endocrine II meds Flashcards
Testosterone/Androgen Replacement Therapy
treats hypopituitarism
treats hypopituitarism
used to replace deficient hormones or to treat hormone-sensitive disorders
can cause bleeding if the client is taking oral anticoagulants (increase the effect of anticoagulants)
can cause decreased serum glucose concentration, thereby reducing insulin requirements in the client with diabetes mellitus.
hepatotoxic medications are avoided with the use of androgens because of the risk of additive damage to the liver.
androgens usually are avoided in men with known prostate or breast carcinoma, because androgens often stimulate growth of these tumors.
androgen/testosterone interventions
monitor vital signs
monitor for edema, weight gain, and skin changes
assess mental status and neurological function
assess for signs of liver dysfunction, including right upper quadrant abdominal pain, malaise, fever, jaundice and pruritis.
assess for the development of secondary sexual characteristics.
instruct the client to take medication with meals or a snack.
instruct the client to notify the PHCP if priapism develops.
instruct the client to notify the PHCP if fluid retention occurs.
instruct women to use a nonhormonal contraceptive while on therapy.
For women, monitor for menstrual irregularities and decreased breast size.
Androgen side effects
masculine secondary sexual characteristics
Estrogens and Progestins (women with hypopituitarism)
estrogens are steroids that stimulate femal reproductive tissue.
progestins are steroids that specifically stimulate the uterine lining.
estrogens and progestin preparations may be used to stimulate the endogenous hormones to restore hormonal balance or to treat hormone sensitive tumors (suppress tumor growth) or for contraception.
Estrogen contraindications
estrogens are contraindicated in clients with breast cancer, endometrial hyperplasia, endometrial cancer, history of thromboembolism, known or suspected pregnancy or lactation.
use estrogens with caution in clients with hypertension, gallbladder disease, or liver or kidney dysfunction.
estrogens increase the risk of toxicity when used with hepatotoxic medications.
barbiturates, phenytoin, and rifampin decrease the effectiveness of estrogen.
Progestins are contraindicated
in clients with thromboembolic disorders and should be avoided in clients with breast tumors or hepatic disease.
estrogen/progestin side effects and interventions
breast tenderness, menstrual changes
nausea, vomiting, and diarrhea
malaise, depression, excessive irritability
weight gain
edema and fluid retention
atherosclerosis
hypertension, stroke, myocardial infarction
thromboembolism (estrogen)
migraine headaches and vomiting (estrogen)
monitor vital signs
monitor for hypertension
assess for edema and weight gain
advise client not to smoke
advise the client to undergo routine breast and pelvic examinations.
Bromocriptine mesylate (Parlodel)
treats hyperpituitarism/acromegaly
dopamine agonists: stimulates dopamine receptors in the brain and inhibit the release of GH and PRL (prolactin)
in most cases, small tumors decrease until the pituitary gland is normal size
large pituitary tumors usually decrease to some extent
side effects of bromocriptine include orthostatic (postural) hypotension, headache, nausea, abdominal cramps, and constipation.
give bromocriptine with a meal or a snack to reducce GI side effects.
treatment starts with a low dose & is gradually increased until the desired level is reach.
if pregnancy occurs, the drug is stopped.
treac pts taking bromocriptine to seek medical care immediately if chest pain, dizziness, or water nasal discharge occurs because of the possiblity of serious side effects including cardiac dysrhythmias, coronary artery spasms, and cerebrospinal fluid leakage.
Octreotide (Sandostatin)
treats hyperpituitarism/acromegaly
inhibits GH release through negative feedback
assess frequenct and consistency of stools and bowel sounds throughout therapy.
use cautiously in gallbladder disease.
Desmopressin acetate (DDAVP)
treats diabetes insipidus
a synthetic form of vasopressin given orally, as a sublingual “melt” or intranasally in metered spray
the frequency of dosing varies with patient responses.
teach patients that each metered spray delivers 10 mcg and those with mild DI may need only one or two doses in 24 hours
for more severe DI, one or two metered doses two or three times daily may be needed.
During severe dehydration, ADH may be given IV or IM.
Ulceration of the mucous membranes, allergy, a sensation of chest tightness, and lung inhalation of spray may occur with the use of the intranasal preparations.
if side effects occur or if the patient has an upper respiratory infection, oral or subcutaneous vasopressin is used.
the parenteral form of desmopressin is 10 times stronger than the oral form, and the dosage must be reduced.
vasopressin (Vasostrict)
used in diabetes insipidus
allows the permeability of the renal collecting ducts, allowing reabsorption of water.
decreased urine output and increased urine osmolality in diabetes insipidus. Increased BP.
contraindicated in chronic renal railure with increased BUN
side effects: dizziness, pounding sensation in head, abdominal cramps, flatulence, sweating.
monitor BP, Hr and ECG periodically throughout therapy and continuously throughout cardiopulmonary resuscitation.
monitor urine osmolality and urine volume frequently.
monitor for S&S of water intoxication (confusion, drowsiness, headache, weight gain, difficulty urinating, seizures and coma.
Chlorpropamide (Diabinese)
management of neurogenic diabetes inspidus
lowers blood sugar by stimulating release of insulin from the pancreas and increasing the sensitivity to insulin at receptor sites. may also decrease hepatic glucose production
side effects: photosensitivity, hypoglycemia
monitor CBC periodically during therapy.. Notify health care provider promptly if decrease in blood counts occurs.
Tolvaptan (Samsca, Jynarque)
Used in SIADH
vasopressin receptor antagonists
Promotes water excretion without causing sodium loss.
Tolvaptan has a black box warning that rapid increases in serum sodium levels (those greater than a 12 meq/L increase in 24 hours) have been associated with central nervous system demyelination that can lead to serious complications and death.
In addition, when this drug is used at higher dosages or for longer than 30 days, there is significant risk for liver failure and death.
administer tolvaptan only in the hospital setting so serum sodium levels can be monitored closely for the development of hypernatremia.
demeclocycline (Declomycin) a tetracycline antibiotic
used for milder SIADH
an oral antibiotic , may help reach fluid and electrolyte balance, although the drug is not approved for this problem.
water excretion without sodium loss.
Fludrocortisone (FLorinef)
used in addison’s disease
causes sodium reabsorption, hydrogen and potassium excretion, and water retention by its effects on the distal renal tubule.
maintenance of sodium balance and BP in patients with adrenocortical insufficiency.
used for hypofunction of the adrenal gland.
monitor the patient’s blood pressure to assess for the potential side effect of hypertension.
instruct the patient to report weight gain or edema because sodium intake may need to be restricted.
