The Examination

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PYRAMID POINTS
CHAPTER 54:
ENDOCRINE
MEDICATIONS
PYRAMID POINTS
I. Pituitary Medications

Description
• Administered to replace deficient amounts of hormones
secreted by the anterior and posterior pituitary gland
• The anterior pituitary gland secretes growth hormone
(GH), thyroid-stimulating hormone (TSH),
adrenocorticotropic hormone (ACTH), prolactin,
melanocyte-stimulating hormone (MSH), and
gonadotropins (follicle-stimulating hormone [FSH] and
luteinizing hormone [LH])
• The posterior pituitary gland secretes antidiuretic
hormones (vasopressin) and oxytocin
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I. Pituitary Medications (continued)

Growth hormones and related medications
• Assess child’s physical growth; compare with standards
• Monitor blood glucose levels, thyroid function tests
• Teach client, family signs of hyperglycemia, importance
of follow-up blood tests
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II. Antidiuretic Hormones

Description
• Enhance reabsorption of water in kidneys, promoting
antidiuretic effect, regulating fluid balance

Side effects
• Include flushing, headache, water intoxication,
hypertension
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II. Antidiuretic Hormones (continued)

Interventions
• Monitor strict intake and output; urine osmolality
• Monitor daily weights, vital signs
• Monitor electrolyte serum levels
• Restrict fluid intake as prescribed
• Monitor for signs of water intoxication, including
drowsiness, listlessness, headache
• Instruct client how to use intranasal spray medication
• Instruct client to report any signs of water intoxication,
dyspnea, SOB, headache to primary health care provider
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PYRAMID POINTS
III. Thyroid Hormones

Description
• Control metabolic rate of tissues; accelerate heat production,
oxygen consumption
• Should be given at least 4 hours apart from multivitamins,
aluminum hydroxide, magnesium hydroxide, simethicone,
calcium carbonate, bile acid sequestrants, iron, sucralfate
(Carafate)

Side effects
• Include weight loss, nervousness, insomnia, diaphoresis,
tachycardia, hypertension, chest palpitations, chest pain

Interventions
• Instruct client to take medication at same time each day,
preferably in morning, without food
• Advise client to report symptoms of hyperthyroidism
(tachycardia, chest pain, palpitations, diaphoresis)
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IV. Antithyroid Medications


Description
• Inhibit synthesis of thyroid hormone
Side effects
• Include agranulocytosis with leukopenia,
thrombocytopenia, hypothyroidism (toxic response),
iodism
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PYRAMID POINTS
IV. Antithyroid Medications (continued)

Interventions
• Instruct client how to take pulse
• Advise client to contact physician if fever, sore throat develops
• Instruct client regarding importance of medication compliance
• Advise client to consult physician before eating iodized salt,
foods containing iodine
• Instruct client to avoid acetylsalicylic acid (aspirin), medications
containing iodine
• Monitor for signs of thyroid storm (fever, flushed skin,
confusion, behavioral changes, tachycardia, dysrhythmias,
signs of heart failure)
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V. Parathyroid Medications

Description
• Regulate serum calcium levels
• Hyperparathyroidism results in high serum calcium
levels, bone demineralization
• Hypoparathyroidism results in low serum calcium levels,
neuromuscular excitability
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V. Parathyroid Medications (continued)

Interventions
• Assess for symptoms of tetany in client with hypocalcemia
• Instruct client to maintain intake of vitamin D if receiving oral
calcium supplements
• Instruct client receiving calcium regulators to


Swallow tablet whole with water at least 30 minutes before
breakfast
Not to lie down for at least 30 minutes
• Instruct client using antihypercalcemic agents to avoid foods
rich in calcium, including green leafy vegetables
• Instruct client not to take other medications within 1 hour of
taking calcium salts
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VI. Corticosteroids (Mineralocorticoids)

Description
• Used for replacement therapy in primary or secondary
adrenal insufficiency in Addison’s disease

Side effects
• Include sodium and water retention, hypokalemia,
hypertension, weight gain
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VI. Corticosteroids (Mineralocorticoids)
(continued)

Interventions
• Instruct client not to stop medication abruptly
• Instruct client to take medication with food or milk
• Instruct client to consume diet high in potassium as
prescribed
• Instruct client to notify physician if signs of infection,
muscle aches, sudden weight gain, headache occur
• Instruct client not to take aspirin products without
consulting physician
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VII. Corticosteroids (Glucocorticoids)


Description
• Alter the normal immune response, suppress inflammation
• Promote sodium and water retention, potassium excretion
• Produce anti-inflammatory, antiallergic, antistress effects
• May be used as replacement for adrenocortical insufficiency
Side effects
• Include hyperglycemia, hypokalemia, sodium and fluid
retention, weight gain, mood swings, moon face and buffalo
hump, increased susceptibility to infection, hirsutism
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PYRAMID POINTS
VII. Corticosteroids (Glucocorticoids)
(continued)


Contraindications and cautions
• Should be used with caution in clients with DM
• Use with extreme caution in clients with infections
Interventions
• Instruct client to take medication with food
• Instruct client to avoid individuals with infections
• Instruct client to eat diet high in potassium as prescribed
• Instruct client to report signs of Cushing’s syndrome
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VIII. Androgens

Description
• Used to replace deficient hormones, treat hormonesensitive disorders

Side effects
• Include hepatotoxicity, jaundice
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VIII. Androgens (continued)

Interventions
• Monitor for edema, weight gain, skin changes
• Assess for liver dysfunction, including right upper
quadrant abdominal pain, malaise, fever, jaundice,
pruritis
• Assess for development of secondary sexual
characteristics
• Instruct client to notify physician if fluid retention occurs
• Instruct women clients to use nonhormonal contraceptive
while on therapy
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IX. Estrogens and Progestins

Description
• Preparations may be used to stimulate endogenous
hormones to restore hormonal balance; treat hormonesensitive tumors; for contraception

Contraindications and cautions
• Estrogens


Contraindicated in clients with breast cancer, endometrial
hyperplasia, endometrial cancer, history of
thromboembolism, known or suspected pregnancy or
lactation
Barbiturates, phenytoin (Dilantin), rifampin (Rifadin)
decrease effectiveness
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PYRAMID POINTS
IX. Estrogens and Progestins (continued)

Contraindications and cautions (continued)
• Progestins


Contraindicated in clients with thromboembolic disorders;
should be avoided in clients with breast tumors, hepatic
disease
Side effects
• Hypertension, stroke, myocardial infarction,
thromboembolism

Interventions
• Instruct client not to smoke
• Instruct client to undergo routine breast and pelvic
examinations
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X. Contraceptives

Description
• Usually taken for 21 consecutive days, stopped for 7 days;
cycle then repeated
• Risk factors include smoking, obesity, hypertension
• Contraindicated in women with hypertension, thromboembolic
disease, cerebrovascular or coronary artery disease, cancer,
pregnancy
• Should be avoided with use of hepatotoxic medications

Side effects
• Breakthrough bleeding; excessive cervical mucus formation;
breast tenderness; hypertension; nausea and vomiting
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X. Contraceptives (continued)

Interventions
• Instruct client to report signs of thromboembolic complications
• Advise client to use alternative form of birth control when taking
•
•
•
•
antibiotics
Instruct client to perform breast self-examination (BSE) monthly
If client decides to discontinue contraceptive to become
pregnant, recommend alternative form of birth control for 2month period
If using patch and it remains off for less than 24 hours, reapply
If using patch and it is off longer than 24 hours, new 4-week
cycle must be started immediately
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XI. Fertility Medications

Description
• Act to stimulate follicle development, ovulation in
functioning ovaries; combined with human chorionic
gonadotropin to maintain follicles once ovulation has
occurred
• Contraindicated in presence of primary ovarian
dysfunction, thyroid or adrenal dysfunction, ovarian cysts,
pregnancy, idiopathic uterine bleeding
• Should be used with caution in clients with
thromboembolic or respiratory diseases
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XI. Fertility Medications (continued)


Side effects
• Risk of multiple births, birth defects
Interventions
• Instruct client on administration of medication
• Instruct client on when intercourse should occur to
increase therapeutic effectiveness of medication
• Instruct client about risks and hazards of multiple births
• Instruct client about regular follow-up care
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XII. Medications for Erectile Dysfunction

Description
• Cause smooth muscle relaxation; promote blood flow into
corpus cavernosum
• Contraindicated in presence of anatomical obstruction or
condition that might predispose to priapism; contraindicated in
clients with penile implants
• Sildenafil, tadalafil, vardenafil used cautiously in clients with
coronary artery disease (CAD), active peptic ulcer disease,
bleeding disorders, retinitis pigmentosa.
• Sildenafil, tadalafil, vardenafil cannot be administered to clients
taking nitrates, nitroprusside, β-blockers
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PYRAMID POINTS
XII. Medications for Erectile Dysfunction
(continued)


Side effects
• Pain at injection site; rash; hypertension (alprostadil)
• Headache; flushing; dyspepsia; rash; insomnia
Interventions
• Inform client of side effects about which physician needs
to be informed
• Perform a thorough assessment of health and medication
history
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XIII. Medications for Diabetes Mellitus

Insulin and oral hypoglycemic medications
• -adrenergic blocking agents may mask signs, symptoms
of hyperglycemia
• Corticosteroids, sympathomimetics, thiazide diuretics,
phenytoin (Dilantin), thyroid preparations, oral
contraceptives, estrogen compounds may cause
hyperglycemia
• Side effects of sulfonylurea oral hypoglycemics include
gastrointestinal symptoms, hypoglycemia

Chlorpropamide (Diabinese) can cause disulfiram
(Antabuse)-type reaction when alcohol ingested
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XIII. Medications for Diabetes Mellitus
(continued)

Oral hypoglycemic medications
• Obtain medication history
• Instruct client not to ingest alcohol with sulfonylureas
• Inform client that insulin may be needed during stress,
surgery, infection
• Teach client about signs and symptoms of hypoglycemia
and hyperglycemia
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XIII. Medications for Diabetes Mellitus
(continued)

Insulin
• Onset, peak, duration of action depend on insulin type
• Storing insulin:


Avoid extreme temperatures
Do not freeze or keep in direct sunlight
• Insulin injection sites: Main areas include abdomen, arms
(posterior surface), thighs (anterior surface), hips
• Mixing NPH and Regular insulin: Draw up clear (Regular)
insulin before cloudy (NPH) insulin
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XIII. Medications for Diabetes Mellitus
(continued)
• Administering insulin



Before use, swirl vial gently or rotate between palms, but
avoid vigorous shaking.
Administer mixed dose within 5 to 15 minutes of
preparation
Regular insulin is only type of insulin that can be
administered IV
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XIII. Medications for Diabetes Mellitus (continued)

Exubera (insulin, human [rDNA origin]) inhalation powder
• Causes decrease in pulmonary function
• Pulmonary function studies done before treatment starts,
periodically during treatment
• Contraindicated in client who smokes, starts smoking, or quits
smoking less than 6 months prior to beginning treatment, in
clients with unstable or poorly controlled lung disease, in
pregnant clients, in clients younger than 18 years

Exenatide (Byetta)
• Used for clients with type 2 DM
• Administered as subcutaneous injection within 60 minutes
before morning and evening meals
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XIII. Medications for Diabetes Mellitus (continued)



Pramlintide (Symlin)
• Used for clients with type 1 or 2 DM
• Associated with increased risk of hypoglycemia
Glucagon
• Used to treat insulin-induced hypoglycemia
• Instruct family in procedure for administration
Diazoxide (Proglycem)
• Used to treat hypoglycemia caused by hyperinsulinism resulting
from islet cell cancer or hyperplasia
• Not used for hypoglycemic reactions from insulin
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A diabetic client taking daily NPH insulin has been started on
therapy with dexamethasone (Decadron). The nurse anticipates
that which of the following adjustments in medication dosage will
be made?
1.
2.
3.
4.
Decreased NPH insulin
Increased NPH insulin
Lower dose of dexamethasone than usual
Higher dose of dexamethasone than usual
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The nurse has given medication information to the client who is
beginning hormone replacement therapy with levothyroxine
(Synthroid). The nurse determines that the client can recognize
signs of medication toxicity if the client states that he or she will
report which of the following to the physician?
1.
2.
3.
4.
Heat intolerance
Slow pulse rate
Low body temperature
Drowsiness
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