Pharm 2: Endocrine

what is the prototype for growth hormone agonists?

Somatropin (synthetic form of GH)

how is somatropin (GH agonist) administered?

IM or SubQ (not orally because it is destroyed in the GI tract)

how does somatropin (GH agonist) work?

Replaces human GH

stimulates skeletal growth, growth of internal organs

what is somatropin (GH agonist) used for?

GH deficiency, girls with Turner syndrome, and treatment of growth failure in children of small gestational age who do not achieve catch-up growth by 2 years of age

what are the cautions for somatropin (GH agonist)?

diabetes and pregnancy/lactation

what are the contrindications for somatropin (GH agonist)?

underlying cranial lesions (don't want the lesions to grow), allergy, closed epiphyses (growth plates), severe obesity

what are the adverse effects of somatropin (GH agonist)?

intracranial HTN, development of antibodies to GH, insulin resistance, swelling, joint pain, HA, injection-site pain

what are the Drug Interactions for somatropin (GH agonist)?

glucocorticoids (steroids) - can counteract the growth we want

what are the Nursing Interventions for somatropin (GH agonist)?

Stop treatment prior to epiphyseal closure

not given after pt starts puberty, Monitor growth patterns monthly, Rotate injections sites

What are the main complications of Somatropin?

1. Hyperglycemia - Observe for symptoms 2. Inactivation - develop the neutralizing antibodies 3. Hypercalciuria and Renal Calculi (kidney stones) - teach clients to monitor for s/s: flank pain, blood in urine, N/V

What is involved in the patient teaching for Somatropin?

Monitor for s/s of hyperglycemia and report to provider, Monitor for symptoms of renal calculi and reports to provider

what is the prototype for Growth Hormone Antagonists?

Bromocriptine Mesylate

how does Bromocriptine Mesylate (Growth Hormone Antagonists) work?

inhibits GH secretion and blocks its effects

what is Bromocriptine (Growth Hormone Antagonists) used for?

treatment of acromegaly

what are the cautions of Bromocriptine (Growth Hormone Antagonists)?

in individuals who have another endocrine disorder (DM, thyroid dysfunction)

what are the contraindications of Bromocriptine (Growth Hormone Antagonists)?

pregnancy

what are the adverse effects of Bromocriptine (Growth Hormone Antagonists)?

dizziness, fatigue, light-headedness, orthostatic hypotension, drowsiness, HA, GI disturbances

what are the drug interactions of Bromocriptine (Growth Hormone Antagonists)?

1. erythromycin (macrolids)- increases effects of bromo 2. phenothiazine- decreases effects of bromo

what are the client teaching points of Bromocriptine (Growth Hormone Antagonists)?

1. Give with milk or food to reduce GI effects 2. Avoid sudden position changes

especially from lying to standing

what is the prototype for Drug Affecting Posterior Pituitary Hormones?

Desmopressin

ATI: Vasopressin

How is desmopressin administered?

PO, intranasal, SubQ, IV, IM

how does desmopressin work?

As pressor and antidiuretic effects

aids in reabsorption of water, given when there is too little ADH

When is desmopressin indicated for use?

Treatment of neurogenic diabetes insipidus (aids in reabsorption of water)

What are contraindications for desmopressin?

severe renal dysfunction, pregnancy/lactation, allergy, acute illnesses that might lead to fluid and/or electrolyte imbalances

What are cautions for desmopressin?

known vascular disease (this med has vasoconstrictioning effect), epilepsy, asthma, hyponatremia, pts who consume large amounts of fluid

What are the adverse effects for desmopressin?

HA, facial flushing, nausea, fluid retention, slight increase in BP, hyponatremia (dilutional), local reaction at injection site

water intoxication at high doses

What are the drug interactions for desmopressin?

1. carbamazepine and tricyclic antidepressants- increase diuretic effect 2. alcohol, heparin, lithium, or phenytoin can decrease antidiuretic effects

What are the main complications of Desmopressin?

1. Water Intoxication - monitor and reports signs of overhydration (s/s: pounding HA, edema, watch e-lytes, sleepy, gaining weight) 2. MI (Vasopressin) - from excessive vasoconstriction

monitor EKG and BP (chest pain, SOB, tingling arm)

What are the nursing interventions of Desmopressin?

1. Monitor I&Os, VS, specific gravity, K+, Na, BUN/Cr 2. daily weights 3. Intranasal admin can have AE of epistaxis, nasal congestion 4. Dosage is adjusted according to patient's UOP

what is involved in the patient teaching for desmopressin?

1. Lifelong therapy will be required 2. Report weight gain \> 2lbs in 24 hours 3. Pt should reduce fluid intake 4. Smallest Effective Dose

what are the Adrenocortical agents?

Glucocorticoid, Mineralocorticoid

what are the child considerations for Adrenocortical agents (Steroids)?

1. Needs to have growth/development needs to be monitored frequently if using chronically
2. Topicals should be limited (bc children skin is thinner so they absorb larger amounts)
3. also the same as adults

what are the adult considerations for Adrenocortical agents (Steroids)?

1. Importance of taking medication in the morning. Why? Insomnia. And that is when most natural hormones are released 2. Read OTC labels 3. Caution with pregnancy/lactation-risk and benefits

what are the older adult considerations for Adrenocortical agents (Steroids)?

More likely to show adverse effects, More comorbidities

what is the prototype for Glucocorticoids?

Prednisone

ATI: Hydrocortisone

how does Prednisone (Glucocorticoids) work?

binds to intracellular corticosteroid receptors, initiates reactions responsible for its anti-inflammatory and immunosuppressive effects

what are the indications for Prednisone (Glucocorticoids)?

replacement therapy in adrenal cortical insufficiency, short-term management of various inflammatory and allergic disorders

what are the contraindications for Prednisone (Glucocorticoids)?

allergy, acute infection, lactation

what are the cautions for Prednisone (Glucocorticoids)?

pts with diabetes (bc it increases BS

may need dosage adjusted for a short time), acute peptic ulcers, preg., other endocrine disorders

what are the adverse effects for Prednisone (Glucocorticoids)?

osteoporosis, vertigo, HA, hypotension, Na+ and fluid retention, amenorrhea, increased appetite, weight gain, immunosuppression, aggravation or masking of infections, impaired wound healing, peptic ulcer

what are the drug interactions for Prednisone (Glucocorticoids)?

1. erythromycin, ketoconazole, and troleandomycin: increase effectiveness of Glucocorticoids 2. salicylates, barbiturates, phenytoin, or rifampin: decrease effectiveness of Glucocorticoids

what is a nursing intervention for prednisone?

Should use minimal dose for minimum amount of time

what are the nursing interventions based on the adverse effects for Prednisone (Glucocorticoids)?

1. increases glucose levels causing hyperglycemia and glycosuria 2. can cause Na+/water retention and K+ loss leading to HTN, edema, and serious dysrhythmias 3. increase dose w/ stress, the adrenals stop working bc we are getting it exogenously so do not stop abruptly 4. Infection bc immunosuppression 5. Cushing's Syndrome - with long-term use

observe for s/s (muscle weakness, moon face, buffalo hump, acne)

notify

what are teaching points for Prednisone (Glucocorticoids)?

1. s/s of hyperglycemia and/or instruct a patient with DM abt regular checking of BS 2. Take supps: vit D (for bones) 3. get regular exercise 4. Observe for s/s of PUD (coffee grounds, black tarry stool, abd. Pain) and notify provider 5.Monitor for fever (bc immunosuppression) 6. avoid contact with sick ppl 6. Take early AM

what is the prototype for Mineralocorticoids?

Fludrocortisone

how does Fludrocortisone (Mineralocorticoids) work?

Increases Na+ reabsorption in the renal tubules and increases K+ excretion leading to water and Na+ retention

when is Fludrocortisone (Mineralocorticoids) indicated for use?

replacement therapy in cortical insufficiency, treatment of salt-losing adrenogenital syndrome

off-label use: treatment of hypotension

what are the contrindications for Fludrocortisone (Mineralocorticoids)?

allergy, severe HTN, HF, cardiac disease

lactation

what are the cautions for Fludrocortisone (Mineralocorticoids)?

pregnancy, presence of infection, high sodium intake

what are the Adverse effects of Fludrocortisone (Mineralocorticoids)?

HA, increased blood volume, F&E imbalance, edema, HTN, HF, rash

what are the drug interactions for Fludrocortisone (Mineralocorticoids)?

barbiturates, hydantoin- can reduce effects of the steroid

what are the main complications for Fludrocortisone (Mineralocorticoids)?

Retention of sodium and water - lead to HTN, HF, and hypokalemia

what are the Nursing Considerations for all Adrenocorticals?

1. Monitor glucose levels and WBC 2. pts who have DM may require increased dose of insulin/PO med 3. Give with food to reduce gastric distress 4. Don't stop abruptly! Why? Don't want pt to develop adrenal suppression and need the adrenals to wake back up

what are the nursing interventions for Fludrocortisone (Mineralocorticoids)?

1. Monitor weight, BP, K+ levels 2. Educate client on s/s of Na+ and water retention (weight gain, peripheral edema) and hypokalemia (muscle weakness, irregular pulse)

notify if occur

what are the teaching points for all Adrenocorticals?

1. Monitor for s/s peptic ulcer and notify 2. Notify provider of manifestations of acute adrenal insufficiency 3. Dosages increased in times of stress

what is the prototype for thyroid hormones?

Levothyroxine

how is Levothyroxine (thyroid hormones) administered?

oral, can be IV in severe cases

how does Levothyroxine (thyroid hormones) work?

Synthetic T3 and T4 hormones to mimic natural thyroid hormones

increases metabolic rate of body tissues

what is the indication of use for Levothyroxine (thyroid hormones)?

replacement therapy in hypothyroidism

emergency treatment of myxedema coma (IV route)

What are contraindications for Levothyroxine (thyroid hormones)?

allergy, acute thyrotoxicosis (hyper), during or following acute MI

What are the cautions for Levothyroxine (thyroid hormones)?

lactation, CV problems

diabetes

What are the adverse effects for Levothyroxine (thyroid hormones)?

tremors, HA, nervousness, palpitations, tachycardia, allergic skin reactions, GI effects

What are the drug interactions for Levothyroxine (thyroid hormones)?

1. catecholamines: increased risk of cardiac arrhythmia and effects 2. insulin: may need increased insulin dose 3. digoxin: may need to increase dig dose 4. oral anticoags: increases effects of anticoag so may need to decrease the dose 5.theophylline: decreased clearing of Theo so may need to decrease dose

What are the main complications for Levothyroxine (thyroid hormones)?

1. Overmedication - results in s/s hyperthyroidism and thyrotoxicosis (anxiety, tachycardia, chest pain, nervousness, tremors, palpitations, abd cramping, heat intolerance, fever, diaphoresis, weight loss)

report to provider
2. Chronic overtreatment - can cause afib and increased risk of fractures from accelerated bone loss

what are the nursing interventions for Levothyroxine (thyroid hormones)?

1. Monitor for s/s cardiac excitability (angina, chest pain, palpitations, dysrhythmias) 2. start low, go slow 3. Monitor T4 and TSH levels (checked at 6 to 8 weeks following initiation

at least once a year when stable) 4. Prescribed in micrograms

what are the teaching points for Levothyroxine (thyroid hormones)?

1. Take daily on an empty stomach, 30 to 60 minutes before breakfast 2. Don't take with anything that will bind (calcium supplements, iron, fiber) or change pH of stomach acid immediately 3. nothing to eat for 30 min after taking 4.Different brands have varied effects 5. Full effect takes 6 to 8 weeks
6. lifelong therapy

don't stop abruptly

what is the black box warning for levothyroxine?

should not be used for weight loss or to treat obesity, need larger dose for weight loss that can cause serious or life-threatening toxicity

what is the prototype for Antithyroid agents: Thioamides?

Methimazole

how does Methimazole (antithyroid) work?

decrease activity of thyroid, inhibits synthesis of T3 and T4, blocks conversion of T4 into T3 (T3 is the more active one)

what is Methimazole (antithyroid) used for?

treatment of hyperthyroidism, emergency treatment for thyrotoxicosis

what are the contraindications for Methimazole (antithyroid)?

allergy, pregnancy

what are the cautions for Methimazole (antithyroid)?

bone marrow suppression, immunosuppression

what are the adverse effects for Methimazole (antithyroid)?

r/t hypothyroidism, Bone Marrow Suppression

what are the drug interactions for Methimazole (antithyroid)?

anticoagulants and digoxin: may need to adjust doses

what are the main complications for Methimazole (antithyroid)?

1. Hypothyroidism - overmed can result in s/s hypothyroidism

report 2. Agranulocytosis - monitor for sore throat or fever, promptly report to provider

monitor blood counts

stop treatment if occurs

what are the nursing interventions for Methimazole (antithyroid)?

Monitor VS, weight, I&Os, s/s hypothyroidism, If childbearing age: handle with caution

what are the teaching points for Methimazole (antithyroid)?

1. Therapeutic effects can take 1 to 2 weeks to be evident, full benefit can take 3 to 12 weeks 2. Take med consistently/day
3. Do not stop abruptly 4. Avoid shellfish (iodine-increases T3 and T4)