Download PowerPoint Chapter 20

Chapter 20
Hormones and Steroids
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Chapter 20
Lesson 20.1
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Learning Objectives
• Describe the use of antidiabetic
medications
• Identify preparations that act on the
uterus
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Overview
• Hormones and steroids
• Natural and synthetic preparations
• Used to replace and/or increase natural
chemicals in the body
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Endocrine System
• Regulation and coordination of body
systems
• Endocrine glands
• Pituitary, thyroid, parathyroid, adrenal
glands, pancreas, testes, ovaries, and
placenta
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Endocrine System
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Male Reproductive System
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Female Reproductive System
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Antidiabetic Drugs
• Diabetes mellitus: chronic disorder of
metabolism
• Insulin: necessary for the metabolism
and use of glucose in the body
• Pancreas
• Type 1 and type 2 diabetes
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Insulin
Action
• Lowers blood glucose levels by helping
glucose move into target tissues
Uses
• Treatment of type 1 diabetes
Table 20-1
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Insulin (cont.)
Adverse Reactions
• Lipodystrophy, local itching, swelling, erythema
• Hypoglycemia: serum glucose less than 60
mg/dL
Drug Interactions
• Insulin antagonists
• Anabolic steroids and alcohol may increase the
hypoglycemic effects of insulin
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Insulin (cont.)
Nursing Implications
• Assessment: polyuria, polyphagia, polydipsia,
weight loss, blurred vision, and fatigue
• Hyperglycemia: systemic acidosis
• Conditions that alter requirements for insulin
Patient Teaching
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Oral Hypoglycemics
Action
• Stimulate insulin release from pancreatic beta cells; decrease
insulin resistance
Uses
• Monotherapy versus combination therapy
• Six classes
–
–
–
–
–
–
Sulfonylureas, 1st and 2nd generation
Biguanides
Alpha-glucosidase inhibitors
Meglitinides
Thiazolidinediones
Incretins
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Oral Hypoglycemics (cont.)
Adverse Reactions
• Hypoglycemia; allergic reactions
Drug Interactions
• Displacement; potentiation
• Thiazides oppose the secretion of insulin
from beta cells and decrease the
effectiveness of sulfonylureas
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Oral Hypoglycemics (cont.)
Nursing Implications
• Assessment: health history; renal and liver
function; sulfa allergies
Patient Teaching
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Selected Drugs Used with
Pregnancy and Delivery
Overview
• Antepartum, intrapartum, and postpartum
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–
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Tocolytics
Oxytocics
Uterine relaxants
Abortifacients
Drug Table 20-4
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Selected Drugs Used with
Pregnancy and Delivery (cont.)
Action and Uses
• Abortifacients stimulate uterine contractions and
cause the uterus to empty
• Oxytocic agents and ergot preparations cause
the uterus to contract
• Uterine relaxants act on beta-adrenergic
receptors to stop smooth-muscle contraction in
the uterus
• Tocolytics are used to stop preterm labor
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Selected Drugs Used with
Pregnancy and Delivery (cont.)
Adverse Reactions
• Abortifacients: cramping and pain
• Tocolytics: visual disturbance, malaise, nausea, and
confusion
• Oxytocics: dysrhythmias, edema, fetal bradycardia,
anxiety, redness of skin during administration, nausea,
vomiting, anaphylaxis, postpartum hemorrhage,
cyanosis, and dyspnea
• Ergots: nausea and vomiting, allergic reactions,
bradycardia, hypotension, hypertension, cerebrospinal
symptoms, and spasms
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Selected Drugs Used with
Pregnancy and Delivery (cont.)
Drug Interactions
• Vasoconstrictors and local anesthetics
increase the effectiveness of oxytocics
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Selected Drugs Used with
Pregnancy and Delivery (cont.)
Nursing Implications and Patient Teaching
•
•
•
•
Assessment
Diagnosis
Planning
Implementation: nursing care and monitoring
during drug administration
• Evaluation
• Patient and family teaching: adverse effects of
ergonovine
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Chapter 20
Lesson 20.2
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Learning Objectives
• Compare and contrast the action of adrenal and
pituitary hormones
• Describe at least five adverse reactions that
may result from the use of glucocorticoid and
mineralocorticoid steroids
• Compare the actions of various male and
female hormones
• List the indications for the use of thyroid
preparations
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Pituitary and Adrenocortical
Hormones
• Pituitary gland: “master gland”
• Adenohypophysis
• Neurohypophysis
• Hormone production, control growth,
electrolyte balance, water retention or loss,
and reproductive cycle
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Pituitary Hormones
Anterior Pituitary Hormones
•
•
•
•
HCG
LH and FSH
STG
ACTH
Drug Table 20-5
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Anterior Pituitary Hormones
(cont.)
Adverse Reactions (systemic or local reaction)
• Menotropins: enlarged ovaries; multiple births when
used for fertilization
• Clomiphene: abdominal discomfort, ovarian
enlargement, blurred vision, nervousness, nausea and
vomiting, vasomotor flushes
• Chorionic gonadotropins: headache, irritability,
restlessness, fatigue, and edema
• Somatotropin: antibody stimulation
• ACTH: adrenal gland
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Posterior Pituitary Hormones
• ADH
• Vasopressin may cause abdominal cramps,
anaphylaxis, bronchial constriction, circumoral
pallor, diarrhea, flatus, intestinal hyperactivity,
headache, sweating, tremors, urticaria, uterine
cramps, vertigo, vomiting; large doses may
produce death
• Oxytocin
• ACTH
• Drug Table 20-6
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Adrenocortical Hormones
Actions
• Manufactures glucocorticoids,
mineralocorticoids, and small amounts of sex
hormones
Uses
• Adrenal insufficiency (Addison’s disease)
• Reduce inflammation in allergic or
immunologic responses; treat hematologic
and malignant diseases
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Adrenocortical Hormones (cont.)
Adverse Reactions
• Table 20-7
Drug Interactions
• Increase effects of barbiturates, sedatives,
narcotics, and certain anticoagulants
• Decrease effects of insulin, oral
hypoglycemics, Coumadin, isoniazid, aspirin,
and broad-spectrum antibiotics
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Adrenocortical Hormones (cont.)
Nursing Implications and Patient Teaching
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•
•
•
•
•
•
•
•
•
•
•
•
Frequent medical monitoring
Avoid smoking
Alcohol use: ulcer development
Risk for infection
Increase dose during times of stress
Signs and symptoms of adrenal insufficiency
Do not stop drug abruptly
MedicAlert bracelet
Immunization considerations
Diet
Storage of drug
Drug interactions
Dosage schedule, missed dosage
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Sex Hormones
• Production influenced by the anterior
pituitary
• Male: testosterone; androgens
• Female: estrogen; progesterone
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Androgens
Actions
• Develop secondary sex characteristics; tissue building
Uses
• Hypogonadism, hypopituitarism, dwarfism, eunuchism,
cryptorchidism, oligospermia, and male androgen deficiency
Adverse Reactions
• Edema due to sodium retention, acne, hirsutism, male pattern
baldness, cholestatic hepatitis with jaundice, buccal irritation,
nausea and vomiting, diarrhea
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Androgens (cont.)
Drug Interactions
• Increased effects – anticoagulants, antidiabetic agents,
and other drugs
• Decreased effects – barbiturates
• Concurrent use with corticosteroids increase edema
Nursing Implications
• Assessment, diagnosis, planning, implementation, and
evaluation
Drug Table 20-9
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Androgens (cont.)
Patient and Family Teaching
•
•
•
•
•
Administration
Response time
Diet
Symptoms to report
Administration considerations
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Female Sex Hormones
• Estrogens
• Progestins
• Table 20-10
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Estrogens
Action and Uses
• Used for hormone replacement therapy in menopause
and other conditions (ovarian failure); infertility workups; palliative breast cancer treatment
Adverse Reactions
Drug Interactions
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Progestins
Action
Uses
• Contraception, control excessive uterine bleeding, treatment of
secondary amenorrhea, dysmenorrhea, premenstrual tension, and
control of pain in endometriosis
Drug Interactions
Nursing Implications and Patient Teaching
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Oral Contraceptives
Combination Drugs: Estrogen and Progestin
•
Table 20-11
Action
•
Prevent ovulation
Use
•
Contraception
Adverse Reactions
•
Estrogen excess, progestin excess, androgen excess, estrogen deficiency,
progestin deficiency
Contraindications for Oral Contraceptives
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Thyroid Hormones
Thyroid Supplements or Replacements
Action
• Increase metabolic rate: increase tissue oxygen consumption, body
temperature, heart and respiratory rate, cardiac output, and
carbohydrate, lipid, and protein metabolism; influence the
development of the skeletal system
Uses
• Replacement therapy for several conditions
Table 20-12
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Thyroid Hormones (cont.)
Adverse Reactions
• Dysrhythmias, hypertension, tachycardia,
hand tremors, headache, insomnia,
nervousness, diarrhea, vomiting, weight loss,
menstrual irregularities, rash, glycosuria,
hyperglycemia, increase prothrombin time,
and increase serum cholesterol levels
Drug Interactions
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Thyroid Hormones (cont.)
Nursing Implications and Patient Teaching
• Assessment, diagnosis, planning,
implementation, evaluation
• Administration
• Drug action/expected outcomes
• Drug interactions: diabetes; anticoagulants;
checking with healthcare provider
• Signs/symptoms of hyperthyroidism and
hypothyroidism
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Antithyroid Products
Action
• Stop the production of thyroid hormones
Uses
• Treatment of hyperthyroidism; to improve hyperthyroidism in
preparation for surgery or radioactive iodine therapy
Adverse Reactions
Drug Interactions
Nursing Implications and Patient Teaching
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