs, lifespan considerations include concern
about their use during pregnancy and lactation. Growth suppression may occur in children who are receiving long-term adrenal drug therapy. Perform and document baseline height and weight measurements in
pediatric patients. Older adult patients are more prone to adrenal suppression with prolonged adrenal drug
therapy and may require dosage alterations by the prescriber to minimize the impact of the drug on muscle mass, blood pressure, and serum glucose and electrolyte levels.
Implementation – make sure to teach the patient how glucocorticoids work in the body so that they can
state and implement measures that maximize the drug’s therapeutic effects and minimize AEs. The best
time to give glucocorticoids is early in the morning to minimize the amount of adrenal suppression. It is
important to remember, however, that the patient must not alter dosing or abruptly discontinue medication
without consulting the prescriber. Prednisone, a synthetic glucocorticoid, and fludrocortisone, a synthetic mineralocorticoid, are given orally. It is recommended that oral dosage forms be given with a snack
and/or a meal to help minimize GI upset. Emphasize to patients the importance of avoiding alcohol, caf-
feine, and aspirin and other nonsteroidal antiinflammatory drugs to minimize gastric irritation and possible gastric bleeding from the compounding ulcerogenic effects. Because of the immunosuppression with
these drugs, monitor patients for flulike symptoms, sore throat, and fever. If an incision or wound is present, assess affected area for redness, edema, drainage, and approximation. Methylprednisolone, a systemic corticosteroid, is given intravenously. Mix all parenteral forms per manufacturer guidelines, with
intravenous doses administered over the recommended time period and in the proper diluent. In summary,
because of their suppressed immune systems, patients taking corticosteroids need to avoid contact with
people with known infections and report any fever, increased weakness and lethargy, or sore throat. Monitoring nutritional status, weight, fluid volume, electrolyte status, skin turgor, and glucose levels during
therapy is very important to ensure safe and effective therapy. The prescriber needs to be notified if there
is any edema, shortness of breath (possible heart failure), joint pain, fever, mood swings, or other unusual
symptoms.
Evaluation - A therapeutic response to glucocorticoids includes a resolution of the underlying manifestations of the disease or pathology, such as a decrease in inflammation, increased feeling of well-being, less
pain and discomfort in the joints, decrease in lymphocytes, or other improvement in the condition for
which the medication was ordered.
Chapter 34 – Women’s Health Drugs
Estrogens are female sex hormones. There are 3 major endogenous estrogens: estradiol, estrone, and estriol. They are structurally similar to steroids. The most widely used estrogen product is called conjugated
estrogens – a combo of estrogens.
Estrogens are required at puberty for the development and maintenance of the female reproductive system
and the development of female secondary sex characteristics. Estrogens produce their effects in estrogenresponsive tissues which include the female genital organs, breasts, the pituitary gland, and the hypothalamus. When the production of estrogen during puberty increases, menses is initiated, breasts begin to develop, body fat is redistributed, and skin softens.
Estrogen therapy is indicated when someone has estrogen deficiency.
Contraindications include known drug allergy, an estrogen-dependent cancer, active thromboembolic disorder (stroke, thrombophlebitis), abnormal vaginal bleeding, and pregnancy.
Adverse Effects – most serious AEs are thromboembolic events. Most common is nausea.
Interactions – estrogens can decrease the activity of oral anticoagulants. Smoking with estrogen therapy
will increase the risk for thrombosis.
Progestins (progesterone) – treat functional uterine bleeding caused by hormonal imbalance, fibroids, or
cancer; treat primary and secondary amenorrhea; treat some cancers and endometriosis; and also help prevent a threatened miscarriage.
Contraceptives prevent pregnancy, treat endometriosis and hypermenorrhea. Common adverse effects
include HTN, thromboembolism, PE, MI, stroke, N/V, anorexia, increased weight, amenorrhea, dysmenorrhea, breast changes. Several drugs and drug classes can potentially reduce the effectiveness of oral
contraceptives, which can possibly result in an unintended pregnancy. Educate patients about the need to
use alternative birth control methods for at least 1 month during and after taking any of the following
drugs: antibiotics (especially penicillins and cephalosporins), barbiturates, isoniazid, and rifampin. The
effectiveness of other drugs, such as anticonvulsants, beta blockers, hypnotics, antidiabetic drugs, warfarin, theophylline, tricyclic antidepressants, and vitamins, may be reduced when they are taken with oral
contraceptives.
Fertility Drugs
Clomiphene (Clomid) is an ovulation stimulant.
Uterine Stimulants
Oxytocin stimulates uterine contractions during childbirth. During lactation, it promotes the movement of
milk from the mammary glands to the nipples.
Chapter 35 – Men’s Health Drugs
Androgens are the group of male sex hormones (primarily testosterone) that mediate the normal development and maintenance of the primary and secondary male sex characteristics. The most important androgen is testosterone. Besides having androgenic activity, testosterone is also involved in the development of bone and muscle tissue; inhibition of protein catabolism (metabolic breakdown); and retention of
nitrogen, phosphorus, potassium, and sodium.
The primary use for androgens is as hormone replacement therapy.
Although rare, some of the most devastating effects of androgenic steroids occur in the liver, where they
cause the formation of multiple, randomly distributed blood-filled spaces or cavities, a condition known
as peliosis of the liver. This condition is a possible consequence of the long-term administration of androgenic anabolic steroids and can be life-threatening if they rupture.
Androgens, when used with oral anticoagulants, can significantly increase or decrease anticoagulant activity
Erectile Dysfunction Drugs – treat ED
Sildenafil, tadalafil
Contraindicated in men with major cardiovascular disorders, especially if they use nitrate medications
such as nitroglycerin. Concurrent use of erectile dysfunction drugs and nitrates may cause severe hypotension, which may not respond to treatment.
*As always, make sure to review the Patient-Centered Care: Patient Teaching section and the Key
Points section at the end of each chapter, and look over the NCLEX Review questions at the end of
each chapter*