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NR 292 STUDY GUIDE EXAM 2 WITH ANSWERS.
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NR 292 STUDY GUIDE EXAM 2 WITHANSWERS
Mod 5
30 - Pituitary Drugs
Terms
➔ Hypothalamus - Secretes the hormone vasopressin and oxytocin (stored in the posterior pituitary gland).
Also secretes several hormone-releasing factors that stimulate the anterior pituitary gland to secrete a
variety of hormones that control many bodily functions
➔ Negative feedback loop - regulates hormone secretion in the body
➔ Neuroendocrine system - regulates the reactions to both internal and external stimuli and involves the
integrated activities of the endocrine glands and nervous system
➔ Pituitary gland - an endocrine gland that is suspended beneath the brain and supplies numerous
hormones that control many vital processes
Endocrine System
➔ Main goal of this system: physiologic stability
➔ Every cell and organ in the body is influenced by the endocrine system.
➔ Hormones: “chemical language” of endocrine system
◆ Natural substances
◆ Secreted into the bloodstream and travel through the blood to their site of action
➔ Neuroendocrine System : Pituitary Hormones
◆ Hypothalamus
● Part of the central nervous system
◆ Pituitary gland
● Anterior pituitary (adenohypophysis)
● Posterior pituitary (neurohypophysis)
◆ Together they govern all bodily functions
● Hormones
● Negative feedback loop
○ Activity of endocrine system regulated by a system of surveillance and signaling
based on body’s ongoing needs
○ Hormone secretion is commonly regulated by a negative feedback loop
Pituitary Drugs
➔ Anterior pituitary drugs
◆ Cosyntropin
● Stimulates release of cortisol from adrenal cortex
● Antiinflammatory effect
● Diagnosis of adrenocortical insufficiency
● Wasting associated with human immunodeficiency virus infection
1
, ● Promotes renal retention of sodium, which can result in edema and hypertension
◆ Somatropin
◆ Octreotide
➔ Posterior pituitary drugs
◆ Vasopressin
◆ Desmopressin
➔ MOA
◆ Differs depending on the drug
◆ Either augments or antagonizes the natural effects of the pituitary hormones
➔ Contraindications
◆ Because even the smallest amounts of these drugs can initiate major physiologic changes, they
need to be used with special caution in patients with acute or chronic illnesses such as : migraine
headaches, epilepsy, and asthma
➔ Adverse Effects
◆ Specific to individual drug
◆ CNS - fatigue, malaise, headache
◆ Endocrine - ↑/↓ in blood glucose level
◆ Gastrointestinal - diarrhea, nausea, vomiting
◆ Respiratory - dyspnea
◆ Musculoskeletal - arthralgia (pain in a joint)
◆ Cardiovascular - conduction abnormalities
➔ DRUGS
◆ Octreotide (Sandostatin)
● Useful in alleviating certain symptoms of carcinoid tumors stemming from the secretion
of VIP, including severe diarrhea, flushing, and the potentially life-threatening
hypotension associated with carcinoid crisis
● Also used for treatment of esophageal varices
● Contraindication: hypersensitivity
● May impair gallbladder function and needs to be used with caution in patients with
renal impairment
● May affect glucose regulation and severe hypoglycemia may occur in patients with type
1 diabetes
● May cause hyperglycemia with type 2 patients or in patients w/o diabetes
● May enhance the toxic effects of drugs (ciprofloxacin) that prolong the QT interval
● IV, IM, subQ
◆ Somatropin (Humatrope, Nutropin, Seostim, and others)
● Recombinantly made growth hormone (GH) that is indicated in the treatment of growth
failure due to inadequate endogenous GH secretion
● Stimulate skeletal growth in patients with deficient GH, such as hypopituitary dwarfism
● Also used in patients with HIV infection with wasting or cachexia (weakness and wasting
of the body due to severe chronic illness) in conjunction with antiviral therapy
● Contraindicated: hypersensitivity to any component of the product and in children with
closed growth plates, patients with tumors, and acute illnesses
● Adverse Effects: headache, injection site reactions, muscle pain, hypoglycemia, or
hyperglycemia
2
, ● Important not to shake the product
● Generally given subQ, can be given IM
◆ Vasopressin (Pitressin)
● Used to prevent or control polydipsia (excessive thirst), polyuria (excessive urine), and
dehydration with patients with diabetes insipidus caused by a deficiency of endogenous
ADH
● Mimic the action of antidiuretic hormone
● Increase water reabsorption in the distal tubules and collecting ducts of the nephrons,
and they concentrate urine, reducing water excretion by up to 90%
● Vasopressin used to control various types of bleeding (gastrointestinal hemorrhage) and
in pulse;ess arrest and vasodilatory shock
○ Use with caution in patients with seizure disorders, asthma, CVD, renal disease
○ IV infiltration may lead to severe vasoconstriction and localized tissue necrosis -
watch IV site closely
○ Nasal spray, IM, IV
○ When used to treat septic shock = continuous IV
● Desmopressin used in treatment of hemophilia A and type 1 von Willebrand disease
because of its effects on various blood-clotting factors
◆ NOTE - Somatropin is human GH that is used for the treatment of hypopituitary dwarfism.
Cosyntropin is used for the diagnosis of adrenocortical insufficiency. Octreotide is used for
esophageal varices. Vasopressin is indicated for septic shock
Nursing Implications
➔ Obtain thorough nursing assessment and medication history
➔ Assess and document height, weight, VS
➔ Assess for contraindications specific to each drug
➔ Assess medication history for possible interactions
➔ Assess diagnostic lab values (e.g., glucose levels, liver, and kidney function)
➔ 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 a health care provider
➔ Parents of children who are receiving GHs should keep a journal reflecting the child’s growth
➔ Monitor for therapeutic responses
◆ Somatropin should increase growth in children
◆ Desmopressin and vasopressin should reduce severe thirst and decreased urinary output
◆ Octreotide should reduce symptoms of carcinoid crisis
➔ Monitor for adverse effects
➔ Normal lab values
◆ Glucose - 65-99 mg/dL
◆ TSH - 0.4-4.0
◆ Calcium in urine - 100-300 mg/day
3
, 31 - Thyroid and Antithyroid Drugs
Terms
➔ Euthyroid - normal thyroid function
➔ Hyperthyroidism - excessive production of thyroid hormones
➔ Hypothyroidism - diminished production of thyroid hormones
➔ Thyroid-stimulating hormone (TSH) - endogenous substances secreted by the pituitary gland that controls
the release of thyroid gland hormones; necessary for the growth and function of the thyroid gland (aka:
Thyrotropin)
➔ Thyroxine (T4) - principle thyroid hormone that influences the metabolic rate
➔ Triiodothyronine (T3) - secondary thyroid hormone that also affects body metabolism
Thyroid Function
➔ Secretes three hormones essential for proper regulation of metabolism
◆ Thyroxine (T4)
◆ Triiodothyronine (T3)
◆ Calcitonin
➔ Located near the parathyroid gland, which is responsible for maintaining adequate levels of calcium in the
extracellular fluid
Pathophysiology of Hypothyroidism
➔ Primary: abnormality in the thyroid gland itself
➔ Secondary: results when the pituitary gland is dysfunctional and does not secrete thyroid-stimulating
hormone (TSH)
➔ Tertiary: results when the hypothalamus gland does not secrete thyrotropin-releasing hormone, which
stimulates the release of TSH
➔ Classified also by when it occurs in lifespan
◆ Congenital hypothyroidism (Cretinism)
● Hyposecretion of thyroid hormone during youth
● Low metabolic rate, retarded growth and sexual development, possible mental
retardation
◆ Myxedema
● Hyposecretion of thyroid hormone during adulthood
● Decreased metabolic rate, loss of mental and physical stamina, weight gain, loss of hair,
firm edema, yellow dullness of the skin
◆ Goiter
● Enlargement of the thyroid gland
● Results from overstimulation by elevated levels of TSH
● TSH is elevated because there is little or no thyroid hormone in circulation
◆ Common symptoms
● Thickened skin
● Hair loss
● Constipation
● Lethargy
● Anorexia
Pathophysiology of Hyperthyroidism
➔ Caused by several diseases
◆ Graves’ disease
4
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