adrenal cortex pt 2 Flashcards
Why are corticosteroids widely used?
They have similar indications, actions, and adverse effects, with more than 20 available as medications.
What are the general properties of corticosteroids?
Same mechanism of action, dose-dependent adverse effects, well-absorbed, widely distributed, highly bound to plasma proteins, metabolized by liver, excreted by kidneys, pregnancy category C, secreted in breast milk.
What are the main adverse effects of corticosteroids?
Glucose intolerance, fluid/electrolyte disturbances, osteoporosis, adrenal suppression, peptic ulcer/GI discomfort, infection, Cushing’s syndrome, CNS effects, cataracts.
What are the signs of glucose intolerance from corticosteroids?
Hyperglycemia, glucosuria.
What are the fluid and electrolyte disturbances from corticosteroids?
Sodium & water retention, potassium loss, hypertension, edema, dysrhythmias.
How do corticosteroids cause osteoporosis?
Long-term use decreases bone density, leading to fractures.
How do corticosteroids cause adrenal suppression?
They reduce natural cortisol production, requiring increased doses during stress and gradual tapering to prevent withdrawal.
What are the GI risks associated with corticosteroids?
Peptic ulcer, GI discomfort, black/tarry stools, coffee-ground emesis.
How do corticosteroids affect infection risk?
Immunosuppression masks signs of infection, increasing susceptibility.
What CNS effects can corticosteroids cause?
Insomnia, anxiety, headache, vertigo, depression, confusion.
What are strategies to prevent corticosteroid adverse effects?
Use lowest possible dose, alternate-day dosing, taper gradually for acute conditions, use local administration when possible.
What nursing considerations apply to corticosteroids?
Monitor BP, blood glucose, mood swings, weight gain, GI bleeding, infection signs, osteoporosis risk (Ca & Vit D intake, weight-bearing exercises).
What is an important instruction for stopping corticosteroids?
Do not stop abruptly.
How should corticosteroids be taken to reduce GI upset?
With food, milk, or a meal.
What are common glucocorticoids?
Hydrocortisone, prednisone, dexamethasone.
What is the primary endocrine use of glucocorticoids?
Adrenal insufficiency (low dose).
What are non-endocrine uses of glucocorticoids?
Arthritis, asthma, allergies, transplant rejection, IBD, skin conditions, cancer.
What conditions require caution with glucocorticoids?
Recent MI, gastric ulcer, hypertension, kidney disorder, osteoporosis, diabetes, cirrhosis, hypothyroid, myasthenia gravis, glaucoma, seizures.
What are key drug interactions with glucocorticoids?
Oral antidiabetics, NSAIDs, acetaminophen, alcohol, vaccines.
What is the main mineralocorticoid?
Fludrocortisone.
What are the indications for fludrocortisone?
Addison’s disease, primary hypoaldosteronism, congenital adrenal hyperplasia.
What are the adverse effects of fludrocortisone?
Fluid & sodium retention, hypertension, edema, cardiac enlargement, hypokalemia.
What patient teaching is important for fludrocortisone?
Monitor for signs of fluid & sodium retention and potassium loss.
What are key drug interactions with fludrocortisone?
Barbiturates & phenytoin (reduce effectiveness), insulin & sulfonylureas (reduce glucose control).
