ENDOCRINE SYSTEM MEDICATIONS

by: JAY LAPAZ ANDRES, RN BSN, MAN ©

I. MEDICATIONS AFFECTING THE PITUITARY GLAND

II. MEDICATIONS AFFECTING THE ADRENAL GLANDS

III. MEDICATIONS AFFECTING THE THYROID GLANDS

IV. MEDICATIONS AFFECTING THE PARATHYROID GLANDS

V. MEDICATIONS USED TO TREAT DIABETES MELLITUS

MEDICATIONS AFFECTING THE PITUITARY GLAND

A. Growth hormone (GH) or GH suppressants

ACTION and USE:a. stimulates growth and metabolism of

all body cellsb. ACTION: determines adult physical size

by regulating growth of organs and tissues, specifically length of long bones

c. USE: approved only for use in children to treat GH deficiency or inadequate GH secretion related to documented lack of GH.

*** REDUCE GH LEVELS; BROMOCRIPTINE MAY MANAGE AMENORRHEA ASSOCIATED WITH PROLACTINEMIA, SYTMPTOMS OF PARKINSON’S OR ACROMEGALY.

Administration consideration:1. Only given parenterally (IM/SQ)2. Oral route is inactivated by digestive

enzymes3. Is packaged in powder form and is

reconstituted for administration with 1 to 5 ml of approved diluents; mixture must be clear and not cloudy.

4. Discard refrigerated drug accdg to manufacturer’s direction

5. Rotate IM sites

COMMON MEDICATIONS:GROTH HORMONE SUPPRESSANTS:

1. Bromocriptine (parlodel)2. Ocreotide (sandostatin)

GROWTH HORMONE1. Sermorelin (geref)2. Somatrem (protropin)3. Somatropin (humatrope,nutropin)

plasma GH levels to confirm deficiency ( <5 to 7 ng/ml)

Side Effects:1. metabolic- glucose intolerance,

hypothyroidism2. renal-hypercalcemia during the first 2

to 3 months of treatment, risk of renal calculi, GI upset, urinary frequency, chills, fever, and hematuria

Adverse Effects:1. local allergic reaction: pain and edema

at injection site2. systemic allergic reaction: peripheral

edema, headache, myalgia, and weakness

3. excess dosage: diabetes mellitus, atherosclerosis, enlarged organs, hypertension

Nursing considerations:1. make sure there is documentation of

growth rate for at least 6 to 12 months prior to initiating

2. assess client for any adverse effects or toxicities related to drug administration

3. make sure annual bone age assessments are performed, especially for clients undergoing thyroid,estrogen replacement therapy.

CLIENT EDUCATION:1. REGULAR BONE AGE ASSESSMENT2. 3 to 5 inch growth rate is expected in

the 1st year and less in the 2nd year3. Document accurately height and weight

B. ANTIDIURETIC HORMONE (ADH)

ACTION and USE:a. ACTION: on renal tubules to promote

reabsorption of water, vasopressor effect due to constriction of smooth muscle; increase aggregation of platelets

b. USE: is a pituitary hormone for replacement therapy for clients with DI; also for use in hemophilia A, von willebrand’s disease type 1

Administration consideration:1. Give intranasally, intravenously , subQ,

IM or intra arterially accdg to order and preparation

2. Infusion pump needed for IV/intraarterial routes

Side effects:1. CNS: drowsiness, headache, lethargy2. EENT: nasal congestion, rhinitis3. GI; abdominal cramps, nausea and

hurtburn4. GU: pain in vulva5. CV: Elevated BP6.

Adverse effects:1. IV route may cause anaphylaxis2. Overdose may produce symptoms of

water intoxication

Nursing considerations:1. Check alertness to rule out water

intoxication disorientation, lethargy2. Initial dose in the evening and amount

is increases until uninterrupted sleep is noted

3. Check BP and pulse before IV and SubQ4. Measure I and O

5. Weigh daily

Client education:1. Avoid alcohol2. Do not double dose3. Report nasal congestion

COMMON MEDICATIONS:1. Desmopressin (DDAVP, stimate)2. Lypressin (diapid)3. Vasopressin (pitressin)

MEDICATIONS AFFECTING THE ADRENAL GLANDS

A. MINERALOCORTICOIDS

ACTION and USE: a. A mineralocorticoid is a steroid

hormone that acts on kidneys to retain sodium and water and release potassium

b. Synthesis is regulated by RASc. Replacement hormone therapy is

required with missing mineralocorticoid action; which occurs in adrenal gland failure or hypofunction

Administration consideration:1. Fludrocortisone acetate is drug of

choice2. Is given orally from 0.1 mg 3

times/week to 0.2 mg/day

Side effects:1. Sodium and fluid retention2. Nausea3. Acne4. Impaired wound healing

Adverse effects:1. Occurs rarely but use cautiously in

clients with heart disease, CHF or HPN2. Thromboembolism3. Aggravation or masking infection

Nursing considerations:

1. Is used with glucocorticoids for replacement therapy

2. Monitor serum electrolytes level3. Monitor weight and I and O. report

weight gain of 5 lb/week4. Monitor/record BP5. Check for signs of overdose related to

hypercorticism (psychosis, excess weight gain, edema, CHF, increased appetite, severe insomnia and elevated BP)

6. Give daily doses before 9am to mimic peak corticosteroid blood levels

7. Check signs of underdosage: weight loss, poor appetite, nausea, vomiting, diarrhea, muscular weakness, increased fatigue, and low BP

COMMON MEDICATIONS:1. Cortisone (cortone)2. Fludrocortisones (florinef)3. Hydrocortisone (cortof)

Client education:1. Report signs of low potassium

associated with high sodium (muscle weakness, paresthesias, fatigue, anorexia, nausea)

2. Eat foods high in potassium3. Salt intake regulates drug effect, report

signs of edema4. Weigh self daily, report gain5. Report any infections

B. GLUCOCORTICOIDS

Action and Use:a. A glucocorticoid is a steroid hormone

that affects carbohydrate, protein, and fat metabolism and has an anti inflammatory and immunosuppressive activity. Its synthesis is regulated by pituitary gland; may regulate metabolism of skeletal and connective tissues

b. Is used in acute ADRENAL INSUFFICIENCY (inability of adrenal glands to produce sufficient

adrenocortical hormones) caused by trauma or thrombosis; chronic primary adrenal insufficiency (also known as ADDISON’s Diasease)

c. In allergic conditions (asthma, transfusion reaction and serum sickness)

d. In dermatitis and pemphiguse. In Chron’s disease and ulcerative colitisf. In bursitis

Nursing considerations:1. Check BP, lung sounds, weight, nausea

and vomiting and signs of dependent edema

2. Check skin for striae, thinning, bruising, change in color, change in hair growth and acne

3. Check stool for occult blood4. Take with meals (oral) and avoid alcohol5. Avoid skin testing during therapy

COMMON MEDICATIONS:1. BETAMETHASONE (CELESTRONE)2. Cortisone (cortone)3. Hydrocortisone (cortef)4. Triamcinolone (aristacort, kenacort)

C. ADRENOCORTICOTROPIC HORMONE (ACTH)

Action and Use:a. Directly stimulates adrenal cortex to

synthesize adrenal steroidsb. Used to diagnose adrenal disorders

such as Addison’s disease and secondary adrenal insufficiency caused by pituitary dysfunction

c. Used in treatment of adrenocorticoid-responsive doiseases, such as multiple sclerosis

Side effects:1. Nausea and vomiting2. Dizziness3. drowsiness4. light headedness

Adverse effects:

1. urticaria2. pruritis3. dizziness4. anaphylactic shock5. cataracts6. glaucoma7. hirsutism8. amenorrhea9. sodium and water retention10. potassium and calcium loss11. hyperglycemia12. osteoporosis

Nursing considerations:1. monitor BP and assess for dizziness,

fever, flushing, rash and urticaria2. monitor plasma or urinary cortisol

levels and serum electrolytes3. monitor growth and development in

children4. do not discontinue5. low salt or potassium diet if ordered6. oral dose with food, milk or meals7. avoid driving

COMMON MEDICATIONS:1. corticotrophin (acthar)2. cosyntropin (cortrosyn)3. metyrapone (metopirone)