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Pharm Chapter 30: Pituitary Drugs, chapter 40 antiviral, Lilley Chapter 40: Antiviral Drugs, Lilley Chapter 52: Antiemetic and Antinausea Drugs, Ch. 58 Otic Drugs, Pharm - Ch. 58: Otic Drugs - NCLEX, Ch. 57 Ophthalmic Drugs, Pharm. - Ch. 56 : Dermato...

Terms in this set (210)

-Drugs are generally used either as replacement drug therapy to make up for a hormone deficiency or as diagnostic aids to determine the status of the patient's hormonal functions. They either augment or antagonize the natural effects of the pituitary hormones.
-Exogenously administered corticotropin elicits all of the same pharmacologic responses as those elicited by endogenous corticotropin (known as ACTH).
-Cosyntropin travels to the adrenal cortex, located just above the kidney, and stimulates the secretion of cortisol.
-Cortisol has many anti-inflammatory effects, including reduction of inflammatory leukocyte functions and scar tissue formation. Cortisol also promotes renal retention of sodium, which can result in edema and hypertension.
-The drugs that mimic GH are somatropin and somatrem. These drugs promote growth by stimulating various anabolic (tissue-building) processes, liver glycogenolysis (to raise blood sugar levels), lipid mobilization from body fat stores, and retention of sodium, potassium, and phosphorus. Both drugs promote linear growth in children who lack normal amounts of the endogenous hormone. Octreotide is a drug that antagonizes the effects of natural GH by inhibiting GH release. It also reduces plasma concentrations of vasoactive intestinal polypeptide (VIP), a protein secreted by a type of tumor known as a VIPoma that causes profuse watery diarrhea.
-The drugs that affect the posterior pituitary gland, such as vasopressin and desmopressin, mimic the actions of the naturally occurring ADH. They increase water resorption in the distal tubules and collecting ducts of the nephrons, and they concentrate urine, reducing water excretion by up to 90%.
-Vasopressin is also a potent vasoconstrictor in larger doses and is therefore used in certain hypotensive emergencies, such as vasodilatory shock (septic shock). It is also used in the Advanced Cardiac Life Support guidelines for treatment of pulseless cardiac arrest.
-Vasopressin is also used to stop bleeding of esophageal varices. Desmopressin causes a dose-dependent increase in the plasma levels of factor VIII (antihemophilic factor), von Willebrand factor (acts closely with factor VIII), and tissue plasminogen activator. These properties make it useful in treating certain blood disorders including hemophilia A and type I von Willebrand's disease.
-Desmopressin is also used for management of nocturnal enuresis.
-The drug form of oxytocin mimics the endogenous hormone, thus promoting uterine contractions.
-Cosyntropin is used in the diagnosis of adrenocortical insufficiency. Upon diagnosis, the actual drug treatment generally involves replacement hormonal therapy using drug forms of the deficient corticosteroid hormones.
-Somatropin and somatrem are human GH produced by recombinant technology. They are effective in stimulating skeletal growth in patients with an inadequate secretion of normal endogenous GH, such as those with hypopituitary dwarfism, and are also used for wasting associated with human immunodeficiency virus (HIV) infection. Octreotide is useful in alleviating certain symptoms of carcinoid tumors stemming from the secretion of VIP, including severe diarrhea and flushing and potentially life-threatening hypotension associated with a carcinoid crisis. It is also used for the treatment of esophageal varices.
-Vasopressin and desmopressin are used to prevent or control polydipsia (excessive thirst), polyuria, and dehydration in patients with diabetes insipidus caused by a deficiency of endogenous ADH. Because of their vasoconstrictor properties, they are useful in the treatment of various types of bleeding, in particular gastrointestinal hemorrhage.
-In the assessment of patients receiving pituitary hormones, measure baseline vital signs, review blood glucose levels, and measure weight.
-Assess the patient's height, weight, and vital signs, and take a complete medication history with notation of allergies, prescription drug use, and use of over-the-counter (OTC) drugs and herbals.
-With octreotide, the prescriber may order an electrocardiogram (ECG) before use because of the adverse effect of conduction abnormalities. Assess baseline glucose levels, and assess respiratory status and gallbladder disorders with octreotide acetate use.
-Patients taking octreotide may require special dosing if they have decreased liver and kidney function; therefore, assess and record baseline liver and kidney function test results.
-It is also important to be sure that assessment includes steps to prevent medication errors as well as awareness of concerns regarding look-alike sound-alike drugs.
-With desmopressin, check vital signs and assess for a history of seizures, asthma, or cardiovascular disease. These conditions require cautious use with careful monitoring of vital signs, heart sounds, and breath sounds. Perform a thorough nursing assessment with documentation of the patient's height, weight, and vital signs, and obtain a complete medication history with notation of allergies, prescription drug use, and use of OTC drugs and herbals.
-If vasopressin is being administered for shock, close monitoring in an intensive care setting is needed with ECG, vital signs, and other possibly invasive monitoring methods.
-Obtain baseline thyroid, glucose, and calcium levels in patients receiving GHs due to the potential side effects of hyperglycemia, hypothyroidism, and hypercalciuria.
-Use of somatropin requires attention to the growth, motor skills, height, and weight of the pediatric patient.
-Octreotide must be given as ordered with attention to the route of administration. To avoid giving the wrong medication, be careful not to confuse octreotide acetate injection with the injectable depot suspension dosage form. Use only clear solutions, and always check for incompatibilities.
-Make sure patients understand the importance of immediately reporting to the prescriber any abdominal distress such as diarrhea, nausea, or vomiting if not manageable. Stress the importance of follow-up appointments for laboratory testing during treatment with this drug.
-Octreotide may cause alterations in blood glucose levels; closely monitor blood glucose during drug therapy, especially if patients are already diabetic.
-For patients receiving somatropin, constantly monitor levels of thyroid hormones and GHs. Include measurement of vital signs, intake/output, and weight in the assessment.
-For desmopressin and somatropin, rotate subcutaneous injection sites (also given intramuscularly [IM], in ventral gluteal site) to avoid tissue damage. Mix injectable solutions by gently swirling the liquid, using only clear solutions. If used in patients diagnosed with diabetes insipidus, fluid intake may be adjusted according to the predicted risk of water intoxication and sodium deficit.
-Vasopressin is available as a nasal spray or as an injection for IM or intravenous use. Always check the clarity of parenteral solutions before administering the medication, and discard the solution if there are visible particles or any fluid discoloration. Be alert to the adverse effects of elevated blood pressure, fever, nausea, abdominal cramping, or diarrhea.
-With octreotide, therapeutic effects include improved symptoms related to carcinoid tumors, VIPoma, or esophageal varices.
-With vasopressin, an improvement in diabetes insipidus, esophageal varices, or vasodilatory shock is expected.
-With somatropin, increased growth is expected in patients with GH deficiency. Adverse effects to assess for include fatigue, headache, altered blood glucose levels, diarrhea, nausea, vomiting, conduction disorders, and dyspnea.
-Adverse effects associated with desmopressin and vasopressin include increased blood pressure, fever, headache, abdominal cramps, and nausea. GHs may lead to headache, hyperglycemia, hypothyroidism, hypercalciuria, and flu-like syndrome.