Transcript Pituitary Drugs

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
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Hypothalamus
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Pituitary gland
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Part of the CNS
Anterior pituitary (adenohypophysis)
Posterior pituitary (neurohypophysis)
Together, govern all bodily functions
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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
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Anterior pituitary drugs
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corticotropin
somatotropin
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somatrem
 octreotide
Posterior pituitary drugs
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vasopressin
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desmopressin
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Uses
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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
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Mechanism of Action
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Differs depending on the drug
Either augments or antagonizes the natural
effects of the pituitary hormones
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Indications
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corticotropin
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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
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Indications (cont’d)
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somatropin and somatrem
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Recombinantly made growth hormone (GH)
Stimulate skeletal growth in patients with deficient
GH, such as hypopituitary dwarfism
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Indications (cont’d)
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octreotide (Sandostatin)
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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
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Indications (cont’d)
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vasopressin and desmopressin
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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
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Adverse Effects
Corticotropin: Sodium retention, hypokalemia,
hyperpigmentation, convulsions, euphoria,
psychosis
Vasopressin: High BP, headache, flushing
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Nursing Implications
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Obtain thorough nursing assessment,
medication history
Assess for contraindications specific to each
drug
Assess medication history for possible
interactions
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Nursing Implications (cont’d)
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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
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Nursing Implications (cont’d)
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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
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Nursing Implications (cont’d)
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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)
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Monitor for therapeutic responses
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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.