1. Endocrine Medications

2. Pituitary Medications
Anterior
Growth hormone (GH)
Somatrem (Protropin)
Somatropin (Humatrope)
Sermorelin (Geref)
Thyroid-stimulating hormone (TSH)
Adrenocorticotropic hormone (ACTH)
Gonadotropins
Follicle stimulating hormone (FSH)
Luteininzing hormone (LH)

3. Pituitary Medications
Posterior
Antidiuretic Hormone (ADH)
Vasopressin
Antidiuretic Hormones
Desmopressin acetate (DDAVP, Stimate)
Lypressin (Diapid)
Vasopressin (Pitressin)
Oxytocin

4. Using your DDAVP® Nasal Spray Pump
1. Remove protective cap.
2. The spray pump must be primed prior to the first use. To prime pump, press down 4 times.
3. Once primed, the spray pump delivers 10 micrograms of medication each time it is pressed. To ensure dosing accuracy, tilt bottle so that dip tube inside the bottle draws from the deepest portion of the medication.

5. Pituitary Medications
Posterior
Antidiuretic Hormones
Enhance reabsorption of water in the kidneys, promoting an antidiuretic effect and regulating fluid balance
Used in diabetes insipidus
Side effects
Flushing
Headache
Nausea and abdominal cramps
Water intoxication
Hypertension with water intoxication
Nasal congestion with nasal administration

6. Antidiuretic Hormones
Nursing Implementation
Monitor weight
Monitor I and O and urine Osmolality
Monitor electrolytes
Restrict fluids intake as prescribed to prevent water intoxication
Monitor for signs of water intoxication, such as drowsiness, listlessness, and headache
Instruct patient in use of intranasal medication
Instruct the patient to report signs of water intoxication or symptoms of headache or shortness of breath

7. Thyroid Hormones
Control the metabolic rate of tissues and accelerate heat production and oxygen consumption
To replace hormonal deficit in the treatment of hypothyroidism, myxedema, or cretinism
Enhance the action of oral anticoagulants, sympathomimetics, and antidepressants, and decrease the action of insulin, oral hypoglycemics, and digitalis preparations
Phenytoin (Dilantin) and ASA can enhance the action of thyroid hormone

8. Thyroid Hormones Levothyroxine (synthroid, Levethroid, Levoxyl)
Liothyronine (Cytomel)
Liotrix (Thyrolar)
Thyroglobulin (Proloid)
Thyroid (Thyrar)

9. Thyroid Hormones Side effects Nausea and vomiting Cramps and diarrhea
Weight loss
Nervousness and tremors
Headache
Hypertension
Tachycardia and dysrhythmias
Sweating and heat intolerance
Insomnia
Toxicity: Hyperthyroidism

10. Thyroid Hormones Nursing Implementation
Assess patient for history of medications currently being taken
Monitor vital signs
Monitor weight
Monitor triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels
Instruct patient to take the medication at the same time each day, preferably in the morning without food

11. Thyroid Hormones Nursing Implementation (continued)
Instruct patient in how to monitor pulse rate
Advise patient to report symptoms of hyperthyroidism (tachycardia, CP, palpitations, excessive sweating).
Instruct patient to avoid foods that can inhibit thyroid secretion (strawberries, peaches, pears, cabbage, turnips, spinach, kale, Brussels sprouts, cauliflower, radishes, peas)
Advise patient to avoid OTC meds
Instruct patient to wear Medic alert bracelet

12. Antithyroid Hormones Inhibit the synthesis of thyroid hormone
Used for hyperthyroidism, or Grave’s disease
Iodine solution (Lugol solution, potassium iodide solution
Methimazole (Tapazole)
Propylthiouricil (PTU)

13. Antithyroid Hormones Side effects Nausea and vomiting Diarrhea
Hypersensitivity
Agranulocytosis
Toxicity: Hypothyroidism
Iodism: characterized by vomiting, abdominal pain, metallic taste in the mouth, rash, sore salivary glands

14. Antithyroid Hormones Nursing Implementation Monitor vital signs
Monitor T3,T4 and TSH levels
Monitor weight
Instruct patient to take medication with meals to avoid GI upset
***note the difference between this and Synthroid**

15. Antithyroid Hormones Nursing Implementation (continued)
Instruct patient in how to monitor the pulse rate
Inform the patient of side effects and when to notify the physician
Advise patient to contact the physician if fever or sore throat develops
Instruct patient of signs of hypothyroidism
Instruct patient regarding the importance of medication compliance and that abruptly stopping the med could cause thyroid crisis (storm).

16. Antithyroid Hormones Nursing Implementation (continued)
Instruct patient to monitor for signs and symptoms of thyroid crisis (fever, flushed skin, confusion and behavioral changes, tachycardia, dysrhythmias and signs of heart failure.)
Instruct patient to monitor for signs of iodism
Advise patient to consult physician before eating iodized salt and iodine-rich foods
Instruct patient to avoid acetylsalicylic acid (ASA) and medications containing iodine

17. Parathyroid medications
Parathyroid hormone regulates serum calcium levels
Low serum levels of calcium stimulate parathyroid hormone release
Hyperparathyroidism results in a high serum calcium level and bone demineralization, and medication is used to lower the serum calcium level
Hypoparathyroidism results in a low serum calcium level, which increases neuromuscular excitability, and the treatment includes calcium and vitamin D supplements
Parathyroid and antihypercalemic agents may cause hypermagnesemia
Calcium salts administered with digoxin (Lanoxin) increases the risk of digoxin toxicity
Oral calcium salts reduce the absorption of tetracyline hydrochloride

18. Parathyroid medications
Nursing Implementation
Monitor electrolyte and calcium levels
Assess for signs and symptoms of hypocalcemia and hypercalcemia
Instruct patient in the S/S of hypercalcemia and symptoms of hypocalcemia and hypercalcemia
Assess for symptoms of tetany in client with hypocalcemia

19. Parathyroid medications
Nursing Implementation (continued)
Instruct the patient to check OTC medication labels for the possibility of calcium content
Instruct the patient receiving oral calcium to maintain an adequate intake of vitamin D, because vitamin D enhances absorption of calcium

20. Medications to treat calcium disorders
Calcium supplements
Caltrate 600, OsCal, Oysco, Rolaids, Tums
Citracal (Calcium citrate)
Vitamin D Supplements
Calcifediol (Calderol)
Calcitriol (Calcijex, Rocaltrol)
MILK- calcium and Vitamin D
Calcium Regulators
Alendronate (Fosamax)
Antihypercalcemics
Edetrate disodium (Disotate, Endrate)

21. Corticosteroids Produce metabolic effects
Alter normal immune response and suppress inflammation
Promote sodium and water retention and potassium excretion
Produce anti-inflammatory, anti-allergic, and anti-stress effects
May be used as a replacement for adrenocortical insufficiency

22. Corticosteroids Side Effects Hyperglycemia Hypokalemia
Sodium and water retention
Edema
Muscle wasting, osteoporosis, growth retardation in children, peptic ulcer, increased serum glucose levels, hypertension, convulsions, mood swings, cataracts, glaucoma, fragile skin, hirsutism, altered fat distribution
Mask the signs and symptoms of infection

23. Corticosteroids Contraindications and Cautions
Hypersensitivity, psychosis, fungal infection
Use with great caution in DM
Dexamethasone (Decadron) decreases the effects of oral anticoagulants and oral antidiabetic agents

24. Corticosteroids Contraindications and Cautions (continued)
Increase the potency of medications taken concurrently
ASA, NSAIDS (increasing risk of GI bleeding)
Use of potassium-wasting diuretics increases potassium loss, resulting in hypokalemia
Barbiturates, phenytoin (Dilantin) and Rifampin (Rifadin) decrease effect of prednisone
The action of dexamethasone (Decadron) is decreased by the use of phenytoin (Dilantin), theophylline, rifampin, barbiturates, and antacids

25. Corticosteroids Contraindications and Cautions (continued)
NSAIDs, ASA and estrogen increase the effect of dexamethasone (Decadron)
Should be used with extreme caution in patients with infections because they mask S/S of infection
Advise patient to wear Medic-Alert bracelet

26. Corticosteroids Monitor for hypokalemia and Hyperglycemia
Nursing Implementation
Monitor vital signs, I and O, weight
Monitor serum electrolytes and BS
Monitor for hypokalemia and Hyperglycemia
Monitor for hypertension
Assess medical history for glaucoma, cataracts, peptic ulcer, mental health disorders, or DM
Monitor for oseoporosis

27. Corticosteroids Nursing Implementation (continued)
Assess for changes in muscle strength
Prepare a schedule for patient on short-term, tapered doses (a pulse)
Instruct to take at mealtime or with food
Advise to eat foods high in potassium
Instruct patient to inform all health providers of taking medication
Instruct patient to avoid individuals with respiratory infections

28. Corticosteroids Nursing Implementation (continued)
Instruct patient to report S/S of a medication overdose or Cushing’s Syndrome, including moon face, puffy eyelids, edema in the feet, increased bruising, dizziness, bleeding and menstrual irregularities
Note that the patient may need additional doses during periods of stress such as surgery
Instruct patient NOT TO STOP medication abruptly! Abrupt withdrawal may result in severe adrenal insufficiency
Advise the patient to consult with the physician before receiving vaccinations
Advise patient to wear a Medic-Alert identification

29. Mineralcorticoids
Steroid hormones that enhance the reabsorption of sodium and chloride and promote the excretion of potassium and hydrogen from the renal tubules, thereby helping to maintain fluid and electrolyte balance
Used for replacement therapy in primary and secondary adrenal insufficiency in Addison’s Disease

30. Mineralocorticoids Medication: Fludrocortisone (Florinef)
Side Effects
Sodium and water retention
Hypokalemia
Hypocalcemia
Increased susceptibility to infection
Delayed wound healing
GI distress
Diarrhea or constipation
Increased appetite
Weight gain
Insomnia
Mood swings
Abdominal distention

31. Mineralocorticoids Nursing Implementation Monitor VS, weight
Monitor electrolytes and calcium level
Instruct patient to take medication with food and milk
Instruct to consume high-potassium diet
Instruct NOT TO STOP medication abruptly
Instruct to notify physician id signs of infection, muscle aches, sudden weight gain, or headaches occurs
Instruct to avoid exposure to disease or trauma
Instruct NOT TO TAKE ASA or other meds without consulting physician
Wear Medic-Alert ID

32. The End