Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacology in Nursing Pituitary Drugs

Mosby items and derived items © 2007, 2005, 2002 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, govern all bodily functions  Hormones  Negative feedback loop

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

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

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

Mosby items and derived items © 2007, 2005, 2002 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

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

Mosby items and derived items © 2007, 2005, 2002 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

Mosby items and derived items © 2007, 2005, 2002 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  Unlabeled use: Control bleeding in esophageal varices

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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 Hemophilia A Type I von Willebrand’s disease Type I von Willebrand’s disease

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects Corticotropin: Sodium retention, hypokalemia, hyperpigmentation, convulsions, euphoria, psychosis Vasopressin: High BP, headache, flushing

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Obtain thorough nursing assessment, medication history  Assess for contraindications specific to each drug  Assess medication history for possible interactions

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Parents of children who are receiving growth hormones should keep a journal reflecting the child’s growth

Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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