What is the ptype drug for growth hormone?
somatropin (Genotropin)
somatropin (Genotropin) primary use
treat growth failure in children
somatropin (Genotropin) MOA
identical to human growth hormone; replaces/supplements human growth hormone
somatropin (Genotropin) adverse effects
hyperglycemia, hypothyroidism, edema of hands and feet
somatropin (Genotropin) nursing considerations
assess ht/wt; give in evening to mimic body; assess glucose and thyroid levels periodically; SQ injection only, daily or 3x/wk, abdomen or thigh preferred sites
somatropin (Genotropin) pt teaching
May need to consult dietician; ensure enough protein and calories for growth
What is Prader Willi syndrome?
people who lack the enzyme to tell them they're full; "lock the frig" syndrome; somatropin admin not recommended in this syndrome
What is the ptype drug for Anti-Diuretic Hormone analogs?
desmopressin (DDAVP, Stimate)
desmopressin (DDAVP, Stimate) primary use
to treat Diabetes insipidus caused by neurogenic factors (head trauma, CVA) (nephrogenic form of DI doesn't respond to ADH replacement)
desmopressin (DDAVP, Stimate) MOA
increases the permeability of renal collecting tubules to water, thereby increasing the reabsorption of water; vasoconstricts; synthetic analog of ADH w/ longer action
desmopressin (DDAVP, Stimate) adverse effects
can cause water intoxication; use with caution in pts with coronary artery disease
desmopressin (DDAVP, Stimate) nursing considerations
check urine specific gravity; assess weight, report sudden increases in weight (can cause water retention)
desmopressin (DDAVP, Stimate) pt teaching
instruct on s/s of sodium and water imbalance; teach to report sudden weight gain to doctor
What is the ptype drug for thyroid replacement hormones?
levothyroxine (Levothyroid)
levothyroxine (Levothyroid) primary use
treat primary hypothyroidism; post-removal of thyroid gland; management of thyroid cancer, myxedema coma
levothyroxine (Levothyroid) MOA
increases the metabolic rate, increases O2 consumption, respiration and heart rate; increases the rate of fat, protein and carb metabolism
levothyroxine (Levothyroid) adverse effects
highly protein-bound, can affect drug levels of other protein-bound drugs (dilantin, phenobarbitol, warfarin, etc.); warfarin levels will increase when taken w/ this drug; normally no SE when on properdose
levothyroxine (Levothyroid) overdose s/s
rapid or irregular HR, chest discomfort, nervousness, agitation, tremors, irritation, insomnia
levothyroxine (Levothyroid) nursing considerations
Assess VS, esp. HR, consider holding drug if HR>100; assess CBG, adjustment of anti-diabetic meds may be required; assess T3/4, TSH levels for narrow therapeutic index
levothyroxine (Levothyroid) pt teaching
take on an empty stomach, 1/2 hour before breakfast; do not take w/ Ca+ or iron; report chest discomfort, irregular or fast HR, nervousness, insomnia; regular lab level checks; do not d/c med unilaterally
What is the ptype drug for hyperthyroid treatment?
propylthiouracil (PTU), if a drug is required; usual treatment is surgery or radioactive iodine
propylthiouracil (PTU) primary use
palliative treatment of hyperthyroidism; adjunct in the control of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy (shrinks it)
propylthiouracil (PTU) MOA
suppresses conversion of T4 to T3; therapeutic effects may take months
propylthiouracil (PTU) adverse effects
skin rash, swollen lymph nodes, sore throat, fever; serious SE include aplastic anemia (anemia caused by deficient RBC production due to bone marrow disorders) and/or granulocytosis (an abnormal increase of neutrophils, basophils, eosinophils in the blood
propylthiouracil (PTU) nursing considerations
increases actions of anticoagulants, altered levels of metoprolol, propranolol and digoxin can occur; report if HR is >100 or <60; assess for s/s of hyperthyroid
propylthiouracil (PTU) pt teaching
take at same time every day; report skin rash, swollen lymph nodes, sore throat, fever
What is the ptype drug for corticosteroids?
hydrocortisone (many trade names); glucocorticoid actions primarily, but some mineralocorticoid actions as well
hydrocortisone primary use
treat inflammation (dose 40-60mg/day); management of adrenocortical insufficiency (dose 7.5mg/day)
hydrocortisone formulations (6)
hydrocortisone acetate: oral, creams, ointments, intra-articular; hydrocortisone cypionate: oral suspension; hydrocortisone sodium succinate: IV only; hydrocortisone valerate: topical
hydrocortisone routes of delivery
po, IM, IV, SQ, rectal, intra-articular, topical
hydrocortisone MOA
mostly glucocorticoid activity: prepare the body for long-term stress and affect the metabolism of the cell; some mineralocorticoid activity: conserve water and sodium
hydrocortisone adverse effects
hyperglycemia; muscle wasting; fat distribution changes; infection due to reduced immune response; HTN; mood swings, irritability; osteoporosis
hydrocortisone nursing considerations
SE are uncommon when given intranasally, inhaled, topically or at low doses
hydrocortisone pt teaching
If higher doses are taken >2 wks, dose will need to be tapered off gradually to allow adrenal gland to resume function gradually;
drugs similar to hydrocortisone
dexamethasone (20-30x more potent); prednisone (most frequently prescribed for po admin, 4x more potent, longer duration of action)
Hyperkalemia s/s
muscle weakness, numbness, fatigue, mental depression, anorexia (side effects of corticosteroids)
Glucocorticoid SE: hyperglycemia
increases blood sugar by inhibiting insulin secretion and promoting gluconeogenesis
Glucocorticoid SE: loss of muscle mass
increases the breakdown of proteins to amino acids
Glucocorticoid SE: fat deposition/redistribution
increases the breakdown of lipids; (lose fat layer under the skin - "tissue" skin; hump deposition)
Glucocorticoid SE: infection
suppresses inflammatory response by stabilizing mast cells, inhibiting the release of inflammatory mediators
Glucocorticoid SE: hypertension
increases the sensitivity of vascular smooth muscle to the actions of norepinephrine and angiotensin II, thus modifying smooth muscle tone
Glucocorticoid SE: mood swings, irritability
affects mood and maintains normal nerve excitability
Glucocorticoid SE: osteoporosis
increases the breakdown of the boney matrix
Glucocorticoid SE: easier breathing
promotes bronchodilation by making bronchial smooth muscle more responsive to sympathetic nervous system activation
Glucocorticoid SE: masks infection, reduces inflammatory response
stabilize mast cells, inhibiting the release of inflammatory mediators
What is ptype drug for mineralocorticoids?
fludrocortisone (Florinel)
fludrocortisone (Florinel) primary use
replacement of mineralocorticoids for pt w/ adrenal insufficiency (such as Addison's disease - they need both glucocorticoid and mineralocorticoid replacement)
fludrocortisone (Florinel) MOA
acts on the distal renal tubule to promote sodium and water reabsorption, and increases urinary potassium excretion
fludrocortisone (Florinel) adverse effects
result of excessive mineralocorticoid activity: fluid retention; edema; CHF; HTN; hypokalemia; N/V; fatigue
fludrocortisone (Florinel) nursing considerations
Assess ht/wt; monitor BP, report increases; monitor for s/s of hypokalemia; monitor for over or under dose
fludrocortisone (Florinel) pt teaching
do not stop "cold turkey", must taper off gradually; teach s/s of hypokalemia; eat foods high in potassium, reduce sodium; report edema, reduced urine output, weight gain of 5 lbs/wk, infection or trauma
Mineralocorticoid activity in body (adverse when in excess)
fluid retention; edema; CHF; HTN; hypokalemia; N/V; fatigue
s/s of mineralocorticoid overdose
aka hypercorticism; psychosis; excessive weight gain; edema; congestive heart failure
s/s of mineralocorticoid under-dose
aka hypocorticism; loss of weight and appetite; N/V/D; muscular weakness; increased fatigue and hypotension