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Medications to treat growth hormone disorders: Nursing Pharmacology

Notes

Notes

MEDICATIONS TO TREAT GROWTH HORMONE DISORDERS
DRUG NAME
somatropin (Genotropin, Humatropin)
octreotide (SandoSTATIN); bromocriptine (Cycloset, Parlodel); pegvisomant
CLASS
Recombinant human growth hormone
Somatostatin analogue; Dopamine receptor agonist
MECHANISM OF ACTION
Stimulates the proliferation of cartilage cells at the epiphyseal plate of long bones, resulting in bone growth
Increases the levels of growth hormone in the body, thus inhibiting its synthesis from the pituitary gland
INDICATIONS
  • Hypopituitary dwarfism
  • Prader-Willi syndrome with obesity or sleep apnea
  • Turner syndrome
  • AIDS-related wasting / cachexia
  • Acromegaly
  • Gigantism
ROUTE(S) OF ADMINISTRATION
  • SubQ
  • IM
  • PO
  • SubQ
  • IV
SIDE EFFECTS
  • Injection site reactions
  • Headache
  • Flu-like symptoms
  • Aggressive behavior
  • Nausea, vomiting
  • Pancreatitis
  • Hypercalciuria
  • Glucose intolerance
  • Ketosis
  • Hypothyroidism
  • Hypoadrenalism
  • Antibodies against growth hormone
  • Headache, dizziness, fatigue, weakness, anxiety, depression, seizures
  • Abdominal pain, nausea, vomiting, diarrhea, constipation
  • Bradycardia, arrhythmia
  • Hypoglycemia
  • Octreotide: injection site reactions, ileus, cholelithiasis, hypertension, heart failure, QT prolongation, hyperglycemia, ketosis, hypothyroidism, galactorrhea
  • Bromocriptine: blurred vision, nasal congestion, dry mouth, gastrointestinal bleeding, hypotension, myocardial infarction
CONTRAINDICATIONS AND CAUTIONS
  • Hypersensitivity to benzyl alcohol
  • Closed growth plates
  • Neoplasms
  • Acute respiratory failure
  • Prader-Willi syndrome with obesity
  • Pregnancy and breastfeeding
  • Newborns or elderly clients
  • Diabetes mellitus
  • Hypothyroidism
  • Pregnancy and breastfeeding
  • Children and elderly clients
  • Renal disease
  • Diabetes mellitus
  • Octreotide: hypothyroidism
  • Bromocriptine: cardiovascular, pulmonary, or hepatic disease; peptic ulcer disease; gastrointestinal bleeding; pituitary tumors; dementia; bipolar disorder; migraines; uncontrolled hypertension; severe peripheral vascular disease
NURSING CONSIDERATIONS:
MEDICATIONS TO TREAT GROWTH HORMONE DISORDERS
DRUG NAME
somatropin 
(Genotropin, Humatropin)
octreotide (SandoSTATIN); bromocriptine (Cycloset, Parlodel); pegvisomant
ASSESSMENT AND MONITORING
GH medications
  • Baseline assessment: height, weight, vital signs
  • Laboratory test results: IGF-1 levels, IGFBP-3 levels, thyroid function tests, glucose level, renal and hepatic function tests
Somatropin
  • Diagnostic test results: X-ray, MRI
  • Monitor for side effects
  • Therapeutic effect: growth pattern normalization
Octreotide
  • Diagnostic test results: ECG, gallbladder ultrasound
  • Monitor for side effects
  • Therapeutic effect: decreased symptoms of acromegaly
CLIENT EDUCATION
  • Purpose of medication: replace missing GH; promote normal growth patterns
  • Administer subcutaneously once daily at the same time each day
    • Back of the upper arm, thigh, abdomen; avoid injecting within two inches of the navel
  • Injection pen
    • Store in the refrigerator; allow it to sit at room temperature before administration
    • Dose selection
    • Review injection technique
    • Rotate injection sites
      • Avoid red, swollen, or bruised
    • Disposal of used needles and cartridges
  • Maintain a monthly record of height and weight
  • Side effects to report
    • Lack of growth; symptoms of glucose intolerance, hypothyroidism; joint pain and swelling
  • Purpose of medication: suppress the release of growth hormone
  • IM depot suspension: administer as an intragluteal injection every four weeks
    • Rotate injection sites
  • PO: take with a full glass of water twice daily in the morning and in the evening on an empty stomach; one hour before or two hours after a meal
  • Side effects to report
    • Symptoms of cholecystitis pancreatitis, glucose intolerance, hypothyroidism; dysrhythmias such as palpitations
  • Diet rich in vitamin B12
Memory Anchors and Partner Content
Transcript

The pituitary gland is a small gland located at the base of the brain, and it produces, stores, and releases various hormones that control other endocrine glands. One of these is growth hormone, and disorders can arise when the pituitary produces too much or too little of it. Okay, so on one end of the spectrum, there’s growth hormone deficiency, which can occur in disorders like hypopituitary dwarfism, as well as Prader-Willi syndromeTurner syndrome, and acquired immunodeficiency syndrome or AIDS-related wasting or cachexia.

Growth hormone deficiency is treated by replacing it using a recombinant human growth hormone, called somatropin. This medication can be injected subcutaneously or intramuscularly. Once administered, it stimulates the proliferation of cartilage cells at the epiphyseal or growth plate of long bones, which results in bone growth.

Now, the most common side effects of somatropin include skin reactions at the injection site, as well as headache, flu-like symptoms, fatigue, weakness, and aggressive behavior. Some clients may experience gastrointestinal symptoms, such as nausea, vomiting, and pancreatitis. In addition, it may cause hypercalciuria, glucose intolerance, and ketosis, as well as endocrine side effects, such as hypothyroidism, and hypoadrenalism. Lastly, some clients may develop antibodies against growth hormone.

All right, now contraindications of somatropin include those with closed growth plates and in clients with neoplasms, acute respiratory failure, and those affected by Prader-Willi syndrome with obesity or sleep apnea. Finally, somatropin should be used with caution during pregnancy and breastfeeding, as well as in newborns or elderly clients, and those with diabetes mellitus or hypothyroidism. On the opposite end of the spectrum, we have disorders characterized by an excess of growth hormone, including acromegaly, which affects adults, and gigantism, which affects children.

Both disorders are treated using agents that interfere with growth hormone, such as octreotide, which is a somatostatin analogue that can be administered orally, subcutaneously, or intravenously; as well as bromocriptine, which is a dopamine receptor agonist that can be administered orally; and pegvisomant, which is a growth hormone receptor antagonist that is administered by subcutaneous injection.

Once administered, both octreotide and bromocriptine suppress the release of growth hormone from the pituitary gland; while pegvisomant binds to the growth hormone receptors, preventing growth hormone from binding and exerting its effects. Now, the most common side effects of these medications include headache, dizziness, fatigue, and weakness. Some clients may have depression, anxiety, and even seizures.

In addition, clients may present with gastrointestinal side effects, such as abdominal pain, nausea, vomiting, diarrhea, or constipation; and octreotide may result in ileus and choleolithiasis; while bromocriptine may also cause dry mouth and gastrointestinal bleeding.

Also, some clients may experience cardiovascular symptoms, such as bradycardia, arrhythmia, and octreotide may cause hypertensionheart failure, and QT prolongation; while bromocriptine may cause hypotension and myocardial infarction.

Next, endocrine symptoms may arise, such as hypoglycemia, while octreotide may also cause hyperglycemia, ketosis, hypothyroidism, and galactorrhea. Lastly, clients on octreotide or pegvisomant may develop injection site reactions; while bromocriptine may cause blurred vision and nasal congestion.

All right, now octreotide and pegvisomant should be used with caution during pregnancy and breastfeeding, while bromocriptine is contraindicated. In addition, precautions should be taken with children and elderly clients, and in those with renal disease or diabetes mellitus. In addition, octreotide should be used with caution in clients with hypothyroidism; while bromocriptine should be used with caution in clients with cardiovascular, pulmonary, or hepatic disease, as well as in those with peptic ulcer disease or gastrointestinal bleeding.

Bromocriptine should also be used cautiously in clients with pituitary tumorsdementia, and bipolar disorder. Finally, bromocriptine is contraindicated in clients with migraines, uncontrolled hypertension, or severe peripheral vascular disease.