CHAPTER 30

Pituitary Drugs

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Neuroendocrine System: Pituitary Hormones

Hypothalamus

Part of the CNS

Pituitary gland

Anterior pituitary (adenohypophysis) Posterior pituitary (neurohypophysis)

Together, they govern all bodily functions

Hormones Negative feedback loop

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Mosby items and derived items 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Pituitary Drugs

Anterior pituitary drugs

Cosyntropin Somatotropin Vasopressin

Somatrem Octreotide

Posterior pituitary drugs

Desmopressin

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Uses

Replacement therapy when a hormone deficiency is present Drug therapy to produce a specific hormone response when a hormone deficiency is present Diagnostic aids to determine hypofunction or hyperfunction of a specific hormonal function

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Mechanism of Action

Differs depending on the drug Either augments or antagonizes the natural effects of the pituitary hormones

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Indications

cosyntropin (Cortrosyn)

Stimulates release of cortisol from adrenal cortex Antiinflammatory effect Promotes renal retention of sodium; may result in edema and HTN

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Indications (contd)

Somatropin and somatrem

Recombinantly made growth hormone (GH) Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism

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Indications (contd)

octreotide (Sandostatin)

Carcinoid tumors secrete VIP (vasoactive intestinal polypeptide) VIP causes profuse, watery diarrhea Octreotide reduces this severe diarrhea, flushing, and potentially life-threatening hypotension that may occur with a carcinoid crisis

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Indications (contd)

Vasopressin and desmopressin

Used in the treatment of diabetes insipidus Vasopressin: A powerful vasoconstrictor used for hypotensive emergencies, GI bleeding, and pulseless cardiac arrest Desmopressin: Used for dose-dependent treatment of blood disorders; also used for nocturnal enuresis

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Adverse Effects

Adverse effects are specific to the individual drugs

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Nursing Implications

Obtain thorough nursing assessment and medication history Assess for contraindications specific to each drug Assess medication history for possible interactions

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Nursing Implications (contd)

cosyntropin (Cortrosyn)

IM, SC, IV forms, and gel and repository forms Follow directions carefully for administration Maintain adequate hydration Decrease sodium and potassium intake Avoid vaccinations during drug therapy

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Nursing Implications (contd)

octreotide (Sandostatin)

May impair gallbladder functioninstruct patient to report abdominal pain Use with caution in patients with renal impairment Monitor glucose levels in patients with diabetes, and even in those who do not have diabetes Can be given IV, IM, or SC

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Nursing Implications (contd)

Provide specific instructions for nasal spray forms of vasopressin Rotate injection sites Do not discontinue drugs abruptly Do not take over-the-counter products without checking with health care provider Parents of children who are receiving growth hormones should keep a journal reflecting the childs growth

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Nursing Implications (contd)

Monitor for therapeutic responses

Cosyntropin should eliminate pain associated with inflammation and produce increased comfort and muscle strength in patients with multiple sclerosis Somatropin should increase growth in children Desmopressin and vasopressin should reduce severe thirst and decrease urinary output Octreotide should reduce symptoms of carcinoid crisis

Monitor for adverse effects

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