Adrenal drugs

Question 1

Adrenal Gland

Answer 1

Adrenal cortex: aldosterone, cortisol, sex hormones

Adrenal medulla: NE/E

Each portion has different functions and secretes different hormones.

Feedback process of hormone regulation

Cortisol has many functions in the human body, such as mediating the stress response, regulating metabolism, the inflammatory response, and immune function.

Question 2

Adrenal medulla secretes catecholamines.

Answer 2

Epinephrine
Norepinephrine

Question 3

Adrenal cortex secretes corticosteroids.

Answer 3

Glucocorticoids (cortisol)
Mineralocorticoids (primarily aldosterone)
Sex hormones (androgen/ estrogen)

Question 4

Adrenocortical Hormones

Oversecretion leads to?

Undersecretion leads to?

Answer 4

Oversecretion (of cortisol) leads to Cushing’s syndrome.

Undersecretion (of cortisol and aldosterone) leads to Addison’s disease.

Question 5

Adrenal Drugs

Answer 5

Can be either synthetic or natural

Glucocorticoids
-Topical, systemic, inhaled, nasal

Mineralocorticoid
-Systemic

Adrenal steroid inhibitors
-Systemic

Question 6

Glucocorticoids three drug name

Answer 6

hydrocortisone
methylprednisolone
prednisolone

Question 7

Mineralocorticoids drug name

Answer 7

fludrocortisone 21-acetate

Question 8

Catecholamines 2

Answer 8

epinephrine, norepinephrine

Question 9

Adrenal steroid inhibitor drug name

Answer 9

ketoconazole

Question 10

Three Mechanism of Action

Answer 10

Most corticosteroids exert their effects by modifying enzyme activity.

Glucocorticoids differ in their potency, duration of action, and the extent to which they cause salt and fluid retention (= low K+)

Glucocorticoids inhibit or help control inflammatory and immune responses.

Question 11

Indications

Answer 11

Adrenocortical deficiency
Adrenogenital syndrome
Allergic disorders
Autoimmune blistering diseases
Bacterial meningitis
Cancer
Cerebral edema
Collagen diseases (e.g., systemic lupus erythematosus)

Dermatological diseases (e.g., exfoliative dermatitis, pemphigus)
Endocrine disorders (thyroiditis)
Gastrointestinal diseases (e.g., ulcerative colitis, regional enteritis)
Exacerbations of chronic respiratory illnesses such as asthma and chronic obstructive pulmonary disease
Hematological disorders (reduction of bleeding tendencies)

Nonrheumatic inflammation
Ophthalmic disorders (e.g., nonpyogenic inflammations)
Organ transplantation (decrease immune response to prevent organ rejection)
Leukemias and lymphomas (palliative management)

Nephrotic syndrome (remission of proteinuria)
Spinal cord injury
Rheumatic disorders: rheumatoid arthritis, psoriatic arthritis, acute gouty arthritis, ankylosing spondylitis (adjunctive therapy)
Thyroiditis

Question 12

Glucocorticoids

three routes and their effects

Answer 12

By inhalation for control of steroid-responsive bronchospastic states

Nasally for rhinitis and to prevent the recurrence of polyps after surgical removal

Topically for inflammations of the eye, ear, and skin

Question 13

Glucocorticoids Contraindications?

Often avoided with? why?

However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory?

Cautious use in patients with which diseases

Answer 13

Drug allergies, Cataracts, glaucoma, peptic ulcer disease mental health problems, and diabetes

Often avoided with serious infections, including septicemia, systemic fungal infections, and varicella – immunosuppressive quality

However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory central nervous system damage.

Cautious use in patients with:

Gastritis, reflux disease, ulcer disease
Diabetes
Cardiac, renal, or liver dysfunction

Question 14

Glucocorticoids
Adverse Effects

Answer 14

Potent effects on all body systems

Cardiovascular system: heart failure, cardiac edema, hypertension—all caused by electrolyte imbalances (hypokalemia, hypernatremia), impaired glucose tolerance, dysrhythmias, bradycardia, pulmonary edema, syncope, vasculitis

Central nervous system: convulsions, headache, vertigo, mood swings, nervousness, aggressive behaviours, psychotic symptoms, neuritis, peripheral neuropathy, paresthesia, arachnoiditis, meningitis, insomnia

Endocrine system: growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, hypothalamic–pituitary–adrenal axis suppression, hirsutism, hypertrichosis, glycosuria

Gastrointestinal system: peptic ulcers, pancreatitis, ulcerative esophagitis, abdominal distension

Integumentary system: fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, urticaria, hypersensitivity reactions, acne, dry skin, skin hyperpigmentation, skin striae

Musculoskeletal system: myopathy, muscle weakness, loss of muscle mass, osteoporosis, osteonecrosis of femoral and humeral heads, pathological fracture, malaise

Ocular system: increased intraocular pressure, glaucoma, cataracts

Other: weight gain, leukocytosis, opportunistic infections, hypokalemia alkalosis, impaired healing

Question 15

Glucocorticoids Interactions

Answer 15

Non–potassium-sparing diuretics (e.g., thiazides, loop diuretics) can lead to severe hypocalcemia and hypokalemia.
* Cortisol/ aldosterone would reabsorb Na+ and excrestes K+; cause metabolic acidosis (low pH, low HC03-)

Aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and other ulcerogenic medications produce additive gastrointestinal effects and an increased chance of gastric ulcer development.

Anticholinesterase medications produce weakness in patients with myasthenia gravis.

Immunizing biologics inhibit the immune response to the biological.

Antidiabetic drugs may reduce the hypoglycemic effects and result in elevated blood glucose levels.

Question 16

Prednisone

Answer 16

Most commonly used oral glucocorticoid for anti-inflammatory or
immunosuppressant purposes

Also used to treat exacerbations of chronic respiratory illnesses

Inadequate for the management of adrenocortical insufficiency (Addison’s disease)

Question 17

Methylprednisolone (Solu-Medrol)
Actions?
Not given in children younger than?

Answer 17

Most commonly used injectable glucocorticoid drug

Primary use: anti-inflammatory or immunosuppressant drug

Usually administered intravenously

Not recommended for use during pregnancy

Most injectable formulations contain a preservative (benzyl alcohol) that cannot be given to children younger than 28 days of age.

Question 18

Look-Alike/Sound-Alike Drugs

Solu-Cortef® and Solu-Medrol®

Answer 18

Both are glucocorticoids, and both are given intravenously, but they are different.

4 mg of Solu-Medrol is equivalent to 20 mg of Solu-Cortef.

These drugs are not interchangeable.

Medication errors often occur when drug names are similar.

Question 19

Nursing Implications

Answer 19

Perform a physical assessment to determine baseline weight, height, intake and output status, vital signs (especially blood pressure), hydration and nutritional status, skin condition, and immune status.

Obtain baseline laboratory studies.

Assess for edema and electrolyte imbalances.

Assess for contraindications to adrenal drugs, especially the presence of peptic ulcer disease.

Assess for drug allergies and potential drug interactions (prescription drugs, natural health products and over-the-counter drugs).

Be aware that these drugs may alter serum glucose and electrolyte levels (e.g., serum potassium levels).

Prepare and administer according to manufacturer’s directions.

Oral forms should be given with food or milk to minimize gastrointestinal upset.

For topical applications, follow instructions for their use and the type of dressing (if any) to apply.

Clear nasal passages before giving a nasal corticosteroid.

After using an orally inhaled corticosteroid, instruct the patient to rinse the mouth with lukewarm water to prevent possible oral fungal infections.

Teach patients taking corticosteroids to avoid contact with people with infections and to report any fever, increased weakness, lethargy, or sore throat.

Patients should be taught to take all adrenal medications at the same time every day, usually in the morning, with meals or food.

Patients should not take adrenal medications with alcohol, caffeine, aspirin, or NSAIDs.

Sudden discontinuation of these medications can precipitate an adrenal crisis caused by a sudden drop in serum levels of cortisone.

Doses are usually TAPERED before the medication is discontinued.