Pharmacology in Nursing Pituitary Drugs

Neuroendocrine System: Pituitary Hormones Hypothalamus Part of the CNS Pituitary gland Anterior pituitary (adenohypophysis) Posterior pituitary (neurohypophysis) Together, govern all bodily functions Hormones Negative feedback loop

Pituitary Drugs Anterior pituitary drugs Posterior pituitary drugs corticotropin somatotropin Posterior pituitary drugs vasopressin somatrem octreotide desmopressin

Uses Replacement therapy to make up for hormone deficiency Drug therapy to produce a specific hormone response when a hormone deficiency is present Diagnostic aids to determine hypofunction or hyperfunction of a specific hormonal function

Mechanism of Action Differs depending on the drug Either augments or antagonizes the natural effects of the pituitary hormones

Indications corticotropin Stimulation of release of cortisol from adrenal cortex Used to diagnose, but not treat, adrenocortical insufficiency Multiple sclerosis Corticotropin insufficiency caused by long-term corticosteroid use

Indications (cont’d) somatropin and somatrem Recombinantly made growth hormone (GH) Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism

Indications (cont’d) octreotide (Sandostatin) Carcinoid tumors secrete VIP (vasoactive intestinal polypeptide) VIP causes profuse, watery diarrhea Octreotide reduces this severe diarrhea, flushing, and potentially life-threatening hypotension that may occur with a carcinoid crisis Unlabeled use: Control bleeding in esophageal varices

Indications (cont’d) vasopressin and desmopressin Used in the treatment of diabetes insipidus Used in the treatment of various types of bleeding, especially GI bleeding desmopressin is useful for: Hemophilia A Type I von Willebrand’s disease

Adverse Effects Corticotropin: Sodium retention, hypokalemia, hyperpigmentation, convulsions, euphoria, psychosis Vasopressin: High BP, headache, flushing

Nursing Implications Obtain thorough nursing assessment, medication history Assess for contraindications specific to each drug Assess medication history for possible interactions

Nursing Implications (cont’d) corticotropin IM, SC, IV forms, and gel and repository forms Follow directions carefully for administration Maintain adequate hydration Sodium and potassium intake should be decreased Avoid vaccinations during drug therapy

Nursing Implications (cont’d) Provide specific instructions for nasal spray forms of lypressin and vasopressin Rotate injection sites Drugs should not be discontinued abruptly Do not take OTC products without checking with health care provider

Nursing Implications (cont’d) Parents of children who are receiving growth hormones should keep a journal reflecting the child’s growth

Nursing Implications (cont’d) Monitor for therapeutic responses Corticotropin should eliminate pain associated with inflammation and produce increased comfort and muscle strength in patients with multiple sclerosis Somatropin should increase growth in children Desmopressin, vasopressin should reduce severe thirst and decrease urinary output Octreotide should reduce symptoms of carcinoid crisis Monitor for adverse effects