PYRAMID POINTS CHAPTER 54: ENDOCRINE MEDICATIONS

PYRAMID POINTSPYRAMID POINTS

CHAPTER 54:CHAPTER 54:

ENDOCRINE ENDOCRINE MEDICATIONSMEDICATIONS

Elsevier items and derived items © 2008 by Saunders, an imprint of Elsevier Inc.

ADULT HEALTH: Endocrine Medications

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I. Pituitary MedicationsI. Pituitary Medications DescriptionDescription

• Administered to replace deficient amounts of hormones Administered to replace deficient amounts of hormones secreted by the anterior and posterior pituitary glandsecreted by the anterior and posterior pituitary gland

• The anterior pituitary gland secretes growth hormone The anterior pituitary gland secretes growth hormone (GH), thyroid-stimulating hormone (TSH), (GH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), prolactin, adrenocorticotropic hormone (ACTH), prolactin, melanocyte-stimulating hormone (MSH), and melanocyte-stimulating hormone (MSH), and gonadotropins (follicle-stimulating hormone [FSH] and gonadotropins (follicle-stimulating hormone [FSH] and luteinizing hormone [LH])luteinizing hormone [LH])

• The posterior pituitary gland secretes antidiuretic The posterior pituitary gland secretes antidiuretic hormones (vasopressin) and oxytocinhormones (vasopressin) and oxytocin



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I. Pituitary Medications (continued)I. Pituitary Medications (continued) Growth hormones and related medicationsGrowth hormones and related medications

• Assess child’s physical growth; compare with standardsAssess child’s physical growth; compare with standards

• Monitor blood glucose levels, thyroid function testsMonitor blood glucose levels, thyroid function tests

• Teach client, family signs of hyperglycemia, importance Teach client, family signs of hyperglycemia, importance of follow-up blood testsof follow-up blood tests



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II. Antidiuretic HormonesII. Antidiuretic Hormones DescriptionDescription

• Enhance reabsorption of water in kidneys, promoting Enhance reabsorption of water in kidneys, promoting antidiuretic effect, regulating fluid balanceantidiuretic effect, regulating fluid balance

Side effectsSide effects• Include flushing, headache, water intoxication, Include flushing, headache, water intoxication,

hypertensionhypertension



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II. Antidiuretic Hormones (continued)II. Antidiuretic Hormones (continued) InterventionsInterventions

• Monitor strict intake and output; urine osmolalityMonitor strict intake and output; urine osmolality• Monitor daily weights, vital signsMonitor daily weights, vital signs• Monitor electrolyte serum levelsMonitor electrolyte serum levels• Restrict fluid intake as prescribedRestrict fluid intake as prescribed• Monitor for signs of water intoxication, including Monitor for signs of water intoxication, including

drowsiness, listlessness, headachedrowsiness, listlessness, headache• Instruct client how to use intranasal spray medicationInstruct client how to use intranasal spray medication• Instruct client to report any signs of water intoxication, Instruct client to report any signs of water intoxication,

dyspnea, SOB, headache to primary health care providerdyspnea, SOB, headache to primary health care provider



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III. Thyroid HormonesIII. Thyroid Hormones DescriptionDescription

• Control metabolic rate of tissues; accelerate heat production, Control metabolic rate of tissues; accelerate heat production, oxygen consumptionoxygen consumption

• Should be given at least 4 hours apart from multivitamins, Should be given at least 4 hours apart from multivitamins, aluminum hydroxide, magnesium hydroxide, simethicone, aluminum hydroxide, magnesium hydroxide, simethicone, calcium carbonate, bile acid sequestrants, iron, sucralfate calcium carbonate, bile acid sequestrants, iron, sucralfate (Carafate)(Carafate)

Side effectsSide effects• Include weight loss, nervousness, insomnia, diaphoresis, Include weight loss, nervousness, insomnia, diaphoresis,

tachycardia, hypertension, chest palpitations, chest paintachycardia, hypertension, chest palpitations, chest pain InterventionsInterventions

• Instruct client to take medication at same time each day, Instruct client to take medication at same time each day, preferably in morning, without foodpreferably in morning, without food

• Advise client to report symptoms of hyperthyroidism Advise client to report symptoms of hyperthyroidism (tachycardia, chest pain, palpitations, diaphoresis)(tachycardia, chest pain, palpitations, diaphoresis)



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IV. Antithyroid MedicationsIV. Antithyroid Medications DescriptionDescription

• Inhibit synthesis of thyroid hormoneInhibit synthesis of thyroid hormone

Side effectsSide effects• Include agranulocytosis with leukopenia, Include agranulocytosis with leukopenia,

thrombocytopenia, hypothyroidism (toxic response), thrombocytopenia, hypothyroidism (toxic response), iodismiodism



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IV. Antithyroid Medications (continued)IV. Antithyroid Medications (continued) InterventionsInterventions

• Instruct client how to take pulseInstruct client how to take pulse

• Advise client to contact physician if fever, sore throat developsAdvise client to contact physician if fever, sore throat develops

• Instruct client regarding importance of medication complianceInstruct client regarding importance of medication compliance

• Advise client to consult physician before eating iodized salt, Advise client to consult physician before eating iodized salt, foods containing iodinefoods containing iodine

• Instruct client to avoid acetylsalicylic acid (aspirin), medications Instruct client to avoid acetylsalicylic acid (aspirin), medications containing iodinecontaining iodine

• Monitor for signs of thyroid storm (fever, flushed skin, Monitor for signs of thyroid storm (fever, flushed skin, confusion, behavioral changes, tachycardia, dysrhythmias, confusion, behavioral changes, tachycardia, dysrhythmias, signs of heart failure)signs of heart failure)



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V. Parathyroid MedicationsV. Parathyroid Medications DescriptionDescription

• Regulate serum calcium levelsRegulate serum calcium levels

• Hyperparathyroidism results in high serum calcium Hyperparathyroidism results in high serum calcium levels, bone demineralizationlevels, bone demineralization

• Hypoparathyroidism results in low serum calcium levels, Hypoparathyroidism results in low serum calcium levels, neuromuscular excitabilityneuromuscular excitability



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V. Parathyroid Medications (continued) V. Parathyroid Medications (continued) InterventionsInterventions

• Assess for symptoms of tetany in client with hypocalcemiaAssess for symptoms of tetany in client with hypocalcemia

• Instruct client to maintain intake of vitamin D if receiving oral Instruct client to maintain intake of vitamin D if receiving oral calcium supplementscalcium supplements

• Instruct client receiving calcium regulators to Instruct client receiving calcium regulators to Swallow tablet whole with water at least 30 minutes before Swallow tablet whole with water at least 30 minutes before

breakfast breakfast Not to lie down for at least 30 minutesNot to lie down for at least 30 minutes

• Instruct client using antihypercalcemic agents to avoid foods Instruct client using antihypercalcemic agents to avoid foods rich in calcium, including green leafy vegetablesrich in calcium, including green leafy vegetables

• Instruct client not to take other medications within 1 hour of Instruct client not to take other medications within 1 hour of taking calcium saltstaking calcium salts



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VI. Corticosteroids (Mineralocorticoids)VI. Corticosteroids (Mineralocorticoids) DescriptionDescription

• Used for replacement therapy in primary or secondary Used for replacement therapy in primary or secondary adrenal insufficiency in Addison’s diseaseadrenal insufficiency in Addison’s disease

Side effectsSide effects• Include sodium and water retention, hypokalemia, Include sodium and water retention, hypokalemia,

hypertension, weight gainhypertension, weight gain



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VI. Corticosteroids (Mineralocorticoids) VI. Corticosteroids (Mineralocorticoids) (continued)(continued) InterventionsInterventions

• Instruct client not to stop medication abruptlyInstruct client not to stop medication abruptly

• Instruct client to take medication with food or milkInstruct client to take medication with food or milk

• Instruct client to consume diet high in potassium as Instruct client to consume diet high in potassium as prescribedprescribed

• Instruct client to notify physician if signs of infection, Instruct client to notify physician if signs of infection, muscle aches, sudden weight gain, headache occurmuscle aches, sudden weight gain, headache occur

• Instruct client not to take aspirin products without Instruct client not to take aspirin products without consulting physicianconsulting physician



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VII. Corticosteroids (Glucocorticoids)VII. Corticosteroids (Glucocorticoids) DescriptionDescription

• Alter the normal immune response, suppress inflammationAlter the normal immune response, suppress inflammation

• Promote sodium and water retention, potassium excretion Promote sodium and water retention, potassium excretion

• Produce anti-inflammatory, antiallergic, antistress effects Produce anti-inflammatory, antiallergic, antistress effects

• May be used as replacement for adrenocortical insufficiencyMay be used as replacement for adrenocortical insufficiency Side effectsSide effects

• Include hyperglycemia, Include hyperglycemia, hypokalemia, hypokalemia, sodium and fluid sodium and fluid retention, weight gain, mood swings, moon face and buffalo retention, weight gain, mood swings, moon face and buffalo hump, increased susceptibility to infection, hirsutismhump, increased susceptibility to infection, hirsutism



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VII. Corticosteroids (Glucocorticoids) VII. Corticosteroids (Glucocorticoids) (continued)(continued) Contraindications and cautionsContraindications and cautions

• Should be used with caution in clients with DMShould be used with caution in clients with DM

• Use with extreme caution in clients with infections Use with extreme caution in clients with infections

InterventionsInterventions• Instruct client to take medication with foodInstruct client to take medication with food

• Instruct client to avoid individuals with infectionsInstruct client to avoid individuals with infections

• Instruct client to eat diet high in potassium as prescribedInstruct client to eat diet high in potassium as prescribed

• Instruct client to report signs of Cushing’s syndromeInstruct client to report signs of Cushing’s syndrome



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VIII. AndrogensVIII. Androgens DescriptionDescription

• Used to replace deficient hormones, treat hormone-Used to replace deficient hormones, treat hormone-sensitive disorderssensitive disorders

Side effectsSide effects• Include hepatotoxicity, jaundiceInclude hepatotoxicity, jaundice



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VIII. Androgens (continued)VIII. Androgens (continued) InterventionsInterventions

• Monitor for edema, weight gain, skin changesMonitor for edema, weight gain, skin changes

• Assess for liver dysfunction, including right upper Assess for liver dysfunction, including right upper quadrant abdominal pain, malaise, fever, jaundice, quadrant abdominal pain, malaise, fever, jaundice, pruritispruritis

• Assess for development of secondary sexual Assess for development of secondary sexual characteristicscharacteristics

• Instruct client to notify physician if fluid retention occursInstruct client to notify physician if fluid retention occurs

• Instruct women clients to use nonhormonal contraceptive Instruct women clients to use nonhormonal contraceptive while on therapywhile on therapy



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IX. Estrogens and ProgestinsIX. Estrogens and Progestins DescriptionDescription

• Preparations may be used to stimulate endogenous Preparations may be used to stimulate endogenous hormones to restore hormonal balance; treat hormone-hormones to restore hormonal balance; treat hormone-sensitive tumors; for contraception sensitive tumors; for contraception

Contraindications and cautionsContraindications and cautions• EstrogensEstrogens

Contraindicated in clients with breast cancer, endometrial Contraindicated in clients with breast cancer, endometrial hyperplasia, endometrial cancer, history of hyperplasia, endometrial cancer, history of thromboembolism, known or suspected pregnancy or thromboembolism, known or suspected pregnancy or lactationlactation

Barbiturates, phenytoin (Dilantin), rifampin (Rifadin) Barbiturates, phenytoin (Dilantin), rifampin (Rifadin) decrease effectivenessdecrease effectiveness



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IX. Estrogens and Progestins (continued) IX. Estrogens and Progestins (continued) Contraindications and cautions (continued)Contraindications and cautions (continued)

• ProgestinsProgestins Contraindicated in clients with thromboembolic disorders; Contraindicated in clients with thromboembolic disorders;

should be avoided in clients with breast tumors, hepatic should be avoided in clients with breast tumors, hepatic diseasedisease

Side effectsSide effects• Hypertension, stroke, myocardial infarction, Hypertension, stroke, myocardial infarction,

thromboembolismthromboembolism InterventionsInterventions

• Instruct client not to smokeInstruct client not to smoke• Instruct client to undergo routine breast and pelvic Instruct client to undergo routine breast and pelvic

examinationsexaminations



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X. ContraceptivesX. Contraceptives DescriptionDescription

• Usually taken for 21 consecutive days, stopped for 7 days; Usually taken for 21 consecutive days, stopped for 7 days; cycle then repeatedcycle then repeated

• Risk factors include smoking, obesity, hypertensionRisk factors include smoking, obesity, hypertension

• Contraindicated in women with hypertension, thromboembolic Contraindicated in women with hypertension, thromboembolic disease, cerebrovascular or coronary artery disease, cancer, disease, cerebrovascular or coronary artery disease, cancer, pregnancypregnancy

• Should be avoided with use of hepatotoxic medicationsShould be avoided with use of hepatotoxic medications Side effectsSide effects

• Breakthrough bleeding; excessive cervical mucus formation; Breakthrough bleeding; excessive cervical mucus formation; breast tenderness; hypertension; nausea and vomitingbreast tenderness; hypertension; nausea and vomiting



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X. Contraceptives (continued) X. Contraceptives (continued) InterventionsInterventions

• Instruct client to report signs of thromboembolic complicationsInstruct client to report signs of thromboembolic complications• Advise client to use alternative form of birth control when taking Advise client to use alternative form of birth control when taking

antibioticsantibiotics• Instruct client to perform breast self-examination (BSE) monthlyInstruct client to perform breast self-examination (BSE) monthly• If client decides to discontinue contraceptive to become If client decides to discontinue contraceptive to become

pregnant, recommend alternative form of birth control for 2-pregnant, recommend alternative form of birth control for 2-month periodmonth period

• If using patch and it remains off for less than 24 hours, reapplyIf using patch and it remains off for less than 24 hours, reapply• If using patch and it is off longer than 24 hours, new 4-week If using patch and it is off longer than 24 hours, new 4-week

cycle must be started immediatelycycle must be started immediately



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XI. Fertility MedicationsXI. Fertility Medications DescriptionDescription

• Act to stimulate follicle development, ovulation in Act to stimulate follicle development, ovulation in functioning ovaries; combined with human chorionic functioning ovaries; combined with human chorionic gonadotropin to maintain follicles once ovulation has gonadotropin to maintain follicles once ovulation has occurredoccurred

• Contraindicated in presence of primary ovarian Contraindicated in presence of primary ovarian dysfunction, thyroid or adrenal dysfunction, ovarian dysfunction, thyroid or adrenal dysfunction, ovarian cysts, pregnancy, idiopathic uterine bleedingcysts, pregnancy, idiopathic uterine bleeding

• Should be used with caution in clients with Should be used with caution in clients with thromboembolic or respiratory diseasesthromboembolic or respiratory diseases



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XI. Fertility Medications (continued)XI. Fertility Medications (continued) Side effectsSide effects

• Risk of multiple births, birth defectsRisk of multiple births, birth defects

InterventionsInterventions• Instruct client on administration of medicationInstruct client on administration of medication

• Instruct client on when intercourse should occur to Instruct client on when intercourse should occur to increase therapeutic effectiveness of medicationincrease therapeutic effectiveness of medication

• Instruct client about risks and hazards of multiple birthsInstruct client about risks and hazards of multiple births

• Instruct client about regular follow-up careInstruct client about regular follow-up care



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XII. Medications for Erectile DysfunctionXII. Medications for Erectile Dysfunction DescriptionDescription

• Cause smooth muscle relaxation; promote blood flow into Cause smooth muscle relaxation; promote blood flow into corpus cavernosumcorpus cavernosum

• Contraindicated in presence of anatomical obstruction or Contraindicated in presence of anatomical obstruction or condition that might predispose to priapism; contraindicated in condition that might predispose to priapism; contraindicated in clients with penile implantsclients with penile implants

• Sildenafil, tadalafil, vardenafil used cautiously in clients with Sildenafil, tadalafil, vardenafil used cautiously in clients with coronary artery disease (CAD), active peptic ulcer disease, coronary artery disease (CAD), active peptic ulcer disease, bleeding disorders, retinitis pigmentosa.bleeding disorders, retinitis pigmentosa.

• Sildenafil, tadalafil, vardenafil cannot be administered to clients Sildenafil, tadalafil, vardenafil cannot be administered to clients taking nitrates, nitroprusside, taking nitrates, nitroprusside, ββ-blockers-blockers



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XII. Medications for Erectile Dysfunction XII. Medications for Erectile Dysfunction (continued)(continued) Side effectsSide effects

• Pain at injection site; rash; hypertension (alprostadil)Pain at injection site; rash; hypertension (alprostadil)

• Headache; flushing; dyspepsia; rash; insomniaHeadache; flushing; dyspepsia; rash; insomnia

InterventionsInterventions• Inform client of side effects about which physician needs Inform client of side effects about which physician needs

to be informedto be informed

• Perform a thorough assessment of health and Perform a thorough assessment of health and medication historymedication history



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XIII. Medications for Diabetes MellitusXIII. Medications for Diabetes Mellitus Insulin and oral hypoglycemic medicationsInsulin and oral hypoglycemic medications

-adrenergic blocking agents may mask signs, -adrenergic blocking agents may mask signs, symptoms of hyperglycemia symptoms of hyperglycemia

• Corticosteroids, sympathomimetics, thiazide diuretics, Corticosteroids, sympathomimetics, thiazide diuretics, phenytoin (Dilantin), thyroid preparations, oral phenytoin (Dilantin), thyroid preparations, oral contraceptives, estrogen compounds may cause contraceptives, estrogen compounds may cause hyperglycemiahyperglycemia

• Side effects of sulfonylurea oral hypoglycemics include Side effects of sulfonylurea oral hypoglycemics include gastrointestinal symptoms, hypoglycemiagastrointestinal symptoms, hypoglycemia

Chlorpropamide (Diabinese) can cause disulfiram Chlorpropamide (Diabinese) can cause disulfiram (Antabuse)-type reaction when alcohol ingested(Antabuse)-type reaction when alcohol ingested



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XIII. Medications for Diabetes Mellitus XIII. Medications for Diabetes Mellitus (continued) (continued) Oral hypoglycemic medicationsOral hypoglycemic medications

• Obtain medication historyObtain medication history

• Instruct client not to ingest alcohol with sulfonylureasInstruct client not to ingest alcohol with sulfonylureas

• Inform client that insulin may be needed during stress, Inform client that insulin may be needed during stress, surgery, infectionsurgery, infection

• Teach client about signs and symptoms of hypoglycemia Teach client about signs and symptoms of hypoglycemia and hyperglycemiaand hyperglycemia



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XIII. Medications for Diabetes Mellitus XIII. Medications for Diabetes Mellitus (continued) (continued) InsulinInsulin

• Onset, peak, duration of action depend on insulin typeOnset, peak, duration of action depend on insulin type• Storing insulin: Storing insulin:

Avoid extreme temperatures Avoid extreme temperatures Do not freeze or keep in direct sunlightDo not freeze or keep in direct sunlight

• Insulin injection sites: Main areas include abdomen, Insulin injection sites: Main areas include abdomen, arms (posterior surface), thighs (anterior surface), hipsarms (posterior surface), thighs (anterior surface), hips

• Mixing NPH and Regular insulin: Draw up clear (Regular) Mixing NPH and Regular insulin: Draw up clear (Regular) insulin before cloudy (NPH) insulininsulin before cloudy (NPH) insulin



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XIII. Medications for Diabetes Mellitus XIII. Medications for Diabetes Mellitus (continued)(continued)

• Administering insulinAdministering insulin Before use, swirl vial gently or rotate between palms, but Before use, swirl vial gently or rotate between palms, but

avoid vigorous shaking.avoid vigorous shaking. Administer mixed dose within 5 to 15 minutes of Administer mixed dose within 5 to 15 minutes of

preparationpreparation Regular insulin is only type of insulin that can be Regular insulin is only type of insulin that can be

administered IVadministered IV



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XIII. Medications for Diabetes Mellitus (continued)XIII. Medications for Diabetes Mellitus (continued) Exubera (insulin, human [rDNA origin]) inhalation powderExubera (insulin, human [rDNA origin]) inhalation powder

• Causes decrease in pulmonary functionCauses decrease in pulmonary function• Pulmonary function studies done before treatment starts, Pulmonary function studies done before treatment starts,

periodically during treatmentperiodically during treatment• Contraindicated in client who smokes, starts smoking, or quits Contraindicated in client who smokes, starts smoking, or quits

smoking less than 6 months prior to beginning treatment, in smoking less than 6 months prior to beginning treatment, in clients with unstable or poorly controlled lung disease, in clients with unstable or poorly controlled lung disease, in pregnant clients, in clients younger than 18 yearspregnant clients, in clients younger than 18 years

Exenatide (Byetta)Exenatide (Byetta)• Used for clients with type 2 DM Used for clients with type 2 DM • Administered as subcutaneous injection within 60 minutes Administered as subcutaneous injection within 60 minutes

before morning and evening mealsbefore morning and evening meals



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XIII. Medications for Diabetes Mellitus (continued)XIII. Medications for Diabetes Mellitus (continued) Pramlintide (Symlin)Pramlintide (Symlin)

• Used for clients with type 1 or 2 DM Used for clients with type 1 or 2 DM

• Associated with increased risk of hypoglycemiaAssociated with increased risk of hypoglycemia GlucagonGlucagon

• Used to treat insulin-induced hypoglycemiaUsed to treat insulin-induced hypoglycemia

• Instruct family in procedure for administrationInstruct family in procedure for administration Diazoxide (Proglycem)Diazoxide (Proglycem)

• Used to treat hypoglycemia caused by hyperinsulinism resulting Used to treat hypoglycemia caused by hyperinsulinism resulting from islet cell cancer or hyperplasiafrom islet cell cancer or hyperplasia

• Not used for hypoglycemic reactions from insulinNot used for hypoglycemic reactions from insulin



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A diabetic client taking daily NPH insulin has been started on A diabetic client taking daily NPH insulin has been started on therapy with dexamethasone (Decadron). The nurse anticipates therapy with dexamethasone (Decadron). The nurse anticipates that which of the following adjustments in medication dosage that which of the following adjustments in medication dosage will be made?will be made?

1. Decreased NPH insulin1. Decreased NPH insulin

2. Increased NPH insulin2. Increased NPH insulin

3. Lower dose of dexamethasone than usual3. Lower dose of dexamethasone than usual

4. Higher dose of dexamethasone than usual4. Higher dose of dexamethasone than usual



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The nurse has given medication information to the client who is The nurse has given medication information to the client who is beginning hormone replacement therapy with levothyroxine beginning hormone replacement therapy with levothyroxine (Synthroid). The nurse determines that the client can recognize (Synthroid). The nurse determines that the client can recognize signs of medication toxicity if the client states that he or she will signs of medication toxicity if the client states that he or she will report which of the following to the physician?report which of the following to the physician?

1. Heat intolerance1. Heat intolerance

2. Slow pulse rate2. Slow pulse rate

3. Low body temperature3. Low body temperature

4. Drowsiness4. Drowsiness

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PYRAMID POINTS CHAPTER 54: ENDOCRINE MEDICATIONS