Pharmacology, part 35: Endocrine Medications - Growth Hormone, Antidiuretic Hormone, Corticosteroids
by Cathy Parkes September 06, 2021 Updated: March 20, 2022 9 min read
This article concludes our coverage of endocrine system medications, focusing on growth hormone, antidiuretic hormone, and corticosteroids.
The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
Thyroid, pituitary, and adrenal disorders
The endocrine system affects growth and development, metabolism, sexual function, and mood and includes eight major glands, including the thyroid gland, pituitary gland, and adrenal gland. If a patient's hormone levels are too high or too low, that might indicate an endocrine disease or disorder. Endocrine diseases and disorders also occur if the body doesn't respond to hormones the way it is supposed to.
Endocrine medications that address these disorders include growth hormone, antidiuretic hormone, and corticosteroids.
Growth hormone fuels childhood growth and helps maintain tissues and organs throughout life. It's produced by the pituitary gland, located at the base of the brain. As we age, the pituitary gland gradually reduces the amount of growth hormone it produces. In some cases, hormone deficiencies may occur — in adults as well as children. Medication may be required to alleviate the loss.
Sommer wants that basketball trophy, so she is taking somatropin for her growth hormone deficiency.
Somatropin is a peptide hormone that is similar to naturally occurring human growth hormone (GH).
Mode of action
Somatropin stimulates growth, cell reproduction, and cell regeneration, mimicking the body's naturally occurring GH to support both growth and protein synthesis.
The side effects of somatropin can include hyperglycemia and pancreatitis.
Administer somatropin through the IM (intramuscular injection — a technique used to deliver a medication deep into the muscles, allowing medication to be absorbed into the bloodstream) or subcutaneous route. Make sure to rotate the injection site to avoid a build up of scar tissue in one place.
If somatropin is being given to children, closely monitor their growth rate and their bone age because treatment with somatropin must be stopped prior to epiphyseal closure (when the bones stop growing).
Be sure to instruct the patient to report persistent, severe abdominal pain.
Antidiuretic hormone (ADH) or arginine vasopressin (AVP) is a nonapeptide synthesized in the hypothalamus that helps control the body’s osmotic balance (when the body’s fluids are neither too diluted nor too concentrated), blood pressure regulation, sodium homeostasis, and kidney functioning. ADH primarily affects the ability of the kidney to reabsorb water. A lack of ADH can lead to diabetes insipidus — an endocrine disorder that causes the patient to expel large amounts of dilute urine.
Vasopressin (Vasostrict), desmopressin (DDAVP)
Vasopressin will help to suppress all that urine (it decreases urine output).
Mode of action
Vasopressin and desmopressin mimic ADH, which allows for the reabsorption of water at the kidneys. This decreases the patient's urine output and increases the patient's urine osmolality. In other words, it concentrates the urine.
Side effects of vasopressin can include overhydration, that is, retaining too much fluid, which can manifest as a pounding headache.
Make sure to closely monitor the patient's inputs & outputs (in case they are eliminating excess fluid), as well as their urine-specific gravity. Normal urine output is 0.5 to 1.5 mL/kg/hr.
Corticosteroids are a class of steroid hormones, which are a group of hormones derived from cholesterol. They are secreted by the adrenal cortex, testes and ovaries, and by the placenta during pregnancy.
In terms of medication, corticosteroids (also known simply as “steroids”) are anti-inflammatory medicines used to treat a range of conditions, including asthma, autoimmune disorders (e.g., rheumatoid arthritis), and inflammatory disorders (e.g., Crohn's disease).
Prednisone, hydrocortisone, methylprednisolone (Solu-medrol), dexamethasone (Decadron)
Glucocorticoids — and steroids generally — are among the most important drug classes to know for nursing school. Medications that fall within the glucocorticoids drug class include prednisone, hydrocortisone, and dexamethasone. All of these medications end in “-sone.”
Modes of action
The mode of action of glucocorticoids is to decrease inflammation and suppress the body's immune response.
There are many side effects to glucocorticoids. Among the most important are bone loss, weight gain and fluid retention, hyperglycemia, hypokalemia (an excess of aldosterone that causes excess excretion of potassium, which could lead to a life-threatening dysrhythmia), peptic ulcer disease, infection, adrenal gland suppression, skin fragility, and GI upset.
Because glucocorticoids suppress a patient's immune response, it's important to monitor them for signs of infection. Also monitor them for signs of peptic ulcer disease, which can include coffee ground emesis and tarry stools.
Educate the patient that periods of stress may require them to take higher doses of prednisone or another glucocorticoid.
To combat the risk of bone loss, patients should take vitamin D and calcium supplements.
When taking prednisone, the patient is predisposed to getting conditions exacerbated by NSAIDs, such as GI bleeding and peptic ulcer disease. So NSAIDs should not be administered while a patient is taking a corticosteroid.
Finally, a patient should never stop taking prednisone suddenly. They must taper this drug very slowly.
Like glucocorticoids, mineralocorticoids are a class of steroid hormones. Mineralocorticoids are produced in the adrenal cortex and regulate the body’s salt and water balances.
Fludrocortisone is a steroid that helps flood your body with more salt and water!
Fludrocortisone is used to treat adrenocortical insufficiency, such as Addison's disease.
Mode of action
Fludrocortisone's mode of action is to mimic aldosterone, which causes the reabsorption of salt and water in the kidneys. This allows the patient to maintain their blood pressure and sodium balance.
The list of side effects includes many of the same ones when administering glucocorticoids, including hypertension, edema, hyperglycemia, hypokalemia, infection, peptic ulcer disease, adrenal gland suppression, skin fragility, and GI upset.
If a patient is diagnosed with Addison's disease, they will likely be administered both fludrocortisone and a glucocorticoid. Similar to discontinuing prednisone, when a patient discontinues fludrocortisone, they must not abruptly stop taking it, but taper their drug use slowly. Abrupt discontinuation may cause an Addisonian crisis.
Hi, I'm Cathy with Level Up RN. In this video, we are going to wrap up our coverage of endocrine system medications. Specifically, I'll be covering growth hormone, anti-diuretic hormone, and corticosteroids. At the end of the video. I'm going to give you guys a little quiz to test your knowledge of some of the facts I'll be covering in this video. So definitely stay tuned for that. If you have our Pharmacology Second Edition Flashcards, definitely grab those and follow along with me. And if you are new to our channel, be sure to subscribe because we have hundreds of free videos to help you learn the most important facts and concepts you need to know for nursing school and in your nursing practice.
Let's begin our coverage with somatropin, which mimics are naturally occurring growth hormone. So this supports growth as well as protein synthesis. So we would use somatropin to address growth hormone deficiencies in adults and children. Side effects of somatropin can include hyperglycemia as well as pancreatitis. Some key nursing care points include the fact that we administer this medication through the IM or subcutaneous route. We're going to want to make sure we rotate our injection site so we don't end up with a build up of scar tissue in one place. If we're giving this medication to children, we're going to want to closely monitor their growth rate and their bone age because we want to stop treatment with somatropin prior to epiphyseal closure.
So my way of remembering this drug name and our cool chicken hint here on the card, if you look at somatropin, I think of summer and trophy. So there's a woman named Summer, and she takes somatropin to address her growth hormone deficiency so that she can win a basketball trophy. So obviously, no one's going to give-- there's not a provider out there who's going to give someone somatropin so they can get a basketball trophy. But for the purpose of remembering this drug name and what it's for summer. So Amir spoke a little different summer trophy. So much open, so hopefully that's helpful for you.
Next, let's talk about our anti-diuretic hormones, which include vasopressin and desmopressin. So these medications would be used to treat diabetes insipidus. And if you recall, diabetes insipidus is an endocrine disorder that causes the patient to pee out large amounts of dilute urine. So these medications mimic ADH, which is produced by the posterior pituitary gland. This allows for the reabsorption of water at the kidneys. And this in turn decreases the patient's urine output and increases the patient's urine osmolality. So it really concentrates the urine more. Side effects can include over hydration. So if we have too much ADH, then we can be retaining too much fluid. So over hydration, which can manifest into a pounding headache for the patient. In terms of nursing care, we're going to want to closely monitor the patient's Is & Os, as well as their urine specific gravity.
The way I remember these medications and what they're for and our cool chicken hint here on our flashcard is that vasopressin helps to suppress all that urine. So really it helps to decrease urine output in patients with diabetes insipidus.
Next, let's talk about glucocorticoids. So if someone asked me to list out the five most important drug classes you need to know for nursing school, this would definitely, definitely be on the list. So if you have our flashcard deck, definitely review the bold, red text on the back of this card because there's a lot of important signs and symptoms and key points you need to know for this drug class. So medications that fall within this drug class include prednisone, hydrocortisone, and dexamethasone. You'll notice they all end in that sone. So this drug class can be used for a variety of conditions, including asthma, autoimmune disorders like rheumatoid arthritis, and inflammatory disorders such as Crohn's disease. So the mode of action of glucocorticoids is to decrease inflammation and suppress the body's immune response. Side effects are plentiful. There are a lot of side effects. Some of the more important ones include bone loss, weight gain and fluid retention, hyperglycemia, hypokalemia, peptic ulcer disease, infection, adrenal gland suppression, and GI upset.
So some key points to keep in mind, as the nurse you're going to want to monitor the patient for signs of infection because we are suppressing their immune response. We also want to monitor them for signs of peptic ulcer disease. So this includes coffee ground emesis and tarry stools. We want to educate the patient that periods of stress may require them to take higher doses of prednisone or another glucocorticoid. Also, it's important that the patient know that they should never stop taking prednisone suddenly. They will need to taper this drug very slowly. So they're not going to just suddenly discontinue it. And then they should take vitamin D and calcium supplements because of that risk of bone loss. And then they should avoid NSAIDs as well, because NSAIDs are linked to GI bleeding and peptic ulcer disease, and by taking prednisone, the patient is already predisposed to getting those conditions. So NSAIDs should be off the table.
The last medication class that I'm going to cover in this video is a mineral coracoid, which is fludrocortisone. Fludrocortisone is used to treat adrenal cortical insufficiency such as Addison's disease, and the mode of action of this medication is that it mimics aldosterone. So that causes the reabsorption of salt and water at the kidneys, which helps the patient maintain their blood pressure and their sodium balance.
So the way that I remember this mode of action, if you look at the drug name, fludrocortisone, it starts with that flud, F-L-U-D, and I think fludrocortisone is a steroid that helps to flood your body with more salt and water. So hopefully that will help you remember the mode of action as well.
Side effects can include hypertension, edema, hyperglycemia, hypokalemia, infection, peptic ulcer disease, and adrenal gland suppression. So a lot of the same side effects that we saw with glucocorticoids. So for a patient with Addison's disease, they are often treated with fludrocortisone and a glucocorticoid. It's going to be important to teach our patient to never abruptly discontinue this medication because that can cause an addisonian crisis.
Okay, it's time for quiz. I have three questions for you. Question number one, in a child receiving somatropin for a growth hormone deficiency, when should treatment be stopped? The answer is prior to the epiphyseal closure. Second question, vasopressin is a medication used to treat what disorder? The answer is diabetes insipidus. Question number three, prednisone should never be discontinued abruptly, true or false? The answer is true. We never want to stop those steroids abruptly, we want to taper slowly.
Okay, I hope this video and these quiz questions have been helpful for you. If so, be sure to like this video and leave me a comment, and take care and good luck studying.
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