NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2

Adrenal Gland, GH, and ADHGROWTH HORMONE DISORDERS (Deficiency: small stature; Excess: Gigantism or Acromegaly)

Growth Hormone Agents

Deficiency

o GH replacement: somatropin

Somatropin= synthetic growth hormone that can be given for growth hormone

insufficiency

Somatotropin= natural growth hormone

o Therapy for small stature r/t GH

Children who are not growing properly

Can have growth hormone injections even if not documented deficiency

This is expensive though

Educate parents

For kids without hormone deficiency, maybe will only add an inch or two

With deficiency, could add 6+ inches, however side effects (increased risk of

diabetes)

Excess

o GH antagonist: octreotide

Can not be administered after a certain age, usually teen years, bc when apephyses seal

you won’t get added height, you will get acromegaly

Decreases GI motility (used for severe diarrhea)

One of the most common uses for this drug

o Therapy for acromegaly

Can give GH antagonist

Side effects of GH

o Hyperglycemia & DM

Diabetes in children is harder to manage bc they have more GH since they are growing

Revised 8/20117

NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2

Adrenal Gland, GH, and ADHo Acromegaly

Nursing implications & Patient Teaching

o Growth plates must not be sealed

o Monitor blood glucose

o Monitor height and weight through growth charts

ADRENAL CORTEX DISORDERS: Addison’s (Adrenal Insufficiency) and Cushing’s

Adrenal medulla is hard wired via nerves; Related to fight or flight response

Adrenal cortex is hormonal connection to sustain fight or flight response

Replacement therapy for endocrine disorders bc gland isn’t making any

Glucocorticosteroids

Mechanism of Action: Multiple actions and effects on metabolic processes

Indications

o Inflammatory processes, Cerebral edema, Cancer, Prevent organ transplant rejection

o Replacement therapy (cortisol & Addison’s disease)

Typical Examples (systemic) review

o Short Acting: Cortisone, hydrocortisone

o Intermediate Acting: Prednisone, methylprednisolone (most common)

o Long Acting: Bethamethasone, dexamethasone

Cushingoid Side Effects

Cataracts

Ulcers and gastric bleeding

Skin: striae, thinning, bruising, tears

HTN/ Hirsutism

Ingection

Necrosis of femoral head

Glycosuria

Revised 8/20117

NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2

Adrenal Gland, GH, and ADHObesity/Osteoporosis

Immunosuppression

Diabetes

More likely when taking exogenous glucocorticosteroids and already functioning adrenal gland(affects immune

system, skin, etc.)

Nursing Implications

o Give in the morning with food bc this is when normal cortisol levels rise

o Monitor labs

CBC- look at white count bc suppression of immune system

Blood Glucose bc they are linked with action of glucocorticosteroids

o Monitor V/S

BP

Weight particularly at start of therapy

Temp

o Dose adjustments and taper

o When we are under stress, adrenal gland responds to reduce this. With addison’s, be aware of

dose tapering (increase when sick to get over illness, etc.)

Patient Teaching

o Take exactly as prescribed bc if abrupt stopping Addison’s crisis (looks like CVD collapse)

Nothing activating BP, no mineralcorticosteroids (fluid retention), no reserve system

o Signs of infection may be masked w/ long term therapy

o Report increased stress (dose adjustment)

o Monitor blood sugar with long term therapy

o Report black tarry stools

Very hard on GI system

Take with food!! Significantly reduces risk of this

Revised 8/20117

NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2

Adrenal Gland, GH, and ADH See Corticosteroid slide

Mineralocorticoids

Typical Examples: fludrocortisone (basically synthetic aldosterone)

Mechanism of Action

o Reabsorb Na in kidney tubule

o K+ excretion

o Basically concentrate minerals in body (Na, hold onto water)

Not enough like with addison’s, do not hold onto sodium, CVD collapse

Indications: Replacement therapy for adrenal insufficiency (Addison’s)

o Take regularly

Side Effects: Fluid and electrolyte imbalances

o If we are conserving sodium, water follows, also exchanging for potassium

o Watch sodium and potassium levels of patient and signs of fluid imbalance (weight, I/O)

Nursing Implications

o Assess for s/sx of fluid retention

Body weight

Edema

SOB

BP increasing

o Labs

Monitor electrolytes

Hyper and hypo stiuations (REVIEW FROM UNIT 1)

Patient Teaching

o S/Sx inadequate dose

o Report signs of edema (increasing BP)

o Eat high potassium foods and avoid high-sodium foods

Revised 8/20117

NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2

Adrenal Gland, GH, and ADH Due to fact that we hold onto sodium and are losing potassium

o Dosage adjustment when under stress

Naturally aldosterone would come into play increasing BP, but does not occur here

POSTERIOR PITUITARY DISORDERS: Diabetes Insipidus and SIADH

Too little or too much water concentration

Affects electrolyte concentrations by diluting or not diluting body fluids

Diabetes insipidus

Typical examples

o desmopressin (DDAVP)

used with reduced or absent ADH

basically prevents copious amounts of urine output associated with this

synthetic

conserves water like normal ADH

nasal spray, but comes SubQ and oral (used less often)

o vasopressin

IV used critical care bc ability to raise BP very quickly

Ability to raise BP via -pressin affect (vasoconstriction to increase BP when not enough

fluid)

Mechanism of action

o Enhances water re-absorption

Indications

o Treatment of DI

Temporarily due to head trauma or due to life long deficiency

o Bedwetting

Preschool kids

If we give nasal spray, helps children retain fluid longer and stay dry during the night

Revised 8/20117

NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2

Adrenal Gland, GH, and ADHo VonWillbrand disease

Clotting factor disorder

When not enough vonwillebrand factor, bleeding results

This is used for this bc it activates and increases action of specific clotting factors

o CV collapse (vasopressin)

In ICU

Side effects: Too much medication = SIADH

o Increase BP too much

o Conserve too much water hyponatremia

o S/Sx of SIADH

o Managed by looking at specific gravity (how much stuff is in urine)

Concentration of stuff in urine compared to water

Teach patients to do this

Nursing Implications

o Intranasal form

Don’t inhale

Alternate nares to prevent irritation

Just want it to be absorbed, not

inhaled into respiratory tree

If highly congested (sinus infection/cold), this

interferes with absorption

Might be converted to SubQ injection for a short period of time

o Monitor effectiveness

Urine specific gravity

Should be 1.01-1.04

Digital machine

Revised 8/20117

NURS 3400Chapter 44: Drugs for Endocrine Disorders Part 2

Adrenal Gland, GH, and ADH I/O

BP

o Patient Teaching

Report nasal congestion

Monitor voiding pattern (I/O)

Should void 6-8 times per day minimum

Each void should be about 300 mL

Check urine specific gravity

Report <1.01 and >1.04

SIADH- a little more problematic

Holding onto fluid, too much water conservation, too much ADH

Treatment

o Fluid restriction and DDAVP dose adjustment to make sure you are not holding onto too much

o Demeclocycline (tetracycline antibiotic)

ADH receptor antagonist

Off label use for SIADH bc it has ability to antagonize receptors for ADH

Potentially a drug used in these circumstances

Revised 8/20117