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Chapter 20

Chapter 20. Hormones and Steroids. Chapter 20 Lesson 20.1. Learning Objectives. Describe the use of antidiabetic medications Identify preparations that act on the uterus. Overview. Hormones and steroids Natural and synthetic preparations

sigourney-emerson
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Chapter 20

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  1. Chapter 20 Hormones and Steroids

  2. Chapter 20 Lesson 20.1

  3. Learning Objectives • Describe the use of antidiabetic medications • Identify preparations that act on the uterus

  4. Overview • Hormones and steroids • Natural and synthetic preparations • Used to replace and/or increase natural chemicals in the body

  5. Endocrine System • Regulation and coordination of body systems • Endocrine glands • Pituitary, thyroid, parathyroid, adrenal glands, pancreas, testes, ovaries, and placenta

  6. Endocrine System

  7. Male Reproductive System

  8. Female Reproductive System

  9. Antidiabetic Drugs • Diabetes mellitus: chronic disorder of metabolism • Insulin: necessary for the metabolism and use of glucose in the body • Pancreas • Type 1 and type 2 diabetes

  10. Insulin Action • Lowers blood glucose levels by helping glucose move into target tissues Uses • Treatment of type 1 diabetes Table 20-1

  11. Insulin (cont.) Adverse Reactions • Lipodystrophy, local itching, swelling, erythema • Hypoglycemia: serum glucose less than 60 mg/dL Drug Interactions • Insulin antagonists • Anabolic steroids and alcohol may increase the hypoglycemic effects of insulin

  12. Insulin (cont.) Nursing Implications • Assessment: polyuria, polyphagia, polydipsia, weight loss, blurred vision, and fatigue • Hyperglycemia: systemic acidosis • Conditions that alter requirements for insulin Patient Teaching

  13. Oral Hypoglycemics Action • Stimulate insulin release from pancreatic beta cells; decrease insulin resistance Uses • Monotherapy versus combination therapy • Six classes • Sulfonylureas, 1st and 2nd generation • Biguanides • Alpha-glucosidase inhibitors • Meglitinides • Thiazolidinediones • Incretins

  14. Oral Hypoglycemics (cont.) Adverse Reactions • Hypoglycemia; allergic reactions Drug Interactions • Displacement; potentiation • Thiazides oppose the secretion of insulin from beta cells and decrease the effectiveness of sulfonylureas

  15. Oral Hypoglycemics (cont.) Nursing Implications • Assessment: health history; renal and liver function; sulfa allergies Patient Teaching

  16. Selected Drugs Used with Pregnancy and Delivery Overview • Antepartum, intrapartum, and postpartum • Tocolytics • Oxytocics • Uterine relaxants • Abortifacients Drug Table 20-4

  17. Selected Drugs Used with Pregnancy and Delivery (cont.) Action and Uses • Abortifacients stimulate uterine contractions and cause the uterus to empty • Oxytocic agents and ergot preparations cause the uterus to contract • Uterine relaxants act on beta-adrenergic receptors to stop smooth-muscle contraction in the uterus • Tocolytics are used to stop preterm labor

  18. Selected Drugs Used with Pregnancy and Delivery (cont.) Adverse Reactions • Abortifacients: cramping and pain • Tocolytics: visual disturbance, malaise, nausea, and confusion • Oxytocics: dysrhythmias, edema, fetal bradycardia, anxiety, redness of skin during administration, nausea, vomiting, anaphylaxis, postpartum hemorrhage, cyanosis, and dyspnea • Ergots: nausea and vomiting, allergic reactions, bradycardia, hypotension, hypertension, cerebrospinal symptoms, and spasms

  19. Selected Drugs Used with Pregnancy and Delivery (cont.) Drug Interactions • Vasoconstrictors and local anesthetics increase the effectiveness of oxytocics

  20. Selected Drugs Used with Pregnancy and Delivery (cont.) Nursing Implications and Patient Teaching • Assessment • Diagnosis • Planning • Implementation: nursing care and monitoring during drug administration • Evaluation • Patient and family teaching: adverse effects of ergonovine

  21. Chapter 20 Lesson 20.2

  22. Learning Objectives • Compare and contrast the action of adrenal and pituitary hormones • Describe at least five adverse reactions that may result from the use of glucocorticoid and mineralocorticoid steroids • Compare the actions of various male and female hormones • List the indications for the use of thyroid preparations

  23. Pituitary and Adrenocortical Hormones • Pituitary gland: “master gland” • Adenohypophysis • Neurohypophysis • Hormone production, control growth, electrolyte balance, water retention or loss, and reproductive cycle

  24. Pituitary Hormones Anterior Pituitary Hormones • HCG • LH and FSH • STG • ACTH Drug Table 20-5

  25. Anterior Pituitary Hormones (cont.) Adverse Reactions (systemic or local reaction) • Menotropins: enlarged ovaries; multiple births when used for fertilization • Clomiphene: abdominal discomfort, ovarian enlargement, blurred vision, nervousness, nausea and vomiting, vasomotor flushes • Chorionic gonadotropins: headache, irritability, restlessness, fatigue, and edema • Somatotropin: antibody stimulation • ACTH: adrenal gland

  26. Posterior Pituitary Hormones • ADH • Vasopressin may cause abdominal cramps, anaphylaxis, bronchial constriction, circumoral pallor, diarrhea, flatus, intestinal hyperactivity, headache, sweating, tremors, urticaria, uterine cramps, vertigo, vomiting; large doses may produce death • Oxytocin • ACTH • Drug Table 20-6

  27. Adrenocortical Hormones Actions • Manufactures glucocorticoids, mineralocorticoids, and small amounts of sex hormones Uses • Adrenal insufficiency (Addison’s disease) • Reduce inflammation in allergic or immunologic responses; treat hematologic and malignant diseases

  28. Adrenocortical Hormones (cont.) Adverse Reactions • Table 20-7 Drug Interactions • Increase effects of barbiturates, sedatives, narcotics, and certain anticoagulants • Decrease effects of insulin, oral hypoglycemics, Coumadin, isoniazid, aspirin, and broad-spectrum antibiotics

  29. Adrenocortical Hormones (cont.) Nursing Implications and Patient Teaching • Frequent medical monitoring • Avoid smoking • Alcohol use: ulcer development • Risk for infection • Increase dose during times of stress • Signs and symptoms of adrenal insufficiency • Do not stop drug abruptly • MedicAlert bracelet • Immunization considerations • Diet • Storage of drug • Drug interactions • Dosage schedule, missed dosage

  30. Sex Hormones • Production influenced by the anterior pituitary • Male: testosterone; androgens • Female: estrogen; progesterone

  31. Androgens Actions • Develop secondary sex characteristics; tissue building Uses • Hypogonadism, hypopituitarism, dwarfism, eunuchism, cryptorchidism, oligospermia, and male androgen deficiency Adverse Reactions • Edema due to sodium retention, acne, hirsutism, male pattern baldness, cholestatic hepatitis with jaundice, buccal irritation, nausea and vomiting, diarrhea

  32. Androgens (cont.) Drug Interactions • Increased effects – anticoagulants, antidiabetic agents, and other drugs • Decreased effects – barbiturates • Concurrent use with corticosteroids increase edema Nursing Implications • Assessment, diagnosis, planning, implementation, and evaluation Drug Table 20-9

  33. Androgens (cont.) Patient and Family Teaching • Administration • Response time • Diet • Symptoms to report • Administration considerations

  34. Female Sex Hormones • Estrogens • Progestins • Table 20-10

  35. Estrogens Action and Uses • Used for hormone replacement therapy in menopause and other conditions (ovarian failure); infertility work-ups; palliative breast cancer treatment Adverse Reactions Drug Interactions

  36. Progestins Action Uses • Contraception, control excessive uterine bleeding, treatment of secondary amenorrhea, dysmenorrhea, premenstrual tension, and control of pain in endometriosis Drug Interactions Nursing Implications and Patient Teaching

  37. Oral Contraceptives Combination Drugs: Estrogen and Progestin • Table 20-11 Action • Prevent ovulation Use • Contraception Adverse Reactions • Estrogen excess, progestin excess, androgen excess, estrogen deficiency, progestin deficiency Contraindications for Oral Contraceptives

  38. Thyroid Hormones Thyroid Supplements or Replacements Action • Increase metabolic rate: increase tissue oxygen consumption, body temperature, heart and respiratory rate, cardiac output, and carbohydrate, lipid, and protein metabolism; influence the development of the skeletal system Uses • Replacement therapy for several conditions Table 20-12

  39. Thyroid Hormones (cont.) Adverse Reactions • Dysrhythmias, hypertension, tachycardia, hand tremors, headache, insomnia, nervousness, diarrhea, vomiting, weight loss, menstrual irregularities, rash, glycosuria, hyperglycemia, increase prothrombin time, and increase serum cholesterol levels Drug Interactions

  40. Thyroid Hormones (cont.) Nursing Implications and Patient Teaching • Assessment, diagnosis, planning, implementation, evaluation • Administration • Drug action/expected outcomes • Drug interactions: diabetes; anticoagulants; checking with healthcare provider • Signs/symptoms of hyperthyroidism and hypothyroidism

  41. Antithyroid Products Action • Stop the production of thyroid hormones Uses • Treatment of hyperthyroidism; to improve hyperthyroidism in preparation for surgery or radioactive iodine therapy Adverse Reactions Drug Interactions Nursing Implications and Patient Teaching

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