Week 13 Endocrine Agents
Wednesday, November 16, 2022
2:35 PM
PITUITARY AGENTS - used to replace hormones, hormonal deficiency, to produce hormone response
Increase protein in diet and decrease sodium and potassium on these medications
Assess baseline glucose and liver and kidney function
Do not take OTC products without checking with health care provider
Mechanism of action - differ depending on agent, either augment or antagonize the natural effects of
the pituitary hormones
Anterior pituitary agents:
 Octreotide
 Somatropin
 Cosyntropin
Cosyntropin indications:
 Stimulation of release of cortisol from adrenal cortex
 Used to diagnose but not treat adrenocortical insufficiency
 Used in patients with autoimmune disorders (MS, MG, SLE)
 Cosyntropin insufficiency caused by long term corticosteroid use
Somatropin Indication:
 Recombinantly made growth hormone (GH)
 Stimulate skeletal growth in clients with deficient GH, such as hypopituitary dwarfism
Octreotide Indications:
 Antagonized the effects of natural GH (inhibit GH release)
 Alleviates or eliminates certain symptoms of carcinoid tumors
 Can also be used with GI bleeding
Posterior Pituitary Agents
 Vasopressin
 Desmopressin
Contraindicated in patients with CAD or similar since their arteries are already small, they will only get
smaller
Vasopressin and Desmopressin Indications:
 Used to prevent or control polydipsia, polyuria, and dehydration in patients who has diabetes
insipidus
 Used in the treatment of various types of bleeding, especially GI bleeding
Desmopressin is also useful for patients with hemophilia A and type 1 von Willebrand's disease
Provide specific instructions for nasal forms of vasopressin and desmopressin
ADRENAL AGENTS
In the adrenal cortex and adrenal medulla
Adrenal medulla secretes
Epinephrine and norepinephrine, known as corticosteroids
Adrenal cortex secretes
Glucocorticoids
Mineralocorticoids
All adrenal cortex hormones are steroids
ADRENOCORTICAL HORMONESAS MEDICATIONS
 Can be either synthetic or natural
Many different agents and forms

Glucocorticoids

o Topical, systemic, inhaled, nasal
Mineralocorticoid

o Systemic
Adrenal steroid inhibitors

o Systemic
ADRENOCORTICAL HORMONES GLUCOCORTICOIDS
 betamethasone several formulations
 hydrocortisone (several formulations)
 dexamethasone (Decadron)
 cortisone
 Methylprednisolone (Solu-Medrol)
 prednisone
 prednisolone
ADRENOCORTICAL HORMONES
 Mineralocorticoid
 fludrocortisone (Florinef)
Adrenal steroid inhibitors
 aminoglutethimide
 ketoconazole
 Metyrapone
MECHANISM OF ACTION
Most exert their effects by modifying enzyme activity
Different agents differ in their potency, duration of action, and the extent to which they cause salt and
fluid retention
Glucocorticoids inhibit or help control inflammatory and immune responses
WIDE VARIETY OF INDICATIONS









Adrenocortical deficiency
Cerebral edema
Collagen diseases
Dermatologic diseases
GI diseases
Exacerbations of chronic respiratory illnesses, such as asthma and COPD
Organ transplant (decrease immune response)
Palliative management of leukemias and lymphomas
Spinal cord injury
ADMINISTRATION OF GLUCOCORTICOIDS
 By inhalation for control of steroid-responsive bronchospastic states
 Nasally for rhinitis and to prevent the recurrence of polyps after surgical removal
 Topically for inflammations of the eye, ear, and skin
ANTI-ADRENALS
Antiadrenals (adrenal steroid inhibitors)
Used in the treatment of Cushing’s syndrome
CONTRAINDICATIONS
 Drug allergies
 Serious infections, including septicemia, systemic fungal infections, and varicella
 However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent
inflammatory CNS damage
Weight gain is a large side effect of steroids
ADVERSE/SIDE EFFECTS
 Potent effects on all body systems*
 Cardiovascular
o Heart failure, cardiac edema, hypertension—all due to electrolyte imbalances
 CNS
o Convulsions, headache, vertigo, mood swings, nervousness, insomnia, others
 Endocrine
o Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate
intolerance, hyperglycemia, others
 GI
o Peptic ulcers with possible perforation, pancreatitis, abdominal distention, others
 Integumentary
o Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism,
urticaria
 Musculoskeletal
o Muscle weakness, loss of muscle mass, osteoporosis
 Ocular
o Increased intraocular pressure, glaucoma, others
 Other
o Weight gain
NURSING IMPLICATIONS
 Perform a physical assessment to determine baseline weight, height, intake and output status,
vital signs (especially BP), hydration status, immune status
 Obtain baseline laboratory studies
 Assess for edema and electrolyte imbalances



Systemic forms may be given by oral, IM, IV, or rectal routes (not SC)
Prepare and administer according to manufacturer’s directions
Oral forms should be given with food or milk to minimize GI upset

Sudden discontinuation of these agents can precipitate an adrenal crisis caused by a sudden
drop in serum levels of cortisone
Doses are usually tapered before the agent is discontinued
Clients should be taught to take all adrenal medications at the same time every day, usually in
the morning, with meals or food


THYROID AND ANTI-THYROID AGENTS
THYROID GLAND
 Secretes three hormones essential for proper regulation of metabolism
o Thyroxine (T4)
o Triiodothyronine (T3)
o Calcitonin
 Located near the parathyroid gland
o Responsible for maintaining adequate levels of calcium in the extracellular fluid
HYPOTHYROIDISM: DEFICIENCY IN THYROID HORMONES
 Primary: abnormality in the thyroid gland itself
 Secondary: results when the pituitary gland is dysfunctional and does not secrete TSH
 Tertiary: results when the hypothalamus gland does not secrete TRH, which stimulates the
release of TSH
HYPOTHYROIDISM
 Cretinism
o Hyposecretion of thyroid hormone during youth
o Leads to cretinism: low metabolic rate, retarded growth and sexual development,
possibly mental retardation
 Myxedema
o Hyposecretion of thyroid hormone as an adult
o Decreased metabolic rate, loss of mental and physical stamina, weight gain, loss of hair,
firm edema, yellow dullness of the skin
 Goiter
o Enlargement of the thyroid gland
o Results from overstimulation by elevated levels of TSH
o TSH is elevated because there is little or no thyroid hormone in circulation
Common symptoms
 Thickened skin
 Hair loss
 Constipation
 Lethargy
 Anorexia
Affects multiple body systems, resulting in an overall increase in metabolism
 Diarrhea
 Fatigue
 Flushing
 Palpitations
 Increased appetite
Nervousness

 Muscle weakness
Heat intolerance

 Sleep disorders
 Irritability
 Altered menstrual flow
THYROID PREPARATIONS HYPOTHYROIDISM
 levothyroxine (Synthroid) PREFERRED AGENT
o Synthetic thyroid hormone T4
 liothyronine (Cytomel)
o Synthetic thyroid hormone T3
 liotrix (Thyrolar)
o Synthetic thyroid hormone T3-T4 combined
 Thyroid
o Desiccated (dried) animal thyroid gland
MECHANISM OF ACTION
 Thyroid preparations are given to replace what the thyroid gland cannot produce to achieve
normal thyroid levels (euthyroid)
 Thyroid drugs work the same way as thyroid hormones
INDICATIONS
 To treat all three forms of hypothyroidism
 levothyroxine is the preferred agent because its hormonal content is standardized; therefore, its
effect is predictable
 Also used for thyroid replacement in clients whose thyroid glands have been surgically removed
or destroyed by radioactive iodine in the treatment of thyroid cancer or hyperthyroidism
ADVERSE/SIDE EFFECTS
 Cardiac dysrhythmia is the most significant adverse effect
May also cause:
 Tachycardia, palpitations, angina, hypertension,
 insomnia, tremors, headache, anxiety, nausea, diarrhea, menstrual irregularities, weight loss,
sweating, heat intolerance, others
TREATMENT OF HYPERTHYROIDISM
 Radioactive iodine (131I) works by destroying the thyroid gland
 Surgery to remove all or part of the thyroid gland
 Antithyroid drugs: thioamide derivatives
o methimazole (Tapazole)
o propylthiouracil (PTU)
ANTI-THYROID AGENTS
 Used to palliate hyperthyroidism and to prevent the surge in thyroid hormones that occurs after
the surgical treatment or during radioactive iodine treatment for hyperthyroidism
 May cause liver and bone marrow toxicity
NURSING IMPLICATIONS
• Antithyroid medications
• Better tolerated when given with food
• Give at the same time each day to maintain consistent blood levels
• Never stop these medications abruptly
• Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt)
• Teach client to take thyroid agents once daily in the morning to decrease the likelihood of insomnia if
taken later in the day
• Teach client to take the medications at the same time every day and not to switch brands without
physician approval
• Monitor for side/adverse effects
Symptoms of overdose of thyroid hormones include cold intolerance, depression, edema