Metabolism

Question 1

Oxytocin (Pitocin)

Answer 1

Therapeutic/Pharmacologic Class:
Hormone/oxytocic agent

Indications:
IV: Induction or augmentation of labor at term. Can be used as an abortive agent. Postpartum control of bleeding after expulsion of the placenta.
IM: Prevention of postpartum hemorrhage after separation of placenta.
Unlabeled Uses: Evaluation of fetal competence (fetal stress test).

Action:
Stimulates uterine smooth muscle, producing uterine contractions similar to those in spontaneous labor. Contracts the uterus to squeeze closed the attachment sites of the placenta, so it stops excess postpartum bleeding. Stimulates mammary gland smooth muscle, facilitating lactation. Has vasopressor and antidiuretic effects.

Adverse Reactions/Side Effects:
CNS: maternal - coma, seizures; fetal - intracranial hemorrhage. Resp: fetal - asphyxia, hypoxia. CV: maternal - hypotension; fetal - arrhythmias. F and E: hypochloremia, hyponatremia, water intoxication. Misc: maternal - increased uterine motility, painful contractions, abruptio placentae, decreased uterine blood flow, hypersensitivity.

Patient Teaching:
- Expect contractions to become more severe and last longer.

Nursing Considerations:

• Assess character, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate frequently throughout administration.
• May cause water intoxication
• Make sure there is a Physician in-house at all times when the client is on a continuous drip.

Question 2

Antidiuretic Hormones - Desmopressin (DDAVP, DDAVP Rhinal Tube, DDAVP Rhinyle Drops, Stimate), Vasopressin (Vasostrict, Pressyn)

Answer 2

Therapeutic/Pharmacologic Class:
Hormone/antidiuretic hormones

Indications:
Management of primary nocturnal enuresis unresponsive to other treatment modalities (desmopressin). Treatment of pulseless VT or VFib, GI hemorrhage, vasodilatory, shock, and diabetes insipidus caused by a deficiency.

Action:
Analogues or derivatives of naturally occurring antidiuretic hormone. The primary action is enhanced reabsorption of water in the kidneys.

Adverse Reaction/Side Effects:
CNS: drowsiness, headache, listlessness. EENT: intranasal (DDAVP) - nasal congestion, rhinitis. Resp: dyspnea. CV: HTN, hypotension, tachycardia. GI: mild abdominal cramps, nausea. GU: vulval pain. Derm: flushing. F and E: water intoxication/hyponatremia.

Patient Teaching:

• Notify HCP if bleeding is not controlled or if headache, dyspnea, heartburn, nausea, abdominal cramps, vulval pain, or severe nasal congestion or irritation occurs.
• Avoid use of alcohol with this medication as alcohol decreases the antidiuretic hormone effect.
• If increased urine output occurs, contact HCP for dosage adjustment.
• Wear a Medic-Alert bracelet.

Nursing Considerations:

• Assess for S/S of dehydration
• Weigh daily and assess for edema
• Assess for signs of bleeding. Monitor clotting factors
• Monitor BP and serum Na level.
• Monitor for signs and symptoms of water intoxication.

Question 3

Growth Hormone - Somatotropin (Recombinant) - (Genotropin)

Answer 3

Therapeutic/Pharmacologic Class:
Hormone/growth hormone (GH)

Indications:
Treatment of growth hormone deficiency in adults as a result of pituitary disease, hypothalamic disease, surgery, radiation, trauma, or childhood onset. Treatment of short stature in children with open epiphyses.

Action:
Produces skeletal and cellular growth.

Adverse Reactions/Side Effects:
CV: edema of the hands and feet. Endo: hyperglycemia, hypothyroidism, insulin resistance. Local: pain at injection site MS: arthralgia, carpal tunnel syndrome.

Patient Teaching:

• Follow instructions for IM or SC injections and proper disposal of syringes.
• Follow up with endocrinologist as recommended.
• Report any joint pain (fingers, legs, hips), as this could be an epiphyseal abnormality.

Nursing Considerations:

• Epiphyses must be open in order for medication to have an effect on children with short stature.
• Observe for epiphyseal abnormalities, such as limping, pain or joint disfigurement.
• Measure growth and reassure child that the medication is working.
• Watch glucose levels (GH increases blood glucose level) and monitor thyroid function.

Question 4

Corticosteroids - Cortisone, Hydrocortisone (Cortef, Cortenema, Solo-Cortef), Methylprednisolone (A-Methapred, Depo-Medrol, Medrol, Solu-MEDROL), Prednisone (Rayos, Sterapred)

Answer 4

Therapeutic/Pharmacologic Class:
Anti-inflammatory (steroidal) agent, immunosuppressant/glucocorticosteroids

Indications:
Systemic and local treatment of a wide variety of inflammatory diseases and conditions. Replacement therapy in adrenal insufficiency.

Action:
Suppresses inflammation and the normal immune response.

Adverse Reactions/Side Effects:
CNS: depression, euphoria, headache, ICP (children only), personality changes, psychoses, restlessness. EENT: cataracts, increased intraocular pressure. CV: HTN. GI: peptic ulceration. Derm: acne, decreased wound healing, ecchymosses, fragility, hirsutism, petechiae. Endo: adrenal suppression, hyperglycemia. F and E: fluid retention, hypokalemia. Hemat: thromboembolism, thrombophlebitis. Metab: weight gain, hyperglycemia. MS: muscle wasting, osteoporosis, aseptic necrosis of joints, muscle pain. Misc: cushingoid appearance, increased susceptibility to infection.

Patient Teaching:

• Do not stop the medication suddenly.
• Avoid grapefruit juice and limit caffeine when taking oral forms.

Nursing Considerations:

• Monitor I&O, daily weight, edema, lung sounds, serum electrolytes, CBC, and glucose level.
• Give with food in the AM to decrease gastric upset and mimic natural cortisol.

Question 5

Thyroid Hormones - Levothyroxine (Tirosint, Unithroid, Levoxyl, Levo-T, Synthroid, T4), Liothyronine (Cytomel, Triostat, Triiodothyronine, T3), Thyroid (Armour Thyroid, Westhroid)

Answer 5

Therapeutic/Pharmacologic Class:
Hormone/thyroid hormones

Indications:
Replacement therapy in clients without thyroid hormone or pharmacologic doses to enhance diminished thyroid function. Replacement or pharmacologic doses in neonates to correct inborn errors of metabolism (prevents developmental delay)

Action:
Metabolism of all nutrients is increased, promoting cell growth and increased protein synthesis.

Adverse Reaction/Side Effects:
CNS: insomnia, irritability, nervousness, headache. CV: CV collapse, arrhythmias, tachycardia, angina pectoris, BP changes, increased CO. GI: cramps, diarrhea, committing. Derm: hair loss in children, diaphoresis. Endo: hyperthyroidism, menstrual irregularities. Metab: weight loss, heat intolerance. MS: accelerated bone maturation in children.

Patient Teaching:

• Take medication in the morning to prevent insomnia
• Report chest pain, palpitations, or dizziness immediately
• Full effects may not be felt for several weeks
• Report excessive weight loss

Nursing Considerations:

• The previously sluggish heart will beat faster, increasing myocardial O2 needs. This may lead to angina or even MI
• Monitor T3,T4, and TSH levels (TSH is high when thyroid function is low)
• Monitor glucose, weight, and increasing physical and mental energy.