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Chapter 30
Pituitary Drugs
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2. Neuroendocrine System: Pituitary Hormones
Hypothalamus
Part of the central nervous system
Pituitary gland
Anterior pituitary (adenohypophysis)
Posterior pituitary (neurohypophysis)
Together they govern all bodily functions.
Hormones
Negative feedback loop
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Pituitary Hormones
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Pituitary Drugs
Anterior pituitary drugs
cosyntropin
somatropin
octreotide
Posterior pituitary drugs
vasopressin
desmopressin
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Mechanism of Action
Differs depending on the drug
Either augments or antagonizes the natural effects of the pituitary hormones
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6. Audience Response System 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.
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Anterior Pituitary
Cosyntropin (Cortrosyn)
Stimulates release of cortisol from adrenal cortex
Antiinflammatory effect
Diagnosis of adrenocortical insufficiency
Wasting associated with human immunodeficiency virus infection
Promotes renal retention of sodium, which can result in edema and hypertension
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8. Anterior Pituitary (Cont.)
Somatropin and somatrem
Recombinantly made growth hormone (GH)
Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism
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9. Anterior Pituitary (Cont.)
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.
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10. Audience Response System 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.
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11. Posterior Pituitary Gland
Vasopressin and desmopressin
Mimic the action of antidiuretic hormone
Increase water resorption in the distal tubules and collecting ducts of the nephrons, and they concentrate urine, reducing water excretion by up to 90%
Used in the treatment of diabetes insipidus
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12. Posterior Pituitary Gland (Cont.)
Vasopressin
Potent vasoconstrictor
Hypotensive emergencies such as vasodilatory shock (septic shock)
Advanced Cardiac Life Support (ACLS): pulseless cardiac arrest.
Vasopressin is also used to stop bleeding of esophageal varices.
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13. Posterior Pituitary Gland (Cont.)
Desmopressin
Dose-dependent increase in the plasma levels of factor VIII (antihemophilic factor), von Willebrand factor (acts closely with factor VIII), and tissue plasminogen activator
Management of nocturnal enuresis
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14. Audience Response System 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 GH 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.
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Adverse Effects
Adverse effects are specific to the individual drugs.
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Nursing Implications
Obtain thorough nursing assessment and medication history.
Assess for contraindications specific to each drug.
Assess medication history for possible interactions.
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17. Nursing Implications (Cont.)
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 intravenously, intramuscularly, or subcutaneously.
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18. Nursing Implications (Cont.)
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 GHs should keep a journal reflecting the child’s growth.
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19. Nursing Implications (Cont.)
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.
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20. Audience Response System 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 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.
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Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.