1. Pharmacology in Nursing Pituitary Drugs

2. 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

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

5. 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

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

7. 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

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

9. 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

10. 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

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

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

13. 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

14. 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

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

16. 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