JOSEPH F McCLOSKEY SCHOOL OF NURSING NURSING 101 MEDICATIONS TO TREAT ENDOCRINE DISORDERS DWARFISM

MEDICATION ACTION ROUTE CONTRAINDICATIONS SIDE EFFECTS

1. somatropin (Genotropin, Humatrope, Norditropin, Nutropin, Nutropin AQ, Nutropin Depot, Saizen, Serostim) 2. somatrem (Protropin)

Recombinantly made human GH, stimulates skeletal growth in persons with inadequate GH secretion. Increases protein synthesis, carbohydrate metabolism, lipid metabolism, retention of Na+, P, and K+.

IM or SC

Closure of epiphyses plates, evidence of an active tumor, resp impairment, or intracerebral lesions

Pain at injection site, hyperglycemia, hypothyroidism, and edema of hands & feet

ACROMEGALY
MEDICATION ACTION ROUTE SIDE EFFECTS

bromocriptine (Parlodel) octreotide (Sandostatin, Sandostatin LAR)

Stimulates dopamine receptors in the brain (Antiparkinson effect) & inhibits release of GH. Suppresses the GH

po

IV/SC

Dizziness, orthostatic hypotension, gastric irritation, nausea, headache, abd pain, & constipation Dizziness, orthostatic hypotension, hyper/hypoglycemia, palpitations, N/V, injection-site pain, & edema

DIABETES INSIPIDUS
MEDICATION ACTION ROUTE CONTRAINDICATIONS SIDE EFFECTS

1.Desmopressin (DDAVP, Octostim) 2. vasopressin (Pitressin, Pressyn) 3. lypressin (Diapid)

Increases the reabsorption of Na+ and H2O in the distal tubules & collecting duct of the nephron, decrease urinary flow rate, causing urine to be conserved & increases urine osmolality

po, intranasal, IV, SC IM/SC

Allergy, chronic Hypertension, nephritis, drowsiness, glaucoma, BPH, MI headache, (recovery phase) lethargy, flushing, nausea, cramps, uterine cramping, nasal irritation, congestion, tremor, diaphoresis, & vertigo

SIADH
MEDICATION ACTION ROUTE CONTRAINDICATIONS SIDE EFFECTS

eemeclocycline (Declomycin) tetracycline

Inhibits the action of the Antidiuretic Hormone (ADH)

po

Pregnancy- can possibly slow fetal skeletal development. Newborns & children < 8 yrs old causes discoloration of permanent teeth & tooth enamel hypoplasia. Nursing Mother Allergy

Photosensitivity, superinfection, diarrhea, pseudomembranous colitis, thrombocytopenia, & hemolytic anemia

HYPOTHYROIDISM, MYXEDEMA COMA, CONGENITAL HYPOTHYROIDISM

MEDICATION ACTION ROUTE SIDE EFFECTS

1.levothyroxine (Synthroid, Levoxyl)

Synthetic T4. Induce changes in the metabolic rate, stimulate the cardiovascular system; increase O2consumption, body temperature, blood volume, growth, & overall cellular growth Synthetic T3. Faster acting than other drugs. Synthetic T3 & T4 (4:1 ratio)

po, IM, IV is 50% of oral dose

2. liothyronine (Cytomel, Triostat) 3. liotrix (Thyrolar)

po, IV po

Tachycardia, palpitations, angina, dysrhythmias, HTN, cardiac arrest, insomnia, tremors, headache, anxiety, nausea, diarrhea, or appetite, menstrual irregularities, weight loss, diaphoresis, heat intolerance, fever, thyroid storm As above As above

HYPERTHYROIDISM
MEDICATION ACTION ROUTE SIDE EFFECTS

1.methimazole (Tapazole)

thyroid hormone level. Inhibit the breakdown of iodine molecules into the amino acid tyrosine, a process require to make T3 & T4.

Po

2.propylthiouracil (PTU) 3. Strong iodine solution (Lugols solution, potassium iodide solution)

Inhibits the conversion T4 to T3 in the peripheral circulation. Reduce size and vascularity of thyroid gland. Dilute drug and administer p.c.; sip through straw to avoid discoloration of teeth.

po po (3-5gtt) tid Thyroid Crisis: 1 ml in H2O p.c. tid IV

Drowsiness, headache, fever, N/V/D, jaundice, hepatitis, loss of taste, smoky colored urine, urine output, agranulocytosis, leukopenia, thrombocytopenia, bleeding, rash, pruritus, hyperpigmentation, myalgia, enlarged thyroid, nephritis, BUN & creatinine. As above Hypothyroidism

HYPOPARATHYROIDISM
MEDICATION ACTION ROUTE SIDE EFFECTS

1. calcitriol (Rocaltrol-Vitamin D analogue) 2.dihydrotachyster ol (Hytakerol) 3. calcifediol (Calderol) 4. ergocalciferol (Drisdol)

Enhancement of calcium deposits in bones.

po

Anorexia, N/V/D, cramps, drowsiness, headache, dizziness, lethargy, & photophobia

As above As above

po po/IM

As above As above

HYPERPARATHYROIDISM
MEDICATION ACTION ROUTE SIDE EFFECTS

1. calcitonin (Calcimar, Miacalcin, Osteocalcin, Salmonine) 2.etidronate (Didronel) 3.cinacalcet (Sensipar)

serum Ca+ by a direct effect on bone, kidney, and GI tract. rate of bone turnover and lowers serum Ca+. Promotes renal excretion of Ca+ As above As above

IM, SC, Nasal spray

po po

Headaches Nasal Spray epistaxis, rhinitis, nasal irritation/ulceration. IM/SC injection site reaction, N/V, altered taste, diarrhea, urinary frequency As above As above

CUSHING SYNDROME
MEDICATION ACTION ROUTE SIDE EFFECTS

1. mitotane (Lysodren) Antineoplastic/Adrenal Cytotoxic 2.aminoglutethimide (Cytadren) Antiadrenal & AntiCorticosteroid Agent 3. ketoconazole (Nizoral)

Treatment for inoperable adrenal corticoid carcinoma Inhibits corticosteroid synthesis As above

po po

GU & respiratory toxicities

po

ADDISONS DISEASE
MEDICATION ACTION ROUTE SIDE EFFECTS

1. hydrocortisone 2. fludrocortisone (Florinef)

Glucocorticoid & mineralocorticoid property Mineralocorticoid replacement

IV, po

Review handout on corticosteroids

HYPERALDOSTERONISM PRIMARY HYPERALDOSTERONISM (PA)

MEDICATION ACTION ROUTE SIDE EFFECTS

1. spironolactone (Aldactone) 2. eplerenone (Inspra)

Potassium-Sparing Diuretics Blocks the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney, increases the excretion of Na+ & H2O and retention of K+.

po

Inspra avoid grapefruit juice

PHEOCHROMOCYTOMA
MEDICATION ACTION ROUTE SIDE EFFECTS

1. Alpha-Adrenergic Blockers phenoxybenzamine hydrochloride (Dibenzyline) 2. Beta-Blockers Propranolol (Inderal)

Reduces blood pressure by reducing peripheral vascular resistance. Blocks the stimulation of Beta-1. Used to decrease tachycardia & dysrhythmias

CORTICOSTEROID AGENTS Corticosteroids - systemic Short-acting corticosteroids cortisone (Cortone, Cortone Acetate hydrocortisone (A-hydroCort, Cortef, Hydrocortone, Solu-Cortef) Intermediate-acting corticosteroids methylprednisolone (A-Methapred, depMedalone, Depo-Medrol, Depopred, Duralone, Medralone, Medrol, Solu-Medrol) prednisolone (Articulose, cotolone, Delta-Cortef, Hydeltrasol, Key-Pred, Nor-Pred, OrapredPediapred, Predacort, Predate, Pred-Ject, Prednisol, Prelone prednisone (Cordrol, Deltasone, Liquid Pred, Meticorten, Orasone, Panasol-S, Pred-Pak, Prednicen-M, Prednicot, Sterapred) tramcinolone (Amcort, Aristocort, Aristospan, Atolone, Clinacort, Kenacort, Kenaject, Kenalog, Tac, Triam-A, Triam Forte, Triamolone, Triamonide, TriKort, Trilog, Trilone, Tristoject Long-acting corticosteroids betamethasone (Betnelan, Betnesol, Celestone, Cel-U-Jec budesonide (Entocort EC) dexamethasone (Cortastat, Dalalone, Decadrol, Decadron, Decaject, Deronil, Dexacorten, Dexameth, Dexasone, Dexone, Hexadrol, Primethasone, Solurex Action 1. Suppress inflammation & normal immune response 2. Suppress adrenal function 3. Replacement for deficiency of endogenous cortisol. Route po, IM, IV, SC, suppository Depoject,

Side Effects Heart failure, cardiac edema, hypertension, sodium and water retention, hypokalemia, mood and behavior changes, headache, convulsions, nervousness, insomnia, psychic impairment, growth suppression, Cushings syndrome, fat from extremities is redistributed to trunk and face; hyperglycemia, menstrual irregularities, HPA axis suppression, abd distention, peptic ulcers, pancreatitis, petechia, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria, fragile skin, protein depletion decreases bone formation, density, and strength leading to predisposition to pathologic fractures, esp compression fractures of the vertebrae (osteoporosis), exophthalmos, glaucoma, increased intraocular pressure, wt gain, thromboembolsis, & adrenal insufficiency, skeletal muscle atrophy and weakness; hypocalcemia related to anti-Vitamin D effect. Contraindications Lactation & pregnancy Use cautiously in children & active untreated infection Corticosteroids - topical/local alclometasone (Aclovate) amcinonide (Cyclocort) betamethasone (Betaderm, Diprosone, Teladar, Valisone, etc) clobetasol (Dermovate, Embeline E, Temovate) clocortolone (Cloderm) desonide (DesOwen, Tridesilon) desoximetasone (Topicort) dexamethasone (Decadrone, Decaspray, Aeroseb-Dex) diflorasone (Florone, Maxiflor, Psorcon) fluocinolone (Fluocet, Flurosyn, FS Shampoo, Synalar, etc) fluocinoncide (Fluocin, Licon, Lidex, Lyderm, Topsyn, etc) flurandrenolide (Cordran, Drenison)

fluticasone (Cutivate) halcinonide (Halog) halobestasol (Ultravate) hydrocortisone (Anusol HC, Cortaid, Cortizone, Dermacort, Lemoderm, Pandel, Synacort, etc) methylprednisolone (Medrol) mometasone (Elocon) prednicarbate (Dermatop) triamcinolone (Kenalog, Trianide, etc) Action Anti-inflammatory, antiprutitic, & vasoconstrictive properties. May inhibit migration of macrophages/leukocytes due to vascular dilation & permeability. Side Effects Allergic contact dermatitis, atrophy, burning, dryness, edema, hypersensitivity reaction, maceration, secondary infection, & adrenal suppression. Corticosteroids Inhaler Indication Prophylactic to prevent an asthma attack, seasonal allergic rhinitis beclomethasone dipropionate (Beclovent, Vanceril) budesonide (Pulmicort Turbuhaler, Rhinocort) dexamethasone sodium phosphate (Decadron Phosphate Respihaler) flunisolide (AeroBid, AeroBid M) fluticasone (Flonase, Cutivate, Flovent, Flovent Rotadisk) fluticasone propionate/salmeterol (Advair corticosteroid & long-acting beta2receptor agonist)

triamcinolone acetonide (Azmacort, Nasacort, Nasacort AQ)

Side Effects Pharyngeal irritation, coughing, dry mouth, & oral fungal infections. Patient Education Advise pt. to take medications as directed. Best to take po steroid upon arising in the morning and in the late afternoon. Avoid abruptly stopping the medication. Steroids need to be tapered down to prevent adrenal insufficiency (Addrenal Crisis). sudden drop in cortisol levels - S/S = anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia, wt loss, vomiting, lethargy, confusion, restlessness. This could be life threatening. Could cause immunosuppression and mask symptoms of infection. Avoid people with known contagious illnesses & report possible infections immediately Consult a health care professional before receiving any vaccination. Report the following S/S to a health care professional severe abd. pain, tarry stool, swelling, wt. gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes. Important to carry identification describing the disease process & medication regimen. Take with meals to minimize GI upset Tablets may be crushed but capsules should be swallowed completely. Avoid consumption of grapefruit juice during therapy. Prednisone should be taken in am (6am-9am) when cortisol level is highest & to minimize adrenal crisis. S/S of Cushing syndrome moon face, wt gain, muscle wasting, & increased deposition of fat in the trunk area leading to truncal obesity. Topical agents should be applied as ordered and covered with an occlusive dressing. Take nasal spray as directed by the manufacturer Inhalers should be used as ordered. Rinse mouth after using to avoid gingival hyperplasia. Monitor B/P, Na+, K+, and blood glucose.

Diet high in protein, calcium at least 1500 mg/day, and potassium, but low in fat and concentrated simple carbohydrates such as sugar, honey, syrups, & candy. Adequate rest, daily naps, and avoidance of caffeine late in the day. Develop and maintain an exercise program to help maintain bone integrity. Assess for edema and decrease sodium intake to less than 2000 mg/day if edema or HTN occurs. Monitor blood sugar and recognize s/s of hyperglycemia (polydipsia, polyuria, and polyphagia, blurred vision). Report to MD if blood sugar is > 120 mg/dL or urine is positive for glucose. Notify PCP if experiencing heartburn after meals or epigastric pain that is not relieved by antacids. See an eye specialist yearly to assist for development of cataracts. Get up slowly from bed to chair and use good lightening to avoid accidental injury. Maintain good hygiene and avoid contact with persons with colds or contagious illnesses to prevent infection. Inform all health care providers about long-term corticosteroid use. Corticosteroid may need to be increased in times of physical and emotional stress. NEVER abruptly stop the corticosteroids because this could lead to Addisonian crisis and possible death.

PK 2/11, 2/13