Unit 8

Chapter 43Drugs for Pituitary, Thyroid,

And Adrenal Disorders

Endocrine System

Endocrine System

Describe these terms associated with the endocrine system:– Gland– Hormone– Target tissue– Negative feedback – Biological effectGive an example of a negative feedback

process

Endocrine System: General Concepts

• Regulates body processes• Narrow range• Hormones act as messengers • Controlled by hypothalamus and pituitary

glands What are the divisions of the pituitary gland? What hormones are released from each division?

Hormones

Develop a table to identify hormones and discuss:– Where secreted– Target tissue– Action– Regulation of secretion– Feedback control – Characteristics of deficiency or excess– Metabolic effect

Endocrine Pharmacotherapy

• Describe three reasons to administer hormone therapy.

• Describe why a hormone antagonist would be administered.

It is more effective to give drugs that affect secretion at the target organs.

Growth Hormone

Agonist• Somatotropin • Stimulates cell growth and

metabolism• Deficiency → short stature• Severe deficiency → dwarfism• Recently approved for short

stature with normal GH levels• Costly

Why is GH contraindicated with epiphyseal closure?

Antagonist • Octreotide (Sandostatin)• Structurally R/T

somatostatin• Inhibits GH• Promotes fluid and

electrolyte reabsorption from GI tract

• Prolongs intestinal transit time

Antidiuretic Hormone• conserves body water• Aka: vasopressin• Treatment of diabetes

insipidus• Desmopressin (DDVAP)

most common• Vassopressin (Pitressin)

prototype p. 665• Desmopressing and

lypressin have fewer side effects

Describe the physiologic process associated with ADH release and water conservation.

What are the key physiologic characteristics of Diabetes Insipidus?

What are the key nursing considerations of therapy?

Thyroid Hormones

• Affect most body cells• Regulate BMR• Maintain blood pressure• Regulate G&D• Two cell types– Parafollicular cells– Follicular cells

• Travels via carrier protein

Key points in Thyroid Pharmacology

• Thyroid disorders are common and drug therapy must be individualized.

What does this mean for the patient with a thyroid disorder? What are the goals of therapy?

Thyroid Pharmacology

Hypothyroidism• Due to poor thyroid gland

function or low secretion of TSH

• Most are 2° to Hashimoto’s disease

• Myxedema• ↑ TSH ↓ T3 T4 levels• Treated with thyroid agents• Prototype: levothyroxine

(Synthroid) p. 669

Hyperthyroidism• Hypersecretion of thyroid

hormone• Graves’ Disease most

common• Symptoms opposite of

hypothyroidism• Prototype:

prophyllthiouracil (PTU) p. 671

Nursing Considerations

• What are the pharmacologic nursing considerations for hypothyroidism?

• What teaching should be included?

Nursing Considerations

• What are the pharmacologic nursing considerations for hyperthyroidism?

• What teaching should be included?

Adrenal Glands

• Secrete three classes of steroids– Gonadocorticoids– Mineralocorticoids– Glucocorticoids

• Glucocorticoid Secretion controlled by: – CRF – ACTH

ACTH Agents

• ACTH (corticotropin) available in three preparations:– Corticotropin injection– Repository corticotropin– Corticotropin zinc hydroxide

• Cosyntroppin (Cortrosyn) closely resembles ACTHUsed to diagnose adrenal disorders, rarely used to treat deficiencies

Adrenal Insufficiency

• Hyposecretion of adrenal cortex or inadequate secretion of ACTH

• Sx: hypoglycemia, fatigue, hypotension, ↑ skin pigmentation, GI sx

• ↓ cortisol with ↑ ACTH level is diagnostic• Primary and Secondary • Replacement therapy

Glucocorticoid Therapy

• Adrenal Insufficiency• Allergies• Asthma and COPD• Chronic Inflammatory Bowel Disease • Hepatic, neurological, and renal disorders characterized by

edema• Neoplastic disease• Post-transplant surgery• Rheumatic disorders• Shock• Skin disorders

Nursing Considerations

• What are the nursing considerations in glucocorticoid therapy?

• What teaching should be included?

Cushing’s Syndrome

• 2° to prolonged high levels of glucocorticoids• Excess ACTH, adrenal tumor, or

pharmacotherapy • S/S: adrenal atrophy, osteoporosis,

hypertension, ↑ risk of infection, delayed wound healing, peptic ulcers, acne, general obesity, moon face, buffalo hump, mood and personality changes

Nursing Considerations

• What are the nursing considerations in Cushing’s syndrome?

• What should be included in teaching?