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PYRAMID POINTS

PYRAMID POINTS. MODULE 46: ENDOCRINE MEDICATIONS. PYRAMID POINTS. I. Pituitary Medications Description Administered to replace deficient quantities of hormones secreted by the anterior and posterior pituitary gland

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PYRAMID POINTS

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  1. PYRAMID POINTS MODULE 46: ENDOCRINE MEDICATIONS

  2. PYRAMID POINTS I. Pituitary Medications • Description • Administered to replace deficient quantities of hormones secreted by the anterior and posterior pituitary gland • The anterior pituitary gland secretes growth hormone (GH), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH), prolactin, melanocyte-stimulating hormone (MSH), and gonadotropins (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]) • The posterior pituitary gland secretes antidiuretic hormones (vasopressin) and oxytocin

  3. PYRAMID POINTS I. Pituitary Medications (continued) • Growth hormones and related medications • Assess child’s physical growth; compare with standards • Monitor blood glucose levels, thyroid function tests • Teach client, family signs of hyperglycemia, importance of follow-up blood tests

  4. PYRAMID POINTS II. Antidiuretic Hormones • Description • Enhance reabsorption of water in kidneys, promoting antidiuretic effect, regulating fluid balance • Side effects • Include flushing, headache, water intoxication, hypertension

  5. PYRAMID POINTS II. Antidiuretic Hormones (continued) • Interventions • Monitor strict intake and output; urine osmolality • Monitor daily weights, vital signs • Monitor electrolyte serum levels • Restrict fluid intake as prescribed • Monitor for signs of water intoxication, including drowsiness, listlessness, headache • Instruct client how to use intranasal spray medication • Instruct client to report to primary health care provider any signs of water intoxication, dyspnea, shortness of breath (SOB), headache

  6. PYRAMID POINTS III. Thyroid Hormones • Description • Control metabolic rate of tissues; accelerate heat production, oxygen consumption • Should be given at least 4 hours apart from multivitamins, aluminum hydroxide, magnesium hydroxide, simethicone, calcium carbonate, bile acid sequestrants, iron, sucralfate (Carafate) • Side effects • Include weight loss, nervousness, insomnia, diaphoresis, tachycardia, hypertension, chest palpitations, chest pain • Interventions • Instruct client to take medication at same time each day, preferably in morning, without food • Advise client to report symptoms of hyperthyroidism (tachycardia, chest pain, palpitations, diaphoresis)

  7. PYRAMID POINTS IV. Antithyroid Medications • Description • Inhibit synthesis of thyroid hormone • Side effects • Include agranulocytosis with leukopenia, thrombocytopenia, hypothyroidism (toxic response), iodism

  8. PYRAMID POINTS IV. Antithyroid Medications (continued) • Interventions • Instruct client how to take pulse • Advise client to contact health care provider if fever or sore throat develops • Instruct client regarding importance of medication compliance • Advise client to consult physician before eating iodized salt, foods containing iodine • Instruct client to avoid acetylsalicylic acid (aspirin), medications containing iodine • Monitor for signs of thyroid storm (fever, flushed skin, confusion, behavioral changes, tachycardia, dysrhythmias, signs of heart failure)

  9. PYRAMID POINTS V. Parathyroid Medications • Description • Regulate serum calcium levels • Hyperparathyroidism results in high serum calcium levels, bone demineralization • Hypoparathyroidism results in low serum calcium levels, neuromuscular excitability

  10. PYRAMID POINTS V. Parathyroid Medications (continued) • Interventions • Monitor for symptoms of tetany in client with hypocalcemia • Instruct client to maintain intake of vitamin D if receiving oral calcium supplements • Instruct client receiving calcium regulators to • Swallow tablet whole with water at least 30 minutes before breakfast • Not lie down for at least 30 minutes • Instruct client using antihypercalcemic agents to avoid foods rich in calcium, including green leafy vegetables • Instruct client not to take other medications within 1 hour of taking calcium salts

  11. PYRAMID POINTS VI. Corticosteroids (Mineralocorticoids) • Description • Used for replacement therapy in primary or secondary adrenal insufficiency in Addison’s disease • Side effects • Include sodium and water retention, hypokalemia, hypertension, weight gain

  12. PYRAMID POINTS VI. Corticosteroids (Mineralocorticoids) (continued) • Interventions • Instruct client not to stop medication abruptly • Instruct client to take medication with food or milk • Instruct client to consume diet high in potassium as prescribed • Instruct client to notify health care provider if signs of infection, muscle aches, sudden weight gain, headache occur • Instruct client not to take aspirin products without consulting physician

  13. PYRAMID POINTS VII. Corticosteroids (Glucocorticoids) • Description • Alter the normal immune response, suppress inflammation • Promote sodium and water retention, potassium excretion • Produce anti-inflammatory, antiallergic, antistress effects • May be used as replacement for adrenocortical insufficiency • Side effects • Include hyperglycemia, sodium and fluid retention, weight gain, mood swings, moon face and buffalo hump, increased susceptibility to infection, hirsutism

  14. PYRAMID POINTS VII. Corticosteroids (Glucocorticoids) (continued) • Contraindications and cautions • Should be used with caution in clients with DM • Use with extreme caution in clients with infections • Interventions • Instruct client to take medication with food • Instruct client to avoid individuals with infections • Instruct client to eat diet high in potassium as prescribed • Instruct client to report signs of Cushing’s syndrome

  15. PYRAMID POINTS VIII. Androgens • Description • Used to replace deficient hormones, treat hormone-sensitive disorders • Side effects • Include hepatotoxicity, jaundice

  16. PYRAMID POINTS VIII. Androgens (continued) • Interventions • Monitor for edema, weight gain, skin changes • Assess for liver dysfunction, including right upper quadrant abdominal pain, malaise, fever, jaundice, pruritus • Assess for development of secondary sexual characteristics • Instruct client to notify health care provider if fluid retention occurs • Instruct women to use nonhormonal contraceptive while on therapy

  17. PYRAMID POINTS IX. Estrogens and Progestins • Description • Preparations may be used to stimulate endogenous hormones to restore hormonal balance; to treat hormone-sensitive tumors; for contraception • Contraindications and cautions • Estrogens • Contraindicated in clients with breast cancer, endometrial hyperplasia, endometrial cancer, history of thromboembolism, known or suspected pregnancy or lactation • Barbiturates, phenytoin (Dilantin), rifampin (Rifadin) decrease effectiveness

  18. PYRAMID POINTS IX. Estrogens and Progestins (continued) • Contraindications and cautions (continued) • Progestins • Contraindicated in clients with thromboembolic disorders; should be avoided in clients with breast tumor, hepatic disease • Side effects • Hypertension, stroke, myocardial infarction, thromboembolism • Interventions • Instruct client not to smoke • Instruct client to undergo routine breast and pelvic examinations

  19. PYRAMID POINTS X. Contraceptives • Description • Usually taken for 21 consecutive days, stopped for 7 days; cycle then repeated • Risk factors: smoking, obesity, hypertension • Contraindicated in women with hypertension, thromboembolic disease, cerebrovascular or coronary artery disease, cancer, pregnancy • Should be avoided with use of hepatotoxic medications • Side effects • Breakthrough bleeding; excessive cervical mucus formation; breast tenderness; hypertension; nausea and vomiting

  20. PYRAMID POINTS X. Contraceptives (continued) • Interventions • Instruct client to report signs of thromboembolic complications • Advise client to use alternative form of birth control when taking antibiotics • Instruct client to perform breast self-examination (BSE) monthly • If client decides to discontinue contraceptive to become pregnant, recommend alternative form of birth control for 2-month period • If using patch and it remains off for less than 24 hours, reapply • If using patch and it is off longer than 24 hours, new 4-week cycle must be started immediately

  21. PYRAMID POINTS XI. Fertility Medications • Description • Act to stimulate follicle development, ovulation in functioning ovaries; combined with human chorionic gonadotropin to maintain follicles once ovulation has occurred • Contraindicated in presence of primary ovarian dysfunction, thyroid or adrenal dysfunction, ovarian cysts, pregnancy, idiopathic uterine bleeding • Should be used with caution in clients with thromboembolic or respiratory disease

  22. PYRAMID POINTS XI. Fertility Medications (continued) • Side effects • Risk of multiple births, birth defects • Interventions • Instruct client on administration of medication • Instruct client on when intercourse should occur to increase therapeutic effectiveness of medication • Instruct client about risks and hazards of multiple births • Instruct client about regular follow-up care

  23. PYRAMID POINTS XII. Medications for Erectile Dysfunction • Description • Cause smooth muscle relaxation; promote blood flow into corpus cavernosum • Contraindicated in presence of anatomical obstruction or condition that might predispose to priapism; contraindicated in clients with penile implants • Sildenafil, tadalafil, vardenafil used cautiously in clients with coronary artery disease (CAD), active peptic ulcer disease, bleeding disorders, retinitis pigmentosa • Sildenafil, tadalafil, vardenafil cannot be administered to clients taking nitrates, nitroprusside, β-blockers

  24. PYRAMID POINTS XII. Medications for Erectile Dysfunction (continued) • Side effects • Pain at injection site; rash; hypertension (alprostadil) • Headache; flushing; dyspepsia; rash; insomnia • Interventions • Inform client of side effects about which physician needs to be informed • Perform thorough assessment of health and history

  25. PYRAMID POINTS XIII. Medications for Diabetes Mellitus • Insulin and oral hypoglycemic medications • -Adrenergic blocking agents may mask signs, symptoms of hyperglycemia • Corticosteroids, sympathomimetics, thiazide diuretics, phenytoin (Dilantin), thyroid preparations, oral contraceptives, estrogen compounds may cause hyperglycemia • Side effects of sulfonylurea oral hypoglycemics include gastrointestinal symptoms, hypoglycemia • Chlorpropamide (Diabinese) can cause disulfiram (Antabuse)-type reaction when alcohol is ingested

  26. PYRAMID POINTS XIII. Medications for Diabetes Mellitus (continued) • Oral hypoglycemic medications • Obtain medication history • Instruct client not to ingest alcohol with sulfonylureas • Inform client that insulin may be needed during stress, surgery, infection • Teach client about signs and symptoms of hypoglycemia and hyperglycemia

  27. PYRAMID POINTS XIII. Medications for Diabetes Mellitus (continued) • Insulin • Onset, peak, duration of action depend on insulin type • Storing insulin: • Avoid extreme temperatures • Do not freeze or keep in direct sunlight • Insulin injection sites: main areas include abdomen, arms (posterior surface), thighs (anterior surface), hips • Mixing NPH and regular insulin: draw up clear (Regular) insulin before cloudy (NPH) insulin

  28. PYRAMID POINTS XIII. Medications for Diabetes Mellitus (continued) • Administering insulin • Before use, swirl vial gently or rotate between palms, but avoid vigorous shaking • Administer mixed dose within 5 to 15 minutes of preparation • Regular insulin is only type of insulin that can be administered IV

  29. PYRAMID POINTS XIII. Medications for Diabetes Mellitus (continued) • Exubera (insulin, human [rDNA origin]) inhalation powder • Causes decrease in pulmonary function • Pulmonary function studies done before treatment starts, periodically during treatment • Contraindicated in client who smokes, starts smoking, or quits smoking less than 6 months before beginning treatment, in clients with unstable or poorly controlled lung disease, in pregnant clients, in clients younger than 18 years • Exenatide (Byetta) • Used for clients with type 2 DM • Administered as subcutaneous injection within 60 minutes before morning and evening meals

  30. PYRAMID POINTS XIII. Medications for Diabetes Mellitus (continued) • Pramlintide (Symlin) • Used for clients with type 1 or 2 DM • Use is associated with increased risk of hypoglycemia • Glucagon • Used to treat insulin-induced hypoglycemia • Instruct family in procedure for administration • Diazoxide (Proglycem) • Used to treat hypoglycemia caused by hyperinsulinism resulting from islet cell cancer or hyperplasia • This agent is not used for hypoglycemic reactions from insulin

  31. Question 1 A diabetic client taking daily NPH insulin has been started on therapy with dexamethasone (Decadron). The nurse anticipates that which of the following adjustments in medication dosage will be made? • Decrease in NPH insulin • Increase in NPH insulin • Lower dose of dexamethasone than usual • Higher dose of dexamethasone than usual

  32. Question 2 The nurse has given medication information to the client who is beginning hormone replacement therapy with levothyroxine (Synthroid). The nurse determines that the client can recognize signs of medication toxicity if the client states that he or she will report which of the following to the health care provider? • Heat intolerance • Slow pulse rate • Low body temperature • Drowsiness

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