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Chapter 44
Drugs for Pituitary, Thyroid, and Adrenal Disorders
| Question | Answer |
|---|---|
| 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 |
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alyxinwndrland
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