Download Pharmacology and the Nursing Process, 4th ed. Lilley/Harrington

Chapter 30
Pituitary Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Neuroendocrine System:
Pituitary Hormones

Hypothalamus


Part of the CNS
Pituitary gland

Anterior pituitary (adenohypophysis)
 Posterior pituitary (neurohypophysis)

Together, they govern all bodily functions

Hormones
 Negative feedback loop
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
2
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
3
Pituitary Drugs

Anterior pituitary drugs

cosyntropin
 menotropins
 bromocriptine
 pergonal


somatropin
 somatrem
 octreotide
 thyrotropin
Posterior pituitary drugs



vasopressin
desmopressin
pitocin
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
4
Mechanism of Action


Differs depending on the drug
Either augments or antagonizes the natural
effects of the pituitary hormones
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
5
Classroom Response Question
Which effect does the nurse expect to see in a
patient receiving hydrocortisone (Solu-Cortef) ?
A. Increase in inflammatory leukocyte function
B. Reduction of scar tissue formation
C. Renal excretion of sodium
D. Hypotension
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
6
Indications

cosyntropin (Cortrosyn)



Stimulates release of cortisol from adrenal cortex
Antiinflammatory effect
Used in the diagnosis of adrenocortical insufficiency
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
7
Indications (cont’d)

Somatropin and somatrem

Recombinantly made growth hormone (GH)
 Stimulate skeletal growth in patients with deficient
GH, such as hypopituitary dwarfism
 Also used for wasting associated with human
immunodeficiency virus infection (HIV)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
8
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
 Also used for the treatment of esophageal varices
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
9
Classroom Response Question
When administering octreotide (Sandostatin) to a
patient, it is most important for the nurse to assess
which parameter?
A. Urine output
B. Blood sugar
C. Liver function tests
D. Electrocardiogram
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
10
Indications (cont’d)

Vasopressin and desmopressin



Used in the treatment of diabetes insipidus
Because of their vasoconstrictor properties, they are
useful in the treatment of various types of bleeding, in
particular gastrointestinal hemorrhage
Desmopressin is useful in the treatment of hemophilia
A and type I von Willebrand’s disease because of its
effects on various blood-clotting factors
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
11
Classroom Response Question
A patient will be receiving somatropin. The nurse
expects that the patient has which disorder?
A. Adrenocortical insufficiency
B. Hypopituitary dwarfism
C. Esophageal varices
D. Septic shock
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
12
Adverse Effects

Adverse effects are specific to the individual
drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
13
Nursing Implications



Obtain thorough nursing assessment and
medication history
Assess for contraindications specific to each
drug
Assess medication history for possible
interactions
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
14
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 subcut
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
15
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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
16
Nursing Implications (cont’d)

Monitor for therapeutic responses

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
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
17
Classroom Response Question
A patient is in pulseless cardiac arrest. Which
medication does the nurse anticipate
administering?
A. vasopressin
B. desmopressin
C. cosyntropin
D. somatropin
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
18