Hematological & Endocrine Disorders Medications PDF 2024-2025

Hematological & Endocrine Disorders Medications (Fall) 1st Semester 2024-2025 8th Lecture November 3, 2024 1  Learning Objectives Discuss the pharmacotherapy of hematology & endocrine disorders...

Hematological & Endocrine Disorders Medications (Fall) 1st Semester 2024-2025 8th Lecture November 3, 2024 1  Learning Objectives Discuss the pharmacotherapy of hematology & endocrine disorders Describe the side effects, interaction, and contraindications for different hematology & endocrine medications Use the nursing process as a framework to provide care for patient on hematology & endocrine disorders drugs November 3, 2024 2  Part I Acid Base Imbalance Alkylating drugs Antimetabolite Cancer Blood Electrolyte drugs Drugs Imbalance Anemia November 3, 2024 3  What are the Common Hematological disorders? Fluid & acid base disorders Coagulation Blood Anemia disorders Disorders Leukemia Cancer November 3, 2024 4  Anemia ❖Occurs due to significant shortage of health RBCs ❖Having anemia, also referred to as low hemoglobin, can make you feel tired and weak. ❖RBCs serve as transporters of oxygen to different tissues and organs of the body ❖Detected or confirmed through CBC and bone marrow aspiration ❖ There are many forms of anemia, each with its own cause as ✓Aplastic anemia ✓Iron deficiency anemia ✓Sickle cell anemia ✓Thalassemia ✓Vitamin deficiency anemia November 3, 2024 5  Iron Ferrous fumarate, Ferrous gluconate, Ferrous sulfate, Iron dextran(IV,IM), Iron sucrose(IV). Pharmacodynamic: its most important role is the production of hemoglobin. About 80% of the iron in the plasma goes to the bone marrow, where it’s used for erythropoiesis Pharmacotherapeutics: Prevent or Treat Iron Deficiency Anemia. Adverse Effects: Gastric irritation, Constipation, Dark stool, teeth staining, anaphylactoid reaction( Iron dextran, Iron sucrose) Nursing Implementation ✓If administering iron IM, use a 19G or 20G needle that’s 2″ to 3″ long. Inject into the upper outer quadrant of the buttock. ✓Use the Z-track method to avoid leakage into subcutaneous tissue and staining of the skin.. ✓IV iron is given if the patient has insufficient muscle mass for deep IM injection, or the need for massive and prolonged parenteral therapy November 3, 2024 6  Vitamin B12: Cyanocobalamin , Hydroxocobalamin Pharmacodynamic: It is essential for cell growth and replication and for the maintenance of myelin throughout the nervous system, B12 involved in lipid and carbohydrate metabolism Pharmacotherapeutics: Pernicious Anemia (Megaloblastic Anemia). Megaloblastic anemia is a type of anemia characterized by the formation of unusually large, abnormal and immature red blood cells called as megaloblasts by the bone marrow, which are released into the blood. November 3, 2024 7  Vitamin B12: Cyanocobalamin , Hydroxocobalamin Adverse Effects: Itching, Rash, Hypokalemia, Polycythemia, Peripheral thrombosis, Heart failure, Pulmonary edema, Anaphylaxis & Death) Nursing Implementation ✓Administer IV fluids and electrolytes as necessary to provide nutrients. Oral food intake or tube feedings are preferable to IV therapy. ✓Correct underlying disorders that contribute to mineral and electrolyte deficiency or excess. ✓Promote measures to relieve anorexia, nausea, vomiting, diarrhea, pain, and other signs and symptoms. November 3, 2024 8  Folic acid Pharmacodynamic: is absorbed in the first third of the small intestine, metabolized in the liver. Excreted in urine & feces. Folic acid is also secreted in breast milk. Pharmacotherapeutics: Megaloblastic Anemia (Prevent neural tube defects). Adverse Effects: Itching, erythema, altered sleep patterns, difficulty concentrating, irritability, overactivity. Nursing Implementation ✓If using the IM route, don’t mix folic acid and other drugs in the same syringe. ✓Correct underlying disorders that contribute to mineral and electrolyte deficiency or excess. ✓Serum folic acid levels less than 5 mg indicate folic acid deficiency November 3, 2024 9  Erythropoietin Epoetin alfa and darbepoetin alfa (IV,SC) Pharmacodynamic: Epoetin alfa and darbepoetin alfa are structurally similar to erythropoietin. Therapy will corrects normocytic anemia within 5 to 6 weeks. Pharmacotherapeutics: Normocytic anemia (CRF, HIV). Adverse Effects: Hypertension (Most common), joint pain, skin reactions at the injection site, deep vein thrombosis, transient ischemic attack. Nursing Implementation ✓Give the IV form of the drug by direct injection. ✓Additional heparin may be needed to prevent blood clotting if the patient is on dialysis. ✓Promote a varied diet that’s adequate in protein, calories, minerals, and electrolytes. November 3, 2024 10 Electrolyte Imbalance Electrolyte imbalance ❖ An electrolyte imbalance occurs when you have too much or not enough of certain minerals in your body. This imbalance may be a sign of a problem like kidney disease. ❖ Electrolyte replacement drugs are inorganic or organic salts that increase depleted or deficient electrolyte levels, helping to maintain homeostasis. These drugs include: ✓ Potassium, the primary ICF electrolyte ✓ Calcium, a major ECF electrolyte ✓ Magnesium, an electrolyte essential for homeostasis found in ICF ✓ Sodium, the principal electrolyte in ECF November 3, 2024 12  Potassium Serum Potassium (acetate, chloride, gluconate, phosphate) Pharmacodynamic: It’s an essential element in determining cell membrane potential and excitability. It is necessary for proper functioning of nerve and muscle cells and for nerve impulse transmission. It’s also essential for tissue growth and repair and for maintenance of acid-base balance. Pharmacotherapeutics: Hypokalemia (vomiting, diarrhea, or nasogastric suction, kidney diseases, cystic fibrosis, burn, excessive antidiuretic hormone) Adverse Effects: nausea, vomiting, abdominal pain, and diarrhea (Oral) pain at the injection site and phlebitis (IV), Cardiac Arrest. Nursing Implementation ✓When administering potassium IV, dilute the preparation before infusion. ✓Give diluted IV potassium slowly to prevent life-threatening hyperkalemia. ✓Never give potassium as an IV bolus or IM injection. November 3, 2024 13  Calcium Serum Calcium (carbonate, chloride, gluconate, lactate, citrate) Pharmacodynamic: It plays an essential role in normal nerve and muscle excitability Calcium is integral to normal functioning of the heart, kidneys, and lungs, and it affects the blood coagulation rate as well as cell membrane and capillary permeability. It plays a major role in normal bone and tooth formation Pharmacotherapeutics: Hypocalcemia (Tetany, Cardiac arrest, Alkalosis, Parathyroid surgery) Magnesium intoxication, Osteoporosis, Hypoparathyroidism Adverse Effects: Drowsiness, lethargy, muscle weakness, metallic taste (Oral) cardiac arrhythmias, cardiac Arrest, venous irritation (IV). Nursing Implementation ✓Give an IV infusion slowly to prevent a high calcium level from reaching the heart and possibly causing arrhythmias and cardiac arrest. ✓Only give calcium IM in an emergency and only when the IV route is impossible to use. ✓Give oral calcium supplements 1 to 2 hours after meals. November 3, 2024 14  Magnesium Serum Magnesium sulfate (IV) - Magnesium oxide (Oral) Pharmacodynamic: It plays in transmitting nerve impulses to muscle and activating enzymes necessary for carbohydrate and protein metabolism. Magnesium stimulates PTH secretion, thus regulating ICF calcium levels. It also aids in cell metabolism and the movement of sodium and potassium across cell membranes. Pharmacotherapeutics: Hypomagnesemia, Preeclamptic and Eclamptic Seizure, Ventricular arrhythmias, Acute Nephritis in children, Toxemia Adverse Effects: Hypotension, Circulatory collapse, Respiratory Paralysis. Depressed reflexes, Flushing (IV). Nursing Implementation ✓Keep IV calcium gluconate available to reverse the respiratory depression that an infusion of magnesium sulfate can cause. ✓Administer magnesium sulfate slowly—no faster than 150 mg/ minute. Injecting a bolus dose too rapidly can trigger cardiac arrest. November 3, 2024 15  Sodium Chloride Pharmacodynamic: It maintains the osmotic pressure and concentration of ECF, acid-base balance, and water balance. It contributes to nerve conduction and neuromuscular function. It plays a role in glandular secretion. Sodium chloride solution replaces deficiencies of sodium and chloride ions in blood plasma. Pharmacotherapeutics: Hyponatremia Adverse Effects: Pulmonary edema if it’s given too rapidly or in excess, Hypernatremia, and Potassium loss. Nursing Implementation ✓Use cautiously in elderly and postoperative patients as well as in patients with heart failure, circulatory insufficiency, renal impairment, or hypoproteinemia. ✓Teach the patient to recognize signs and symptoms of pulmonary edema, including shortness of breath, coughing, anxiety, wheezing, and pallor; tell him to notify his practitioner if he experiences any of them. November 3, 2024 16  03 Acid Base Imbalance Acid- Base imbalance ❖ The body's balance between acidity and alkalinity is referred to as acid-base balance. ❖ The body uses different mechanisms to control the blood's acid-base balance. These mechanisms involve the Lungs, Kidneys & Buffer systems Metabolic acidosis and metabolic alkalosis are caused by an imbalance in the production of acids or bases and their excretion by the kidneys. Respiratory acidosis and respiratory alkalosis are caused by changes in carbon dioxide exhalation due to breathing disorder November 3, 2024 18  Alkalinizing drugs Sodium(bicarbonate, citrate, lactate),Tromethamine Pharmacodynamic: Sodium derivates separates in the blood, providing bicarbonate ions that are used in the blood’s buffer system to decrease the hydrogen ion concentration and raise blood pH. As the bicarbonate ions are excreted in urine, urine pH rises. Tromethamine acts by combining with hydrogen ions to alkalinize the blood; the resulting tromethamine–hydrogen ion complex is excreted in urine. Pharmacotherapeutics: Metabolic Acidosis, Diabetic Ketoacidosis Adverse Effects: Metabolic Alkalosis, gastric distention, flatulence (Bicarbonate) Phlebitis, irritation at injection site, Hypoglycemia (Trometh). Nursing Implementation ✓If the patient is receiving sodium bicarbonate, sodium lactate, or tromethamine, watch the IV site for extravasation. If extravasation occurs, elevate the affected limb, apply warm compresses, and administer lidocaine. ✓For a patient receiving tromethamine, check the IV site for phlebitis or irritation and don’t give the drug for more than 24 hours. November 3, 2024 19  Acidifying drugs Acetazolamide - Ammonium chloride - Ascorbic acid Pharmacodynamic: Acetazolamide increases the excretion of bicarbonate, lowering pH. Ammonium chloride lowers the blood pH after being metabolized to urea and hydrochloric acid, which provides hydrogen ions to acidify the blood or urine. Ascorbic acid directly acidifies urine, providing hydrogen ions and lowering urine pH. Pharmacotherapeutics: Metabolic Alkalosis Adverse Effects: Metabolic acidosis (ammonium chloride), GI distress & Hemolytic anemia (Ascorbic acid), aplastic anemia (Acetazolamide) Nursing Implementation: ✓If twitching occurs with ammonium chloride therapy, withhold the next dose and notify the practitioner. Twitching may indicate ammonium toxicity. ✓Give a mild analgesic if a headache results from high-dose ascorbic acid therapy. ✓If insomnia occurs, suggest relaxation techniques before bedtime or request a hypnotic for the patient. November 3, 2024 20  Cancer Medications Antineoplastic drugs Alkylating Antimetabolite drugs drugs Antineoplastic drugs are medications used to treat cancer. Other names for antineoplastic drugs are anticancer, chemotherapy, chemo, cytotoxic, or hazardous drugs. These drugs come in many forms, including liquids or pills. November 3, 2024 21  Nitrogen mustards Chlorambucil- Cyclophosphamide – Stramustine- Ifosfamide Pharmacodynamic: Nitrogen mustards form covalent bonds with DNA molecules In a chemical reaction known as alkylation. Alkylated DNA can’t replicate properly, thereby resulting in cell death. Pharmacotherapeutics: Hodgkin’s disease, Leukemia, Lymphoma, Melanoma Adverse Effects: bone marrow suppression, nausea and vomiting, stomatitis, reversible hair loss Nursing Implementation ✓Follow established procedures for safe and proper handling, administration, and disposal of chemotherapeutic drugs. ✓Treat extravasation promptly. ✓Infection control in immunocompromised patients whose WBC counts fall below 2,000/μL or granulocyte counts fall below 1,000/μL. November 3, 2024 22  Nitrosoureas Carmustine, Lomustine, Streptozocin. Pharmacodynamic: During a process called bifunctional alkylation, nitrosoureas interfere with amino acids, purines, and DNA needed for cancer cells to divide, thus halting their reproduction Pharmacotherapeutics: Brain tumors and meningeal leukemias. Adverse Effects: Bone marrow suppression, Kidney toxicity and kidney failure, hepatotoxicity Nursing Implementation ✓Follow established procedures for safe & proper handling, administration, disposal of chemotherapeutic drugs. ✓Give an antiemetic before giving the drug to reduce nausea. ✓Administer the medications according topolicy for reconstitution, mixing, storage, and administration. ✓Use double gloves when handling carmustine wafer in the operating room. ✓Administer adequate hydration and monitor the patient’s intake and output. November 3, 2024 23  Triaznes (Dacarbazine) Pharmacodynamic: Inhibit ribonucleic acid (RNA) and protein synthesis Pharmacotherapeutics: malignant melanoma, Hodgkin’s disease. Adverse Effects: Leukopenia, thrombocytopenia, nausea and vomiting, phototoxicity Nursing Implementation: ✓Follow established procedures for safe proper handling, administration, disposal of chemotherapeutic drugs. ✓Administer the medications as ordered and monitor for effects. ✓Administer adequate hydration and monitor the patient’s intake and output. ✓Administer an antiemetic before giving dacarbazine to help decrease nausea. Nausea and vomiting may subside after several doses. November 3, 2024 24  Antimetabolite drugs: Folic acid analogues Methotrexate Pharmacodynamic: Methotrexate reversibly inhibits the action of the enzyme Dihydrofolate reductase which inhibits DNA and RNA synthesis. Pharmacotherapeutics: Acute lymphoblastic leukemia, Choriocarcinoma, Osteogenic sarcoma Adverse Effects: bone marrow suppression, stomatitis, pulmonary toxicity, Kidney toxicity Nursing Implementation ✓Follow the established procedures for safe and proper handling, administration, and disposal of drugs. ✓Try to ease anxiety in the patient and his family before treatment. ✓Give an antiemetic before giving the drug to lessen nausea. ✓Provide diligent mouth care to prevent stomatitis with methotrexate therapy. ✓Methotrexate stored in room temperature November 3, 2024 25  Antimetabolite drugs: Pyrimidine analogues Capecitabine, Cytarabine, Floxuridine, Fluorouracil Pharmacodynamic: Pyrimidine analogues kill cancer cells by interfering with the natural function of pyrimidine nucleotides Pharmacotherapeutics: GI tract adenocarcinomas, acute leukemias Adverse Effects: Bone marrow suppression, nausea, anorexia. Nursing Implementation: ✓Follow established procedures for safe and proper handling, administration, and disposal of drugs. ✓Try to ease anxiety in the patient and his family before treatment. ✓Give an antiemetic before giving the drug to lessen nausea. ✓Give cytarabine with allopurinol to decrease the risk of hyperuricemia. ✓Promote a high fluid intake. November 3, 2024 26  Pituitary Part II gland Adrenal Endocrine glands Hypo/hyper Drugs thyroidism Diabetes Mellitus (DM) November 3, 2024 27  Introduction ❖The endocrine system consists of glands, which are specialized cell clusters, and hormones, the chemical transmitters secreted by the glands in response to stimulation. ❖ It regulates and integrates the body’s metabolic activities and maintains homeostasis. ❖ In general, drug types that treat endocrine system disorders include: - Natural hormones and their synthetic analogues, such as insulin and glucagon. - Drugs that stimulate or suppress hormone secretion.  Diabetes Mellitus (DM) ❖ Insufficient insulin production from the β- cells of the pancreas or/and: ❖ Cellular resistance to insulin resulting in elevated blood glucose levels (hyperglycemia). ❖ It leads to complications such as myocardial infarction, stroke, blindness, kidney disease, and lower limb amputations. November 3, 2024 29 Drugs for Diabetes Mellitus Type 1 Type 2 Hypoglycemic agents includes: Insulin Biguanides Sulphonylureas Thiazolidinediones Glinides Dipeptidyl peptidase 4 inhibitors GLP-1 Receptor agonists Selective Sodium-Glucose Transporter-2 Inhibitors Glucosidase inhibitors  INSULIN PHARMACODYNAMICS TYPES OF INSULIN INCLUDE: ❖ Insulin is an anabolic or building hormone that promotes: ❖ Rapid-acting, such as lispro, Aspart (soluble). SubQ and IV infusion only ▪ Glucose transport into muscle and fat cells. ❖ Short-acting, such as regular insulin ▪ Increased glycogen synthesis by liver. (soluble). SubQ and IV infusion only ▪ An increase in protein and fat synthesis by inhibition of ❖ Intermediate-acting, such as NPH lipolysis and increased formation of triglycerides. insulin suspension. (SubQ only) ▪ Movement of potassium from the extracellular fluid into ❖ Long-acting, such as glargine. Mostly SubQ the cell. ▪ https://m.youtube.com/watch?v=5zM-j1V2ruQ  Adverse effects Hypoglycemia Tachycardia. Management with Palpitations - Orange juice/honey (oral glucose) Hypoglycemic reaction - If the patient is Rebound hyperglycemia unconscious: lipodystrophy (ROTATE injection site.) ▪ Glucagon injection Life-threatening: Shock, anaphylaxis ▪ Glucose IV Beta-adrenergic blockers masks signs and symptoms of hypoglycemia. Corticosteroids and diuretics may reduce the effects of insulin, resulting in hyperglycemia.  SULFONYLUREA E.g.; Glyburide, Glipizide, Glimepiride PHARMACODYNAMICS ❖ Stimulate insulin secretion form Drug interactions pancreatic β-cells by binding ❖ Drugs that can reduce effect of to Sulphonylurea receptors. Sulphonylureas > Corticosteroids, diuretics. * Therefore, Functioning pancreatic cells ❖ Drugs that can increase effect of Sulphonylureas is necessary for their action. > Beta-blockers, Clarithromycin. Pharmacokinetic Metabolize by liver and excreted by kidney. Used with caution in hepatic and renal impairment.  Biguanides Metformin insulin sensitizer Pharmacodynamics Reduces hepatic gluconeogenesis (production of glucose). ❖ Slows intestinal absorption of sugars. ❖ Increases peripheral glucose uptake and utilization >>> reduce insulin resistance. ✓ Metformin does not lead to weight gain or hypoglycemia. ✓ Weight loss > reduces appetite(because dose not cause insulin release). ✓ Initial drug of choice for type 2 diabetes.  Adverse effects and Drug interactions Drug interactions Adverse effects Dizziness, Fatigue, Headache Metformin administration with Bitter or metallic taste iodinated contrast dyes can result in acute renal failure. GI Side effects (nausea, vomiting, diarrhea, anorexia) Weight loss Vit. B12 deficiency Contraindicated in renal dysfunction risk of lactic acidosis  Thiazolidines Rosiglitazone, Pioglitazone insulin sensitizers. Pharmacotherapeutics Blood glucose control for type 2 DM Adverse effects Weight gain Fluid retention Osteopenia hepatotoxicity Contraindications: severe heart failure and hepatic impairment.  Meglitinides Repaglinide, Nateglinide Pharmacodynamics like sulfonylureas, they stimulate insulin secretion, They bind to a distinct site on the β cell. This class has a rapid onset and a short duration of action (with meals). Should not be used in combination with sulfonylureas due to overlapping mechanisms of action. This would increase the risk of serious hypoglycemia. Adverse Effects: hypoglycemia, weight gain  Dipeptidyle Peptidase-4 (dpp-4) Inhibitors Alogliptin, linagliptin, saxagliptin, and sitagliptin Pharmacodynamic inhibit the enzyme DPP-4, which is responsible for the inactivation of incretin hormones. Prolonging the activity of incretin hormones increases insulin release in response to meals and reduces inappropriate secretion of glucagon. Adverse Effects: Nasopharyngitis, Hypoglycemia  Glp-1receptor agonists Exenatide, Liraglutide, Semaglutide and Dulaglutide Pharmacodynamic: Synthetic analog of human GLP-I that binds to GLP-I receptors resulting in glucose-dependent insulin secretion, reduction in glucagon secretion without impairing the normal glucagon response to hypoglycemia and reduced gastric emptying. Adverse effects Nausea, vomiting, and diarrhea. Hypoglycemic risk with insulin and Sulphonylurea.  Selective Sodium-Glucose Transporter-2 (SGLT-2) Inhibitors Canagliflozin, Dapagliflozin, Empagliflozin Pharmacodynamic SGLT2 inhibitors have a unique mode of action whereby they increase excretion of glucose by the kidneys by reducing reabsorption in the proximal tubule, consequently decreasing blood glucose SGLT2 have low risk of hypoglycemia and decrease blood pressure. Side effects high frequency of genital mycotic infections, urinary tract infections, ketoacidosis, dehydration, risk of amputation and worsening renal function.  Nursing process Monitor vital signs, Tachycardia can occur during insulin reaction. Administer oral antidiabetics with food to minimize gastric upset. Monitor blood glucose levels, and report changes. Explain that orange juice, sugar-containing drinks, and hard candy may be used when a hypoglycemic reaction begins. Thyroid disorders  Hypothyroidism Hyperthyroidism It is an increase in circulating T4 and T3 levels, A decrease in thyroid hormone which usually results from an overactive thyroid secretion gland Surgical removal of part of thyroid gland Levothyroxine is the drug of Medications: Propylthiouracil (PTU) and choice Methimazole are effective thioamide antithyroid drugs Adverse effects includes; nervousness, Adverse effects includes; headache, hair palpitations and tachycardia, heat intolerance, and unexplained weight loss loss, and epigastric distress  Levothyroxine (Synthroid) Pharmacodynamic: Increases basal metabolic rate, enhances gluconeogenesis, stimulates protein synthesis Pharmacotherapeutics: Replacement in decreased or absent thyroid function. Hypothyroidism, cretinism, myxedema coma, simple goiter. Management of thyroid cancer following surgery Adverse Effects: Overdose may cause thyrotoxicosis—tachycardia, increased blood pressure, angina, tremor, nervousness, insomnia, heat intolerance. Long-term use—osteoporosis and increased risk for atrial fibrillation Nursing Implementation: Monitor for tachycardia and irregular pulse rate. Teach patient to report any symptoms of thyrotoxicosis. Replacement for hypothyroidism is lifelong. Do not discontinue. Instruct patient to have thyroid-stimulating hormone levels measured periodically. Takes approximately 6 to 8 weeks for the full effects of the medication to be seen. Teach patient to take the medication in the morning, preferably 30 to 60 minutes before meals. November 3, 2024 44  Nursing process Monitor vital signs. With hypothyroidism, temperature, heart rate, and blood pressure usually decrease. With hyperthyroidism, tachycardia and palpitations usually occur. Monitor patient’s weight. Weight gain commonly occurs in patients with hypothyroidism. Encourage patient to take drug at early morning before breakfast.  03 PITUITARY GLAND DISORDERS Anterior Pituitary Hormones & Posterior Pituitary Hormones Anterior Pituitary Drugs Drugs act on anterior pituitary hormones include: Adrenocorticotropic hormones (ACTH) or corticotropin Growth hormones (somatropin) Somatostatin (Growth hormone-inhibiting hormone) Gonadotropin-releasing hormone Gonadotropins, which include chorionic gonadotropin and menotropins Drugs that regulate prolactin.  Adrenocorticotropic hormone (ACTH) Pharmacodynamic: ACTH binds to receptors on the surface of the adrenal cortex > synthesis and release of the adrenocorticosteroids (i.e., Cortisol) and the adrenal androgens Pharmacotherapeutics: Can be used as a diagnostic tool Adverse Effects: Irritability, increased appetite and weight gain, high blood pressure. November 3, 2024 49  Growth hormone Somatotropin Somatostatin (Growth hormone inhibiting hormone) Pharmacodynamic: Direct Pharmacodynamic: It is released physiological effects of GH on organs or from hypothalamus and acts on the mediated through insulin-like growth pituitary, somatostatin binds to factors receptors that suppress GH and Pharmacotherapeutics: GH deficiency thyroid-stimulating hormone release or growth failure in children and adults Pharmacotherapeutics: Acromegaly Adverse Effects: Pain at the injection site, Adverse Effects: Diarrhea, edema, arthralgias, myalgias, flu-like gastrointestinal cramps, nausea symptoms, and an increased risk of diabetes. November 3, 2024 50  Gonadotropin releasing hormone (GnRH) Physiologic: GnRH from hypothalamus > release FSH and LH from anterior pituitary Pharmacologic/ Pharmacodynamic : by binding to the pituitary GnRH receptor, they lead to a rapid suppression of gonadotropins Pharmacotherapeutics: Prostate cancer, endometriosis Adverse Effects: In women, hot flushes and sweating, diminished libido, depression, and ovarian cysts. In men, hot flushes, edema, gynecomastia, and diminished libido November 3, 2024 51  Anterior pituitary drugs Gonadotropins (LH, FSH) Prolactin Pharmacodynamic: Pharmacodynamic: Promotes Stimulating the follicle the growth of mammary alveoli development and ovulation Pharmacotherapeutic: Pharmacotherapeutic : Stimulate and maintain Infertility lactation Adverse Effects: Ovarian Adverse Effects: Irregular or enlargement absent menstrual periods, infertility, menopausal symptoms November 3, 2024 52 Posterior Pituitary Hormones Vasopressin Oxytocin Not regulated by hypothalamus releasing hormones, they are synthesized in the hypothalamus and transported to the posterior pituitary.  Nursing process Monitor vital signs: Increased heart rate and decreased systolic pressure can indicate fluid volume loss resulting from decreased ADH production Record urinary output: Increased output can indicate fluid loss caused by a decrease in ADH. Adrenal Gland Disorders Adrenal glands The paired adrenal glands consist of the adrenal medulla and adrenal cortex. Adrenocortical hormones Mineralocorticoids: aldosterone Glucocorticoids (Glucocorticosteroids): cortisol Sex hormones : androgens  Glucocorticoids Endogenous Glucocorticoids Synthetic Glucocorticoids Cortisol Prednisolone Cortisone Prednisone Methylprednisolne Corticosterone Betamethasone Desoxycorticosterone Fludrocortisone Differences between glucocorticoid drugs are potency, duration of action, and pharmacokinetic behavior. Synthetic Drugs: Stronger potency, Lower dose, Longer duration  Glucocorticoids Pharmacotherapeutic Anti-Inflammatory Treatment of Allergic Disorders Arthritis Asthma Autoimmune diseases (Immunosuppression) Prevention of graft rejection (transplant) Dermatological disorders Respiratory distress syndrome Glucocorticoids Side effects Impaired wound healing, increase risk of infection Growth retardation in children. Musculoskeletal effects: osteoporosis (brittle bones) due to negative calcium balance, muscle weakness and atrophy Adrenocortical excess (Cushing’s disease): “Moon face”, “buffalo hump” Diabetes Mellitus CNS effects: psychological and behavioral changes; aggravation of pre-existing psychiatric disorders Increase appetite and centripetal obesity Frequently; CVS effects: myopathy, fluid retention, edema and hypertension. Thin fragile skin,  Nursing process ▪ Monitor vital signs. Glucocorticoids can increase blood pressure ▪ Monitor fluid balance and potassium and glucose levels (electrolyte {Na, K} and water retention). ▪ Advise patient to take drug as prescribed. Caution patient NOT TO ABRUPTLY STOP drug. When drug is discontinued, dose is TAPERED over 1 to 2 weeks. ▪ Assess for side effects from glucocorticoid drugs when therapy has lasted more than 10 days, and drug is taken in high dosages. ▪ Assess for underlying infection and decreased wound healing. ▪ Daily doses need to increase during stress. ▪ Assess for Cushing symptoms. ▪ Check stools for occult blood. ▪ Advise patients to wear a Medic-Alert bracelet. ▪ Teach about alternate-day dosing if ordered and taking medicine before 9 am.  Activity Medication name Therapeutic class Pharmacologic class Action Uses Administration alert Adverse Effects Contraindication Interactions Treatment of overdoses November 3, 2024 61  Nursing Process Assessment Nursing Planning Intervention Evaluation Diagnosis November 3, 2024 62