Week 11 pharmacology

• Hypothalamus


  Almond-sized, located below the thalamus and above the brainstem, its primary function is to maintain homeostasis (stability of the internal environment) in the body, links the nervous and endocrine systems via the pituitary gland, secretes releasing and inhibiting hormones that stimulate or inhibit production of hormones in the anterior pituitary, contains neurosecretory cells that produce ADH and oxytocin

  
• Pituitary gland


  Pea-sized, reddish-gray body that stores hormones from the hypothalamus and releases them into the bloodstream, often called the "Master Gland" because its hormones control other parts of the endocrine system

  
• Pituitary gland lobes


  • Anterior lobe (adenohypophysis)
  • Posterior lobe (neurohypophysis)
• Anterior pituitary hormones


  • Somatotrophs: human growth hormones
  • Lactotrophs: prolactin
  • Gonadotrophs: FSH and LH
  • Corticotrophs: ACTH and MSH
  • Thyrotrophs: TSH

  
• Posterior pituitary


  Produces vasopressin and oxytocin

  
• Pituitary disorders can cause a range of symptoms, are challenging to diagnose, can raise or lower one or more hormones, and can cause physical or mood changes
• Causes of pituitary disorders

  • Tumors, mostly non-cancerous pituitary tumors
  • Head injury
  • Bleeding in or near the pituitary gland
  • Some medications and cancer treatments
• Anterior pituitary disorders


  • Acromegaly
  • Cushing's syndrome
  • Diabetes insipidus
  • Empty Sella Syndrome
  • Hypopituitarism
  • Tumors or Pituitary Adenomas
• Posterior pituitary disorders


  • Diabetes insipidus
• Signs and symptoms of pituitary disorders

  • Anxiety or depression
  • Diabetes
  • Hair loss
  • High blood pressure
  • Irregular menstrual periods
  • Unexpected breast milk production
  • Low energy or low sex drive
  • Stunted growth or unusual growth spurts
  • Unexplained weight gain
  • Vision changes

  
• Anterior pituitary hormone drugs

  • Growth hormone agonists
  • Growth hormone antagonists
  • Other Drugs Affecting Anterior Pituitary Hormones

  
• Posterior pituitary hormone drugs


  • Drugs Affecting Posterior Pituitary Hormones

  
• Somatropin


  Growth hormone agonist drug used for growth failure, growth hormone deficiency, intestinal disorder, HIV-related weight loss or wasting, and to increase height in children with certain disorders

  
• Somatropin side effects


  • Headache
  • Nausea
  • Vomiting
  • Tiredness
  • Muscle pain
  • Weakness
• Serious somatropin side effects


  • Nausea/vomiting that doesn't stop
  • Development of limp
  • Unusual tiredness
  • Unexplained weight gain
  • Cold intolerance
  • Fast/slow heart beat
  • Ear pain
  • Hearing problems
  • Joint/hip/knee problems
  • Numbness/tingling
  • Increase in thirst and urination
  • Swelling hands/ankles/feet
  • Change in appearance or size of any mole
  • Abdominal pain

  
• Somatropin nursing responsibilities


  • Rotate injection site
  • Do not shake while mixing solution
  • Report serious side effects
  • Check for breathing problems
  • Monitor blood sugar level
  • Use sterile water for injection in newborns
  • Consult doctor if pregnant or breastfeeding
• Pegvisomant


  Growth hormone receptor antagonist drug that blocks the hepatic production of IGF-1, used to treat acromegaly

  
• Pegvisomant side effects


  • Bleeding/blistering/burning/coldness or discoloration at injection site
  • Bloating/swelling
  • Blurred vision
  • Chest pain
  • Chills
  • Cough
  • Dizziness
  • Feeling of pressure
  • Fever
  • Headache
  • Hives
  • Hoarseness
  • Nervousness
  • Lower back or side pain
  • Painful urination
  • Rapid weight gain
  • Pounding in the ears
  • Slow or rapid heart beat
  • Tingling of hands or feet
  • Infection/lump at injection site
• Pegvisomant nursing responsibilities


  • Consult doctor for lactating mothers
  • Monitor for allergic reactions
  • Use caution in diabetic patients
  • Use caution in liver/kidney disease
  • Use caution in patients with tumors
  • Rotate injection sites
  • Do not double missed dose
• Bromocriptine


  Dopamine agonist drug that lowers hormone levels, may help lower GH and IGF-1 and decrease tumor size, decreases prolactin secretion
• Bromocriptine indications


  • Tumor
  • Acromegaly
  • Tremors in Parkinsonism
  • Infertility in hyperprolactinemia

  
• Bromocriptine side effects


  • Nausea
  • Vomiting
  • Stuffy nose
  • Tiredness
  • Dizziness
  • Sleep problems
  • Mood changes
  • Confusion
  • Hallucination
  • Nightmares
  • Burning eyes
  • Pulmonary infiltrates
  • Effusions
  • Hypotension
  • Anorexia
  • Dry mouth
  • Metallic taste
  • Urticaria
  • Leg cramps
  • Digital vasospasm in acromegaly
• Bromocriptine nursing responsibilities


  • Assess BP and report low BP
  • Monitor respiratory function and report signs of pulmonary issues
  • Assess dizziness and drowsiness and report balance problems
  • Monitor confusion and hallucinations
  • Monitor cardiac symptoms and report signs of MI
  • Watch for digital vasospasm in acromegaly
• Somatostatin analogues


  Drugs that reduce growth hormone production by signaling the pituitary gland to produce less GH, may reduce pituitary tumor size

  
• Somatostatin analogues


  • Lantreotide (Somatulin Depot)
  • Octreotide (Sandostatin)
• Somatostatin analogues side effects

  • Blurred vision
  • Gaseous abdominal or stomach pain
  • Headache
  • Lightheadedness, dizziness, or fainting
  • Recurrent fever
  • Slow, fast, or irregular heartbeat
  • Stomach fullness
  • Troubled breathing with exertion
• Somatostatin analogues nursing responsibilities

  • Report side effects to healthcare provider
  • Alternate injection sites
  • Consult doctor if pregnant, breastfeeding, or planning pregnancy
  • Advise patient not to drive or operate machinery until effects known
  • Store medication properly
• Antidiuretic hormone (ADH)


  Regulates the body's fluid balance, decreases urine production, produced in the hypothalamus and stored in the pituitary gland, promotes water reabsorption in the kidneys
• ADH is often administered to treat diabetes insipidus, bleeding disorders, and bedwetting problems
• Antidiuretic hormone (ADH)


  Hormone used to regulate the body's fluid balance. Works with the kidneys to manage the amount of water released from the body and in general, decreases the production of urine.
• ADH


  Also known as vasopressin or arginine vasopressin (AVP). Peptide hormone produced in the hypothalamus gland and stored in the pituitary gland.

  
• ADH


  • Regulates how the kidneys concentrate urine or retain water
  • Helps manage blood pressure and fluid volume by regulating water retention in the body
  • Promotes the reabsorption of water in the kidneys and decreases the excretion of water in the urine
  • Helps conserve the fluid volume in the body and decreases water dilution of the urine
  • Can cause blood vessels to constrict, which increases blood pressure
• Thyroid gland


  Small organ, about 2-inch long, located in the front of the neck, wrapped around the windpipe (trachea). Shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of the throat.
• Thyroid gland


  • Makes hormones that help control many vital functions of the body.
  • When the body makes too much thyroid hormone, a condition called hyperthyroidism develops.
  • If the body makes too little thyroid hormone, hypothyroidism develops.
  • Plays a major role in the metabolism, growth and development of the human body.

  
• Hyperthyroidism


  Condition where the body makes too much thyroid hormone.

  
• Causes of hyperthyroidism


  • Graves' disease
  • Thyroid nodules
  • Thyroiditis
  • Consuming excess iodine

  
• Hypothyroidism


  Condition where the body makes too little thyroid hormone.

  
• Causes of hypothyroidism


  • Hashimoto's disease (autoimmune condition)
  • Thyroiditis (inflammation of the thyroid)
  • Treatment of hyperthyroidism (radiation and surgical removal of the thyroid)
  • Iodine deficiency
  • Hereditary conditions

  
• Symptoms of too much medicine in the body

  • Dache
  • Irritability
  • Tremors
  • Diarrhea
  • Fever
  • Weight gain or loss
  • Changes in menstrual periods
• Myxedema coma


  Severe hypothyroidism