PROTOTYPE

 

Somatropin 

 

Expected outcome: Stimulate overall growth and the production of protein, and decrease the use of glucose. 

 

Therapeutic use: treats growth hormone defeiencies ( pediatric and adult growth hormone defeincy, turners syndrome)

AIDS wasting syndrome

 

Complications: Hyperglycemia , Hypercalciuria and renal calculi

 

Client education: Monitor glucose leves, Montior for flank pain, fever and dysuria

 

Contradindications/Precautions: Pregnancy risk B or C (depdens on the brand)

Contraindicated in obesesity and sleep apnea patients

Use cautiously in clients with hypothyrioism – evaluate thyroid functions prior to

 

Interactions: concurrent use of glucocorticoids can counteract growth- promoting effects 

 

Nursing Administration: Obtain baseline height and weigh, monoitor growth patterns monthly, Rotate injection site 

NCLEX question

A nurse is caring for a client who is taking somatropin to stimulate growth. The nurse should plan to monitor the clients urine for which of the following?
A. Billrubin
B. Protein
C. Potassium
D. Calcium





Answer:
D. Calcium

A large amount of calcium can be present in the urine of a client who takes somatropin. This puts them at risk for renal calculi

Vasopressin

 Other medication Desmopressin 

 

Expected outcome: ADH (anti diuretic hormone) produced by the hypothalamus and stored in the posterior pituary,, promoted reabsorption of water into the kidney, while desmopressin causes much less vasoconstriction

 

Natural ADH causes vasoconstriction due to the contraction of vascular smooth muscle.  Vasopressin stimulates the potent action of ADH. 

 

Therapeutic use:  treats Diabetes Insipidus 

(desmopressin)

Vasopressin sometimes used during CPR to temporaily decrease blood flow to the peripheray and increase flow to brain and heart
 
 

Administration: Desmopressin – Oral, Intra nasal, SUB Q , IV

Vasopressin- SUB Q, IM, IV 

 

Complications: Reabsoprtion of too much water 

Nursing considerations; monitor for over hydration (sleepiness, pounding headache), teach clients to reduce fluid intake during therapy,

 

Myocardial Ischemia

From excessive vasoconstriction( vasopressin)

Nursing consideration- monitor ECG and blood pressure, advise client to notify HCP of chest pain, tightness or diaphoresis

 

Contraindications/precautions :

Use of vasopressin contraindicated in clients with CAD, decreased peripheral circulation or chornic nephritis. 

Vasopressin catergory risk C 

Desmopression catergory risk B

Use caution in clients who have renal impairment  - ADH should not be administered to clients who have creatinine clearance less than 50ML/min 

 

Interactions

Carbamazepine and tricyclic antidepressants can increase the antidiuretic action

Nursing considerations:  use cautiously together

 

Con current use of alcohol,  heparin,  lithium,  and phenytoin can decrease the antidiuretic effects

Nursing consideration:  established baseline I&O and weight,  Monitor frequently

 

Nursing administration:

Monitor vital signs, Central venous pressure, I&O, specific gravity, and laboratory studies( potassium,  sodium, BUN, creatinine,  specific gravity, osmality)

Monitor for headache confusion for other indications of water intoxication

With IV administration of vasopressin,  Monitor the IV site carefully because extravastration can lead to gangrene

Intranasal desmopressin starts with the bedtime dose. I &O is monitored

.  When nocturia is controlled doses are given twice daily

 

 

Nursing evaluation of medication effectiveness

Reduction in the large volumes of urine output (1.5-2L in 24 hours)

Cardiac arrest survival

 

 

 

 

 

Expected action:  mimic effects of natural steroid hormones

 

Therapeutic use: acute and chronic replacement therapy for adrenocortical insufficiency ( addisons disease, adrenal crisis)

Non-ended grin disorders including cancer,  inflammation,  and allergic reaction

 

Route of administration: oral, IV

 

Complication:

Osteoporosis

Advise clients to take calcium supplements vitamin D and or bio phosphonate and get regular exercise

 

Adrenal suppression

Advised client to observe for Manifestations ( fatigue, weakness, weight loss hypotension)

Increase dose with stress.  Do not stop suddenly. Tapered dose to discontinue. 

 

Peptic ulcer,  G.I. discomfort

Advise client to observe for Manifestations ( coffee ground emesis,  bloody or tarry stools,  abdominal pain)

Administer prophylactic H2 receptor antagonist

 

Infection

Advise clients to avoid contact with people who have a communicable disease

Monitor for any indication of infection such as fever

 

Cushing syndrome

Risks are associated with long-term use of glucocorticoids and excessive doses. 

Advise client to observe for Manifestations ( muscle weakness,  Moon face,  Buffalo hump, cutaneous striations)

 

 

Contraindications/ precautions

Pregnancy risk category C

Use is contraindicated in clients to have a viral bacterial or fungal infection is not controlled by antibiotics

Using caution with clients who have had in recent and MI gastric ulcer hypertension kidney disorder osteoporosis diabetes mellitus hypothyroidism myasthenia gravis glaucoma or seizure disorder

 

Interaction

NSAIDs,  acetaminophen or alcohol can cause increased gastric distress  distress or bleed

 Concurrent use with oral anti coagulants can increase/decrease anticoagulation

Concurrent use with potassium depleting agents can cause increased potassium loss

Concurrent use with vaccines and toxoids can reduce the antibody response

 

Nursing administration

Monitor weight blood pressure and electrolytes

Given with food to reduce gastric distress

Advise client to monitor for indications of peptic ulcer

Do not stop medication suddenly , tapper dose if  discontinuing

Advised provider of indications of acute adrenal insufficiency

instruct clients that dosages need to be increased during times of stress

Advise clients that replacement therapy for Addison’s disease must continue for life

Instruct client to carry an extra supply of glucocorticoids for emergencies into wear medical identification at all times

 

Evidence Based Article.
http://www.nejm.org/doi/full/10.1056/NEJMoa071366#t=article

 

Prototype Octreotide 

 

Expected action: suppresses growth hormone release

 

therapeutic uses:  gigantism in children acromegaly in adults

Route of administration: IM or Sub Q

 

Complications: G.I. disturbances ( nausea cramps diarrhea and flatulence)

Nursing considerations:  advise client’s symptoms usually subside 1-2  weeks,

Given injections without food or at bedtime to minimize symptoms

 

Hypo/ hyperglycemia

Nursing considerations:  monitoring glucose levels regularly

 

 

Contra indications/ precautions

Pregnancy risk category B

Use cautiously in client who have diabetes,  hypothyroidism,  renal disease,  and in older adults

 

Interaction: conduction delay can occur if used with anti dysrhythmics 

 

 

Nursing administration:  teach client proper technique for sub Q injection

Minimize injection site pain by rotating sites

 

Nursing evaluation of medication effectiveness: depending on therapeutic intent evidence of effectiveness can include the suppression of excess growth hormone for the management of acromegaly when surgery or radiation has failed