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Unit 8
Chapter 43Drugs for Pituitary, Thyroid,
And Adrenal Disorders
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Endocrine System
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Endocrine System
Describe these terms associated with the endocrine system:– Gland– Hormone– Target tissue– Negative feedback – Biological effectGive an example of a negative feedback
process
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Endocrine System: General Concepts
• Regulates body processes• Narrow range• Hormones act as messengers • Controlled by hypothalamus and pituitary
glands What are the divisions of the pituitary gland? What hormones are released from each division?
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Hormones
Develop a table to identify hormones and discuss:– Where secreted– Target tissue– Action– Regulation of secretion– Feedback control – Characteristics of deficiency or excess– Metabolic effect
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Endocrine Pharmacotherapy
• Describe three reasons to administer hormone therapy.
• Describe why a hormone antagonist would be administered.
It is more effective to give drugs that affect secretion at the target organs.
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Growth Hormone
Agonist• Somatotropin • Stimulates cell growth and
metabolism• Deficiency → short stature• Severe deficiency → dwarfism• Recently approved for short
stature with normal GH levels• Costly
Why is GH contraindicated with epiphyseal closure?
Antagonist • Octreotide (Sandostatin)• Structurally R/T
somatostatin• Inhibits GH• Promotes fluid and
electrolyte reabsorption from GI tract
• Prolongs intestinal transit time
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Antidiuretic Hormone• conserves body water• Aka: vasopressin• Treatment of diabetes
insipidus• Desmopressin (DDVAP)
most common• Vassopressin (Pitressin)
prototype p. 665• Desmopressing and
lypressin have fewer side effects
Describe the physiologic process associated with ADH release and water conservation.
What are the key physiologic characteristics of Diabetes Insipidus?
What are the key nursing considerations of therapy?
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Thyroid Hormones
• Affect most body cells• Regulate BMR• Maintain blood pressure• Regulate G&D• Two cell types– Parafollicular cells– Follicular cells
• Travels via carrier protein
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Key points in Thyroid Pharmacology
• Thyroid disorders are common and drug therapy must be individualized.
What does this mean for the patient with a thyroid disorder? What are the goals of therapy?
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Thyroid Pharmacology
Hypothyroidism• Due to poor thyroid gland
function or low secretion of TSH
• Most are 2° to Hashimoto’s disease
• Myxedema• ↑ TSH ↓ T3 T4 levels• Treated with thyroid agents• Prototype: levothyroxine
(Synthroid) p. 669
Hyperthyroidism• Hypersecretion of thyroid
hormone• Graves’ Disease most
common• Symptoms opposite of
hypothyroidism• Prototype:
prophyllthiouracil (PTU) p. 671
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Nursing Considerations
• What are the pharmacologic nursing considerations for hypothyroidism?
• What teaching should be included?
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Nursing Considerations
• What are the pharmacologic nursing considerations for hyperthyroidism?
• What teaching should be included?
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Adrenal Glands
• Secrete three classes of steroids– Gonadocorticoids– Mineralocorticoids– Glucocorticoids
• Glucocorticoid Secretion controlled by: – CRF – ACTH
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ACTH Agents
• ACTH (corticotropin) available in three preparations:– Corticotropin injection– Repository corticotropin– Corticotropin zinc hydroxide
• Cosyntroppin (Cortrosyn) closely resembles ACTHUsed to diagnose adrenal disorders, rarely used to treat deficiencies
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Adrenal Insufficiency
• Hyposecretion of adrenal cortex or inadequate secretion of ACTH
• Sx: hypoglycemia, fatigue, hypotension, ↑ skin pigmentation, GI sx
• ↓ cortisol with ↑ ACTH level is diagnostic• Primary and Secondary • Replacement therapy
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Glucocorticoid Therapy
• Adrenal Insufficiency• Allergies• Asthma and COPD• Chronic Inflammatory Bowel Disease • Hepatic, neurological, and renal disorders characterized by
edema• Neoplastic disease• Post-transplant surgery• Rheumatic disorders• Shock• Skin disorders
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Nursing Considerations
• What are the nursing considerations in glucocorticoid therapy?
• What teaching should be included?
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Cushing’s Syndrome
• 2° to prolonged high levels of glucocorticoids• Excess ACTH, adrenal tumor, or
pharmacotherapy • S/S: adrenal atrophy, osteoporosis,
hypertension, ↑ risk of infection, delayed wound healing, peptic ulcers, acne, general obesity, moon face, buffalo hump, mood and personality changes
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Nursing Considerations
• What are the nursing considerations in Cushing’s syndrome?
• What should be included in teaching?