Adrenal Drugs Flashcards
Adrenal Medulla
Secretes catecholamines (epinephrine and norepinephrine)
Adrenal Cortex
Secretes corticosteroids (glucocorticoids, mineralocorticoids, androgens)
Glucocorticoids affect blood sugar
Mineralocorticoids pair with salt
Androgens are male sex hormones
Adrenocortical Hormones
Oversecretion leads to Cushing’s Syndrome
Undersecretion leads to Addison’s disease/Adrenal insufficiency
Cushing’s Syndrome
Causes hypersecretion of ACTH and glucocorticoids
Presents with obesity, hyperglycemia, glycosuria, hypertension, and fluid/electrolyte disturbances (hypernatremia)
NANDA: disturbed body image
Addison’s Disease
Adrenocortical Insufficiency
Presents with weakness, hypotension, emaciation, hypoglycemia, bronze skin pigmentation
Treated with hydrocortisone
Normal Potassium Level
3.5-5
Addison’s Crisis
ADRENAL CRISIS; CAN LEAD TO DEATH
Presents with hypotension, dehydration, weakness, lethargy, GI symptoms
Caused by adrenal failure, pituitary failure, or inadequate doses of corticosteroids or abrupt withdrawal (mostly due to inadequate therapy)
Corticosteroids
Exert effects by modifying enzyme activity
Indications for Adrenal Drugs
ADRENOCORTICAL DEFICIENCY CEREBRAL EDEMA GI DISEASES ASTHMA AND COPD ORGAN TRANSPLANTATION
Contraindications for Adrenal Drugs
SERIOUS INFECTIONS, INCLUDING SEPTICEMIA, SYSTEMIC FUNGAL INFECTIONS, AND VARICELLA
Watch for infections and avoid severe immunosuppressants
If infection occurs, gradually taper off
CAUTIOUS USE IN PATIENTS WITH:
GASTRITIS, REFLUX DISEASE, ULCER DISEASE
DIABETES
CARDIAC, RENAL, OR LIVER DYSFUNCTION
Adverse Effects
ELECTROLYTE IMBALANCES (HYPOKALEMIA, HYPERNATREMIA)
HYPERGLYCEMIA
PEPTIC ULCERS
FRAGILE SKIN, ECCHYMOSIS, POOR WOUND HEALING, OSTEOPOROSIS
WEIGHT GAIN
Interactions
LOOP DIURETICS–>Hypokalemia
ULCEROGENIC DRUGS–>Additive GI effects and gastric ulcer development
Hydrocortisone
Primarily used to treat Addison’s Disease
Also used for allergic reactions to inflammation and cancer
Adverse effects include adrenal suppression and Cushing’s syndrome
Prednisone
Most commonly used oral glucocorticoid for anti-inflammatory or immunosuppressant purposes
Treats exacerbations of chronic respiratory illnesses
Does not treat adrenocortical insufficiency alone, must be paired with a glucocorticoid
Tablet, must gradually taper off
Methylprednisone
Anti-inflammatory or immunosuppressant drug
Most commonly used injectable glucocorticoid drug
Used for Crohn’s and COPD
MOST INJECTABLE FORMULATIONS CONTAIN A PRESERVATIVE (BENZYL ALCOHOL) THAT CANNOT BE GIVEN TO CHILDREN YOUNGER THAN 28 DAYS OF AGE
Fludrocortisone (Florinef)
Potent mineralocorticoid
Only oral corticosteroid used
Treats Addison’s disease, primary hypoaldosteronism, and congenital adrenal hyperplasia
Adverse effects include hypertension, edema, cardiac enlargement, and hypokalemia
Nursing Implications
MEASURE BLOOD PRESSURE FREQUENTLY
ASSESS FOR EDEMA AND ELECTROLYTE IMBALANCES
SYSTEMIC FORMS SHOULD NOT BE GIVEN SUBCUTANEOUSLY
ORAL FORMS SHOULD BE GIVEN WITH FOOD OR MILK
CLEAR NASAL PASSAGES BEFORE NASAL DOSES
RINSE MOUTHS TO PREVENT ORAL FUNGAL INFECTIONS
TAKE MEDICATIONS AT THE SAME TIME
DO NOT TAKE WITH ASPIRIN, ALCOHOL, OR NSAIDS
SUDDEN DISCONTINUATION CAN PRECIPITATE AN ADRENAL CRISIS
