-growth hormone (GH)

-thyroid stimulating hormone (TSH)

-adrenocorticotropic hormone (ACTH)

-follicle-stimulating hormone (FSH)

-luteinizing hormone (LH)

-no specific target, affects bone & tissues

-SQ or IM; inactivated by gastric secretions

-long-term use increases glucose level, causing diabetes

-not given if obese, severe resp issues or w/ Prader-Willi syndrome

-example drugs: somatrem (Protropin), somatotropin (Humatrope)

-secondary to pituitary tumor

-tx: radiation to destroy tumor or bromocriptine (Parlodel) to inhibit release of GH, octreotide (Sandostatin) to suppress GH release

-secreted in response to thyroid-releasing hormone from hypothalamus

-TSH stimulates thyroid to release thyroxine (T4) & triiodothyronine (T3)

-for diagnosing hypothyroidism & tx for thyroid cancer

-SQ or IM

-hypothalamus releases CRF...ACTH from pituitary

-ACTH...adrenal cortex to release cortisol, aldosterone, androgen

-stress, surgery, burns override body's natural secretion rhythm

-diagnose adrenocortical disorders, anti-inflammatory agent, treat acute MS

-dose: 10-25 units in 500 mL q8h (dx testing); 80-120 units/day SQ/IM for 2-3 weeks, Acute MS

-SE: mood swings, increased appetite, water/sodium retention, hypokalemia, hypocalcemia

-adverse: osteoporosis, muscle atrophy, ulcer

-drug-drug: ulcers with aspirin, decreases effects of insulin/antidiabetics

-caution: psychiatric disorders, CHF

-promotes water reabsorption from kidneys to maintain fluid balance

-head injury, brain tumors, trauma cause ADH deficiency

-if ADH deficiency, large amounts of urine produced --> Diabetes Insipidus

-ADH replacement drugs: vasopressin (Pitressin), desmopressin (DDAVP)-intranasal, also for enuresis

-primary thyroid gland disorder

-decreased T4 & elevated TSH

-s/s: cold, weight gain, lethargy, abnormal menses

-surgery & radioiodine therapy can lead to hypothyroid state

-drug of choice for hypothyroid

-increases T3 & T4

-dose: 25-50mcg

SE: tremors, weight loss

-adverse: tachycardia, HTN, angina, cardiac dysrhythmias

-drug-drug: decreases effect of diabetic agents, increases warfarin, phenytoin (Dilantin) increases T3 levels

-increase in T3 & T4 levels, overactive thyroid

-severe/life-threatening: thyroid storm

-Grave's disease, thyrotoxicosis are most common types

-drug of choice for hyperthyroidism, block thyroid hormone action

-treat thyrotoxic crisis & prepare for sub-total thyroidectomy

-can cause goiter (decreased iodine) formation if use prolonged

-tx hyperthyroid, potent, long half-life (1 week for effect)

-SE: rash, headache, GI distress

-for hyperthyroidism

-avoid foods high in iodine (seafood, iodized salt)

-dilute, drink through straw after meals

-destroys thyroid cells, tx thyroid cancer & hyperthyroidism

-SE: radiation sickness, bone marrow depression

-take thyroid med before breakfast w/ no other meds

-pt wears MedicAlert ID

-s/s: hyperthyroidism

-2-4 weeks for improvement

-Avoid strawberries, peaches, pears, cabbage, turnips, spinach, kale, Brussel sprouts, cauliflower, radishes, peas (all inhibit thyroid secretion)

-take meds with meals

-do not stop abruptly --> thyroid crisis

-s/s: hypothyroid

-1-3 weeks for improvement

-monitor pulse for increase or decrease

-SE: rash, hives, alopecia, loss of hair pigment, bruising, weakness

-report fever or sore throat (agranulocytosis); monitor CBC

-secrete parathyroid hormone (PTH)

-regulates Ca+ levels in blood

-calcitonin agent decreases serum Ca+ by promoting renal excretion of Ca+ (hyperparathyroidism)

-PTH agents treat hypoparathyroidism

-Vitamin D analogue, PTH agent

-promotes Ca+ absorption from GI tract, increasing serum Ca+ level

-treats hypoparathyroidism & hypocalcemia in CRF

-monitor Ca+ levels weekly (narrow therapeutic range)

-Dose: 0.25 mcg/day; long onset, peak, duration

-SE: anorexia, lethargy, photophobia

-adverse: hypercalciuria, hyperphosphatemia, hematuria

-caution: malabsorption, renal calculi

-drug-drug: digoxin, verapamil, thiazide diuretics

-PTH agent for bone disease & low Ca+ due to CRF & dialysis

-300-350 mcg/week

-PTH agent for Paget's, hyperparathyroid, hypercalcemia

-0.5 mg/day SQ

-adrenal cortex hormones

-Na+ & water retention, K+ excretion...elevated BP (ACTH)

-antiinflammatory, antiallergic, & antistress effects

-treat head trauma/cerebral edema, MS, MG, RA (autoimmune), asthma, prevent organ transplant rejection

-oral, deep IM, IV, topical, aerosol

-drug-drug: decreased effect of warfarin, barbiturates, phenytoin, watch herbals!

-antiinflammatory

-dose: 5-60 mg/day, taper dose to avoid severe adrenal insufficiency

-SE: increased appetite, weight gain, euphoria, hyperglycemia, abnormal fat deposits

-adverse: muscle wasting, GI hemorrhage

-take w/ food to prevent ulcers

-cortisone acetate (Cortate); some mineralcorticoid also

-hydrocortisone (Cortef, hydrocortone); some mineralcorticoid also

-methylprednisone (Medrol, Solu-medrol, Depo-medrol)

-prednisone (Hydeltrasol)-parental into joints/soft tissue

-prednisone triamcinolone (Aristocort, Kenacort, Kenalog, Azmacort)-topical

-SE: rash

-beclomethasone (Vancenase AQ, Beconase AQ)-inhalation

-betamethasone (Celestone)-oral, IV, IM; very potent

-SE: resp issues

-emergency corticosteroid-glucocorticoid (long-acting) for shock, asthma attack, cardiac arrest

-IV push/IV, IM, po

-drug-drug: oral antidiabetics, anticoagulants, hypokalemia w/ anti pseudo, PCN, thiazides

SE: resp issues

-glucocorticoid inhibitor for Cushing's or as adjunct to surgery/radiation

-avoid high doses due to cardiac rhythm issues

-baseline VS, weight/height

-monitor K+, glucose

-avoid herbals, thiazides

-MedicAlert ID

-diet high in K+

-do not stop abruptly; taper dose

-avoid w/ URI due to immune suppression

-take w/ food to avoid GI issues

-secrete aldosterone (renin-angiotensin system)

-reabsorb Na+, excrete K+ --> water retention, edema

-severe decrease in aldosterone --> hypotension --> vascular collapse (Addison's)

-mineralcorticoid (can be given w/ glucocorticoid) for Addison's

-cause negative nitrogen balance, need high protein diet

-very potent

-monitor K+ level due to hypokalemia