1. Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 30 Pituitary Drugs

2. 2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

3. 3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

4. 4 Pituitary Drugs  Anterior pituitary drugs  Cosyntropin  Somatotropin  Posterior pituitary drugs  Vasopressin  Somatrem  Octreotide  Desmopressin

5. 5 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Uses  Replacement therapy when a hormone deficiency is present  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. 6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Mechanism of Action  Differs depending on the drug  Either augments or antagonizes the natural effects of the pituitary hormones

7. 7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indications  cosyntropin (Cortrosyn)  Stimulates release of cortisol from adrenal cortex  Antiinflammatory effect  Promotes renal retention of sodium; may result in edema and HTN

8. 8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

9. 9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

10. 10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d)  Vasopressin and desmopressin  Used in the treatment of diabetes insipidus  Vasopressin: A powerful vasoconstrictor used for hypotensive emergencies, GI bleeding, and pulseless cardiac arrest  Desmopressin: Used for dose-dependent treatment of blood disorders; also used for nocturnal enuresis

11. 11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects  Adverse effects are specific to the individual drugs

12. 12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

13. 13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  cosyntropin (Cortrosyn)  IM, SC, IV forms, and gel and repository forms  Follow directions carefully for administration  Maintain adequate hydration  Decrease sodium and potassium intake  Avoid vaccinations during drug therapy

14. 14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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 SC

15. 15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate 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

16. 16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic responses  Cosyntropin 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 and vasopressin should reduce severe thirst and decrease urinary output  Octreotide should reduce symptoms of carcinoid crisis  Monitor for adverse effects