Adrenal

Question 1

what are the adrenocortical hormone disorders

Answer 1

cushings and addisons

Question 2

what is cushing syndrome

Answer 2

a collection of s/s associated with HYPERcortisolism

Question 3

what causes cushing syndrome

Answer 3

primary hyperfunction: disease of adrenal cortex
secondary hyperfucntion: disease of anterior pituitary
exogenous steroids: used in management of various diseases

Question 4

what is the difference between cushing syndrome and disease

Answer 4

syndrome: inc in hormone level itself
disease: inc in the triggering hormone

Question 5

what is the function of cortisol

Answer 5

raised blood sugar
protects against physiological effects of stress
suppresses immune and infalmmatory porcess
breaks down proteins and fats
inc cholesterol
maintain vascular system by keep BP up

Question 6

clinical manifestations of cushings: inc glucose

Answer 6

glucose intolerance, hyperglycemia

Question 7

clinical manifestations of cushings: maintain vascular system

Answer 7

HTN, capillary friability (ecchymoses)

Question 8

clinical manifestations of cushings: protein breakdown

Answer 8

muscle wasting, muscle weakness, thinning of skin, osteoporosis, bone pain

Question 9

clinical manifestations of cushings: fat breakdown

Answer 9

redistribution of fat to the abdomen, shoulders, face

Question 10

clinical manifestations of cushings: supper of immune and inflammatory response

Answer 10

impaired wound healing and immune response, risk for infection

Question 11

clinical manifestations of cushings: CNS excitability

Answer 11

mood swings, insomnia

Question 12

other clinical manifesations of cushings

Answer 12

hirsutism, buffalo hump, thinning hair, thinning extremites, striae (stretch marks), moon face

Question 13

drug therapy for cushings

Answer 13

remove tumor with surgery, taper off steriods

Question 14

what drugs help suppress the synthesis of steroids

Answer 14

aminoglutethimide
ketoconazole
should not be used by themselves, not primary treatment

Question 15

aminoglutethimide moa

Answer 15

blocks the synthesis of all adrenal steroids

Question 16

aminoglutethimide indications

Answer 16

temporary therapy to dec cortisol production
- typically for ppl waiting for surgery

Question 17

aminoglutethimide effects

Answer 17

reduces cortisol by 50%
does not affect underlying disease process

Question 18

aminoglutethimide adverse effects

Answer 18

drowsy
N
anorexia
rash

Question 19

ketoconazole moa

Answer 19

antifungal drug that inhibits glucocorticoid steroid synthesis

Question 20

ketoconazole indications

Answer 20

adjunct therapy to surgery or radiation

Question 21

ketoconazole adverse effects

Answer 21

severe liver damage

Question 22

ketoconazole nursing considerations

Answer 22

do not take with ETOH or other liver harmers
no for pregnancy (fetal thyroid damage)
monitor liver function tests

Question 23

what is addison disease

Answer 23

disease of the adrenal cortex that causes HYPO secretion of cortisol, aldosterone, androgen (male sex hormoes)
* more severe is low cortisol *

Question 24

cause of addison disease

Answer 24

idiopathic
autoimmune
other

Question 25

pathogenesis of addison disease

Answer 25

- adrenal gland is destroyed by disease (primary insufficiency) - adrenal gland stops secreting cortisol, causes lack of negative feedback - anterior pituitary continues to secrete ACTH and MSH to stimulate cortisol production

Question 26

when do symptoms of Addison become evident

Answer 26

when adrenal cortex is about 90% destroyed

Question 27

clinical manifestations of addison: early

Answer 27

anorexia wt loss weakness, malaise, apathy electrolyte imbalances hyperpigmentation of skin

Question 28

clinical manifestations of addison: broad

Answer 28

hypoaldosteronism --> hypoTN, salt cravings hypocorticolism --> hypoglycemia, weakness, fatigue,

Question 29

what does hypoaldosterone cause and why

Answer 29

hypotension for dec vascular tone, CO, circulating blood volume salt cravings: dec serum Na levels, inc serum K levels, and dehydration *fluid volume deficit*

Question 30

what does hypocortisol cause

Answer 30

dec in sugar so hypoglycemia, weakness, fatigue, unsuppressed ACTH production resulting in hyper-pigmentation

Question 31

what is a major complication of addison disease

Answer 31

addisonian crisis --> acute adrenal insufficiency * body has no cortisol to combat stress *

Question 32

cause of addisonian crisis

Answer 32

sudden insufficiency of serum corticosteroids resulting from - sudden loss of adrenal gland - sudden inc in stress in chronic condition - sudden cessation of corticosteroid drug therapy

Question 33

addison pharm in general

Answer 33

replacement of corticosteroids - glucocorticoid: hydrocortisone (drug of choice), prednisone, dexamethasone - some need mineralocorticoid: fludrocortisone

Question 34

steroid replacement therapy information

Answer 34

- dosing needs to mimic natural release of hormones so timing is important and doses are small - never abruptly stop - doses will need to be inc durign times of stress - always maintain emergency supply - wear a medical alert bracelet

Question 35

what is the 3x3 rule

Answer 35

inc dose for 3 days by 3x then taper back down when stress is no longer present

Question 36

what is pheochromocytoma

Answer 36

rare tumor of the adrenal medulla that produces excessive catecholamines (norep, epi) - benign most of the time

Question 37

who is at risk for pheochromocytoma

Answer 37

young to middle age

Question 38

pheochromocytoma pathogenesis

Answer 38

tumor cells secrete catecholamines in response to SNS stimulation (on top of adrenal medulla)

Question 39

what does epi stimulate

Answer 39

alpha and beta recpetors of heart and lungs and vessels

Question 40

what does norepi stimulate

Answer 40

alpha receptors in the vessels

Question 41

clinical manifestations of pheochromocytoma

Answer 41

HTN leads to headache, diaphoresis, tachycardia *can be intermittent of persistent*

Question 42

drug therapy for pheochromocytoma

Answer 42

prefer surgery, but can use alpha adrenergic when tumors are inoperable or preop to reduce HTN

Question 43

what cause HTN in pheochromocytoma

Answer 43

activation of alpha 1 receptors on blood vessels

Question 44

phenoxybenzamine HCL moa

Answer 44

long lasting irreversible blockage of alpha adrenergic receptors to lower BP - alpha 1 and 2 - irreverisble --> so will only be free again once new receptors are made

Question 45

pheochromocytoma adveres effects

Answer 45

orthostatic hypotension reflex tachycardia nasal congestion sexual side effects in men (inability to ejaculate)