-
Growth Hormone
- a.
- Action: increases cellular size and rate of growth
- b.
- Indications for Use: pituitary dwarfism
- c.
- Related Drugs: somatrem (Protropin), somatropin (Humatrope, Nutropin), bromcriptine
- (Parlodel)
-
Corticotropin – ACTH (Avthar)
- a.
- Adrenal gland stimulates secretion of
- mineralocorticoid cortisol (hydrocortisone), glucocorticoids, and androgens
- b.
- Action: controls cortisol release and assists in dealing with stress; causes
- sodium to be retained and, therefore, water which leads to edema and HTN; also
- decreases inflammation
- c.
- Indications for Use: diagnostic testing of adrenocortical function, treatment of
- panhypopituitarism.
- d.
- Nursing action: monitor VS, electrolytes, blood sugar, CXR, weight, cortisol level;
- assess for allergy to pork because of cross-sensitivity.
-
Thyroid-stimulation hormone (TSH)
- a.
- Action: Controls functional activity of the
- thyroid gland and increases production and release of the thyroid hormone.
- b.
- Indications for Use: diagnosing hypothyroidism
- c.
- Related Drugs: thyrotropin (thytropar), protirelin (Relefact TRH)
-
Vasopressin:
Antidiuretic hormone (ADH)
- a.
- Action: Vasopressin acts as an antidiuretic
- by increasing reabsorption of water by renal tubules;
- concentrates urine and is a potent vasoconstrictor (so… would BP go up or
- down??)
- b.
- Indications for Use: vasopressin treats diabetes insipidus
- (Diabetes insipidus causes huge amounts of urine output, therefore, when
- vasopressin is working, urine output decreases.
- c.
- Related Drugs: vasopressin (Pitressin), desmopressin acetate (DDAVP) – usually given
- nasally
- d. Major
- Adverse Effects
- a)
- Pain at injection site
- b)
- Water intoxication and
- hyponatremia
- c)
- Hypertension, anginal pain
- e.
- Major
- Nursing Implications
- a)
- Assess/Monitor
- VS (lying and standing BP
- since BP goes up)
- I&O, wt changes-
- S/S of water intoxication:
- hyponatremia and decreased urine output
- b)
- Give IM deep into muscle
- c)
- Avoid IV extravasation (make
- sure IV is patent in vein)
-
Oxytocin
- Action: contract smooth muscle, primarily on the uterus and mammary glands;
- stimulates ejection of milk
- b. Indications
- for Use: induce labor and to control
- postpartum bleeding; promote milk ejection during lactation
- c. Prototype: oxytocin (Pitocin)
- a.
- Related
- Drugs: ergonovine maleate
- (Ergotrate Maleate), ergotamine (Ergostate), methylergonovine (Methergine)
- b.
- Common
- Adverse Effects: N/V, hypertension, ergotism
- c.
- Major
- Nursing Implications
- a)
- Assess/Monitor
- Fetal activity, fetal heart tones, contraction
- Fluid status, I&O
- VS and BP
- Ergotism
- b)
- Give PO
- form with food
- c)
- Give IV form diluted and via
- IV pump
- d) Discontinue
- infusion if contractions exceed 70-90 seconds, for signs of tetany or abruptio
- placentae, and fetal distress; turn patient to left side.
-
Thyroid Agents: no single prototype
- Action: increases metabolic rate of body tissues
- (action of thyroid hormones). Stimulates cardiovascular system, increases
- oxygen consumption, increases body temp., blood volume, growth and overall
- cellular growth. Euthyroid means normal thyroid function. When a patient has a
- return to normal thyroid function, the hair will be thick and shiny.
- b.
- Indications
- for Use: replacement of absent
- or diminished thyroid function
- c.
- Related Drugs: desiccated thyroid, thyroglobulin (Proloid), Thyroid, levothyroxine (Synthroid),
- liothyronine (Cytomel), liotrix (Thyrolar)
- d.
- Major Adverse Effects: signs and symptoms of
- hyperthyroidism: palpitations, tachycardia, angina, nervousness, irritability,
- insomnia, heat intolerance, wt loss, thyrotoxicosis (or thyroid storm). Elderly
- patients are more sensitive to thyroid replacement.
- e. Major
- Nursing Implications:
- 1)
- Assess/Monitor
- HR, BP, and ECG
- Wt
- 2)
- Give a single morning dose at
- breakfast to prevent sleep interferences
- 3)
- Take apical pulse. Hold if resting
- HR is more than 100 beats/min
- 4)
- Teach S/S of hypo and
- hyperthyroidism
-
Antithyroid Agents
- a.
- Action: Lower the thyroid level by three
- mechanism:
- 1)
- Block the synthesis of
- thyroid hormones.
- 2)
- Interfere with the hormone
- production: iodine must be present in the body for thyroid hormone synthesis. A
- high dose of iodine (iodism) has a suppressant effect and cause a decrease in
- the production of thyroid hormone (remember the negative feedback??)
- 3)
- Destroys the gland:
- radioactive preparations destroy the thyroid tissue, thereby decreasing the
- production of thyroid hormone.
- b.
- Indications
- for Use: management of hyperthyroidism (palpitations, tachycardia,
- angina, heat intolerance, etc). Thyrotoxicosis (thyroid storm)
- c. Related
- Drugs:
- a)
- propylthiouracil (PTU)
- b)
- methimazole (Tapazole)
- 2)
- Iodines
- a)
- Strong iodine solution
- (Lugol’s solution)
- b)
- Potassium iodine solution
- (SSKI), Thyro-block)
- 3)
- Radioactive iodine (sodium
- iodide, Iodine 131 Iodotope)
- a)
- Requires avoidance of
- extended contact with children, spouse, and coworkers for 1 week
- b)
- Refrain from coughing or
- expectoration for the first 24 hours to avoid emitting radioisotopes
- c)
- Increase fluids up to 3 to 4
- L/day for the first 48 hours to help with the excretion of the agent
- d)
- Void frequently during
- initial 48 hours. Flush the toilet twice after each voiding.
- e)
- No restriction of the
- bathroom use is necessary for others in the family.
- d. Major
- Adverse Effects:
- Granulocytopenia,
- Hypersensitivity, Iodism (increased thirst, burning, brassy taste in the
- mouth). Hypothyroidism (all body functions decrease except wt increases,
- lethargy, anorexia, constipation).
- e.
- Major Nursing Implication:
- 1) Assess/monitor VS and body wt
- 2) Dilute liquid iodine preparations in water
- and encourage use of a straw to prevent staining of the teeth.
- 3) Instruct
- a) S/S of hypo and hyperthyroidism
- b) Follow-up is needed to evaluate for
- hypothyroidism
-
Parathyroid Agents
- Action: Parathyroid hormone increases renal
- excretion of phosphorus, stimulates tubular calcium reabsorption, and release
- of calcium and phosphorus from bone into bloodstream. Calcitonin decreases
- serum calcium by inhibiting osteoclastic bone resorption and by blocking
- tubular reabsorption of calcium and phosphorus.
- b. Related
- Drugs/Indications for Use:
- 1)
- Agents
- for hypoparathyroidism (a deficiency of parathyroid hormone that cause a low Ca
- level and high phosphate level): Calcium products and Vitamin D products to
- treat hypocalcemia
- 2)
- Agents
- for hyperparathyroidism (an excess of parathyroid hormone that cause a high Ca
- level and low phosphate level): Calcitonin treats Paget’s
- disease and hypercalcemia.
- c.
- Major Adverse Effects:
- 1)
- Agents
- for hypoparathyroidism: Azotemia (excess nitrogenous waste in the blood with
- elevated BUN level). Hypotension. Hypercalcemia
- 2)
- Agents
- for hyperparathyroidism: N/V, flushing of the face, Hypocalcemia
-
Major Nursing Implications:
Agents for
hypoparathyroidism
Assess/monitor
BUN and Creatinine
S/S of hypercalcemia
I & O
BP
-
Major nursing implications
Agents
for hyperparathyroidism
1) Assess/monitor the S/S of Hypocalcemia
- 1) Instruct the pt that N/V usually occur with
- initial therapy and lessens as treatment continues
-
A patient, 48 years old, has
been diagnosed as having hypothyroidism. The patient is taking liothyronine
sodium (Cytomel) 50 micrograms daily. Which side effect may occur?
- 1. Angina
- 2. Fatigue
- 3. Rash
- 4. Gastritis
-
The patient is taking
levothyroxine 75 micrograms po qd. The nurse recognizes the drug is becoming
effective if which result is found?
Increased urine output
-
Insulin analog: insulin
lispro (Humalog)
- Rapid onset of action within 15
- minutes
- Must
- be given 15 minutes before the meal
-
Short Acting Insulins: Regular
insulin, Humulin-R, Novolin R, Semilente
- Onset
- in 1/2 to 1 hour
- Peak
- in 2 to 4 hours
- Duration
- is 8 to 12 hours
-
Intermediate Acting Insulins:
NPH, Humulin-N, Lente, Novolin L, Humulin-L
- Onset in 1 to 3 hours
- Peak
- in 4 to 12 hours
- Duration is 24 hours.
-
Long Acting Insulins: Protamine
zinc Insulin (PZI) & Ultra Lente.
- Onset in 4 to 8 hours
- Peak
- in 10 to 30 hours
- Duration
- is 36 hours or longer.
- Rarely given
-
Glargine (Lantus).
- Do not mix with other
- insulins or solutions. This insulin is also clear; however, it is not to be
- given IV (Remember, only Regular insulin, which is clear, is given IV)
Onset in 1 hour
Peak is continuous
Duration is 24 hours.
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