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Chapter 50

Chapter 50. Pituitary and Adrenocortical Hormones. Pituitary Gland. Anterior Pituitary Hormones. Follicle-stimulating hormone (FSH) Luteinizing hormone (LH) Growth hormone (GH) Adrenocorticotropic hormone (ACTH) Thyroid-stimulating hormone (TSH) (Chapter 51)

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Chapter 50

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  1. Chapter 50 Pituitary and Adrenocortical Hormones

  2. Pituitary Gland

  3. Anterior Pituitary Hormones • Follicle-stimulating hormone (FSH) • Luteinizing hormone (LH) • Growth hormone (GH) • Adrenocorticotropic hormone (ACTH) • Thyroid-stimulating hormone (TSH) (Chapter 51) • Prolactin (not used medically)

  4. Also called somatotropic hormone Secreted by the anterior pituitary Regulates individual growth Example—somatropin Uses—children who fail to grow Adverse Reactions—failure to respond, hypothyroidism, insulin resistance, joint swelling and pain Growth Hormone

  5. Contraindications to Growth Hormones

  6. Nursing Considerations

  7. Adrenocorticotropic Hormone: Corticotropin (ACTH) • Anterior pituitary hormone • Stimulates adrenal cortex to produce and secrete glucocorticoids • Used to diagnosis adrenocortical function, multiple sclerosis, thyroiditis, hypercalcemia (with cancer)

  8. Many Adverse Reactions

  9. Posterior Pituitary Hormones Vasopressin and oxytocin (not discussed in this chapter)

  10. Examples—vasopressin (Pitressin), lypressin (Diapid), desmopressin (DDAVP) Uses—diabetes insipidus, postoperative abdominal distention, dispel gas interfering with X-rays Vasopressin

  11. Adverse Reaction • Adverse Reactions—hypersensitivity reactions, tremor, sweating, vertigo, nausea, vomiting, water intoxication

  12. Nursing Considerations • Assessment: vital signs, weight e-lytes, abdominal girth, BS, urine specific gravity • Teaching: measure I & O, drink 2 glasses of water before taking drug, avoid alcohol, rotate injection sites, medical alert identification

  13. Adrenocortical Hormones Glucocorticoids and mineralocorticoids

  14. Glucocorticoids • Influence immune response; regulate glucose, fat and protein metabolism, and antiinflammatory response • Act by entering target cells and binding to receptors • Used as replacement therapy with adrenocorticol insufficency, allergic conditions, collagen diseases (systemic lupus erythematosus, dermatologic conditions, rheumatic disorders, shock, etc • Examples : Desamethosone (Decadron), hydrocortisone (solu-cortef), methylprednisolone (solumedrol), and prednisone

  15. Select Adverse Reactions • Many adverse reactions may occur:

  16. Contraindications • Serious infections • Tuberculosis • Fungal or antibiotic resistant infections • Caution with renal, hepatic, hypothryoidism, ulcerative colitis, diverticulitis, peptic ulcer, IBD, HTN, osteoporosis, convulsive disorders, diabetes, pregnancy • Multiple drug interactions-Table 50-2, page 525

  17. Mineralocorticoids • Aldosterone and desoxycorticosterone • Act to conserve sodium and increase potassium excretion • Deficiencies result in a loss of sodium and retention of potassium • Used a replacement therapy for deficiency

  18. Mineralocorticoids Adverse Reactions • Edema, hypertension, CHF, enlargement of the heart, increased sweating, allergic skin rash, hypokalemia, muscular weakness, headache, hypersensitivity reactions

  19. Nursing Process for Patients Receiving Corticosteroids

  20. Long term therapy

  21. Nursing Considerations, cont • Administration of corticosteroids several times a day in as little as one week results in shutting off the pituitary release of ACTH because there are always high levels of glucocorticoids in the plasma. Without ACTH, the adrenals fail to manufacture glucocorticoids which can lead to acute adrenal insufficiency (life threatening) • May be ordered alternate day therapy:

  22. Nursing Diagnoses

  23. Chapter 51 Thyroid and Antithyroid Drugs

  24. Thyroid Gland

  25. Thyroid Gland • Secretes hormones thyroxine (T4) and triiodothyronine (T3) • Iodine is an essential element in hormone production • Activity regulated by thyroid-stimulating hormone (TSH)

  26. Two Diseases Related to Hormone-Producing Activity Hypothyroidism Hyperthyroidism

  27. Thyroid Hormones • Example—levothyroxine • Act to increase metabolic rate • Uses—replacement therapy in hypothyroidism, euthyroid creation, thyrotoxicosis • Adverse Reactions—palpitations, tachycardia, nervousness, headache, insomnia, diarrhea • Contraindicated with recent MI, Thyrotoxicosis • Used with caution with Addison’s disease • Replacement therapy may take several weeks or begin in 48 hours

  28. Patient Teaching

  29. Antithyroid Drugs Also called thyroid antagonists; used to treat hyperthyroidism and before surgery to decrease bleeding tendency

  30. Antithyroid Drugs • Examples—methimazole (Tapazole), propylthiouracil (PTU) • Action—inhibit thyroid hormone manufacture • Used to manage hyperthryoidism • Adverse Reactions—agranulocytosis, hay fever, sore throat, skin rash, fever, headache, nausea, vomiting, paresthesias

  31. Iodine (Lugol’s solution)

  32. Radioactive Iodine • Used to treat hyperthyroidism and thyroid cancer

  33. Nursing considerations

  34. Patient Teaching • Isolation/quarantined for specified days (3-5 days) • Avoid pregnant women for 2 weeks

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