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Pharmacology in Nursing Pituitary Drugs Mosby items and derived items © 2007, 2005, 2002 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, govern all bodily functions Hormones Negative feedback loop Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Pituitary Drugs Anterior pituitary drugs corticotropin somatotropin somatrem octreotide Posterior pituitary drugs vasopressin desmopressin Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Uses Replacement therapy to make up for hormone deficiency 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 Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Mechanism of Action Differs depending on the drug Either augments or antagonizes the natural effects of the pituitary hormones Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications corticotropin Stimulation of release of cortisol from adrenal cortex Used to diagnose, but not treat, adrenocortical insufficiency Multiple sclerosis Corticotropin insufficiency caused by long-term corticosteroid use Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d) somatropin and somatrem Recombinantly made growth hormone (GH) Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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 Unlabeled use: Control bleeding in esophageal varices Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d) vasopressin and desmopressin Used in the treatment of diabetes insipidus Used in the treatment of various types of bleeding, especially GI bleeding desmopressin is useful for: • Hemophilia A • Type I von Willebrand’s disease Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects Corticotropin: Sodium retention, hypokalemia, hyperpigmentation, convulsions, euphoria, psychosis Vasopressin: High BP, headache, flushing Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications Obtain thorough nursing assessment, medication history Assess for contraindications specific to each drug Assess medication history for possible interactions Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d) corticotropin IM, SC, IV forms, and gel and repository forms Follow directions carefully for administration Maintain adequate hydration Sodium and potassium intake should be decreased Avoid vaccinations during drug therapy Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d) Provide specific instructions for nasal spray forms of lypressin and vasopressin Rotate injection sites Drugs should not be discontinued abruptly Do not take OTC products without checking with health care provider Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d) Parents of children who are receiving growth hormones should keep a journal reflecting the child’s growth Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d) Monitor for therapeutic responses Corticotropin 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, vasopressin should reduce severe thirst and decrease urinary output Octreotide should reduce symptoms of carcinoid crisis Monitor for adverse effects Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
