Growth Hormone (GH)2 Hormones Regulate GH 1. Growth hormone-releasing hormone (GN-RH) 2. Growth hormone-inhibiting hormone (GN-IH)

* NOT given orally given thru SQ or IM

* Can cause DM

Deficiency of GH

somatrem (Protropin)somatropin (Humatrope) – C/I for pedia patients

with growth deficiency due to Prader Willi syndrome, severely obese, severe respiratory impairment

Promotes bone growth at epiphyseal plates of long bones

Excess of GH

Gigantism – during childhoodAcromegaly – after puberty

* Due to GH hypersecretion or pituitary tumor

bromocriptine mesylate (Parlodel) – inhibits the release of GH from pituitary

octreotide (Sandostatin) – also used for severe diarrhea due to carcinoid tumor

Thyroid-Stimulating Hormone (TSH)Releases thyroxine (T4) and triiodothyronine (T3)

Excess TSH – HyperthyroidismDeficit TSH – Hypothyroidism. Maybe caused by

thyroid gland disorder (primary) or decrease in TSH secretion (secondary)

thyrotropin (Thyropar) – purified extract of TSH used to diagnose primary and secondary hypothyroidism

Adrenocorticotropic hormone (ACTH) Stimulates the release of the ff:

1. glucocorticoids (cortisol)2. mineralocorticoids (aldosterone)3. androgen* follows diurnal rythmn

corticotropin (Acthar) given IV or IM Agent in the diagnosis of adrenal gland disorder Used in the treatment of adrenal gland

insufficiency Suppresses inflammatory and immune response

secretes Antidiuretic Hormone/Vasopressin AND Oxytocin

ADH promotes water reabsorptionADH deficit leads to Diabetes Insipidus

desmopressin (DDAVP – desmopressin acetate)vasopressin (Pitressin)Given intranasally or injection

Nursing ProcessAssessment:1. Determine urinary output and weight2. Assess for infectious process3. Compare child’s growth with standards

Diagnosis:Ineffective health maintenanceDelayed growth and development

Interventions:ADH Monitor V/S, increase HR, decrease systolic

pressure (hypovolemia)

ACTH Observe client’s weight for possible edema.

Side effect is sodium and water retention Taper dose Electrolyte monitoring

GH Monitor blood sugar and electrolyte levels

(possible hyperglycemia)

THYROID GLANDSThyroid hormones stimulate metabolism and cardiac

function, and are essential for normal growth and development of the nervous and musculoskeletal systems.

Hypothyroidism is the abnormally decreased secretion of thyroid hormone.

Caused by: Primary cause (thyroid gland disorder) Secondary cause (lack of TSH secretion)

Cretinism is hypothyroidism in infants.

Unless treated early, the infant will be short in stature and delayed in mental and physical development.

Myxedema is hypothyroidism in adults.

Manifestations: bradycardia, cold and dry skin, brittle hair, low

body temperature, fatigue, cold intolerance, flat affect, slowed cognition, and weight gain

Drug Therapy:

Levothyroxine (Synthroid, Levothroid), the most commonly used replacement

- used to treat simple goiter and chronic lymphocytic (Hashimoto) thyroiditis

Liothyronine (Cytomel), synthetic T3, useful in treating Myxedema Coma, better absorbed from GI, NOT for maintenance therapy

Liotrix (Euthroid, Thyrolar)Mixture of levothyroxine sodium and liothyronine

sodium in 4:1 ratio

Antithyroid Agents Hyperthyroidism is the abnormal increase secretion of thyroid hormone. Grave’s disease/thyrotoxicosis

- common Manifestations:

tachycardia, dysrhythmias, palpitations, excessive perspiration, heat intolerance, nervousness, irritability, exopthalmos, weight loss

*** can be treated by surgery

Thyroid crisis (or “storm”) characterized by hyperthermia, tachycardia, and profound weakness, behavioral changes

Drug Therapy: Thiourea derivatives (Thioamides) – drug of choice.

Blocks thyroid hormone2 thioamides:

propylthiouracil (PTU) - Inhibit peripheral conversion of T4 to T3methimazole (Tapazole) – 10 times more potent, with longer half-life

Iodide preparations have been used to suppress thyroid function for those who have undergone subtotal thyroidectomy.

strong iodine solution (Lugol’s solution, Potassium iodide solution)

SE: teeth discoloration

Nursing ProcessAssessment1. Assess serum T3, T4, and TSH levels

2. Drug history because of drug-drug interactions like oral anticoagulants, digoxin, insulin, oral hypoglycemics,

3. Assess for signs of thyroid crisis

Client health teaching:

For hypothyroidism-Take drug same time each day, pre-breakfast-To report signs of hyperthyroidism-Avoid foods that can inhibit thyroid

secretions(strawberry, peach, pear, cabbage, cauliflower, radish, peas)

For hyperthyroidism-Taken with meals-Avoid iodine and iodine-containing food, OTC

cough meds-Do not discontinue abruptly-Avoid the drugs if pregnant or breastfeeding

Parathyroid Glands

Parathyroid hormone (PTH) regulates calcium levels in the blood.

Decrease in serum calcium stimulates the release of PTHCalcitonin decreases serum calcium

PTH agents treat hypoparathyroidism Synthetic calcitonin is used for decreasing serum

calcium levels (hyperparathyroidism)

Hypoparathyroidism and Hypocalcemia Agentscalcitriol (Rocaltrol) – Increases serum calcium with

long onset of action.calcifediol (Calderol) – bone disease and

hypocalcemia associated with chronic renal disease and dialysis

Hyperparathyroidism and Hypercalcemia Agentscalcitonin (human) (Cibacalcin) – Paget’s diseasecalcitonin (salmon) (Calcimar)

Nursing Process

Assessment Assess for symptoms of tetany in hypocalcemia:

twitching of the mouth, tingling and numbness of the fingers, carpopedal and laryngeal and carpopedal spasm

Interventions1. Monitor serum Ca levels (reference is 8.5-

10.5 mg/dl)

2. Client teaching: Report signs of tetany and hypercalcemia

(bone pain, anorexia, N/V, thirst, constipation, lethargy, bradycardia, polyuria)

Check OTC drugs

Adrenal GlandsAdrenal cortex produces two hormones or

corticosteroids: glucocorticoids (cortisol) and mineralocorticoids (aldosterone)

It affects carbohydrate, protein and fat metabolism; Na retention and water reabsorption and K excretion; have antinflammatory, antiallergic, and anti-stress effects

Addison’s disease- decrease in corticosteroidCushing’s syndrome - increase in corticosteroid

Addison’s disease: weight loss, fatigue, hyperpigmentation, muscle weakness, low blood pressure

1. Glucocorticoids Short-acting cortisone acetate (Cortone Acetate) hydrocortisone (Cortef, Hydrocortone)

Intermediate-actingmethylprednisolone (Medrol, Solu-Medrol)prednisolone (Hydeltrasol) prednisone (Deltasone)

Long-actingbetamethasone (Celestone)dexamethasone (Decadron)

2. Glucocorticoid InhibitorsUsed in treating clients with Cushing’s syndrome

ketoconazole (Nizoral)aminogluthethimide (Cytadren)Mitotane (Lysodren) – ANTINEOPLASTIC hormone

antagonist

3. Mineralocorticoids (aldosterone)Secrete aldosterone that maintain fluid balance

fludrocortisone (Florinef) – oral mineralocorticoid

Nursing ProcessAssessment1. Monitor electrolyte (hypokalemia) ana blood sugar2. Obtain weight and urine outputInterventions1. Watch out for increase in BP2. Report weight gain of 5 lbs in several days3. Encourage foods high in potassium4. Taper the dose:5. Taken with meals

Blood glucose is regulated by insulin. Responsible for:

◦Facilitating the passage of glucose into cells for energy

◦Suppressing excess production of sugar in the liver and muscles

◦Suppressing the breakdown of fat for energy

ANTIDIABETIC AGENTS

Two Major Classes of Drugs: Insulins Oral Hypoglycemic Agents

These agents can be used as monotherapy in the treatment of type 2 diabetes

May be used in combination therapy with insulin in the treatment of type 1 diabetes

INSULINS INSULINS

Two Main Sources:Two Main Sources:Domesticated animals Domesticated animals Recombinant DNA technologyRecombinant DNA technology

Activity Classification Brand RAPID-ACTING Humalog

lisproSHORT-ACTING Humulin R,

regular

INTERMEDIATE-ACTINGNPH insulinHumulin NLente insulinHumulin L insulin

LONG-ACTING-Ultralente insulin-Lantus

CombinationsHumulin 70/30 – isophane NPH 70%, regular 30%Humulin 50/50 – isophane NPH 50%, regular 50%

InsulinTypes: Onset Peak DurationRapid-acting 5 min 0.5-1 hr 2-4 hrs

Short-acting 0.5-1 hr 2-4 hrs 6-8 hrs

Intermediate-acting 1-2 hrs 6-12 hrs 18-24 hrs

Long-acting 5-8 hrs 14-20 hrs 30-36 hrs

Premixed Insulin- 0.5 hour 4-8 hrs 22-24 hrs

Complications of Insulin Administration: Allergic reactions Insulin lipodystrophy(lipoatrophy, lipohypertrophy) Insulin resistance Somogyi and Dawn phenomenon

Easier Administration:Insulin pen injectorsInsulin pumpsInsulin jet injectors

Interventions:Avoid extremes in temperature when storing insulinBefore injection, insulin should be at room

temperatureInjection sites are abdomen, arms, thighs, and hipsDon’t use same site more than once in a 2- 3 week

period

Use a syringe with a matched calibration of units to the insulin concentration

1-2 week supply of insulin may be preparedRegular insulin firstREGULAR INSULIN THE ONLY ONE THAT CAN BE

GIVEN IV

Oral Antidiabetic Drugs

First and Second-Generation Sulfonylureas- Stimulate pancreatic beta cells to secrete more

insulin

First Generation1. Short-acting

tolbutamide (Orinase)2. Intermediate-acting

acetohexamide (Dymelor)tolazamide (Tolinase)

3. Long-actingchlorpropamide (Diabinese)

Second Generation- Increase tissue response to insulin, decrease

glucose production of the liverGlimepiride (Amaryl), glipizide (Glucotrol)

Non-Sulfonylureas

1. BIGUANIDES Reduces hepatic production of glucose by inhibiting

glycogenolysis; decreasing intestinal absorption of glucose; and improving lipid profile.

metformin (Glucophage)

2. ALPHA-GLUCOSIDASE INHIBITORS Inhibits alpha-glucosidase enzymes in the small

intestine and alpha-amylase in the pancreas. The result is reduced rate of glucose absorption postprandially.

acarbose (Precose)miglitol (Glyset)

3. THIAZOLIDINEDIONES Functions primarily by enhancing insulin action at

the receptor sites and decreases insulin resistance

rosiglitazone (Avandia)

4. MEGLITINIDE Also increases insulin secretion.

repaglinide (Prandin)nateglinide (Starlix)

5. Incretin Modifier Increase level of incretin hormones, increase

insulin secretion, decrease glucagon secretion to reduce glucose production

sitaglipitin phosphate (Januvia)

Nursing ProcessAssessment1. Note blood sugar levels2. Determine knowledge of DM and oral

antidiabeticsIntervention1. Teach symptoms of hypoglycemia2. Insulin might be needed during stress,

surgery, or serious infection3. No alcohol, no skipping/delaying meals

Hyperglycemic Agents

Glucagon – stimulates glycogen breakdown- Available parenteral use (SC, IM, IV)

diazoxide (Proglycem, Hyperstat)- inhibits insulin release- parenteral form