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Drug Classifications HYPOTHALAMIC AND PITUITARY DRUGS HYPOTHALAMIC HORMONES ANTERIOR PITUITARY Corticotropin, Cosyntropin, Somatrem, Somatropin, Goserelin, Histrelin, HCG, Choriogonandotropin Leuprolide, Nafarelin, alpha, Follitropin alfa, Octreotide, Triptorelin Follitropin beta, Menotropins, Pegvisomant, A synthetic analogue of Thyrotropin alfa, LHRH. Urofollitropin Initially causes a transient Binds to growth hormone increase in testerone; (GH) receptor sites on cell however, with continuous surfaces, blocking the effects administration, testerone of endogenous growth levels are decreased. hormone Reduces gonadotropins, Bound to polyethylene testosterone, and estradiol. glycol (PEG) to reduce clearance and increase duration of action. Rapidly and almost completely absorbed following SQ injection. More slowly absorbed following IM administration of depot form. Side Effects: headache, anxiety, depression, dizziness, fatigue, insomnia, weakness.dyspnea, chest pain, MI CEREBROVASCULAR ACCIDENT 57% absorbed following SQ injection. Metabolism unknown. Side Effects: hypertension, peripheral edema. LFTs. back pain. growth hormone deficiency, glucose tolerance. lipohypertrophy. POSTERIOR PITUITARY
Desmopressin, Vasopressin, Oxytocin An analogue of naturally occurring vasopressin (antidiuretic hormone). Primary action is enhanced reabsorption of water in the kidneys
5% absorbed following oral administration; some 1020% absorbed from nasal mucosa. Metabolism unknown Side Effects: SEIZURES, drowsiness, headache, listlessness.nasal congestion, rhinitis. dyspnea. hypertension, hypotension, tachycardia (large IV doses only). mild abdominal cramps, nausea.
Facquet_Fall 2010
Assess patient for signs and symptoms of acromegaly. Monitor patient for signs and symptoms or hepatitis or other liver injury Monitor serum IGF-1 levels 4 6 wk after therapy is initiated. Monitor serum glucose carefully in patients with insulin-dependent diabetes Measure liver tests (serum ALT, AST, total bilirubin and alkaline at baseline.
Monitor frequency of enuresis throughout therapy Monitor urine and plasma osmolality and urine volume frequently. Weigh patient daily and assess for edema Monitor plasma factor VIII coagulant, factor VIII antigen, and ristocetin cofactor.
Drug Classifications GLUCOCORTICOIDS Examples & Action: Beclamethasone, Bethametasone, Budesonide, Cortisone, Dexamethasone, Flunisolide, Fluticasone, Hydrocortisone, Methylprednisolone, MOmetasone, Prednisolone, Prednisone In pharmacologic doses, suppresses inflammation and the normal immune response. Has numerous intense metabolic effects (see Adverse Reactions and Side Effects) MINERALOCORTICOIDS HYPOTHYROIDISM Levothyroxine Replacement of or supplementation to endogenous thyroid hormones. Principal effect is increasing metabolic rate of body tissues Promote gluconeogenesis Increase utilization and mobilization of lycogen stores Stimulate protein synthesis Promote cell growth and differentiation Aid in the development of the brain and CNS
Fludrocortisone Causes sodium reabsorption, hydrogen and potassium excretion, and water retention by its effects on the distal renal tubule
Facquet_Fall 2010
Nursing Implications
Facquet_Fall 2010
Calcitrol, cholecalciferol, ergocalciferol, paricalcitrol Calcitriol is the active form of vitamin D Promotes the absorption of calcium and decreases parathyroid hormone concentrations
Absorption from the GI tract requires vitamin D Excreted mostly in the feces; 20% eliminated by the kidneys Side Effects: headche, tingling. arrhythmias, bradycardia. constipation, nausea, vomiting. calculi, hypercalciuria.
IV administration results in complete bioavailability; well absorbed following oral administration Undergoes enterohepatic recycling and is excreted mostly in bile. Side Effects: albuminuria, azotemia, decreased libido, nocturia, polyuria. pruritus.hypercalcemia.pain at injection site
Facquet_Fall 2010
Drug Classifications SELECTIVE ESTROGEN REC. Examples & Action: PARATHYROID HORMONE Teriparatide, phosphate salt, prednisone or hydrocortisone, 0.9% Sodium Chloride injection Regulates calcium and phosphate metabolism in bone and kidney by binding to specific cell receptors; stimulates osteoblastic activity Increases serum calcium and decreases serum phosphorus BIPHOSPHONATES
Raloxifene, Calcitoninsalmon Binds to estrogen receptors, producing estrogen-like effects on bone, resulting in reduced resorption of bone and decreased bone turnover
Alendronate, Ibandronate, Pamidronate, Risedronate, Zoledronate Inhibits resorption of bone by inhibiting osteoclast activity
Facquet_Fall 2010
Extensively absorbed after subcut administration Metabolized by the liver Side effects: orthostatic hypotension. muscle spasms
Nursing Implications Assess patient for bone mineral density before and periodically during therapy. Monitor labs.
Facquet_Fall 2010