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Chapter 44

Drugs for Pituitary, Thyroid, and Adrenal Disorders

Hormone release commonly controlled by? Negative feedback
Hypothalamus talks to the ________to release hormones Pituitary gland
What is the treatment for growth hormone excess? Combination surgery, radiation therapy, and pharmacotherapy to suppress GH secretion or block GH receptors.
What is the pharmacotherapy treatment for growth hormone excess? Octreotide Pegvisomant Bromcriptine Lanreotide
What is the treatment for growth hormone deficiency? Somatroprin Accretin, genotropin Mecasermin Humatrope nutropin
Growth hormone is also called? Somatotropin
What are the manifestations of deficient amounts of ADH vs. excessive amounts of ADH? Deficiency;DI- Diabetes insipidious,Polyuria Hypernatremia,Polydyspia dehydration, Tx: desmopressin (DDAVP), vasopressin. Excess;SIADH- syndrome of inappropriate ADH, water intoxication, headache, nausea, mild abdominal pain, hypertension
Prototype drug: desmopressin (DDAVP, Stimate) Mechanism of action: Synthetic analog of human ADH, acts on the kidneys to increase water reabsorption, contracts smooth muscle of vascular system, uterus, and GI tract
Primary use of desmopressin (DDAVP, Stimate): Treatment of diabetes insipidus; also used for management of bleeding patients with hemophilia A
Adverse effects of desmopressin (DDAVP, Stimate): Water intoxication, headache, nausea, mild abdominal pain, hypertension
What should the nurse asses for in Antidiuretic Hormone Therapy for ADH Deficiency? Assess for electrolyte imbalances, changes in specific gravity and fluid intake. Vital signs, especially blood pressure and pulse. Assess neurologic status: Symptoms of headache. Changes in mental status: drowsiness, confusion. Avoid alcohol
Hypothyroid: Increased TSH, decrease t3 and t4
Hyperthyroidism: Decreased TSH, increase T3 and T4
Parafollicular cells in thyroid secrete________ and are responsible for? calcitonin, calcium homeostasis
Early symptoms of hypothyroidism are? General weakness, muscle cramps, and dry skin
What is the treatment for hypothyroidism? Natural or synthetic thyroid hormones. Especially levothyroxine (T4)
Adverse effects of levothyroxine? Hyperthyroidism, palpitations, dysrhythmias, anxiety, insomnia, weight loss, heat intolerance, menstrual irregularities and osteoporosis in women
What should the nurse asses in thyroid hormone therapy? Patient's weight and vital signs. Assess tachycardia, irregular heart rate, hypertension. Assess nervousness, weight loss, diarrhea, heat intolerance
What should the nurse monitor for in thyroid hormone therapy? Monitor patients with impaired renal function closely. Monitor for excess fatigue, slow speech, hoarseness, or slow pulse
Hyperthyroid is the most common cause in: Graves' disease
What is the goal in hyperthyroidism? To lower activity of thyroid
What is the treatment for hyperthyroidism? Administer thioamides, which decrease activity of thyroid gland. Propylthiouracil (PTU), methimazole (Tapazole), others. Radioactive iodide that kills overactive thyroid cells. Sodium iodide-131, Lugol's solution
Prototype drug: propylthiouracil (PTU) mechanism of action: To interfere with synthesis of T3 and T4 in thyroid gland. Also prevents conversion of T4 to T3 in target tissues
Primary use of propylthiouracil (PTU) : Administered to patients with hyperthyroidism
Adverse effects of propylthiouracil (PTU) : Symptoms of hypothyroidism. Rash and transient leukopenia most common side effects. Small percentage of patients experience agranulocytosis
Assessment for patients receiving antithyroid hormone therapy? Obtain complete health history & complete physical examination. Assess for presence and history of hyperthyroidism. Obtain laboratory studies T3, T4 levels, TSH level, ECG, CBC
Patient teaching for patients receiving antithyroid hormone therapy? Avoid children and pregnant women for one week after administration of radioactive iodine (I-131). Limit close physical contact with others for a few days
The adrenal cortex secretes? Glucocorticoids
Glucocorticoids functions? Mobilize body for long-term stress. Influence carbohydrate, lipid, and protein metabolism in most cells
Mineralocorticoids functions? Aldosterone promotes sodium reabsorption and potassium secretion
Gonadocorticoids are? Mostly male sex hormones (androgens)
Hypothalamus releases_______ and causes? Corticotropin-releasing factor (CRF). Adrenocorticotropic hormone (ACTH) to be secreted by pituitary.
Adrenal cortex releases: Glucocorticoids
When cortisol level rises: Negative-feedback mechanism shuts off further release of glucocorticoids
Addison's disease is? Primary adrenocortical insufficiency. Deficiency of both corticosteroids and mineralocorticoids
What are the symptoms of addison's disease? Nausea, vomiting, lethargy, confusion, and coma. Low plasma cortisol, accompanied by high plasma ACTH levels
Prototype drug: hydrocortisone (Aeroseb-HC, Alphaderm) mechanism of action? Acts as synthetic corticosteroid
Primary use of hydrocortisone (Aeroseb-HC, Alphaderm) Drug of choice for treating adrenocortical insufficiency
Adverse effects of hydrocortisone (Aeroseb-HC, Alphaderm)? Sodium and fluid retention. CNS effects: insomnia, anxiety, headache, vertigo, confusion, depression. Hypertension, tachycardia, peptic ulcer disease,Cushing syndrome. Can occur with long-term therapy
Anti adrenal Drugs? Used to treat severe Cushing syndrome
Antiadrenal drugs are not? Curative. Use usually limited to 3 months of therapy
Antiadrenal Therapy for Adrenocortical Insufficiency role of the nurse? Monitor for orthostatic hypotension and dizziness Assist with ambulation Caution patient to change positions slowly
Created by: alyxinwndrland