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Chapter 20
Hormones and Steroids
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 1
Chapter 20
Lesson 20.1
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 2
Learning Objectives
• Describe the use of antidiabetic
medications
• Identify preparations that act on the uterus
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 3
Overview
• Hormones and steroids
• Natural and synthetic preparations
• Used to replace and/or increase natural
chemicals in the body
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 4
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
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 12
Selected Drugs Used with
Pregnancy and Delivery
• Overview: antepartum, intrapartum, and
postpartum
• Tocolytics
• Oxytocics
• Uterine relaxants
• Abortifacients
• Table 20-4
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 13
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
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 15
Nursing Implications
• Assessment; diagnosis; planning;
implementation; evaluation
Patient Teaching
• Nursing care and monitoring during drug
administration; adverse effects of
ergonovine
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 16
Chapter 20
Lesson 20.2
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 17
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
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 18
Pituitary and Adrenocortical
Hormones
• Pituitary gland: “Master gland”
• Adenohypophysis
• Neurohypophysis
• Hormone production; control growth; electrolyte
balance; water retention or loss; and
reproductive cycle
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 19
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
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 23
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
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 29
Female Sex Hormones
• Estrogens
• Progestins
• Table 20-10
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 30
Estrogens
• Used for hormone replacement therapy in
menopause and other conditions (ovarian
failure); infertility work-ups, palliative
breast cancer treatment
• Adverse reactions
• Drug interactions
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 31
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
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 32
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
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 33
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
Elsevier Inc. items and derived items © 2006 by Elsevier Inc. Slide 34
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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