Pharm chapters 34-38

Somatropin is injected and reaches peak levels within how many hours

7 hours

______ an adrenocorticoid hormone, is released in response to ACTH but also is released directly in response to high potassium levels.

Aldosterone

Activation of the sympathetic nervous system directly causes release of ______ and the ______ hormones to prepare the body for fight or flight.

ACTH and the adrenocorticoid hormones

when an adrenal gland is damaged and cannot produce enough hormones, can lead to what ds

Addison's disease

Increases glucose levels, suppresses inflammatory and immune reactions Sodium retention, potassium excretion

Adrenal cortex Cortisol Aldosterone

are widely used to suppress the immune system and help people to feel better. These drugs do not, however, cure any inflammatory disorders.

Adrenocortical agents

are a form of the male sex hormone testosterone. They affect electrolytes, stimulate protein production, and decrease protein breakdown. They are used pharmacologically to treat hypogonadism or to increase protein growth and red blood cell production

Androgens

Indications: Treatment of Parkinson's disease, hyperprolactinemia associated with pituitary adenomas, female infertility associated with hyperprolactinemia, and acromegaly; short-term treatment of amenorrhea or galactorrhea. Actions: Acts directly on postsynaptic dopamine receptors in the brain Adverse Effects: Dizziness, fatigue, light-headedness, nasal congestion, drowsiness, nausea, vomiting, abdominal cramps, constipation, diarrhea, headache.

Bromocriptine Mesylate PO

Contraindications and Cautions: Steroids

Caution should be used in patients with diabetes because the glucose-elevating effects disrupt glucose control

are antagonists of GnRH.

Degarelix and ganirelix

Indications: Treatment of neurogenic diabetes insipidus, hemophilia A. Actions: Has pressor and antidiuretic effects; increases levels of clotting factor VIII. Adverse Effects: Headache, facial flushing, nausea, fluid retention, slight increase in blood pressure, local reaction at injection site, water intoxication at high doses.

Desmopressin

Indications: Partial replacement therapy in cortical insufficiency conditions, treatment of salt-losing adrenogenital syndrome; off-label use: treatment of hypotension. Actions: Increases sodium reabsorption in the renal tubules and increases potassium and hydrogen excretion, leading to water and sodium retention. Adverse Effects: Frontal and occipital headaches, arthralgia, weakness, increased blood volume, edema, hypertension, heart failure, rash, anaphylaxis.

Fludrocortisone PO

The anterior pituitary hormone that is most commonly used pharmacologically is

GH

deficiency in children results in short stature

GH

is responsible for linear skeletal growth, the growth of internal organs, protein synthesis, and the stimulation of many other processes that are required for normal growth

GH

is usually caused by pituitary tumors and can occur at any time of life. This is often referred to as

GH hypersecretion hyperpituitarism.

are so named because they stimulate an increase in glucose levels for energy

GLUCOCORTICOIDS

are analogues (agonist) of GnRH

Goserelin, histrelin, leuprolide, and nafarelin

react with receptors on the cell membrane to cause an immediate effect on a cell by altering enzyme systems near the cell membrane or they may enter the cell and react with receptor sites on messenger RNA, which then enters the nucleus and alters cell function.

Hormones

has largely been replaced for other uses (e.g., intra-articular, intravenous) by other steroid hormones with less mineralocorticoid effect. It may be preferred for use as a topical or ophthalmic agent.

Hydrocortisone

Nursing Diagnoses

Imbalanced Nutrition: Less Than Body Requirements related to metabolic changes Deficient Knowledge regarding drug therapy

Activation of the stress reaction through the SNS bypasses the usual diurnal rhythm and causes release of ACTH and secretion of the adrenocortical hormones—an important aspect of the stress ("fight-or-flight") response. The stress response is activated with cellular injury or when a person perceives fear or feels anxious. These hormones have many actions, including the following:

Increasing the blood volume (aldosterone effect). Causing the release of glucose for energy. Slowing the rate of protein production (which preserves energy). Blocking the activities of the inflammatory and immune systems (which preserves a great deal of energy).

is associated with increased toxicity in African Americans

Methylprednisolone

is available in multiple forms, including oral, parenteral, intra-articular, and retention enema preparations

Methylprednisolone

Stops release of PRL

PIF (prolactin-inhibiting factors)

Increases serum calcium levels

Parathyroid glands Parathyroid hormone

Affects secretion of hypothalamic hormones, particularly gonadotropin-releasing hormone

Pineal gland Melatonin

is an intermediate-acting corticosteroid with effects lasting only a day or so

Prednisolone

Stops release of GH

Somatostatin (growth hormone-inhibiting factor)

Indications: Long-term treatment of children with growth failure associated with various deficiencies, girls with Turner's syndrome, AIDS wasting and cachexia, GH deficiency in adults, and treatment of growth failure in children of small gestational age who do not achieve catch-up growth by 2 years of age. Actions: Replaces human GH; stimulates skeletal growth, growth of internal organs, and protein synthesis Adverse Effects: Development of antibodies to growth hormone, insulin resistance, swelling, joint pain, headache, injection-site pain.

Somatropin IM and SQ

regulates growth and development, reproduction, energy use in the body, and electrolyte balance.

The endocrine system

has various neurocenters—areas specifically sensitive to certain stimuli—that regulate a number of body functions, including body temperature, thirst, hunger, water retention, blood pressure, respiration, reproduction, and emotional reactions.

The hypothalamus

is connected to the pituitary gland by two networks: A vascular capillary network carries the hypothalamic releasing factors directly into the anterior pituitary, and a neurological network delivers two other hypothalamic hormones—antidiuretic hormone (ADH) and oxytocin—to the posterior pituitary to be stored.

The hypothalamus

lobe of the pituitary produces endorphins and enkephalins, which are released in response to severe pain or stress and occupy specific endorphin-receptor sites in the brainstem to block the perception of pain.

The intermediate lobe of the pituitary

A patient who is taking corticosteroids is at increased risk for infection and should be protected from exposure to infections and invasive procedures. take anti-inflammatory agents regularly throughout the day. receive live virus vaccine to protect him or her from infection. be at no risk if elective surgery is needed.

a

Diurnal rhythm in a person with a regular sleep cycle would show high levels of adrenocorticotropic hormone (ACTH) during the night while sleeping. rising levels of corticosteroids throughout the day. peak levels of ACTH and corticosteroids early in the morning. hypothalamic stimulation to release corticotropin-releasing hormone around noon.

a

Somatropin is widely distributed in the body and localizes in highly perfused tissues, particularly the ____ and ____

liver and kidney

Bromocriptine, a semisynthetic ergot alkaloid, is a dopamine agonist frequently used to treat

acromegaly

thickening of bony surfaces in response to excess growth hormone after the epiphyseal plates have closed

acromegaly

outer layer of the adrenal gland; produces glucocorticoids and mineralocorticoids in response to adrenocorticotropic hormone (ACTH) stimulation; also responds to sympathetic stimulation

adrenal cortex

Patients in ____ ____ are treated with massive infusion of replacement steroids, constant monitoring, and life support procedures.

adrenal crisis

inner layer of the adrenal gland; a sympathetic ganglion, it releases norepinephrine and epinephrine into circulation in response to sympathetic stimulation

adrenal medulla

The two adrenal glands are flattened bodies that sit on top of each kidney. Each gland is made up of an inner core called the ______ and an outer shell called the _____ .

adrenal medulla adrenal cortex

There are three types of corticosteroids:

androgens, glucocorticoids, and mineralocorticoids

Blocking inflammation in the respiratory tract

beclomethasone (Beclovent)

Growth Hormone Antagonists

bromocriptine mesylate (Parlodel)

Treatment of acromegaly in patients who are not candidates for or cannot tolerate other therapy, not recommended for children <15 y

bromocriptine mesylate (Parlodel)

Relief of symptoms of seasonal and allergic rhinitis with few side effects, maintenance treatment of asthma, as an oral agent for the treatment of mild-to-moderate active Crohn's disease

budesonide (Rhinocort, Entocort EC)

Acromegaly and gigantism are both conditions related to excessive secretion of thyroid hormone. melanin-stimulating hormone. GH. oxytocin.

c

Diabetes insipidus is a relatively rare disease characterized by excessive secretion of antidiuretic hormone (ADH). renal damage. the production of large amounts of dilute urine containing no glucose. insufficient pancreatic activity.

c

If a nurse was asked to explain the adrenal medulla to a patient, it would be appropriate for her to tell that patient that it is the outer core of the adrenal gland. is the site of production of aldosterone and corticosteroids. is actually a neural ganglion of the sympathetic nervous system. consists of three layers of cells that produce different hormones.

c

Internal body homeostasis and communication are regulated by the cardiovascular and respiratory systems. the nervous and cardiovascular systems. the endocrine and nervous systems. the endocrine and cardiovascular systems.

c

Mineralocorticoids are used to maintain electrolyte balance in situations of adrenal insufficiency. Mineralocorticoids are usually given alone. can be given only intravenously. are always given in conjunction with appropriate glucocorticoids. are separate in their function from the glucocorticoids.

c

Somatropin (Nutropin and others) is a genetically engineered growth hormone (GH) that is used to diagnose hypothalamic failure. to treat precocious puberty. in the treatment of children with growth failure. to stimulate pituitary response.

c

The hypothalamus maintains internal homeostasis and could be considered the master endocrine gland because it releases stimulating hormones that cause endocrine glands to produce their hormones. no hormone-releasing gland responds unless stimulated by the hypothalamus. it secretes releasing hormones that are an important part of the hypothalamic-pituitary axis (HPA). it regulates temperature control and arousal, as well as hormone release.

c

Drugs Affecting Other Anterior Pituitary Hormones

chorionic gonadotropin (Chorex, others)

Treatment of male hypogonadism, to induce ovulation in females with functioning ovaries, for treatment of prepubertal cryptorchidism when there is no anatomical obstruction to testicular movement

chorionic gonadotropin (Chorex, others)

Somatropin is contraindicated with

closed epiphyses pregnancy and lactation because of the potential for adverse effects on the fetus

The adrenal cortex produces hormones called

corticosteroids

steroid hormones produced by the adrenal cortex; include androgens, glucocorticoids, and mineralocorticoids

corticosteroids

Available antagonists that block the effects of hypothalamic releasing hormones include

degarelix (degarelix for injection) (blocks GnRH and is used as an antineoplastic agent) ganirelix acetate (Antagon) (blocks GnRH).

Treatment of neurogenic diabetes insipidus, von Willebrand's disease, hemophilia; being studied for the treatment of chronic autonomic failure

desmopressin (DDAVP, Stimate) Adult: 0.1-0.4 mL/d PO, IV, subcutaneously, intranasal for diabetes insipidus; 0.3 mcg/kg IV over 15-30 min for von Willebrand's disease; 20 mcg intranasal at bedtime for nocturnal enuresis Pediatric: 0.05-0.3 mL/d intranasal for diabetes insipidus; 0.3 mcg/kg IV over 15-30 min for von Willebrand's disease

Long-Acting Corticosteroids

dexamethasone

Management of allergic and topical inflammatory disorders, adrenal hypofunction

dexamethasone (Decadron)

response of the hypothalamus and then the pituitary and adrenals to wakefulness and sleeping; normally, the hypothalamus begins secretion of corticotropin-releasing factor (CRF) in the evening, peaking at about midnight; adrenocortical peak response is between 6 and 9 AM; levels fall during the day until evening, when the low level is picked up by the hypothalamus and CRF secretion begins again

diurnal rhythm

response of the hypothalamus and then the pituitary and adrenals to wakefulness, sleeping, and light exposure

diurnal rhythm

small stature, resulting from lack of growth hormone in children

dwarfism

response to excess levels of growth hormone before the epiphyseal plates close; heights of 7 to 8 feet are not uncommon

gigantism

steroid hormones released from the adrenal cortex; they increase blood glucose levels, fat deposits, and protein breakdown for energy

glucocorticoids

Available hypothalamic releasing hormones

goserelin (Zoladex) (synthetic GnRH), histrelin (Vantas) (a GnRH used as an antineoplastic agent), leuprolide (Lupron) and nafarelin (Synarel) (potent GnRH agonists which will actually block gonadotropin secretion with continuous use), tesamorelin (Egrifta) (a GRH analogue used to stimulate the release of growth hormone [GH] from the pituitary).

Budesonide is a relatively new steroid for

intranasal use.

hypothalamic agonist/antagonist Contraindications and Cautions

lacation renal peripheral vascular disorders rhinitis when using nafarelin

Treatment of allergic and inflammatory disorders

methylprednisolone (Medrol)

gland found in the sella turcica of the brain; produces hormones, endorphins, and enkephalins and stores two hypothalamic hormones

pituitary gland

is located in the skull in the bony sella turcica under a layer of dura mater. It is divided into three lobes: an anterior lobe, a posterior lobe, and an intermediate lobe.

pituitary gland

Treatment of children with growth failure due to lack of growth hormone (GH) or to chronic renal failure; replacement of GH in patients with GH deficiency; long-term treatment of growth failure in children born small for gestational age who do not achieve catch-up growth by 2 y of age; treatment of short stature associated with Turner's syndrome or Prader-Willi's syndrome; also approved to increase protein production and growth in various AIDS-related states

somatropin (Nutropin, Saizen, Humatrope)

Growth Hormone Agonists

somatropin (Nutropin, Saizen, Humatrope) somatropin rDNA origin (Zorbtive)

Reserved for use in treatment of adults with short bowel syndrome who are receiving specialized nutritional support

somatropin rDNA origin (Zorbtive)

Octreotide and lanreotide must be administered

subcutaneously

Excretion of samatropin occurs through the ____ and ____

urine and feces

Signs and Symptoms of Adrenal Dysfunction: Emotional disturbances Cardiac hypertrophy, hypertension Thin, wrinkled skin; purpura; purple abdominal striae; hirsutism Hyperglycemia, hypokalemia; hypernatremia; osteoporosis; renal calculi; amenorrhea Moon face; buffalo hump; obesity immune and inflammatory suppression; risk of gastric ulcers and bleeding

HYPERALDRENAL FUNCTION (CUSHING'S DISEASE)

Signs and Symptoms of Adrenal Dysfunction: Confusion, disorientation Hypotension, arrhythmias, cardiovascular collapse, loss of extracellular fluid Hyperpigmentation, sparse axillary and pubic hair; bluish-black oral mucosa Hyponatremia, hyperkalemia, hypoglycemia; lethargy, fatigue, weakness Dehydration, fatigue, poor response to stress, limited ability to respond to infection

HYPOADRENAL FUNCTION (ADDISON'S SYNDROME)

Treatment of advanced prostatic cancer, endometriosis, central precocious puberty, uterine leiomyomata. Actions: GnRH agonist that occupies pituitary GnRH receptors and desensitizes them; causes an initial increase and then profound decrease in LH and FSH levels. Adverse Effects: Dizziness, headache, pain, peripheral edema, myocardial infarction, nausea, vomiting, anorexia, constipation, urinary frequency, hematuria, hot flashes, increased sweating.

Leuprolide given IM

is available only as an oral agent

Prednisone

Indications: Replacement therapy in adrenal cortical insufficiency, short-term management of various inflammatory and allergic disorders, hypercalcemia associated with cancer, hematological disorders, ulcerative colitis, acute exacerbations of multiple sclerosis, palliation in some leukemias, trichinosis with systemic involvement. Actions: Enters target cells and binds to intracellular corticosteroid receptors, initiating many complex reactions responsible for its anti-inflammatory and immunosuppressive effects. Adverse Effects: Vertigo, headache, hypotension, shock, sodium and fluid retention, amenorrhea, increased appetite, weight gain, immunosuppression, aggravation or masking of infections, impaired wound healing.

Prednisone PO

steroid hormones released by the adrenal cortex; they cause sodium and water retention and potassium excretion

mineralocorticoids

Stimulates basal metabolic rate (how the body uses energy) Decreases serum calcium levels

Thyroid Thyroid hormone Calcitonin

Hypothalamic hormones are normally present in very small amounts. When used therapeutically, their main indication is diagnosis of endocrine disorders and treatment of specific cancers. treatment of multiple endocrine disorders. treatment of central nervous system-related abnormalities. treatment of autoimmune-related problems.

a

Patients who have been receiving corticosteroid therapy for a prolonged period and suddenly stop the drug will experience an adrenal crisis because their adrenal glands will not be producing any adrenal hormones. Your assessment of a patient for the possibility of adrenal crisis may include physiological exhaustion, shock, and fluid shift. acne development and hypertension. water retention and increased speed of healing. hyperglycemia and water retention.

a

The endocrine glands form part of the communication system of the body. cannot be stimulated by hormones circulating in the blood. cannot be viewed as integrating centers of reflex arcs. are only controlled by the hypothalamus.

a

lobe of the pituitary gland that produces stimulating hormones, as well as growth hormone, prolactin, and melanocyte-stimulating hormone

anterior pituitary

hypothalamus releases what releasing factors to the posterior pituitary

antidiuretic hormone (ADH) and oxytocin—to the posterior pituitary to be stored.

A patient who is receiving an ADH preparation for diabetes insipidus may need instruction in administering the drug orally or intramuscularly. orally or intranasally. rectally or orally. intranasally or by dermal patch.

b

Adrenocortical agents are widely used to cure chronic inflammatory disorders. for short-term treatment to relieve inflammation. for long-term treatment of chronic disorders. to relieve minor aches and pains and to make people feel better.

b

Patients who are receiving GH replacement therapy must be monitored very closely. Routine follow-up examinations would include a bowel program to deal with constipation. tests of thyroid function and glucose tolerance. a calorie check to control weight gain. tests of adrenal hormone levels.

b

When explaining the role of antidiuretic hormone (ADH) to a group of students, which of the following would the instructor include? It is produced by the anterior pituitary. It causes the retention of water by the kidneys. It is released by the hypothalamus. It causes the retention of sodium by the kidneys.

b

Used for replacement therapy in adrenal insufficiency, treatment of allergic and inflammatory disorders

cortisone

Short-Acting Corticosteroids

cortisone hydrocortisone

A patient is started on a regimen of prednisone because of a crisis in her ulcerative colitis. Nursing care of this patient would need to include immunizations to prevent infections. increased calories to deal with metabolic changes. fluid restriction to decrease water retention. administration of the drug around 8 or 9 AM to mimic normal diurnal rhythm.

d

After teaching a group of students about the negative feedback system, identification of which of the following as an example would indicate that the students have understood the teaching? Growth hormone control Prolactin control Melanocyte-stimulating hormone control Thyroid hormone control

d

GH deficiencies occur only in children. always result in dwarfism. are treated only in children because GH is usually produced only until puberty. can occur in adults as well as children.

d

Glucocorticoids are hormones that are released in response to high glucose levels. help to regulate electrolyte levels. help to regulate water balance in the body. promote the preservation of energy through increased glucose levels, protein breakdown, and fat formation.

d

The posterior lobe of the pituitary gland secretes a number of stimulating hormones. produces endorphins to modulate pain perception. has no function that has yet been identified. stores ADH and oxytocin, which are produced in the hypothalamus.

d

Treatment with ADH preparations is associated with adverse effects, including constipation and paralytic ileus. cholecystitis and bile obstruction. nocturia and bed wetting. "hangover" symptoms, including headache, sweating, and tremors.

d

Which of the following best describes aldosterone? It causes the loss of sodium and water from the renal tubules. It is under direct hormonal control from the hypothalamus. It is released into the bloodstream in response to angiotensin I. It is released into the bloodstream in response to high potassium levels.

d

condition resulting from a lack of antidiuretic hormone, which results in the production of copious amounts of glucose-free urine

diabetes insipidus

Used for replacement therapy, treatment of allergic and inflammatory disorders

hydrocortisone (Cortef)

lack of adequate function of the pituitary; reflected in many endocrine disorders

hypopituitarism

"master gland" of the neuroendocrine system; regulates both nervous and endocrine responses to internal and external stimuli

hypothalamus

is the coordinating center for the nervous and endocrine responses to internal and external stimuli.

hypothalamus

Used as antineoplastic agent for treatment of specific cancers, treatment of endometriosis and precocious puberty that results from hypothalamic activity

leuprolide (Lupron)

Patients with ____ or ____ dysfunction may experience reduced clearance and increased concentrations of the drug somatropin

liver or renal

control system in which increasing levels of a hormone lead to decreased levels of releasing and stimulating hormones, leading to decreased hormone levels, which stimulates the release of releasing and stimulating hormones; allows tight control of the endocrine system

negative feedback system

lobe of the pituitary that receives antidiuretic hormone and oxytocin via nerve axons from the hypothalamus and stores them to be released when stimulated by the hypothalamus

posterior pituitary

stores two hormones that are produced by the hypothalamus and deposited in the posterior lobe via the nerve axons where they are produced. These two hormones are ADH, also referred to as vasopressin, and oxytocin.

posterior pituitary gland

Intermediate-Acting Corticosteroids

prednisone

Replacement therapy for adrenal insufficiency, treatment of allergic and inflammatory disorders

prednisone (Deltasone)

Growth Hormone Antagonists: access what

reflexes blood pressure, pulse, and orthostatic blood pressure; abdominal examination; glucose tolerance tests; and GH levels, to determine baseline status before beginning therapy and for any potential adverse effects.

Beclomethasone and flunisolide are available in the form of a

respiratory inhalant and nasal spray

The adverse effects that most often occur when using GH include

swelling and joint pain, and the endocrine reactions of hypothyroidism and insulin resistance.

The adrenal medulla is actually part of the

sympathetic nervous system (SNS)

produces six major hormones: GH, adrenocorticotropic hormone (ACTH), follicle-stimulating hormone, luteinizing hormone, PRL, and thyroid-stimulating hormone (TSH, also called thyrotropin)

the anterior pituitary gland

main function is to maintain homeostasis

the endocrine system's