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Pharmacology > Chapter 30 Pituitary Agents > Flashcards

Chapter 30 Pituitary Agents Flashcards

1
Q

Maintenance of physiologic stability is the main goal of the endocrine system. It communicates with the nearly 50 million target cells in the body using a chemical “language” called?

A

hormones. Hormone secretion is commonly regulated by a negative feedback loop.

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2
Q

The hypothalamus and pituitary gland (referred to as neuroendocrine system) function together as an integrated unit, with the primary direction coming from the?

A

hypothalamus

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3
Q

The pituitary gland is composed of two distinct lobes called the anterior pituitary gland (adenohypophysis) and posterior pituitary gland (neurohypophysis). Each lobe secretes its own set of hormones:

A
  • Anterior: thyroid-stimulating hormone, growth hormone (GH), adrenocorticotropic hormone (ACTH), prolactin, follicle-stimulating hormone, luteinizing hormone
  • Posterior: antidiuretic hormone (ADH), oxytocin
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4
Q

Hormones are either?

A

Water or lipid soluble

  • water soluble hormones are protein-based substances such as the catecholamiens norepinephrine and epinephrine
  • lipid soluble hormones consist of the steroid and thyroid hormones
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5
Q

The activity of the endocrine system is regulated by?

A

A system of surveillance and signaling usually dictated by the body’s ongoing needs. Hormone secretion is commonly regulated by a negative feedback loop.

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6
Q

Pituitary drugs are used to either mimic or antagonize the action of endogenous pituitary hormones. Drugs that mimic the action of endogenous pituitary hormones include?
A drug that antagonizes the actions of endogenous pituitary hormones is?

A
  • Drugs that mimic the action of endogenous pituitary hormones include vasopressin and desmopressin
  • drug that antagonizes the actions of endogenous pituitary hormones is octreotide, which suppresses or inhibits certain symptoms related to carcinoid tumors.
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7
Q

Hormones of the anterior pituitary gland (Adenohypophysis)

A

1) Adrenocorticotropic hormone (ACTH)
2) Follicle-stimulating hormone (FSH)
3) Growth Hormone (GH)
4) Luteinizing hormone (LH)
5) Prolactin (PH)
6) Thyroid stimulating hormone (TSH)

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8
Q

Hormones of the posterior pituitary gland (Neurohypophysis)

A

1) Antidiuretic hormone (ADH)

2) Oxytocin

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9
Q

Drugs are generally used either as replacement drug therapy to make up for a hormone deficiency or as diagnostic aids to determine the status of the patient’s hormonal functions. They either?

A

augment or antagonize the natural effects of the pituitary hormones.

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10
Q

The mechanism of action of the various pituitary drugs differ depending on?

A

The drug, but overall they either augment or antagonize the natural effects of the pituitary hormones

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11
Q

Exogenously administered corticotropin elicits?

A

all of the same pharmacologic responses as those elicited by endogenous corticotropin (known as ACTH).

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12
Q

Intravaneous exogenous corticotropin is no longer manufactured; however, an intramuscular/subcutaneous injection, known as H.P. Acthar Gel, is available. The intravaneous corticotropin has been replaced by?

A

Cosyntropin (Cortrosyn).

  • Cosyntropin travels to the adrenal cortex, located just above the kidney, and stimulates the secretion of cortisol (the drug form of which is hydrocortison)
  • Cortisol has many anti-inflammatory 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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13
Q

The drugs that mimic GH are?

A

somatropin and somatrem. These drugs promote growth by stimulating various anabolic (tissue-building) processes, liver glycogenolysis (to raise blood sugar levels), lipid mobilization from body fat stores, and retention of sodium, potassium, and phosphorus. Both drugs promote linear growth in children who lack normal amounts of the endogenous hormone.

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14
Q

Octreotide is a drug that?

A
  • antagonizes the effects of natural GH by inhibiting GH release. It does so by inhibiting GH release. Octreotide is a synthetic polypeptide that is structurally and pharmacologically similar to GH release-inhibiting factor, which is also called somatostatin.
  • It also reduces plasma concentrations of vasoactive intestinal polypeptide (VIP), a protein secreted by a type of tumor known as a VIPoma that causes profuse watery diarrhea.
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15
Q

The drugs that affect the posterior pituitary gland?

A

such as vasopressin and desmopressin, mimic the actions of the naturally occurring ADH. They increase water resorption in the distal tubules and collecting ducts of the nephrons, and they concentrate urine, reducing water excretion by up to 90%.

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16
Q

Vasopressin is also a?

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 Advanced Cardiac Life Support guidelines for treatment of pulseless cardiac arrest.
- Vasopressin is also used to stop bleeding of esophageal varices

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17
Q

Desmopressin causes a?

A

dose-dependent increase in the plasma levels of factor VIII (antihemophilic factor), von Willebrand factor (acts closely with factor VIII), and tissue plasminogen activator. These properties make it useful in treating certain blood disorders including hemophilia A and type I von Willebrand’s disease.
- Desmopressin also used for management of nocturnal enuresis.

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18
Q

The drug form of oxytocin does what?

A

mimics the endogenous hormone, thus promoting uterine contractions.

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19
Q

Cosyntropin is used in the diagnosis of?

A

adrenocortical insufficiency. Upon diagnosis, the actual drug treatment generally involves replacement hormonal therapy using drug forms of the deficient corticosteroid hormones.

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20
Q

Somatropin and somatrem are human GH produced by recombinant technology. They are effective in stimulating?

A

Skeletal growth in patients with an inadequate secretion of normal endogenous GH, such as those with hypopituitary dwarfism, and are also used for wasting associated with human immunodeficiency virus (HIV) infection.

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21
Q

Octreotide is useful in?

A

alleviating certain symptoms of carcinoid tumors stemming from the secretion of VIP, including severe diarrhea and flushing and potentially life threatening
hypotension associated with a carcinoid crisis. It
is also used for the treatment of esophageal varices.

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22
Q

Vasopressin and desmopressin are used t?

A

prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous ADH. Because of their vasoconstrictor properties, they are useful in the treatment of various types of bleeding, in particular gastrointestinal hemorrhage.
- Desmopressin useful in Tx of hemophilia A and type I von Willebrand’s disease because of its effects on various blood-clotting factors

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23
Q

Contraindications for pituitary drugs

A

Contraindications for each drug varies.
-because even small amounts of these drugs can initiate major physiologic changes, they need to be used with special caution in pt’s w/acute or chronic illnesses such as MIGRAINE HA, EPILEPSY, ASTHMA

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24
Q

Anterior pituitary hormone: Adrenocorticotropic hormone (ACTH)

A

Targets adrenal gland; mediates adaption to physical and emotional stress and starvation; redistributes body nutrients; promotes synthesis of adrenocortical hormones (glucocorticoids, mineralocortioids, adrogens); involved in skin pigmentation
-Cosyntropin: Used for diagnosis of adrenocortical insufficiency

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25
Q

Anterior pituitary hormone: Follicle-stimulating hormone (FSH)

A

Stimulates oogeneiss and follicular growth in females and spermatogenesis in males
-Menotropins: Same pharmacologic effects as FSH; many of the other gonadotropins also stimulate FSH

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26
Q

Anterior pituitary hormone: Growth hormone (GH)

A

Regulates anabolic processes related to growth & adaption to stressors; promotes skeletal and muscle growth; increases protein synthesis; increases liver glycogenolysis; increases fat mobilization

  • somatropin, somatrem: Human GH for treatment of hypopituitary dwarfism
  • Octreotide: A synthetic polypeptide structurally and pharmacologically similar to GH release-inhibiting factor; inhibits GH
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27
Q

Anterior pituitary hormone: Luteinizing hormone (LH)

A

Stimulates ovulation & estrogen release by ovaries in females; stimulates interstitial cells in males to promote spermatogenesis and testosterone secretion
-pergonal and clomiphene: increase LH levels and the chance of pregnancy

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28
Q

Anterior pituitary hormone: Prolactin

A

Targets mammary glands; stimulates lactogenesis & breast growth in females; purpose in males is poorly understood
-Bromociptine: Inhibits action of prolactin and inhibits lactogenesis

29
Q

Anterior pituitary hormone: Thyroid stimulating hormone (TSH)

A

Stimulates secretion of thyroid hormones T3 & T4 by the thyroid gland
-Thyrotropin: increases production & secretion of thyroid hormones

30
Q

Posterior pituitary hormone: Antidiuretic hormone (ADH)

A

Increases water resorption in distal tubules and collecting duct of nephron; concentrates urine; causes potent vasoconstriction

  • vasopressin: ADH; performs all the physiologic functions of ADH
  • Demopressin: A synthetic vasopressin
31
Q

Posterior pituitary hormone: Oxytocin

A

Targets mammary glands; stimulates ejection of milk and contraction of uterine smooth muscle
-Pitocin: Has all the physiologic actions of oxytocin

32
Q

Octreotide: Common adverse effects

A
  • CNS: Fatigue, malaise, HA
  • Endocrine: Increase/decrease in blood glucose levels
  • GI: Diarrhea, N/V
  • Respiratory: Dyspnea
  • Musculoskeletal: Arthralgia
  • Cardiovascular: Conduction abnormalities
33
Q

Desmopressin and Vasopressin: Common adverse effects

A
  • Cardiovascular: Increased BP
  • CNS: Fever, vertigo, HA
  • GI: Nausea, heartburn, cramps
  • GU: Uterine cramping
  • Other: Nasal irritation and congestion, tremor, sweating
34
Q

Growth hormone Analogues: Common adverse effects

A
  • CNS: HA
  • Endocrine: hyperglycemia, hypothyroidism
  • GU: Hypercalciuria
  • Other: Rash, urticaria, development of antibodies to GH, inflammation at injection site, flulike syndrome
35
Q

Drug profile: Octreotide (Sandostatin)

A
  • useful in alleviating certain symptoms of carcinoid tumors stemming from the secretion of VIP, including severe diarrhea and flushing and potentially life-threatening hypotension associated with carcinoid crisis
  • also for tx of esophageal varices
  • contraindicated in pt’s who have hypersensitivity to is or any of its components
  • may impair gallbladder function & needs to be used w/caution in pt’s w/renal impairment
  • may affect glucose regulation, & severe hypoglycemia may occur in pt’s w/type 1 diabetes
  • may cause hyperglycemia in pt’s w/type 2 diabetes or in pt’s w/out
  • may enhance toxic effects of drugs that prolong the QT interval
  • Ciprofloxacin may enhance the QT-prolonging effects of octreotide
  • IV, IM, Subcutaneously
  • Pregnancy B
36
Q

Drug profile: Vasopressin (Pitressin)

A
  • Vasopressin & desmopressin for prevent or control polydipsia (excessive thrist), polyuria, dehydration in pt’s w/diabetes insipidus caused by deficiency of endogenous ADH
  • also used to control various types of bleeding (GI hemorrhage) & in pulseless arrest and vasodilatory shock
  • Desmopressin useful in Tx of hemophilia A and type I von Willibrand’s disease because of its effects on various blood-clotting factors
  • Contraindicated: hypersensitivity
  • Pregnancy C
  • caution w/seizure disorders, asthma, cardiovascular disease, renal disease
  • IV Infiltration may lead to severe vasoconstriction & localized tissue necrosis
  • watch IV site closely for any signs of infiltration, & use central venous access device
  • available as nasal spray or injection for IM or IV use
  • when used to Tx septic shock, given by continuous IV infusion
  • both drugs can be given via the nasal route
  • vasopressin nasal applied topically to nasal membranes & must NOT be inhaled
  • Desmopresvia nasal pump
37
Q

Desmopressin interactions

A
  • Interacting drug: carbamazepine >enhanced desmopressin effects
  • interacting drug: lithium, alcoho, demeclocycline> reduced desmopressin effects
38
Q

Octreotide interactions

A
  • Cyclosporine> case report of transplant rejections

- thioridazine, ciprofloxacin> prolongation of QT interval

39
Q

Somatropin interactions

A

-glucocorticoids> reduction of growth effects

40
Q

Vasopressin interactions

A
  • carbamazepine, fludrocortisone > enhanced antidiuretic effect
  • demeclocycline, norepinephrine, lithium> reduced antidiuretic effect
41
Q

In the assessment of patients receiving pituitary hormones, measure?

A

baseline vital signs, review blood glucose levels, and

measure weight.

42
Q

Assess the patient’s height, weight, and vital signs, and take a complete medication history with notation of?

A

allergies, prescription drug use, and use of over-the-counter (OTC) drugs and herbals.

43
Q

With octreotide, the prescriber may order an electrocardiogram (ECG) before use because of the?

A

adverse effect of conduction abnormalities. Assess baseline glucose levels, and assess respiratory status and gallbladder disorders with octreotide acetate use.
-Patients taking octreotide may require special dosing if
they have decreased liver and kidney function; therefore,
assess and record baseline liver and kidney function test
results.
-assess for sound alike look alike drugs: octreotide acetate, or sandostatin and sandostatin LAR are not to be confused with Sandimmune (cyclosporine) or Sandoglobulin (IV immune globulin)

44
Q

It is also important to be sure that assessment includes steps to prevent medication errors as well as awareness of concerns regarding look-alike sound-alike drugs.

A

-assess for sound alike look alike drugs: octreotide acetate, or sandostatin and sandostatin LAR are not to be confused with Sandimmune (cyclosporine) or Sandoglobulin (IV immune globulin)

45
Q

With desmopressin, check vital signs and assess for a history of?

A

seizures, asthma, or cardiovascular disease. These conditions require cautious use with careful monitoring of vital signs, heart sounds, and breath sounds. Perform a thorough nursing assessment with documentation of the patient’s height, weight, and vital signs, and obtain a complete medication history with notation of allergies, prescription drug use, and use of OTC drugs and herbals.

46
Q

If vasopressin is being administered for shock, close monitoring in an intensive care setting is needed with?

A

ECG, vital signs, and other possibly invasive monitoring methods such as arterial lines, central venous pressure lines, and/or arterial blood gases

47
Q

in patients receiving GHs obtain?

A

Obtain baseline thyroid, glucose, and calcium levels in
patients receiving GHs due to the potential side effects of
hyperglycemia, hypothyroidism, and hypercalciuria.

48
Q

Use of somatropin requires attention to the?

A

growth, motor skills, height, and weight of the pediatric patient.

49
Q

Octreotide must be given as ordered with attention to the?

A

route of administration. To avoid giving the wrong medication, be careful not to confuse octreotide acetate injection with the injectable depot suspension dosage form. Use only clear solutions, and always check for incompatibilities.
-Make sure patients understand the importance of immediately reporting to the prescriber any abdominal distress such as diarrhea, nausea, or vomiting if not manageable. Stress the importance of follow-up appointments for laboratory testing during treatment with this drug.
-Octreotide may cause alterations in blood glucose levels;
closely monitor blood glucose during drug therapy, especially if patients are already diabetic.

50
Q

Administer desmopressin per the prescriber’s orders because dosage and route may vary with the indication. Dosage forms include?

A

oral, IV, intranasal, and subcutaneous

  • for desmopressin and somatropin, rotate subcutaneious and/or intramuscular injection sites
  • Mix injectable solutions by gently swirling the liquid, using only clear solutions. If used in patients diagnosed with diabetes insipidus, fluid intake may be adjusted according to the predicted risk of water intoxication and sodium deficit.
  • intranasal use may lead to changes in the nasal mucosa w/unpredictable drug absorption.
  • if used in pt’s diagnosed w/diabetes insipidus, fluid intake may be adjusted according to the predicted risk for water intoxication and sodium deficit
51
Q

For patients receiving somatropin, constantly monitor levels of?

A

thyroid hormones and GHs. Include measurement of vital

signs, intake/output, and weight in the assessment.

52
Q

Vasopressin is available as a nasal spray or as an injection for IM or intravenous use. Always check the?
- be alert to the AEs of?

A

clarity of parenteral solutions before administering the medication, and discard the solution if there are visible particles or any fluid discoloration.
-Be alert to the adverse effects of elevated blood
pressure, fever, nausea, abdominal cramping, or diarrhea.

53
Q

With octreotide, therapeutic effects include?

A

improved symptoms related to carcinoid tumors, VIPoma, or esophageal varices.

54
Q

With vasopressin, an improvement in?

A

diabetes insipidus, esophageal varices, or vasodilatory shock is expected.

55
Q

With somatropin, increased growth is expected in patients with?

A

GH deficiency. Adverse effects to assess for include
fatigue, headache, altered blood glucose levels, diarrhea,
nausea, vomiting, conduction disorders, and dyspnea.

56
Q

Adverse effects associated with desmopressin and vasopressin include?

A

increased blood pressure, fever, headache, abdominal

cramps, and nausea. GHs may lead to headache, hyperglycemia, hypothyroidism, hypercalciuria, and flu-like syndrome.

57
Q

Growth hormones may lead to

A

HA, hyperglycemia, hypthyroidism, hypercalciuria, & flulike syndrome

58
Q

Intranasal dosage forms of desmopressin are to be given when?

A

Only after the nasal passages have been cleared

  • pump must be primed prior to use
  • instruct the patient to prime the nasal pump by pressing down the pump 4 times
  • spray pump delivers 10 mcg of drug each time it is pressed
  • to administer a 10 mcg dose as ordered, place the spray nozzle in the nostril (for a child, have a parent/adult/caregiver administer the dose) & press the spray pump once
  • if higher dose prescribed, half the dose is to be administered in each nostril
  • pump cannot deliver doses smaller than 10mcg
  • once completed, replace the cap on the bottle
  • pump will stay primed for up to 1 week, after 1 week, pump will require repriming
  • carefully monitor the level of drug left in the pump so that there is always enough medication on hand
  • pump may not have enough medication left after 25 doses (at 150 mcg per spray) or 50 doses (at 10 mcg per spray)
59
Q

How is vasopressin given?

A

Topically to the nasal membranes and is not to be inhaled

60
Q

Educate parents about the fact that children with endocrine disorders may have an increased risk for?

A

Bone problems. Instruct parents that if they notice their child limping, this needs to be evaluated by prescriber

61
Q

Closely monitor the diabetic patient for changes in?

A

Serum glucose levels if he or she is taking octreotide

62
Q

Water intake amounts may need to be monitored closely in patients with?

A

Diabetes insipidus. Exact amounts may be prescribed or determined for each patient

63
Q

A patient is experiencing severe diarrhea, flushing, and life-threatening hypotension associated with carcinoid crisis. The nurse will prepare to administer which drug?

A

Octreotide (Sandostatin)

64
Q

A patient is suspected of having adrenocortical insufficiency. The nurse expects to administer which drug to aid in the diagnosis of this condition?

A

Cosyntroopin (Cortrosyn)

65
Q

The nurse is reviewing the medication list for a patient who will be starting therapy with somatropin. Which type of drug would raise a concern that needs to be addressed before the patient starts the somatropin?

A

Glucocorticoid

66
Q

A patient who is about to be given octreotide is also taking a diuretic, IV heparin, ciprofloxacin (Cipro), and an opioid as needed for pain. The nurse will monitor for what possible interaction.

A

Prolongation of the QT interval due to an interaction with ciprofloxacin

67
Q

When monitoring for the therapeutic effects of intranasal desmopressin (DDAVP) in a patient who has diabetes insipidus, which assessment finding will the nurse look for as an indication that the medication therapy is successful?

A

Decreased thrist

68
Q

Which drugs have an action similar to that of the naturally occurring hormone ADH?

A

Desmopressin (DDAVP)

Vasopressin (Pitressin)

69
Q

The nurse is preparing to administser somatropin (Humatrope) and will monitor the patient for which adverse effects?

A

HA, Flulike syndrome, fever

Pharmacology (28 decks)

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