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CHAPTER 30
Pituitary Drugs
Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Neuroendocrine System:
Pituitary Hormones

Hypothalamus


Pituitary gland



Part of the CNS
Anterior pituitary (adenohypophysis)
Posterior pituitary (neurohypophysis)
Together, they govern all bodily functions

Hormones
 Negative feedback loop
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Pituitary Drugs

Anterior pituitary drugs



Cosyntropin
Somatotropin

Somatrem
 Octreotide
Posterior pituitary drugs

Vasopressin

Desmopressin
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Uses



Replacement therapy when a hormone
deficiency is present
Drug therapy to produce a specific hormone
response when a hormone deficiency is
present
Diagnostic aids to determine hypofunction or
hyperfunction of a specific hormonal function
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Mechanism of Action


Differs depending on the drug
Either augments or antagonizes the natural
effects of the pituitary hormones
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Indications

cosyntropin (Cortrosyn)



Stimulates release of cortisol from adrenal cortex
Antiinflammatory effect
Promotes renal retention of sodium; may result in
edema and HTN
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Indications (cont’d)

Somatropin and somatrem


Recombinantly made growth hormone (GH)
Stimulate skeletal growth in patients with deficient
GH, such as hypopituitary dwarfism
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Indications (cont’d)

octreotide (Sandostatin)



Carcinoid tumors secrete VIP (vasoactive intestinal
polypeptide)
VIP causes profuse, watery diarrhea
Octreotide reduces this severe diarrhea, flushing,
and potentially life-threatening hypotension that
may occur with a carcinoid crisis
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Indications (cont’d)

Vasopressin and desmopressin



Used in the treatment of diabetes insipidus
Vasopressin: A powerful vasoconstrictor used for
hypotensive emergencies, GI bleeding, and
pulseless cardiac arrest
Desmopressin: Used for dose-dependent
treatment of blood disorders; also used for
nocturnal enuresis
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Adverse Effects

Adverse effects are specific to the individual
drugs
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Nursing Implications



Obtain thorough nursing assessment and
medication history
Assess for contraindications specific to each
drug
Assess medication history for possible
interactions
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Nursing Implications (cont’d)

cosyntropin (Cortrosyn)

IM, SC, IV forms, and gel and repository forms
 Follow directions carefully for administration
 Maintain adequate hydration
 Decrease sodium and potassium intake
 Avoid vaccinations during drug therapy
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Nursing Implications (cont’d)

octreotide (Sandostatin)

May impair gallbladder function—instruct patient to
report abdominal pain
 Use with caution in patients with renal impairment
 Monitor glucose levels in patients with diabetes, and
even in those who do not have diabetes
 Can be given IV, IM, or SC
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Nursing Implications (cont’d)





Provide specific instructions for nasal spray
forms of vasopressin
Rotate injection sites
Do not discontinue drugs abruptly
Do not take over-the-counter products without
checking with health care provider
Parents of children who are receiving growth
hormones should keep a journal reflecting the
child’s growth
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Nursing Implications (cont’d)

Monitor for therapeutic responses

Cosyntropin should eliminate pain associated with
inflammation and produce increased comfort and
muscle strength in patients with multiple sclerosis
 Somatropin should increase growth in children
 Desmopressin and vasopressin should reduce
severe thirst and decrease urinary output
 Octreotide should reduce symptoms of carcinoid
crisis

Monitor for adverse effects
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