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                                         Chapter 20
                      Hormones and Steroids




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                                         Chapter 20

                                       Lesson 20.1




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                         Learning Objectives
  • Describe the use of antidiabetic
    medications
  • Identify preparations that act on the uterus




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                                            Overview
  • Hormones and steroids


  • Natural and synthetic preparations


  • Used to replace and/or increase natural
    chemicals in the body

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                            Endocrine System
  • Regulation and coordination of body
    systems

  • Endocrine glands

  • Pituitary, thyroid, parathyroid, adrenal
    glands; duodenum, testes, ovaries, and
    placenta
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                            Antidiabetic Drugs
  • Diabetes mellitus: chronic disorder of
    metabolism

  • Insulin: necessary for the metabolism and
    use of glucose in the body
  • Pancreas

  • Type 1 and type 2 diabetes
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                                                  Insulin
  • Action: lowers blood glucose levels by
    helping glucose move into target tissues

  • Uses: treatment of type 1 diabetes

  • Types: Table 20-1



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                           Adverse Reactions
  • Lipodystrophy, local itching, swelling, erythema
  • Hypoglycemia: serum glucose less than 60
    mg/dL


                              Drug Interactions
  • Insulin antagonists
  • Anabolic steroids and alcohol may increase the
    hypoglycemic effects of insulin

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                        Nursing Implications
  • Assessment: polyuria, polyphagia,
    polydipsia, weight loss, blurred vision, and
    fatigue
  • Hyperglycemia: systemic acidosis
  • Conditions that alter requirements for
    insulin

  • Patient Teaching
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                         Oral Hypoglycemics
  • Action: stimulate insulin release from the
    beta cells of the pancreas; decrease
    insulin resistance
  • Uses: monotherapy versus combination
    therapy
  • 5 classes: sulfonylureas- 1st and 2nd
    generations; biguanides; alpha-
    glucosidase inhibitors

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                           Adverse Reactions
  • Hypoglycemia; allergic reactions


                              Drug Interactions
  • Displacement; potentiation
  • Thiazides oppose the secretion of insulin
    from the beta cells and decrease the
    effectiveness of sulfonylureas

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                        Nursing Implications
  • Assessment: health history; renal and liver
    function; sulfa allergies


                               Patient Teaching



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                  Selected Drugs Used with
                   Pregnancy and Delivery
  • Overview: antepartum, intrapartum, and
    postpartum

  •    Tocolytics
  •    Oxytocics
  •    Uterine relaxants
  •    Abortifacients
  •    Table 20-4

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                               Action and Uses
  • Abortifacients stimulate uterine
    contractions and cause the uterus to
    empty
  • Oxytocic agents and ergo preparations
    cause the uterus to contract
  • Uterine relaxants act on beta-adrenergics
    to stop smooth muscle contraction in the
    uterus
  • Tocolytics are used to stop preterm labor
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                           Adverse Reactions
  • Abortifacients: cramping and pain
  • Tocolytics: visual disturbance, malaise, nausea,
    and confusion
  • Oxytocics: dysrhythmias, edema, fetal
    bradycardia, anxiety, redness of skin during
    administration, nausea, vomiting, anaphylaxis,
    postpartum hemorrhage, cyanosis, and dyspnea
  • Ergots: nausea and vomiting; allergic reactions,
    bradycardia, hypotension, hypertension,
    cerebral-spinal symptoms and spasms
  • Drug Interactions: vasoconstrictors and local
    anesthetics increase the effectiveness of
    oxytocics
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                        Nursing Implications
  • Assessment; diagnosis; planning;
    implementation; evaluation


                               Patient Teaching
  • Nursing care and monitoring during drug
    administration; adverse effects of
    ergonovine

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                                         Chapter 20

                                       Lesson 20.2




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                         Learning Objectives
  • Compare and contrast the action of
    adrenal and pituitary hormones
  • Describe at least five adverse reactions
    that may result from the use of
    glucocortical and mineralocortical steroids
  • Compare the actions of various male and
    female hormones
  • List the indications for the use of thyroid
    preparations
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               Pituitary and Adrenocortical
                         Hormones
  • Pituitary gland: “Master gland”

  • Adenohypophysis

  • Neurohypophysis

  • Hormone production; control growth; electrolyte
    balance; water retention or loss; and
    reproductive cycle
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                          Pituitary Hormones
  • Anterior pituitary hormones:

      HCG
      LH and FSH
      STG
      ACTH

  • Table 20-5
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           Anterior Pituitary Hormones
       Adverse Reactions (systemic or local reaction)
  •    Menotropins: enlarged ovaries; multiple births
       when used for fertilization
  •    Clomiphene: abdominal discomfort; ovarian
       enlargement; blurred vision; nervousness;
       nausea and vomiting; vasomotor flushes
  •    Chorionic gonadotropins: HA; irritability;
       restlessness; fatigue; and edema
  •    Somatotropin: antibody stimulation
  •    ACTH: adrenal gland
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         Posterior Pituitary Hormones
  • ADH
  • Vasopressin may cause abdominal cramps,
    anaphylaxis, bronchial constriction, circumoral
    pallor, diarrhea, flatus, intestinal hyperactivity,
    HA, sweating, tremors, urticaria, uterine cramps,
    vertigo, vomiting; large doses may produce
    death
  • Oxytocin
  • ACTH
  • Table 20-6


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               Adrenocortical Hormones
  • Actions
   Manufactures glucocorticoids,
    mineralcorticoids, and small amounts of
    sex hormones
  • Uses
   Adrenal insufficiency (Addison’s disease)
   Reduce inflammation in allergic or
    immunologic responses; treat hematologic
    and malignant diseases
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                           Adverse Reactions
  • Table 20-5


                              Drug Interactions
  • Increase effects of barbiturates, sedatives,
    narcotics, and anticoagulants
  • Decrease effects of insulin, oral
    hypoglycemics, coumarin, isoniazid,
    aspirin, and broad spectrum antibiotics

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                         Nursing Implications and
                            Patient Teaching
         –   Frequent medical monitoring
         –   Avoid smoking
         –   Alcohol use: ulcer development
         –   Risk for infection
         –   Increase dose during times of stress
         –   Signs and symptoms of adrenal insufficiency
         –   Do not stop drug abruptly
         –   Medic Alert bracelet
         –   Immunization considerations
         –   Diet
         –   Storage of drug
         –   Drug interactions
         –   Dosage schedule, missed dosage
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                                  Sex Hormones
  • Production influenced by the anterior
    pituitary

  • Male: testosterone; androgens

  • Female: estrogen; progesterone



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                                          Androgens
  • Actions: develop secondary sex characteristics;
    tissue building

  • Uses: hypogonadism, hypopituitarism, dwarfism,
    eunuchism, cryptorchidism, oligospermia, and
    male androgen deficiency

  • Adverse Reactions: edema due to sodium
    retention, acne, hirsutism, male pattern
    baldness, cholestatic hepatitis with jaundice,
    buccal irritation, nausea and vomiting, diarrhea

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                             Androgens (cont.)
  • Drug Interactions:
   Increase effects – anticoagulants, antidiabetic
    agents, and other drugs;
   Decrease effects - barbiturates
  • Concurrent use with corticosteroids increase
    edema
  • Nursing Implications:
   Assessment, diagnosis, planning,
    implementation, and evaluation
   Table 20-9

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                             Androgens (cont.)
  • Patient Teaching:

      Administration
      Response time
      Diet
  •    Symptoms to report
  •    Administration considerations

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                   Female Sex Hormones

  • Estrogens


  • Progestins


  • Table 20-10
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                                           Estrogens
  • Used for hormone replacement therapy in
    menopause and other conditions (ovarian
    failure); infertility work-ups, palliative
    breast cancer treatment

  • Adverse reactions

  • Drug interactions
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                                          Progestins
  • Action

  • Use: contraception, control excessive uterine
    bleeding, treatment of secondary amenorrhea,
    dysmenorrhea, and premenstrual tension, and
    control of pain in endometriosis

  • Drug Interactions

  • Nursing Implications and Patient teaching
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                         Oral Contraceptives
  • Combination drugs: estrogen and
    progestin; Table 20-2
  • Action: prevent ovulation
  • Use: contraception
  • Adverse reactions: estrogen excess;
    progestin excess; androgen excess;
    estrogen deficiency; progestin deficiency
  • Contraindications for oral contraceptives
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                            Thyroid Hormones
         Thyroid Supplements or Replacements
  • Action: increase metabolic rate: increase tissue
    oxygen consumption, body temperature, heart
    and respiratory rate, cardiac output, and
    carbohydrate, lipid, and protein metabolism
  • Influence the development of the skeletal system

  • Uses: replacement therapy for several
    conditions
  • Table 20-12
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                           Adverse Reactions
  • Dysrhythmias, hypertension, tachycardia,
    hand tremors, HA, insomnia, nervousness,
    diarrhea, vomiting, weight loss, menstrual
    irregularities, rash, glycosuria,
    hyperglycemia, increase prothrombin time,
    and increase serum cholesterol levels


                              Drug Interactions
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                        Nursing Implications
  • Assessment, diagnosis, planning,
    implementation, evaluation
                               Patient Teaching
  • Administration
  • Drug action/expected outcomes
  • Drug interactions: diabetes; anticoagulants;
    checking with health care provider
  • Signs/symptoms of hyperthyroidism and
    hypothyroidism

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                         Antithyroid Products
  • Use: treatment of hyperthyroidism; to
    improve hyperthyroidism in preparation for
    surgery or radioactive iodine therapy
  • Action: stop the production of thyroid
    hormones
  • Adverse reactions
  • Drug Interactions
  • Nursing Implications and Patient Teaching
  • Table 20-13
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