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Chapter 20Chapter 20

Hormones and Steroids

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Chapter 20

Lesson 20.1

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Learning ObjectivesLearning Objectives

• Describe the use of antidiabetic medications

• Identify preparations that act on the uterus

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Overview 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 Endocrine System

• Regulation and coordination of body systems

• Endocrine glands

• Pituitary, thyroid, parathyroid, adrenal glands, pancreas, testes, ovaries, and placenta

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Endocrine SystemEndocrine System

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Male Reproductive SystemMale Reproductive System

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Female Reproductive SystemFemale Reproductive System

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Antidiabetic Drugs 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 Insulin

Action• Lowers blood glucose levels by helping

glucose move into target tissues

Uses• Treatment of type 1 diabetes

Table 20-1

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Insulin (cont.)Insulin (cont.)

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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Insulin (cont.)Insulin (cont.)

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 Oral Hypoglycemics

Action• Stimulate insulin release from pancreatic beta cells; decrease

insulin resistance

Uses• Monotherapy versus combination therapy• Six classes

– Sulfonylureas, 1st and 2nd generation– Biguanides– Alpha-glucosidase inhibitors– Meglitinides– Thiazolidinediones– Incretins

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Oral Hypoglycemics (cont.)Oral Hypoglycemics (cont.)

Adverse Reactions • Hypoglycemia; allergic reactions

Drug Interactions• Displacement; potentiation• Thiazides oppose the secretion of insulin from

beta cells and decrease the effectiveness of sulfonylureas

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Oral Hypoglycemics (cont.)Oral Hypoglycemics (cont.)

Nursing Implications • Assessment: health history; renal and liver

function; sulfa allergies

Patient Teaching

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Selected Drugs Used with Pregnancy and Delivery

Selected Drugs Used with Pregnancy and Delivery

Overview• Antepartum, intrapartum, and postpartum

– Tocolytics– Oxytocics– Uterine relaxants– Abortifacients

Drug Table 20-4

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Selected Drugs Used with Pregnancy and Delivery (cont.)

Selected Drugs Used with Pregnancy and Delivery (cont.)

Action and Uses• Abortifacients stimulate uterine contractions and

cause the uterus to empty• Oxytocic agents and ergot preparations cause

the uterus to contract• Uterine relaxants act on beta-adrenergic

receptors to stop smooth-muscle contraction in the uterus

• Tocolytics are used to stop preterm labor

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Selected Drugs Used with Pregnancy and Delivery (cont.)

Selected Drugs Used with Pregnancy and Delivery (cont.)

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, cerebrospinal symptoms, and spasms

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Selected Drugs Used with Pregnancy and Delivery (cont.)

Selected Drugs Used with Pregnancy and Delivery (cont.)

Drug Interactions • Vasoconstrictors and local anesthetics

increase the effectiveness of oxytocics

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Selected Drugs Used with Pregnancy and Delivery (cont.)

Selected Drugs Used with Pregnancy and Delivery (cont.)

Nursing Implications and Patient Teaching• Assessment• Diagnosis• Planning• Implementation: nursing care and monitoring

during drug administration• Evaluation• Patient and family teaching: adverse effects of

ergonovine

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Chapter 20

Lesson 20.2

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Learning ObjectivesLearning Objectives

• Compare and contrast the action of adrenal and pituitary hormones

• Describe at least five adverse reactions that may result from the use of glucocorticoid and mineralocorticoid 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 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 Pituitary Hormones

Anterior Pituitary Hormones• HCG• LH and FSH• STG• ACTH

Drug Table 20-5

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Anterior Pituitary Hormones (cont.)

Anterior Pituitary Hormones (cont.)

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: headache, irritability, restlessness, fatigue, and edema

• Somatotropin: antibody stimulation• ACTH: adrenal gland

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Posterior Pituitary Hormones Posterior Pituitary Hormones

• ADH• Vasopressin may cause abdominal cramps,

anaphylaxis, bronchial constriction, circumoral pallor, diarrhea, flatus, intestinal hyperactivity, headache, sweating, tremors, urticaria, uterine cramps, vertigo, vomiting; large doses may produce death

• Oxytocin• ACTH• Drug Table 20-6

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Adrenocortical Hormones Adrenocortical Hormones

Actions• Manufactures glucocorticoids,

mineralocorticoids, 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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Adrenocortical Hormones (cont.)Adrenocortical Hormones (cont.)

Adverse Reactions • Table 20-7

Drug Interactions• Increase effects of barbiturates, sedatives,

narcotics, and certain anticoagulants• Decrease effects of insulin, oral

hypoglycemics, Coumadin, isoniazid, aspirin, and broad-spectrum antibiotics

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Adrenocortical Hormones (cont.)Adrenocortical Hormones (cont.)

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• MedicAlert bracelet• Immunization considerations• Diet• Storage of drug• Drug interactions• Dosage schedule, missed dosage

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Sex Hormones Sex Hormones

• Production influenced by the anterior pituitary

• Male: testosterone; androgens

• Female: estrogen; progesterone

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Androgens 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.) Androgens (cont.)

Drug Interactions • Increased effects – anticoagulants, antidiabetic agents,

and other drugs• Decreased effects – barbiturates • Concurrent use with corticosteroids increase edema

Nursing Implications• Assessment, diagnosis, planning, implementation, and

evaluation

Drug Table 20-9

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Androgens (cont.)Androgens (cont.)

Patient and Family Teaching• Administration• Response time• Diet• Symptoms to report• Administration considerations

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Female Sex Hormones Female Sex Hormones

• Estrogens

• Progestins

• Table 20-10

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Estrogens Estrogens

Action and Uses• 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 Progestins

Action

Uses• Contraception, control excessive uterine bleeding, treatment of

secondary amenorrhea, dysmenorrhea, premenstrual tension, and control of pain in endometriosis

Drug Interactions

Nursing Implications and Patient Teaching

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Oral Contraceptives Oral Contraceptives

Combination Drugs: Estrogen and Progestin• Table 20-11

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 Hormones

Thyroid Supplements or ReplacementsAction• 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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Thyroid Hormones (cont.)Thyroid Hormones (cont.)

Adverse Reactions

• Dysrhythmias, hypertension, tachycardia, hand tremors, headache, 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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Thyroid Hormones (cont.)Thyroid Hormones (cont.)

Nursing Implications and Patient Teaching• Assessment, diagnosis, planning,

implementation, evaluation• Administration• Drug action/expected outcomes• Drug interactions: diabetes; anticoagulants;

checking with healthcare provider• Signs/symptoms of hyperthyroidism and

hypothyroidism

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Antithyroid Products Antithyroid Products

Action• Stop the production of thyroid hormones

Uses• Treatment of hyperthyroidism; to improve hyperthyroidism in

preparation for surgery or radioactive iodine therapy

Adverse Reactions

Drug Interactions

Nursing Implications and Patient Teaching