Chap 30 Pituitary Drugs

Question 1

Neuroendocrine System: Pituitary Hormones**

Answer 1

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**

Question 2

Pituitary Hormones

Answer 2

Anterior Pituitary
Posterior Pituitary
Antidiuretic hormone(ADH)
Oxytocin(OT)
Prolactin(PRL)
Melanocyte stimulating hormone(MSH)
Gonadotropic hormones (FSH and LH)
Thyroid-stimulating hormone (TSH)
adrenocorticotropic hormone(ACTH)
growth hormone (GH)

Question 3

Pituitary Drugs

Answer 3

These drugs either mimic/augments or antagonizes the natural effects of the pituitary hormones
Anterior pituitary drugs**
cosyntropin *
somatropin*
octreotide*
Posterior pituitary drugs*
vasopressin*
desmopressin*

Question 3

Anterior Pituitary

Answer 3

Cosyntropin (Cortrosyn)- Hydrocortisone (Solu-Cortef)**
Stimulates* release of cortisol from adrenal* cortex
Anti-inflammatory effect- reduction of inflammatory leukocyte function and scar tissue formation (used for adrenal insufficiency)
Side Effects: Promotes renal retention of sodium, which can result in edema and hypertension
Somatropin and Somatrem-Humatrope, Nutropin, Serostim
Recombinantly made growth hormone (GH)**
Stimulate linear skeletal growth in patients with deficient GH, such as hypopituitary dwarfism
Also* used for patients with HIV** infection with wasting or cachexia in conjunction with antiviral therapy

Question 4

Anterior Pituitary

Answer 4

Octreotide (Sandostatin)**
Drug that antagonizes the effects of natural growth hormone (GH); It inhibits GH release
It is a synthetic polypeptide that is structurally and pharmacologically similar to GH release-inhibiting factor, which is also called somatostatin
It also reduces plasma concentration of vasoactive intestinal polypeptide (VIP), a protein secreted by a type of tumor known as VIPoma that causes profuse* diarrhea
Octreotide reduces the severe diarrhea, flushing, and potentially life-threatening hypotension* that may occur with a carcinoid crisis.

Also useful for treatment* ofesophageal varices
It may impair gall bladder function and needs to used with caution in patients with renal impairment
It may affect glucose regulation: severe hypoglycemia* in patients with type 1 diabetes; hyperglycemia* in patients with type 2* diabetes or in patients without diabetes
Octreotide may enhance toxic effects of drugs that prolong QT interval**
May be given IV, IM or SubQ
Pregnancy category B

Question 5

Posterior Pituitary Gland

Answer 5

Vasopressin (Pitressin)
prevent dehydration in patient with diabetes insipidus caused by deficiency* of endogenous ADH* (mimic the action of antidiuretic hormone)
Vasopressin* is also used to control various types of bleeding (GI hemorrhage), *pulseless arrest and vasodilatory shock (category C)- *potent vasoconstrictor *
IV, IM, Intranasal route; Watch for IV site closely (IV infiltration may lead to severe vasoconstriction and localized tissue necrosis)

Desmopressin (DDAVP)
treatment of hemophilia A** and type 1 Von Willebrand’s disease (effects blood-clotting factors**); management of nocturnal enuresis *
It causes dose-dependent increase in the plasma levels of factor VIII (antihemophilic factor), von Willebrand factor (acts closely with factor VIII), and tissue plasminogen activator.
PO, IV, Intranasal and Subcutaneous route

Question 6

Nursing Implications

Answer 6

Obtain thorough nursing assessment and medication history.
Assess for contraindications specific to each drug.
Assess medication history for possible interactions.
Provide specific instructions for nasal form 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.**

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.
Adverse effects**
with desmopressin and vasopressin includes increase BP, fever, headache, abdominal cramps, and nausea.
Growth hormone may lead to headache, hyperglycemia, hypothyroidism, hypercalcemia, and flu like syndrome.