Case Study, Chapter 35, Hypothalamic and Pituitary Agents
A registered nurse is preparing three hypothalamic and pituitary medications for
assigned patients. The registered nurse is looking up key information about
leuprolide (Lupron), somatropin (Nutropin, Saizen, Humatrope, Zorbtive), and
desmopressin. (Learning Objectives 2, 4, and 5)
a. What are the indications for the use of somatropin (Nutropin, Saizen,
Humatrope, Zorbtive)?
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In clinical practice, the agents that are used purely as a replacement for
anterior pituitary hormones are those acting as GH, somatropin.
b. What are the most common adverse reactions for leuprolide (Lupron)?
Adverse effects associated with these drugs are related to the stimulation or
blocking of regular hormone control. Agonists can lead to increased release of
sex hormones, leading to ovarian overstimulation, flushing, increased
temperature and appetite, and fluid retention. Antagonists can lead to a
decrease in testosterone levels, leading to loss of energy, decreased sperm
count and activity, and potential alterations in secondary sex characteristics,
or to a decrease in female sex hormones, leading to lack of menstruation,
fluid and electrolyte changes, insomnia, and irritability.
c. What are the therapeutic actions for desmopressin?
ADH is released in response to increases in plasma osmolarity or decreases in
blood volume. It produces its antidiuretic activity in the kidneys, causing the
cortical and medullary parts of the collecting duct to become permeable to
water, thereby increasing water reabsorption and decreasing urine formation.
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These activities reduce plasma osmolarity and increase blood volume.
The vasopressin blockers cause a loss of water through the urine and
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therefore increase in serum sodium levels as the water level decreases. They
must be given under close supervision in the hospital to monitor fluid volume
carefully.
d. What are the key nursing implementation considerations for patients
receiving growth hormones?
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Reconstitute the drug following manufacturer’s directions, monitor response
carefully when beginning therapy, monitor thyroid function, provide thorough
patient teaching, including measures to take to avoid adverse effects,
warning signs of problems, and the need for regular evaluation, storage of
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the drug, preparation of the drug, administration techniques.
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