antidiuretic hormone to kidneys

oxytocin to breasts

From where are these hormones secreted?

Prolactin

LH

FSH

TSH

ACTH

GH

1.desmopressin (DDAVP, Stimate)

2.vasopressin (Pitressin Synthetic)

• For DIABETES INSIPIDUS – a failure of pituitary to secrete ADH/vasopressin, or from surgical removal of pituitary; causes lots of urination and thirst (up to 10L in 24 hours)
• Also for postop ab distension and dispelling gas interfering with abdominal roentgenography (X-rays)

g.local and systemic hypersensitivities

h.tremor, sweating, vertigo

i.nasal congestion

j.N/V and abdominal cramps

k.water intoxication

m.seizures, migraines

n.asthma

o.HF or vascular disease (can cause angina or MI)

p.perioperative polyuria

q.preg cat C vasopressin

r.preg cat B desmopressin (so used instead during pregnancy, with caution)

Decreases antidiuretic effect

norepinehrine 

lithium 

oral anticoagulants 

Increases antidiuresis

carbamezepine for seizures

chlorpropamide for diabetes

i.BP, P RR, weight

ii.serum electrolytes and other labs

i.BP, P, RR

ii.auscultate abdomen

iii.measure abdominal girth

c.monitor BP, P, RR q 4 hours

d.strict I/O

e.Notify PCP if significant changes in BP, P, RR

f.Dosages may change, so watch pt q 10-15 minutes after dose for sign of excess dosage; if occur, will recover in few minutes

i.blanching of skin

ii.abdominal cramps

iii.nausea

• vasopressin can be given paretnterally:  IM, SUBQ, intranasally on cotton/spray/dropper
• 5-10 units 2-3 X day usually enough for diabetes insipidus
• for preventing ab distension, 5 units at first, may be increased to 10 and given q 3-4 hours IM
• for pre abdominal roentgenography, give 1 injection of 10 units 2 hours before x-ray and another injection of 10 units 30 minutes before; may require enema first before 1st dose

• oral
• intranasal
• SUBQ
• IV

• If vasopressin adverse reactions like skin blanching, ab cramps, nausea, can decrease these with 1-2 glasses water; not serious and should subside quickly
• However, vasopressin can lead to water intoxication, which is serious

Deficient Fluid Volume rt inability to replenish fluid intake secondary to diabetes insipidus

• Make sure to give pt lots of water bc constantly peeing and very thirsty.
• Pt may be very anxious about all this, assure pt that drug will most likely reduce or eliminate this
• Esp. early in treatment, I/O and observe for dehydration:
• -----dry mucouse membranes
• -----concentrated urine
• -----poor skin turgor
• -----flushing
• -----dry skin
• -----confusion
• Notify if much more O than I and assist PCP in closer monitoring to adjust dose
• If person with diabetes insipidus unable to take med, dehydration can quickly occur; so must wear med ID bracelet

Acute Pain rt abdominal distension

vasopressin admin

i.if vasopressin for ab distension, may require rectal tube for 1 hour

ii.nurse auscultates abdomen q 15-30 min and measure ab girth hourly or as ordered

m.for nasal desmopressin, ensure pt masters technique; education important

n.sometimes pt will self-admin vasopressin parenterally, teach pt or fam how to prepate and admin and measure specific gravity of urine

o.wear med id

p.carry fluids at all times

q.monitor fluids in and out and report changes

r.carry extra doses of drug

s.avoid alcohol

t.rotate injection sites

u.contact PCP immediately if

i.significant change in urine output

ii.abdominal cramps

iii.blanching of skin

iv.nausea

v.signs of inflammation at injection sites

vi.confusion

vii.headache

viii.drowniess

choriogonadotropin alfa

ovarian stimulant gonadotropin

Is FSH/LH extracted from postmenapausal women or DNA recomb.

for ovulation induction and follicular maturation

Synthetic GNRH

(gonadotropin releasing hormone)

For endometriosis and precosious pubery

cetroelix

ganirelix

• Gonadotropin-Releasing Hormone Antagonists
• Used for infertility

• synthetic nonsteroidal gonadotropin-releasing agent
• binds to estropgen receptos and decrease available estrogen receptors, causing anterior pituitary to increase FSH and LH
• used to induce ovulation in anovulatory women

somatropin

Growth Hormone

 adrenocorticotropic hormone (ACTH)

Actions and Uses

• normally secreted by anterior pituitary
• pharmacological prep is CORTICOTROPIN
• Stmimulates adrenal cortex to produce and secrete its hormones, primarily the GLUCOCORTICOIDS
• Used to dx adrenaocortical fnx and other conditions
• Used to manage acute exacerbations of MS, tyroiditis and cancer
• Used as an anti-infal and immunosupressant when conventional glucocorticoid treatments ineffective

Sandostatin

GH antagonist to treat acromegaly and certain tumors

Cytadren

Suppresses adrenal function

For use in Cushing's syndrome and and certain cancers

Used for hyperprolactinemia, acromegaly and Parkinson's

Cortosyn

screeing for adrenal insufficiency

gonadotropin, chorionic (HCG)

Trade name, action and uses

Pregnyl                                                        

extracted from human placentas. Action same as pituitary LH.

To induce testicular desention

For hypogonadism

And to induce ovulation

•  FSH and LH extracted from urine of postmenapausal women or produced by DNA recomb
• Induction of ovulation
• Menopur used to stim multiple follicles for in vitro
• Follistim used to induce sperm production

Bravelle

Follistim AQ

Gonal-f

Luveris

Menopur

Repronex

                                                               i.      can cause fetal defects, reported in humans, do not admin to pregnant woman; preg cat X

                                                              ii.      patients with high gonadotropin levels

                                                            iii.      thyroid disfunction

                                                            iv.      adrenal dysfunction

                                                             v.      liver disease

                                                            vi.      abnormal bleeding

                                                          vii.      ovarian cysts

                                                         viii.      sex-hormone dependent tumors

                                                             ix.      organic intracranial lesion (pituitary tumor)

                                                          i.      Hormone associated reactions

1.        vasomotor flushes (like hot flashes)

2.        breast tenderness

3.        abdominal discomfort, ovarian enlargement

4.        hemoperitoneum (blood in peritoneum)

                                                              ii.      Generalized reactions

1.        N/V

2.        Headache, irritability, restlessness, fatigue

3.        Edema and irritation at injection site

                                                               i.      epilepsy

                                                              ii.      migraines

                                                            iii.      asthma

                                                            iv.      cardiac or renal dysfunction

                                                             v.      lactation

                                                               i.      no known clinically significant interactions

1.        PCP does thorough med hx and physical exam

2.        lab tests for ovarian function and tubal patency

3.        nurse take VS and weight

1.        ask about adverse reactions

2.        take VS and weight

• Taken for 5 days
• May cause visual disturbances, dc and notify
• Observe for signs of excess ovarian stimulation (ab pain, distension, ovarian enlargement, ascites)
• If overstim, dc and notify

Re gonadotropin admin

 “Acute Pain rt adverse reactions (ovarian enlargement, irritation at injection site)”

1.        Gonadotropin injections given in clinic by IM or subcut bc destroyed in GI tract

2.        rorate site, examine sites for redness/irritation

3.        females examined by PCP q o d during tx and 2 weeks after to detect excessive ovarian stim = HYPERSTIMULATION SYNDROME = sudden ovarian enlargement with ascites; develops quickly w/in 3 to 4 days

4.        NURSING ALERT – check for signd of excessive ovarian enlargement (ab distension, pain, ascites) Drug dced at first sign and usually admit to hospital.  

1.        Nurse assess if pt understands direction of PCP

2.        Report adverse reactions

3.        Hormonal ovarian stimulants

a.        make sure pt understands possibility of multiple births and birth defects

b.       Use calendar for txs and ovulation

c.        report bloating, ab pain, dlushing, breast tenderness and pain at injection site

4.        nonhormonal ovarian stimulants

a.        Notify is pelvic pain, stomach pain, bloating, jaundice, blurred vision, hot flashes, breast discomfort, headache, N/V

b.       May require several courses of tx to induce ovulation.  If after 3 doses no ovulation, drug is dced bc ineffective

                                                               i.      Is synthetic preparation of somatropin,; a recomb DNA product identical to human GH and produced skeletal growth in children

                                                               i.      for children not growing bc of GH deficiency

                                                              ii.      must be used before closure of growth plates (epiphyses); ineffective afterwards

                                                               i.      few

                                                              ii.      antibodies may develop to somatopin in small # pts resulting in tx not working

                                                            iii.      some may have hypothyroidism or insuling resistance

                                                            iv.      swelling, joint pain and muscle pain may occur

                                                               i.      hypersensitivity to benzyl alcohol

                                                              ii.      epiphyseal closure

                                                            iii.      underlying cranial lesions (eg pituitary tumor)

                                                               i.      thyroid disease

                                                              ii.      diabetes

                                                            iii.      during pregnancy/lactation (cat C)

                                                               i.      excessive glucocorticoids à decreased response to somatropin

• Preassesment
• -----height and weight
• Ongoing
• -----growth rate may go from 3.5-4cm/year to 8-10cm/yr 9 (just more than doubles)
• -----child sees PCP q 3-6 months
• -----nurse measure height and weight
• -----bone age monitored to detect epipheseal closure, which indicates dc tx

1.        admin subcut

2.        do not shake, only swirl to mix

3.        do not admin if cloudy, should only be clear

4.        weekly dosage given in 3-7 doses during week

5.        may be given at bedtime, bc natural GH secreted then

6.        review periodic labs of GH levels, glucose tolerance, and thyroid fxn

1.        PCP discusses in detail

2.        if given at home at bedtime, instruct re injection technique

3.        child may have sudden growth, sxs of diabetes (increased thirst, hunger, freq urination) or sxs of hypothyroidism (fatigue, dry skin, intolerance to cold)

a.         

                                                               i.      similar to those of glucocorticoids (bc cause secretion of glucocorticoids).

                                                              ii.      Can be very severe and fatal.  

                                                            iii.      Affects many body functions/systems (if not all):

1.        fluid/electrolyte

2.        musculoskeletal

3.        CV

4.        GI

5.        Derm

6.        Neuro

7.        Endocrine

8.        Opthalamic

9.        Metabolic

10.     Other

The pharmalogical preparation of ACTH

Stimulates the adrenal cortex to secrete its natural hormones (corticosteroids)

                                                               i.      adrenocortical insufficiency (won’t work)

                                                              ii.      allergy to pig (ACTH taken from pig pituitaries)

                                                            iii.      systemic fungal infections (suppresses immunity)

                                                            iv.      ocular herpes simplex

                                                             v.      scleroderma

                                                            vi.      osteoporosis

                                                          vii.      hypertension

                                                         viii.      avoid vaccinations with live virus

a.         

                                                               i.      diabetes

                                                              ii.      diverticulosis

                                                            iii.      renal insufficiency

                                                            iv.      myasthenia gravis

                                                             v.      TB (can reactivate TB)

                                                            vi.      hypothyroidism

                                                          vii.      cirrhosis

                                                         viii.      non-specific ulcerative colitis

                                                             ix.      HF

                                                              x.      seizures

                                                             xi.      febrile infections

                                                           xii.      pregnancy/lactation (cat c)

                                                          xiii.      in children bc can inhibit skeletal growth

                                                               i.      live virus vaccines à viral replication, increased adv rxn to vaccine, decreased antibody response to vaccine

                                                              ii.      amphotericin B à up risk hypoKlemia

                                                            iii.      diuretics à increased risk hypoKalemia

                                                            iv.      insulin or oral antidiabetics à increases need for antidiabetic agent(s)

1.        review dx, labs, etc

2.        get weight

3.        assess skin integrity, lungs and mental status

4.        VSs

5.        PCP may order baseline dx tests

1.        weight

2.        I/O daily

3.        watch for edema, weight gain, rales, increased pulse or dyspne

4.        monitor blood glucose for increase

5.        check stool for evidence of bleeding

6.        review periodic labs

1.        depends on dx and physical/mental status

2.        may assess VS q 4 hrs

3.        watch for adverse reactions

4.        routes are IV, subcut, IM

5.        watch for hypersensitivity reactions like rash, urticaria, hypotension, tachycardia, difficulty breating; if noted, notify PCP immediately

6.        long-term use increases risk of hypersensitivity reaction

Re corticotropin admin

 “Risk for Infection rt masking of signs of infection”

1.        corticotrophin can mask sings of infection, including fugal and viral eye infections

2.        NURSING ALERT – instruct pt to report sore throat, cough, fever, mailainse, sores that don’t heal, redness/irritation of eyes   

3.        Decreased resistance to infections, so harder to identify

4.        Instruct to observe skin daily for sign of infection

5.        visitors monitored to protect pt from infection

Re corticotropin admin

 “Disturbed Thought Processes rt adverse reactions to drug”

1.        report changes in behavior, like mental depression, insomnia, euphoria, mood swings, nervousness

2.        Encourage communication with others and self

3.        provide quiet atmosphere

4.        explain tx regiment to lessen anxiety

                                                               i.      report adverse reactions

                                                              ii.      avoid contact with infection

                                                            iii.      report immediately signs of infections

                                                            iv.      for diabetics – monitor glucose closely and notify if up glucose, ketones in urine – may need higher dose antidiabetic drug

                                                             v.      notify of marked weight gain, swelling, muscle weakness, persistent headache, visual disturbances, or behavior change

are the adrenal cortex hormones

glucocorticoids and mineralocorticoids

1.       betamethasone

2.       budesonide

3.       cortisone

4.       dexamethasone (Decadron)

5.       hydrocortisone (cortisol)

6.       methylprednisolone

7.       prednisolone

8.       prednisone

9.       triamcinolone

                                                               i.      influence many body processes including immunity, metabolism of fat and carbs, anti-inflamm response, BP regulation, protection during stress, CNS excitability which can cause anxiety and depression (hmmm?), or even euphoria.  

                                                               i.      adrenocortical insufficiency

                                                              ii.      allergic reactions

                                                            iii.      collagen diseases like lupus erythematosus

                                                            iv.      dermatologic conditions

                                                             v.      rheumatic disorders

                                                            vi.      shock

                                                          vii.      and many more

• can produce s/s of Cushing’s Syndrome
• sometimes these adv rxns are allowed bc reason for treatment is life-threatening
• Are many more adverse reactions affecting every body system in many many ways

                                                               i.      serious infections like TB, or resistant infections

                                                               i.      renal/hepatic disease

                                                              ii.      hypothyroidism

                                                            iii.      ulcerative colitis and diverticulitis

                                                            iv.      peptic ulcer disease

                                                             v.      inflammatory bowel disease

                                                            vi.      hypetension

                                                          vii.      osteoporosis

                                                         viii.      convulsive disorders

                                                             ix.      diabetes

                                                              x.      pregnancy/lactation

                                                               i.      are very many

                                                              ii.      includes digitalis toxicity with hypoklemia 

 fludrocortisone (Florinef)

What is it and what are its actions and uses

• is a pharm prep of mineralocorticoid
• Mineralocorticoid causes retention of water/sodium and excretion of K
• Natual mineralocorticoid is aldosterone
•  fludrocortisone (Florinef) has both glucocorticoid and mineralocorticoid activity, but only available as a mineralocorticoid drug
• Used for replacement therapy for primary and secondary adrenocortical deficiency to correct mineralocorticoid (aldosterone/desoxy.) deficiencies

• usually occur on prolonged therapy, or if withdrawn to rapidly
• sodium and water retention (HTN, edema, HF, heart enlargement, sweating)
•  hypoKlemia
• muscular weakness
• osteoporosis and fractures
• peptic ulcer and epigastric distress
•  headache
•  hypersensitivity reactions
•  must monitor also for glucocorticoid adverse reactions (which are many)  bc often given together, and has glucocorticoid activity also

                                                               i.      systemic fungal infections

                                                               i.      Addison’s disease

                                                              ii.      infection

                                                            iii.      elderly bc more chance of preexisting conditions like HF, HTN, etc 

                                                            iv.      pregnany/lactation (cat C)

                                                               i.      decreases the effects of barbiturates, hydantoins, and rifampin

                                                              ii.      decreases serum levels of salicylates

                                                               i.      Preassessment

1.        BP, pulse,RR

2.        Assess area of involvement like resp tract or skin

3.        weigh those acutely ill or serious systemic disease

                                                              ii.      Ongoing

1.        Depends on disease being treated

2.        VS q 4-8 hours

3.        wight pt daily to weekly

4.        Assess response to drug daily or more if emergency situation

5.        Adverse reactions esp. electrolyte imbalances

6.        Mental status for change, esp. hx psychiatric problems or if high doses

7.        Watch for signs of infection

8.        Check non-diabetic’s glucose weekly; check diabetic’s glucose more frequently

9.        Monitor BP frequently, hypotension may indicate insufficient dose

10.     weigh pt daily

11.     assess for edema

12.     listen to lungs for adventitious sounds (rales, cracles)

Reduced immunity

Masking of infection from reduced inflammatory response

Hyperglycemia

HypoKlemia

• If GI upset, take with food
• Take antacids to prevent ulcer
• For short-term therapy, take before 9AM and very important to follow tapering instructions
• For alternate-day oral glucocorticoid therpay, take before 9AM q o d.  Use calendar etc
• Do not stop taking
• For long term or high dose therapy (also applies to alternate day tx)
• -----inform other health care providers; wear med ID
• -----Do not receive live virus vaccine bc possible lack of antibody response
• -----Avoid infections.  Contact PCP of failing to heal,
• persistent joint swelling or sign of infection
• -----If taking oral, and for some reason cannot take oral,
• contact PCP right away.  If cannot get in touch, go to
• hospital bc must get by injection.
• -----Weigh self weekly, if signigican weight gain or swelling, contact PCP
• -----Dietary recs are important, follow
• -----Follow rec for eye exams and lab tests
• For intra-articular injections
• -----do not overuse the injected joint, even when pain is gone

• Overproduction of glucocorticoids
• includes buffalo hump, moon face, oily skin/acne, osteoporosis, purple abdominal/hip striae, altered pigmentation of skin, weight gain

When gonadotropins are given, can cuase

sudden ovarian enlargment

ascites (severe cases)

abdominal distension and pain

Usually requires hopital admit and drug dc

• Decreased immunity
• water retention
• hyperglycemia and possible ketoacidosis

Aldosterone

Increases fluid retention and blood pressure

Cannot dc rapidly

When they are administered, the pituitary stops making it's own and somewhat atrophies

It takes a while for the pituitary to secrete pre-treatment level of hormones

Decreased immune response

Masks infections

These dugs can cause hyperglycemia

They interact with antidiabetic drugs to require a higher dose of the antidiabetic drugs

Parenterally:

IV

subcut

IM

1.        Comom adv rxn. 

2.        Monitor for edema

3.        I/O

4.        daily weight

5.        restrict sodium if ordered by PCP

6.        Elevate edemous extremities and change positions frequently

7.        notify PCP of electrolyte imbalances

8.        May req consult with dietician and dietary adjustments to deal with electrolyte imbalances (decreased potassium and increased sodium)

Water intox (fluid overload).

If are signs, notify before next dose due bc may need change in dose, fluid restriction, diuretic, etc.

Symptoms include:

-----drowsiness

-----listlessness

-----confustion

-----headache

-----convulsions

-----coma

•  routes are oral, IM, SQ, IV, topical, inhaled
• PCP may also inject into a joint (intra-articular), a lesion (intralesional), soft tissue or bursa

• Dose individualized and adjusted to response
•  NURSING ALERT – never omit a dose of glucocorticoid.  If pt is N/V and cannot take orally, must contact PCP immediately, bc will need order for different route
•  NURSING ALERT – glucocorticoids never dced suddenly; too fast results is acute adrenal insufficiency which can lead to death.
• Usually given in AM to coincide with natural function; although can be given q o d for long term therapy
• Alternate day therapy reduced adverse reactions

• Glucocorticoids run risk of adrenal insufficiency esp.
• with daily dose (vs q o d). 
• They shut off the pituitary's secretion of ACTH bc not needed; leads to atrophy of pituitary and cessation of ACTH secretion. 
• Adrenals then fail to realease glucocorticoids = ADRENAL INSUFFICIENCY, which is life-threatening, and must be treated with glucocorticoids.

a.        fever

b.       myalgia

c.        arthralgia

d.       malaise

e.        anorexia

f.         nausea

g.       orthostatic hypotension

h.       dizziness and fainting

i.         dyspnea

j.         hypoglycemia

k.        circulatory collapse and death if untreated. 

•  Pt with diabetes may need antidiabetic med adjustment frequently.  
• Nurse monitors glucose several times a day or as ordered.  
• Notify PCP if elevated glucose or ketones in urine.
• Even patients without diabetes can become hyperglycemic, so also should be monitored.