Hypothalamic Agents Nursing Considerations

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Hypothalamic Agents Nursing Implications

Hypothalamic Agents Nursing Pharmacology

Hypothalamic agents are a class of drugs that can release or inhibit hormones coming from the anterior pituitary gland. 

These are drugs that affect the endocrine system, and can address various chronic diseases, such as diabetes and diseases related to sexual development and growth.

Hypothalamic agents are usually administered using the intramuscular route (IM).  Onset of effects may occur in about four hours, but the peak effect time may be variable, and the halftime is about three hours.

Effects may last anywhere from one to four months. It is unknown how the drugs are metabolized in the body, as well as how they are secreted. When taken, hypothalamic agents should only appear in minute quantities.

Indications of Hypothalamic Agents

Hypothalamic agents are mainly used based on their effects on the hormones directly affected by the drug. Agonists like analogues of the GnRH decrease the production of sex hormones, hence they are used to treat:

  • Advanced prostate cancer
  • Endometriosis
  • Precocious puberty

Antagonists of GnRH can be used to inhibit the premature surge of the luteinizing hormone in women who are undergoing fertility treatments using ovarian stimulation, and it can also be used to treat advanced prostate cancer.

While they can be used as medication, some are used for diagnostic purposes, while others are used primarily as antineoplastic agents

. Tesamorelin is uniquely used to stimulate the growth hormone (GH). It is also used for its lipolytic effects to benefit HIV-infected patients with lipodystrophy by decreasing excess abdominal fat.

Actions of Hypothalamic Agents

Hypothalamic agents are classified between two—agonists and antagonists.

  1. Agonists. These are also known as stimulating factors. These include the corticotrophin-releasing hormone (CRH), growth-releasing hormone (GNRH), gonadotropin-releasing hormone (GnRH), prolactin-releasing hormone (PRH), and the thyrotropin-releasing hormone (TRH).
  2. Antagonists. These are hypothalamic agents that inhibit or stop a bodily process. These include the growth hormone-inhibiting factor also known as somatostatin, and the prolactin-inhibiting factor.

Contraindications and Cautions Against Hypothalamic Agents

Hypothalamic Agents may have effects on patients across all ages. Children undergoing treatments using hypothalamic agents may have adverse changes on their overall endocrine function, specifically their development, growth, and metabolism.

To avoid this, their treatment plan should include regular monitoring of blood sugar and electrolytes, as well as periodic x-rays of the long bones. Among adults, these agents may also have adverse effects on the endocrine system, hence, close monitoring of blood sugar and electrolytes is recommended.

To avoid complications during treatment, proper administration of nasal drugs for diabetes insipidus must be thoroughly reviewed. In the case of use among older adults, it is important to ensure that dehydration and ulceration are avoided.

Thus, treatment should include strict monitoring and evaluation of their electrolyte, hydration, and nutritional status. Proper administration techniques of these drugs are also in place to help avoid these complications.

Before prescribing and administering hypothalamic agents, the healthcare provider must take into consideration the age of the patient, as well as the specific hormones affected by the drug being used.

All drugs must also be properly stored, prepared, and administered. Lastly, using hypothalamic agents on pregnant and lactating women is highly discouraged, and may only be allowed if the benefits outweigh the risks.

 Adverse Effects of Hypothalamic Agents

As with any other medication, treatment using hypothalamic agents will need precautions to 

avoid adverse effects. These effects differ depending on the action of the drug. 

  1. Agonists stimulate processes in the endocrine system; thus, management should include monitoring for episodes of:
  2. increased appetite and temperature
  3. fluid retention
  4. flushing
  5. ovarian overstimulation
  6. an increase in the release of sex hormones
  • Antagonists tend to have the opposite side effects. These include:
  • alterations in secondary sex characteristics (i.e., amenorrhea and decreased female sex hormones)
  • decreased sperm count and activity
  • decreased testosterone levels
  • fluid and electrolyte imbalance
  • insomnia
  • irritability
  • loss of energy

Contraindications and Cautions of Hypothalamic Agents

Hypothalamic agents are discouraged for use in pregnant and lactating women to avoid potential adverse effects on fetuses and neonates.

Patients with allergies to any of the components of these drugs are also advised not to take these, hence it is imperative that a patient informs the healthcare provider regarding his/her allergies, if any, before treatment to avoid hypersensitivity reactions.

Patients with peripheral vascular disorders and rhinitis may encounter problems in absorbing the drugs.  Patients with renal and hepatic impairment may encounter interference in the metabolism and excretion of the drugs.

Drug Interactions with Hypothalamic Agents

Some hypothalamic agents should be prescribed in caution when used in patients on several carbonic anhydrase inhibitors, antiretrovirals, and hypoglycemic agents.

Hypothalamic agents may affect the excretion of these drugs, and vice versa. This may result to deranged serum levels and possible toxicities.

Nursing Care Plan for Patients on Hypothalamic Agents

Nurses caring for patients undergoing treatment using hypothalamic agents should watch out for the hormonal changes in the body, specifically the levels of hormones directly affected by the agents in use.

Possible Hypothalamic Agents Nursing Diagnoses

Nursing Assessment

Hypothalamic Agents InterventionsRationales
Assess if the patient is pregnant or lactating. Gain consent for performing a pregnancy test.Hypothalamic agents are not encouraged to be prescribed for pregnant and lactating women. This is to avoid potential adverse effects on fetuses and neonates. A pregnancy test will ensure the pregnancy status of the patient before starting the hypothalamic agent therapy.
Check the patient’s allergy status prior to administering the drug.Components of hypothalamic agents can cause allergic reactions.
Ask for rhinitis and/or peripheral vascular disorders prior to administering the drug.Patients with peripheral vascular disorders and rhinitis may encounter problems in absorbing the drugs. 
Check the renal and hepatic status of the patient prior to administering the drug.Patients with renal and hepatic impairment may encounter interference in the metabolism and excretion of the drugs.
Check medical history for diabetes or pituitary adenoma.Hypothalamic agents can affect serum glucose levels.  Some hypothalamic agents are not recommended for patients with pituitary adenoma.  

Nursing Planning and Interventions

Hypothalamic Agents InterventionsRationales
Perform daily capillary blood glucose (CBG) levels. Monitor and record the patient’s serum glucose levels daily.Some hypothalamic agents affect hormones that regulate blood sugar levels.
Obtain blood samples daily for biochemistry test as ordered by the physician.To monitor the electrolyte status of the patient daily, as some hypothalamic agents put the patient at risk for electrolyte imbalance.
Monitor and record the pediatric patient’s long bones status periodically. Observe for signs of bone compromise or lack of growth.Some hypothalamic agents affect hormones that affect growth and development.
Create a weight chart and weigh the patient daily. Observe for edema or other signs of fluid retention.Hypothalamic agents may cause fluid retention.
Start an input and output monitoring sheet and record the patient’s intake and output daily.Some hypothalamic agents may cause fluid retention while others may cause dehydration.
Routinely check for the blood glucose levels of the patient.Some hypothalamic agents can affect blood glucose levels.
Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking hypothalamic agents. Instruct the patient on how to self-administer subcutaneous hypothalamic medication.To inform the patient on the basic information and proper administration of hypothalamic agents, as well as to empower him/her to safely self-administer the medication.  
Advise the patient to report any signs of dizziness, nausea, and weakness.Some hypothalamic agents can affect blood glucose levels.
Inform the young patient’s parent or guardian regarding the need for periodic radiograph of long bones while on hypothalamic agent therapy.Hypothalamic agents may affect the growth and development of children’s bones.
Encourage the patient to keep himself/ herself hydrated by drinking at least 2000 mL of water per day. Also, advise the patient to eat nutritious food and drinks.Some hypothalamic agents may cause dehydration or malnutrition to the patient.

Nursing Evaluation

Hypothalamic Agents InterventionsRationales
Ask the patient about the information on hypothalamic agents.To evaluate health teachings regarding the drugs.
Monitor the blood sugar status of the patient.Some hypothalamic agents can affect blood glucose levels.
Monitor the patient’s response to the hypothalamic agent.To evaluate the effectivity of the treatment, and be able to adjust doses if needed, or determine if there is a need to stop or change the drug.
Monitor the patient’s input and output.To continuously check the hydration status of the patient.
Monitor and report any signs of adverse effects of the hypothalamic agent.To immediately reverse the adverse effect and prevent any serious complications of using hypothalamic agents. The following are the list of adverse effects to watch for when on hypothalamic agent therapy. Agonistsincreased appetite and temperaturefluid retentionflushingovarian overstimulationan increase in the release of sex hormonesAntagonists:alterations in secondary sex characteristics (i.e., amenorrhea and decreased female sex hormones)decreased sperm count and activitydecreased testosterone levelsfluid and electrolyte imbalanceinsomniairritabilityloss of energy  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

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Nursing Stat Facts

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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