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Pharmacology Test 2 > Adrenocortical Agents > Flashcards

Adrenocortical Agents Flashcards

1
Q

Indications for Use 
of Adrenal Agents

A

Widely used to suppress the immune system
Short-term use to relieve inflammation during acute stages of illness
Do not cure any inflammatory disorders
Don’t use these meds for any longer than we need to

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2
Q

Anatomy of the Adrenal Glands

A

Location
Flattened bodies which sit on top of each kidney
Composition
Adrenal medulla: An inner core; part of the SNS
releases epinephrine and norepinephrine when its stimulated by SNS
Adrenal cortex: An outer shell; produces hormones called corticosteroids

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3
Q

Adrenal Abnormalities

A

Adrenal Excess
- Cushing Disease
Adrenal Insufficiency
- Addison Disease

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4
Q

Adrenal Excess

A 
Cushing Disease (a cushion of hormone - too much of it) 
Symptoms- moon-like face, central obesity, HTN, protein breakdown, osteoporosis, hirsutism
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5
Q

Adrenal Insufficiency

A 
Addison Disease (we need to add hormone back in)
Symptoms- confusion, hypotension, CV collapse (leads to shock and death), fatigue, limited ability to respond to infection
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6
Q

Adrenocortical Agents: Children

A

Dose is determined by severity of condition not age or weight
Monitor growth and development; (can lead to growth retardation in children - if we see it severely, we discontinue, if not severe, we just reduce dose) discontinue if severe growth retardation
Protect against infection and injuries

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7
Q

Adrenocortical Agents: Adults

A

Take in the morning
Taper the medication; do not stop abruptly
Check OTC preparations for corticosteroids (such as cortisol)
Protect against infection and injuries
Cross the placenta and can cause ADE to fetus
avoid use in pregnancy
Enter breastmilk and can cause ADE to baby
find alternative method for feeding

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8
Q

Adrenocortical Agents: Older Adults

A

More likely experience ADE
Reduce dose and monitor closely
More likely to have conditions that are impacted by corticosteroids (DM, HF, osteoporosis) - monitor those conditions that can be exacerbated by corticosteroid agents

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9
Q

Conditions affected by coticosteroids

A

DM, HF, osteoporosis

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10
Q

Types of Corticosteroids

A

Androgens
Male and female sex hormones
Glucocorticoids
Stimulate an increase in glucose levels for energy
Mineralocorticoids
Affect electrolyte levels and homeostasis
helps maintain homeostasis

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11
Q

Causes of Adrenal Insufficiency

A

A patient does not produce enough ACTH
Adrenal glands are not able to respond to ACTH
Adrenal gland is damaged
Secondary to surgical removal of the gland
Prolonged use of corticosteroid hormones
- when body is given an outside source (exogenous) of a hormone, it stops making the hormone altogether

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12
Q

Actions of Adrenocortical 
Hormones

A

Increase blood volume (aldosterone effect)
Cause the release of glucose for energy
Slow rate of protein production (reserves energy)
Block activities of the inflammatory and immune systems (reserves a great deal of energy)

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13
Q

Adrenal Crisis

A 
Signs
Physiological exhaustion
Hypotension
Fluid shift
Shock and even death
a patient has an insufficiency of adrenal hormone - the extreme addisons disease
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14
Q

Treatment of Adrenal Crisis

A

Massive infusion of replacement steroids

Constant monitoring and life support procedures

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15
Q

Common Glucocorticoids: Names

A 
Betamethasone 
Budesonide 
Cortisone 
Dexamethasone 
Hydrocortisone 
Methylprednisolone
Prednisolone
Prednisone
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16
Q

Glucocorticoids: Actions

A

Actions
Enter target cells and bind to cytoplasmic receptors
Initiate many complex reactions responsible for anti-inflammatory and immunosuppressive effects
autoimmune disorders
Hydrocortisone, cortisone, and prednisone have some mineralocorticoid activity

17
Q

Glucocorticoids: Indications

A

Indications
Short-term treatment of many inflammatory disorders
RA / COPD / Any autoimmune condition
To relieve discomfort
To give the body a chance to heal from the effects of inflammation

18
Q

Glucocorticoids: Contraindications

A 
Contraindications
- Known allergy
- Acute infection
- Lactation
Caution
- Diabetes 
- Acute peptic ulcer
19
Q

Glucocorticoids: ADE

A

Adverse Effects
Headache, insomnia, psychosis, GI upset, HF (related to fluid retention), fluid retention, increased blood glucose, osteoporosis, frail skin (skin just rips when you barely touch the skin) , growth retardation (children), diabetes, Cushing syndrome, impaired wound healing, aggravating or masking of infections
teacher sees all of the ADE daily in her practice
put on lowest dose possible and get them off asap

20
Q

Glucocorticoids: Drug drug

A

Drug-Drug Interactions
Increase in drug when given with erythromycin, ketoconazole, or troleandomycin
Decrease in drug when given with salicylates, barbiturates, phenytoin, or rifampin

21
Q

Nursing Considerations for Glucocorticoids: Assess

A

Assess:
History and physical exam
Known allergies, acute infections, peptic ulcer disease, pregnancy, lactation, endocrine disturbances, and renal dysfunction
Weight (baseline and monitor throughout - to detect fluid retention); temperature (baseline and monitor for infection throughout); orientation and affect (CNS effect); grip strength; eye examination; blood pressure, pulse, peripheral perfusion, and vessel evaluation
Respiration and adventitious breath sounds (we hope glucocorticoid alleviates symptoms such as wheezing); glucose tolerance, renal function, serum electrolytes (sodium / calcium / potassium), and endocrine function tests as appropriate

22
Q

Nursing Considerations for Glucocorticoids: Diagnosis

A

Nursing Diagnoses
Altered cardiac output related to fluid retention
Excess fluid volume related to water retention
Disturbed sensory perception
Risk for infection related to immunosuppression
Ineffective coping related to body changes caused by the drug
Deficient knowledge regarding drug therapy
Imbalanced nutrition: more than body requirements related to metabolic changes

23
Q

Nursing Considerations for Glucocorticoids: Implementation

A

Implementation
- Administer drug daily at 8 to 9 am
- Space multiple doses evenly throughout the day
- Use the minimal dose for the minimal amount of time
- Taper doses when discontinuing from high doses or from long-term therapy
- Arrange for increased dose when the patient is under stress
- Use alternate-day maintenance therapy with short-acting drugs
- Do not give live virus vaccines when the patient is immunosuppressed
live virus not good when immunosuppressed
- Protect the patient from unnecessary exposure to infection and invasive procedures
- teach need to be vigilant with monitoring glucose levels in diabetic patients

24
Q

Nursing Considerations for Glucocorticoids: Evaluation

A

Evaluation
Monitor patient response to the drug (relief of signs and symptoms of inflammation, return of adrenal function to within normal limits)
Monitor for adverse effects (increased susceptibility to infections, skin changes, endocrine dysfunctions, fatigue, fluid retention, peptic ulcer, psychological changes)
Evaluate the effectiveness of the teaching plan

25
Q

Prednisone: Prototype Glucocorticoids: Indications

A
  • Indication: replacement therapy in adrenal cortical insufficiency, short-term management of various inflammatory and allergic disorders, hypercalcemia associated with cancer, hematological disorders, ulcerative colitis (an autoimmune condition) , acute exacerbations of multiple sclerosis, palliation in some leukemias, trichinosis with systemic involvement
26
Q

Prednisone: Prototype Glucocorticoids : Actions

A

Actions: enters target cells and binds to intracellular corticosteroid receptors, initiating many complex reactions responsible for its anti-inflammatory and immunosupportive effects

27
Q

Prednisone: Prototype Glucocorticoids: ADE

A

ADE: vertigo, HA, hypotension, shock, sodium and fluid retention, amenorrhea, increased appetite, weight gain, immunosuppression, aggravation or masking of infections, impaired wound healing

28
Q

Common Mineralocorticoids: Names

A

Cortisone
Fludrocortisone
Hydrocortisone
All have effect on electrolytes - they act like aldosterone - very similar

29
Q

Common Mineralocorticoids: Actions

A

Actions
Holds sodium, and with it, water in the body
Causes the excretion of potassium by acting on the renal tubule

30
Q

Mineralocorticoids: Indications

A

Indications

Replacement therapy in primary and secondary adrenal insufficiency

31
Q

Mineralocorticoids: Contraindications

A

Contraindications

  • Known allergy
  • Hypertension
  • CHF
  • Cardiac disease

Caution

  • Pregnancy
  • Presence of any infection
  • High sodium intake
32
Q

Mineralocorticoids: ADE

A

Adverse Effects

Increase fluid volumes, hypokalemia

33
Q

Mineralocorticoids: Drug drug interactions

A

Drug-Drug Interactions

Decrease effectiveness with salicylates, barbiturates, hydantoins, rifampin, and anticholinesterases

34
Q

Nursing Considerations for Mineralocorticoids: Assess

A

Assess:
History and physical exam
Known allergy
Heart failure, hypertension, or infections; high sodium intake; lactation; and pregnancy

35
Q

Nursing Considerations for Mineralocorticoids: Diagnosis

A

Nursing Diagnoses
Imbalanced nutrition: more than body requirements related to metabolic changes
Excess fluid volume related to sodium retention
Impaired urinary elimination related to sodium retention
Deficient knowledge regarding drug therapy

36
Q

Nursing Considerations for Mineralocorticoids

Implementation

A

Implementation
Use only in conjunction with appropriate glucocorticoids
to maintain electrolyte balance
Increase dose in times of stress
Monitor for hypokalemia (weakness, serum electrolytes)
retain sodium and excrete potassium
Discontinue if signs of overdose (excessive weight gain, edema, hypertension, cardiomegaly)
Provide thorough patient teaching
ADE, follow ups, blood tests, teach about signs and symptoms of hypokalemia, daily weights, when to contact health care provider with dramatic weight gain

37
Q

Nursing Considerations for Mineralocorticoids: Evaluation

A

Evaluation
Monitor patient response to the drug (maintenance of electrolyte balance)
Monitor for adverse effects (fluid retention, edema, hypokalemia, headache)
Evaluate the effectiveness of the teaching plan
Monitor compliance with the regimen

38
Q

Prototype Mineralocorticoids: Fludocortisone: Indications

A

Indications: partial replacement therapy in cortical insufficiency conditions, treatment of salt-losing adrenogenital syndrome; off-label use: treatment of hypotension
used a lot in clinical setting when can’t figure out why blood pressure is low

39
Q

Prototype Mineralocorticoids: Fludocortisone: Actions

A

Actions: increases sodium reabsorption in the renal tubules and increases potassium and hydrogen excretion, leading to water and sodium retention

Pharmacology Test 2 (3 decks)

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