Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Chapter 30 Pituitary Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Neuroendocrine System: Pituitary Hormones Hypothalamus Part of the CNS Pituitary gland Anterior pituitary (adenohypophysis) Posterior pituitary (neurohypophysis) Together, they govern all bodily functions Hormones Negative feedback loop Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Pituitary Drugs Anterior pituitary drugs cosyntropin menotropins bromocriptine pergonal Posterior pituitary drugs vasopressin desmopressin pitocin somatropin somatrem octreotide thyrotropin Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Mechanism of Action Differs depending on the drug Either augments or antagonizes the natural effects of the pituitary hormones Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question Which effect does the nurse expect to see in a patient receiving hydrocortisone (Solu-Cortef) ? Increase in inflammatory leukocyte function Reduction of scar tissue formation Renal excretion of sodium Hypotension Correct answer: B Rationale: Hydrocortisone is the drug form of the hormone cortisol. Cortisol has many antiinflammatory effects, including reduction of inflammatory leukocyte functions and scar tissue formation. Cortisol also promotes renal retention of sodium, which can result in edema and hypertension. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Indications cosyntropin (Cortrosyn) Stimulates release of cortisol from adrenal cortex Antiinflammatory effect Used in the diagnosis of adrenocortical insufficiency Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Indications (cont’d) Somatropin and somatrem Recombinantly made growth hormone (GH) Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism Also used for wasting associated with human immunodeficiency virus infection (HIV) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 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 Also used for the treatment of esophageal varices Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question When administering octreotide (Sandostatin) to a patient, it is most important for the nurse to assess which parameter? Urine output Blood sugar Liver function tests Electrocardiogram Correct answer: B Rationale: Octreotide (Sandostatin) may cause alterations in blood glucose levels; closely monitor blood glucose during drug therapy. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Indications (cont’d) Vasopressin and desmopressin Used in the treatment of diabetes insipidus Because of their vasoconstrictor properties, they are useful in the treatment of various types of bleeding, in particular gastrointestinal hemorrhage Desmopressin is useful in the treatment of hemophilia A and type I von Willebrand’s disease because of its effects on various blood-clotting factors Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question A patient will be receiving somatropin. The nurse expects that the patient has which disorder? Adrenocortical insufficiency Hypopituitary dwarfism Esophageal varices Septic shock Correct answer: B Rationale: Somatropin is human growth hormone that is used for the treatment of hypopituitary dwarfism. Cosyntropin is used for the diagnosis of adrenocortical insufficiency. Octreotide is used for esophageal varices. Vasopressin is indicated for septic shock. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Adverse Effects Adverse effects are specific to the individual drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Nursing Implications Obtain thorough nursing assessment and medication history Assess for contraindications specific to each drug Assess medication history for possible interactions Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) octreotide (Sandostatin) May impair gallbladder function—instruct patient to report abdominal pain Use with caution in patients with renal impairment Monitor glucose levels in patients with diabetes, and even in those who do not have diabetes Can be given IV, IM, or subcut Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) Provide specific instructions for nasal spray forms of vasopressin Rotate injection sites Do not discontinue drugs abruptly Do not take over-the-counter products without checking with health care provider Parents of children who are receiving growth hormones should keep a journal reflecting the child’s growth Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implications (cont’d) Monitor for therapeutic responses Somatropin should increase growth in children Desmopressin and vasopressin should reduce severe thirst and decrease urinary output Octreotide should reduce symptoms of carcinoid crisis Monitor for adverse effects Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Classroom Response Question A patient is in pulseless cardiac arrest. Which medication does the nurse anticipate administering? vasopressin desmopressin cosyntropin somatropin Correct answer: A Rationale: Vasopressin is also a potent vasoconstrictor in larger doses and is therefore used in certain hypotensive emergencies, such as vasodilatory shock (septic shock). It is also used in the Advanced Cardiac Life Support (ACLS) guidelines for treatment of pulseless cardiac arrest. Desmopressin is useful in treating certain blood disorders. Cosyntropin is used in the diagnosis of adrenocortical insufficiency. Somatropin and somatrem are effective in stimulating skeletal growth in patients with an inadequate secretion of normal endogenous GH. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.