Somatropin (Recombinant)

INTRODUCTION

Indications

Growth failure in children due to inadequate secretion of growth hormone. Growth hormone deficiency in adults as a result of pituitary disease, hypothalamic disease, surgery, radiation, or trauma.

Action

Produce growth (skeletal and cellular). Metabolic actions include ↑ protein synthesis, ↑ carbohydrate metabolism, Lipid mobilization, Retention of sodium, phosphorus, and potassium. Somatropin has the same amino acid sequence as naturally occurring growth hormone and is produced by recombinant DNA techniques. Growth hormone enhances GI tract mucosal transport of water, electrolytes, and nutrients. Therapeutic Effects: ↑ skeletal growth in children with growth hormone deficiency. Replacement of somatropin in deficient adults. ↑ bone density in adult growth hormone–deficient patients.

Adverse Reactions/Side Effects

CV: edema of the hands and feet. Derm: exacerbation of preexisting psoriasis. Endo: hyperglycemia, hypothyroidism, insulin resistance. Local: pain at injection site, local lipoatrophy, or lipodystrophy with SC use. MS: arthralgia, musculoskeletal pain, swelling, stiffness.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Periodically assess height and weight in children to help document the effects of drug therapy.

• Assess edema in the hands and feet using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling, especially if ROM and function are compromised.

• Assess any joint pain or musculoskeletal pain, swelling, or stiffness to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Be alert for signs of hyperglycemia and insulin resistance, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels frequently.

• Monitor any decrease in metabolism that might indicate hypothyroidism. Common signs include bradycardia, lethargy, cold intolerance, weight gain, and muscle weakness. Report these signs to the physician.

• Monitor skin reactions in patients with preexisting psoriasis, and report any increase in symptoms such as scaly patches and red, itching, burning, dry, and cracked skin.

• Monitor subcutaneous injection site for bruising or decreased local fat accumulation (lipoatrophy, lipodystrophy). Report prolonged or excessive injection site reactions to the physician.

Interventions

• Design and implement therapeutic exercise programs to capitalize on growth hormone effects and increase muscle strength and bone mineral density in children and adults.

• Do not apply physical agents (heat, cold, electrotherapeutic modalities) or massage over the injection site; these interventions can alter drug absorption from subcutaneous tissues.

Patient/Client-Related Instruction

• Advise patient and family/caregivers to adhere to recommended dosing schedule. Emphasize that growth hormones must not be used to increase athletic performance, and that administration to people without growth hormone deficiency ...