Endocrine drug 1

Growth Hormone (Somatotropin/Genotropin)

• Growth hormone (GH) is typically secreted by the anterior pituitary gland.
• Somatotropin is the generic name, and Genotropin is the brand name for synthetic growth hormone.
• Synthetic GH is used when the anterior pituitary doesn't secrete enough GH.
• GH is crucial for regulating growth.
• GH medication is most effective before the closure of the child's growth plates (bone epiphyses).
• The goal of GH medication is to stimulate skeletal growth.
• Regular follow-ups for height and weight measurements are essential for children on GH medication.
• Adverse reactions to GH medication can include hypothyroidism, insulin resistance, edema, joint pain, and muscle pain.
• Use GH cautiously in clients with thyroid disease, diabetes, and during pregnancy.
• Baseline data collection before starting GH includes vital signs, height, and weight.
• Monitoring is frequent in the beginning to assess medication effectiveness and make adjustments.
• GH is typically administered subcutaneously but can also be given intramuscularly, depending on the brand.
• Rotate injection sites.
• GH is available in pre-filled liquid syringes and powder form.
• If the powder form, mix by swirling, not shaking, to avoid breaking down enzymes.
• Administer GH at bedtime if possible.
• Ongoing assessment includes periodic monitoring of height, weight, growth hormone levels, glucose tolerance, and thyroid function.

Hyperpituitarism Treatment

• Hyperpituitarism involves excessive growth hormone release.
• Medications suppress growth hormone release when surgery and radiation are ineffective.
• Treats gigantism in children and acromegaly in adults.
• Adverse effects can include nausea, diarrhea, cramps, flatulence (gas), hypo- or hyperglycemia, liver injury, and chest pain.
• Monitor for and report liver injury signs (abdominal pain, jaundice) and chest pain.
• Use cautiously in clients with diabetes, hypothyroidism, renal or gallbladder disease, and older adults.
• Can cause gallstones.
• Can decrease the effects of anti-arrhythmics.
• Administer at room temperature and push slowly.
• Rotate injection sites; most are given subcutaneously.
• Octreotide can be given intramuscularly, subcutaneously, or intravenously.
  • IM cannot be given in the deltoid

Posterior Pituitary Hormones: Vasopressin (Pitressin)

• Regulates water reabsorption by the kidneys through vasoconstriction.
• Vasoconstriction helps pull water back into the vascular system.
• Secreted by the pituitary gland when body fluids need to be conserved.
• Used to treat diabetes insipidus (ADH deficiency), postoperative abdominal distension, and to dispel gas interfering with abdominal x-rays.
• Adverse reactions include tremor, sweating, vertigo, nasal congestion, nausea, abdominal cramping, and water intoxication.
• Baseline data before starting vasopressin: weight, blood pressure, pulse, and respiratory rate.
• Auscultate the abdomen and measure abdominal girth, especially if for gas removal.
• Monitor for signs of excessive dosage, such as blanching of the skin, abdominal cramps, and nausea.
• Desmopressin can be given orally, IV, subcutaneously, or via nasal spray.
• Vasopressin is only given IM, IV, or subcutaneously.
• Avoid caffeine while on this medication, as it can cause diuresis
• If unable to maintain PO fluid intake, start IV fluids.
• Desmopressin acetate (DDAVP) is a common medication.
• Aqueous vasopressin (Pitressin) can be given IM or intranasally.
• For intranasal administration, hold the bottle upright, keep the head vertical, occlude one nostril, and squeeze while inhaling, usually starting with a nighttime dose.

Water Intoxication

• Can result from excessive dosage or water retention.
• Symptoms: drowsiness, listlessness, confusion, and severe headache.
• If untreated, can lead to seizures and coma.
• A potentially fatal condition that disrupts brain function and electrolyte balance.
• May cause hyponatremia and hypokalemia due to dilution.
• Monitor for these signs and notify the doctor for dosage adjustments, fluid restrictions, or diuretics.
• Explain the importance of measuring intake and output.
• Drink one to two glasses of water immediately before taking the drug.
• Maintain a 24-hour total intake and output record.
• Avoid alcohol and caffeine, as they cause diuresis and suppress antidiuretic hormone release.
• Explain injection methods and site rotation.
• Wear medical identification specifying the disease process and drugs being taken.

Thyroid Hormones (Levothyroxine/Synthroid)

• Used to treat hypothyroidism.
• Also treats myxedema (severe hypothyroidism), cretinism (congenital hypothyroidism), euthyroid goiters, and thyroid cancer.
• Thyroid hormones regulate metabolism, heart rate, respiratory rate, body temperature, cardiac output, oxygen consumption, and mental function.
• Levothyroxine (Synthroid) is the drug of choice.
• Do not change brands or types unless directed by a doctor; critical for consistent dosing.
• Common adverse reactions are signs of overdose and hyperthyroidism.
• Symptoms of hyperthyroidism: vomiting, diarrhea, weight loss, tachycardia, palpitations, angina, nervousness, tremors, irritability, insomnia, menstrual irregularities, sweating, and heat intolerance.
• Adverse reactions other than hyperthyroidism symptoms are rare.
• Contraindicated in clients with known hypersensitivity, uncorrected adrenal cortical insufficiency (Addison's disease), or thyrotoxicosis (thyroid storm).
• Use cautiously with heart disease, renal disease, high blood pressure, and diabetes.
• Interactions:
  • Decrease effectiveness of digoxin and beta blockers.
  • Can increase the risk of hyperglycemia.
  • Increase risk of bleeding with oral anticoagulants.
  • Increase the metabolism of thyroid drugs when given with antidepressants.
• Before starting the medication, collect baseline data: vital signs, weight, height, and a general assessment of hypothyroidism signs and symptoms.
• During follow-ups, check vital signs, weight, height, and assess for signs of overdose or hyperthyroidism and improvement of hypothyroidism symptoms.
• It takes six to eight weeks to get the full effect of the therapy.
• Monitor TSH and T4 levels.
• Take it once a day, initially at a low dose, increased as needed.
• Administer early in the morning, 30 to 60 minutes before breakfast
• For clients with diabetes, monitor closely for signs of hypoglycemia - may need to monitor/or adjust their insulin.
• Weigh weekly and report significant gains or losses.
• Dosage adjustments may be needed based on periodic T4 and TSH tests.
• Replacement therapy is typically lifelong.
• Do not alter the dose or discontinue unless directed by a doctor.
• Therapeutic goal is a decrease in TSH levels and T3 and T4 levels in a normal range.
• Expected outcomes include weight loss, diuresis, increased appetite, increased pulse, no cardiac dysrhythmias, and decreased puffiness.

Antithyroid Drugs (Thioamides)

• Used in the medical management of hyperthyroidism.
• Can be used to achieve a euthyroid state prior to thyroid surgery.
  • Euthyroid = thyroid is behaving/producing normally
• Can be used as an adjunct to IR radiation of the thyroid gland.
• May be used in emergency treatment of thyroid toxicosis (thyroid storm).
• Adverse reactions include hypothyroidism, agranulocytosis, exfoliative dermatitis, and thrombocytopenia.
  • Agranulocytosis = decreased WBCs - leading to infection. Look for fatigue, fever, sore throat.
• Contraindicated with hypersensitivity
• Caution during pregnancy because it can cause fetal hypothyroidism.
• Increases bleeding potential when taken with anticoagulants.
• Monitor digoxin levels if taken concurrently.
• Before starting, obtain a history of hyperthyroidism signs and symptoms.
• Assess for iodine allergy if prescribed iodine as an adjunct.
• Monitor levels, vital signs, weight, and intake/output.
• Observe for adverse drug effects, worsening or relief of symptoms, thyroid storm, or hypothyroidism.
• Watch for agranulocytosis and thrombocytopenia.
• Beta blockers may be given for cardiac symptoms like tachycardia.
• Maintain consistent dosage times each day, take with meals.
• Use reminders to take at the correct time.
• Notify the provider if the dose interferes with sleep.
• Do not stop abruptly, as it can throw clients back into hyperthyroidism.
• Monitor for granulocytosis and thrombocytopenia.
• Encourage clients to avoid those with upper respiratory infections to prevent exposure.
• Check weight two to three times weekly.

Radio Pharmaceuticals (Radioactive Iodine)

• Radioactive iodine accumulates in the thyroid gland and destroys thyroid cells without damaging other cells.
• Used to treat hyperthyroidism and thyroid cancer.
• Also used when antithyroid drugs have not worked.
• Adverse effects include radiation sickness, bone marrow depression, and hypothyroidism.
• Follow the Department of Nuclear Medicine's precautions:
  • Limit contact (one minute per day per person).
  • Follow disposal methods for urine, feces, and secretions.
  • Maintain six feet distance from others, including children and pregnant women.
  • Increase fluid intake to 2 to 3 liters a day.
• Thyroid hormone replacement therapy is necessary if hypothyroidism develops.

Iodine Products (Non-Radioactive)

• Creates a high level of iodide to reduce iodine uptake by the thyroid.
• Helps prevent the release of thyroid hormones.
• Used to reduce gland size before surgery and as an emergency treatment for thyroid toxicosis (thyroid storm).
• Adverse effects include iodism (metallic taste, stomatitis, frontal headache, skin rash).
• Do not take with foods high in iodine.
• Mix with juice to help with the taste.
• Take at the same time each day.
• Do not stop taking abruptly.
• Increase fluid intake.