CHAPTER 30 - Pituitary Drugs Neuroendocrine System y Communicates with 50 million target cells in the body via hormones; y Hormones

large group of natural substances with chemical structures that are highly specific for causing physiological effects in the cells of their target tissues. Pituitary Hormones Two systems govern all bodily functions Hypothalamus: Part of the central nervous system (CNS) above and behind the pituitary gland; controls the pituitary gland. Pituitary gland: Anterior pituitary (adenohypophysis): y Adrenocorticotropic hormone (ACTH) targets adrenal gland; mediates adaptation to physical and emotional stress and starvation; redistributes body nutrients; promotes synthesis of adrenocortical hormone (glucocorticoids, mineralocorticoids, androgens); involved in skin pigmentation. o Cosyntropin (synthetic corticotrophin)/Cortrosyn: Diagnosis of adrenocortical insufficiency; reduction of inflammatory leukocyte functions, edema, and scar tissue formation; promotes kidney retention of sodium (which can result in edema and hypertension)  Stimulates release of cortisol from adrenal cortex  Is used to diagnose, but not treat, adrenocortical insufficiency  Is used in treatment of multiple sclerosis  Is used in treatment of corticotropin insufficiency caused by long-term corticosteroid use y Follicle-stimulating hormone (FSH) Stimulates oogenesis and follicular growth in females and spermatogenesis in males. o Menotropins : Same pharmacological effects as FSH; many of the other gonadotropins also stimulate FSH. y Growth hoemone (GH) Regulates anabolic processes related to growth and adaptation to stressors promotes skeletal and muscle growth; increases protein synthesis; increases liver glycogenolysis; increases fat metabolization. o Somatropin/somatrem, Humatrope: Human GH for hypopituitary dwarfism; promotes growth by stimulating anabolic (tissue-building) processes, including nitrogen retention and increased cellular protein synthesis; liver glycogenolysis (to raise blood sugar levels); lipid mobilization from body fat stores; and rentetion of sodium, potassium, and phosphorus; promotes linear growth in children who lack normal amounts of the endogenous hormone.  Are recombinantly made growth hormones (GH)  Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism o Octreotide/Sandostatin: A synthetic polypeptide structurally and pharmacologically similar to GH release-inhibiting factor, also called somatostatin; it inhibits the release of GH; reduces plasma concentrations of vasoactive intestinal polypeptide (VIP), a protein secreted by a type of tumour know as VIPoma that causes profuse watery diarrhea.  octreotide reduces severe diarrhea, flushing, and potentially life-threatening hypotension that may occur with a carcinoid crisis y Luteinizing hormone (LH) Stimulates ovulation and estrogen release by ovaries in females; stimulates interstitial cells in males tp promote spermatogenesis and testosterone secretion. o Gonadotropins: Many of the drugs discussed in chapter 34 stimulate LH. y Prolactin (PH) Targets mammary glands; stimulates lactogenesis and breast growth. o Bromocriptine: Inhibits action of PH and therefore inhibits lactogenesis. y Thyroid-stimulating hormone (TSH) Stimualtes secretion of thyroid hormone T and T by the thyroid. o Thyrotropin: Increases the production and secretion of thyroid hormones. Posterior pituitary (neurohypophysis): y Antidiuretic hormone (ADH) Increases water reabsorption in distal tubules and collecting duct of nephron; concentrates urine; causes potent vasoconstriction. o Vasopressin/Pressyn: ADH; performs all the physiological function of ADH; increase water reabsoprtion in the distal tubules and collecting ducts of the nephrons, resulting in concentrated urine and, thus, reduced water excretion by up to 90%;potent vasoconstrictor in larger doses and is thus used in certain hypotensive emergencies.  Used in the treatment of diabetes insipidus  Used in the treatment of various types of bleeding, especially gastrointestinal (GI) bleeding

o Desmopressin/DDAVP: A synthetic vasopressin; causes a dose-dependent increase in the plasma levels of factor VIII (antihemophilic factor), von Willebrand s factor (acts closely with factor VIII), and tissue plasminogen activator; useful for teating certain blood disorders  Used in the treatment of hemophilia A  Used in the treatment of type I von Willebrand s disease y Oxytocin Targets mammary glands; stimulates ejection of milk and contraction of uterine smooth muscle. o Pitocin: Has all the physiological actions of oxytocin (endogenous hormone) promoting uterine contractions. Hormones: Water soluble protein-based substance such as the catecholamines norepinephrine and epinephrine; receptors located on the cell s membrane; either directly activate the cell to perform a function or cause a chemical signal to be sent by means of a second messenger to generate an appropriate cellular response. Lipid soluble consists of the steroid and thyroid hormones; capable of crossing the plasma membrane through the process of simple diffusion and of binding with receptors within the cell nucleus, where they stimulate a specific response. Negative feedback loop: regulation of hormone secretion by monitoring and signalling activity of the endocrine system. Pituitary Drugs used as replacement therapy to balance a hormone deficiency and as diagnostic aids to determine whether there is hypofunction or hyperfunction of a patient s hormonal functions; differs depending on the drug; either augments or antagonizes the natural effects of the pituitary hormones. ASSESSMENT: medication history, hypersensitivity, baseline weight, BP, serum glucose levels, cholesterol, and electrolytes. y Small doses may initiate major physiological changes, so should be used with caution in patients with acute or chronic illnesses such as migraine headache, epilepsy, asthma, and other chronic disease processes. y Other growth hormones should be avoided when using other drugs that antagonize their effects. NURSING DX: y Disturbed body image r/t specific disease processes or drug adverse effects and their influence on physical characteristics. y Excess fluid volume r/t adverse effects of pituitary drugs. y Fatigue r/t adverse effects of the pituitary drugs. y Acute pain r/t gastrointestinal adverse effects of the pituitary drugs. y Deficient knowledge r/t new treatment with pituitary drugs. IMPLEMENTATION: y Csyntropin is available in IM, SC, and IV form and in a repository form. y Use 21-gauge needle for IM; y IV injections should be given over 2 minutes, or as designated in the packaging insert, and should bbe diluted with the recommended amounts of normal saline solution. y This drug should never be stopped orr doses changed without a physician s order. y Patient in long-term therapy will need to be weaned off the drug with medical supervision. y Dentists and other physicians involved in the patient s care should be aware of cosyntropin therapy up to the previous 12 months. y Patients receiving cosyntropin should avoid vaccinations during drug therapy. y Patients who are receiving synthetic corticotrophin and corticotrophin-like drugs should be encouraged to maintain adequate hydration of up to 2000mL per day, unless this is contraindicated. y Fluids should be low in sodium content, especially if the patient has heart disorders. y Report to physician if muscle twitching (positive Trouseau s sign or Chvostek s signs), from possible hypocalcemia, muscle weakness, numbness, tingling and cramping (from hypokalemia), nausea, vomiting, ECG changes, and irritability. y Emotional status, mood and ability to sleep may be affected by cosyntropin; these adverse effects or problems need to be monitored and documented throughout the treatment regimen. y Desmopressin should be administered according to physician s orders because it may vary for each indication (i.e., diabetes insipidus versus other forms of pituitary dysfunction). y Injection sites for somatropin should be rotated; injections are usually given SC (somatrem may be given IM as well).

y Vasopressin is administered IV, into the ventral gluteal muscle, orin the subcutaneous tissure but only as prescribed by the physician; to minimize adverse effects, drink on or two glasses of water when receiving this medication or as directed by the doctor. y Always check the clarity of the parenteral solutions before using the medication; if there are visible particles or any fluid discoloration, the solution should not be used. y Be alert to the adverse effects of nausea, diarrhea, pallor, abdominal pain, and flatus (gas); if these worsen or persist, the physician or health care provider should be notified immediately. y Severe headache, sweating, chest pain, tremors, heart irregularities, unexplained weight gain, blood in the stool, black tarry stools, or seizure activity should be reported to the physician. Michele s nursing implications: EVALUATION: Follow directions carefully for administration Maintain adequate hydration y For cosynotropin, there should be less inflammation and Sodium and potassium intake should be improved symptoms as related to the indication. decreased y For desmopressin and vasopressin, severe thirst should be Avoid vaccinations during drug therapy reduced and urinary output improved; may cause adverse Provide specific instructions for nasal spray effects similar to those of cosynotropin and somatropin but forms of vasopressin with additional adverse effects of hypertension, nausea, GI Rotate injection sites upset, tremors, respiratory distress, and drowsiness; allergic Drugs should not be discontinued abruptly reactions to these drugs may include rash, urticaria, fever, Advise patients not to take over-the-counter and dyspnea (if these problems occur, the drug should be products without checking with their health care provider discontinued and the physician notified). Parents of children who are receiving growth y With somatropin, increased growth should occur in patients hormones should keep a journal reflecting the in whom this is indicated. child s growth y For cosynotropin and somatropin, expected adverse effects include dependent edema, moon face, pulmonary edema, infection, and mental health status changes such as increased aggressive behaviour and irritability. y Somatropin may increase serum calcium levels. Patient Education: (1) Pt should be encouraged to avoid alcohol while taking these medications. (2) Pt should be encouraged to avoid abrupt discontinuation of these drugs because of the negative impact on pituitary hormones and the impact on blood levels of the hormones. (3) Pt should be counselled that the drug does not lead to a cure but does help alleviate the symptoms of the disease. (4) Pt and anyone else involved in their care should be properly educated in the routes and techniques of drug administration. With children, demonstration of the technique of administration should be done with the family or caregiver before discharge and re-evaluation with repeat demonstrations. Written instructions should always be used with patients of any age. (5) Pt should be encouraged to keep a journal about the drug therapy and how the drugs are being tolerated. (6) As with any medication or illness, patients should be encouraged to keep a medical alert bracelet, necklace, or card (in the wallet) on the individual at all times. (7) Pt should be encouraged to notify their physician if they experience fever, sore throat, joint pain, or muscular pain.