Adrenal Drugs

Question 1

What are the 2 parts of the adrenal gland?

Answer 1

Adrenal medulla
Adrenal cortex

Question 2

What does the adrenal medulla secrete?

Answer 2

Catecholamines: Epinephrine and norepinephrine

Question 3

What does the adrenal cortex secrete?

Answer 3

Corticosteroids: Glucocorticoids and mineralocorticoids

Question 4

What is the difference between oversecretion and undersecretion of adrenocortical hormones?

Answer 4

Over: Cushing syndrome
Under: Addison’s disease

Question 5

Name 3 glucocorticoids

Answer 5

Hydrocortisone
Methylprednisolone
Prednisone

Question 6

Name a mineralocorticoid

Answer 6

Fludrocortisone 21-acetate

Question 7

Name an adrenal steroid inhibitor

Answer 7

Ketoconazole

Question 8

What is the MOA of most corticosteroids?

Answer 8

Modification of enzyme activity

Question 9

What are the general indications of adrenal drugs?

Answer 9

Any adrenal deficiencies or disorders
Overexaggeration of the immune system
Inflammation diseases (-itis)
Rheumatic disorders

Question 10

What are the different forms of glucocorticoids used for? 3

Answer 10

Inhalation: Control of steroid-responsive bronchospastic states
Nasal: Rhinitis and prevention of recurring polyps after surgical removal
Topical: Inflammations of the eye, ear, and skin

Question 11

What are the contraindications of adrenal drugs?

Answer 11

Cataracts, glaucoma, PUD, mental health problems, diabetes, serious infections

Question 12

In what conditions should you exercise caution when administering adrenal drugs?

Answer 12

Gastritis, reflux disease, ulcer disease, diabetes.
Cardiac, renal or liver dysfunction

Question 13

What are the cardiovascular adverse effects of adrenal drugs?

Answer 13

HF, Cerebral edema, HTN, impaired glucose tolerance, dysrhythmias, bradycardia, pulmonary edema, syncope, vasculitis

Question 14

What are the CNS adverse effects of adrenal drugs ?

Answer 14

Convulsions, headache, vertigo, mood swings, nervousness, aggressive behaviours, psychotic symptoms, neuritis, peripheral neuropathy, paresthesia, arachnoiditis, meningitis, insomnia

Question 15

What are the endocrine adverse effects of adrenal drugs?

Answer 15

Growth suppression, cushing’s syndrome, menstrual irregularities, carbs intolerance, hyperglycemia, suppression of hypothalamic-pituitary-adrenal axis, hirsutism, hypertrichosis, glycosuria

Question 16

What are the integumentary adverse effects of adrenal drugs?

Answer 16

Fragile skin, petechiase, ecchymosis, facial erythema, poor wound healing, urticarial, hypersensitivity reactions, acne, dry skin, skin hyperpigmentation, skin striae

Question 17

What are the MSK adverse effects of adrenal drugs?

Answer 17

Myopathy, muscle weakness, loss of muscle mass, osteoporosis, osteonecrosis of femoral and humeral heads, pathological fracture, malaise

Question 18

What are the GI, ocular and other adverse effects of adrenal drugs?

Answer 18

GI: PUD, pancreatitis, ulcerative esophagitis, abdominal distension
Ocular: Increased intraocular pressure, glaucoma, cataracts
Other: Weight gain, leukocytosis, opportunistic infections, hypokalemia alkalosis, impaired healing

Question 19

What are possible interactions with adrenal drugs?

Answer 19

Non-K-sparing diuretics can lead to severe hypocalcemia and hypokalemia
Aspirin, NSAIDs and other ulcerogenic meds increase GI effects the chance of gastric ulcer development
Anticholinesterase meds produce weakness in pts with myasthenia gravis
Antidiabetic drugs can reduce hypoglycemic effects and result in elevated CBGs
Immunizing biologics inhibit the immune response to the biological agent

Question 20

What is the most commonly used oral glucocorticoid for anti-inflammatory or immunosuppressant purposes? and what else is it used for ?

Answer 20

Prednisone
Treatment of exacerbations of chronic respiratory illnesses

Question 21

What is the most commonly used injectable glucocorticoid? What are its primary uses and contraindications?

Answer 21

Methyprednisolone (Solu-medrol)
ID: Anti-inflammatory or immunosuppressant drugs
CI: Pregnancy, children <28 days of age

Question 22

What is a consideration for the drugs: Solu-cortef and Solu-Medrol?

Answer 22

They are LASA drugs
Both are IV glucocorticoids but are different.

Question 23

_______ of Solu-Medrol is equivalent to _______ of Solu-cortef

Answer 23

4 mg; 20 mg

Question 24

It is important to ___________ before giving a nasal corticosteroid

Answer 24

Clear nasal passages

Question 25

What is a consideration regarding the time of administration of adrenal meds?

Answer 25

They should be taken at the same time every day; preferably in the morning

Question 26

T/F: Pts can take adrenal drugs with alcohol and coffee.

Answer 26

False: Do not take adrenal drugs with alcohol, caffeine, aspirin or nsaids

Question 27

What can occur if adrenal drugs are suddenly discontinued?

Answer 27

Adrenal crisis caused by a sudden drop in serum levels of cortisone.