Adrenocortical Agents ppt

Question 1

Why do we use Adrenal agents?

Answer 1

To suppress the immune system.
In short term illnesses to relieve inflammation during the acute stage.
Replacement therapy for adrenal insufficiency.
Not in ling-term therapy as there are other safer alternatives.

Question 2

Where in the body do we find the Adrenal Glands?

Answer 2

Superior aspect of the kidneys.

Question 3

What is the composition of the adrenal glands?

Answer 3

Adrenal medulla: inner core - part of the SNS
Adrenal cortex: outer “sgell” produces the hormones collectively called corticosteroids.

Question 4

What does the adrenal glands control?

Answer 4

Control the diurnal rhythm.
Activates the stress reaction though the SNS.

Question 5

What are the actions of the corticosteroids?

Answer 5

Increases blood volume
Causes release of glucose for energy during fight or flight.
Slows down the rate or protein production while increasing
protein breakdown.
Mobilizes fatty acids into plasma.
Decreases the activity of the inflammatory & immune system.

Question 6

What diseases/symptoms can be caused by Adrenal Excess?

Answer 6

Cushing Disease - may result from adrenal hyperplasia or tumor, ACTH- secreting tumor or early sign of excessive administration of exogenous steroids.

Moon-face, central obesity, HTN, protein breakdown, osteoporosis and hirsutism.

Question 7

what diseases/symptoms may happen with Adrenal Insufficiency?

Answer 7

Addison Disease - may happen when a person doesn’t produce enough ACTH/Adrenal glands do not respond to ACTH/ damaged gland/surgical removal/prolonged use of corticosteroid hormones.

Confusion, hypotension, CV collapse, fatigue, limited ability to respond to infection.

Question 8

What are the signs & symptoms of an Adrenal crisis?

Answer 8

Physiological exhaustion
Hypotension
Fluid shift
Hypoglycemia
Hair loss
Back pain
confusion and/or psychosis
Fever
Loss of consciousness
Vomiting
Joint pain
Shock - may lead to death.

Question 9

What’s the treatment for an Adrenal Crisis?

Answer 9

Massive infusion of replacement steroids.
Constant monitoring and life support procedures.

Question 10

Lifespan consideration when children are prescribed Adrenocortical agents.

Answer 10

Dose = determined by severity and not weight or age.

Monitor growth & development closely and discontinue if severe growth retardation occur.

Take cautions to protect the child from infection and injuries.

Question 11

Lifespan consideration when adults are prescribed Adrenocortical agents.

Answer 11

Medications should be taken in the morning.
Medications should be tapered off and not abruptly stopped.
See if they are using any OTC medications for corticosteroids.
they should protect themselves against infection and injuries.
Medication may cross placenta and cause adverse effects to fetus.
May enter breastmilk and affect baby.

Question 12

Lifespan consideration when older adults are prescribed Adrenocortical agents

Answer 12

Older adults are more likely to experience adverse effects - if adverse effects occur, reduce dose and monitor.
More likely to have conditions that are impacted by corticosteroids (DM, HF, Osteoporosis)

Question 13

What are some types of Corticosteroids?

Answer 13

Androgens - Sex hormones
Glucocorticoids - Stimulates increase in glucose levels
Mineralocorticoids - affect electrolyte levels & homeostasis.

Question 14

What are the most common Glucocorticoids?

Answer 14

Betamethasone
Budesonide
Cortisone
Dexamethasone
Hydrocortisone
Methylprednisolone
Prednisolone
Prednisone

Question 15

How does Prednisone work on the body?

Answer 15

Prednisone is a Glucocorticoid which enters the target cells and bind to the cytoplasmic receptors which initiate several reactions responsible for anti-inflammatory and immunosuppressive effects.

Prednisone, cortisone, prednisolone also have some mineralocorticoid actions.

Question 16

Why would we give a patient Betamethasone?

Answer 16

Bemethasone is a glucocorticoid and we give them to patients for short term treatment of various inflammatory disorders, and to relive discomfort.
They can be used in conjunction with other immunosuppressant drugs to inhibit transplant rejection and to treat some cancers and cancer associated disorders and some forms of meningitis.

Question 17

Are there any contraindications to Glucocorticoids? If so what are they?

Answer 17

Allergy.

Question 18

What patients and/or conditions should we be cautious of before administering Dexamethasone?

Answer 18

Dexamethasone is a Glucocorticoid and we should be careful of giving glucocorticoids to patients who have an acute infection not controlled by antibiotics.
Also patients who suffer from Diabetes and acute peptic ulcer, as well as pregnancy and lactation.

Question 19

what are the adverse reactions to glucocorticoids?

Answer 19

Headache, insomnia, psychosis, GI upset, HF, fluid retention, increased blood glucose, osteoporosis, frail skin, growth retardation
(children), diabetes, Cushing syndrome, impaired wound healing, aggravating or masking of infections

Question 20

Are there any drug-drug interactions to glucocorticoids?

Answer 20

yes, there are many

Question 21

What nursing assessment should we do prior to administering Methylprednisolone?

Answer 21

Methylprednisolone is a glucocorticoid and before administering these drugs we should assess for contraindications and cautions.

Physical assessment for : Assess weight; temperature; orientation and affect; grip strength; eye examination; blood pressure, pulse, peripheral perfusion, respiration and adventitious breath sounds.

Monitor glucose tolerance, renal function, serum electrolytes, and endocrine function tests.

Question 22

What nursing diagnosis could we make before giving a patient Glucocorticoids?

Answer 22

HTN & fluid overload due to fluid retention.
Altered skin and tissue integrity risk due to decreased protein synthesis.
Infection risk due to immunosuppressant.
Ineffective coping due to body changes.
Self- harm risk due to hormonal changes.
Hyperglycemia
Knowledge deficit.

Question 23

What are important implementation when taking Glucocorticoids?

Answer 23

Administer drug in the am (8-9)
Space out other drugs throughout the day.
Use minimal dose for minimal amount of time.
Taper doses when discontinuing.
Increase dose when patient is under stress.
Do not give live virus injection when the patient is immunosuppressed.
Protect patient from infection.
Assess for drug-drug reactions.
Education.

Question 24

What are the Mineralocorticoids that we need to know?

Answer 24

Cortisone
Fludrocortisone
Hydrocortisone
Prednisone
Prednisolone

Question 25

What does mineralocorticoids do?

Answer 25

Holds sodium, therefore the body retains water.
Excretion of potassium by action on the renal tubules.

Question 26

Why would we give a patient Fludrocortisone?

Answer 26

Fludrocortisone is a Mineralocorticoid and we would give this to treat salt-wasting adrenogenital syndrome and as replacement therapy for primary and secondary adrenal insufficiency.

Question 27

Are there any contraindications to mineralocorticoids? If so, which ones?

Answer 27

There are many.

Question 28

What should we be assessing for before administering mineralocorticoids?

Answer 28

Contraindications and cautions
Physical assessment: BP, Pulse, adventitious breath sounds, temperature, weight, tissue, turgor, reflexes and bilateral grip strenght.
Serum and electrolyte levels.

Question 29

What nursing diagnosis can we anticipate prior to administering mineralocorticoids?

Answer 29

Hyperglycemia related to metabolic changes
Fluid overload and urine retention risk due to sodium retention.
Knowledge deficit.

Question 30

What implementations should we have in place when a patient is given mineralocorticoids?

Answer 30

Increase does in time of stress
Monitor for hypokalemia
Discontinue if signs of overdose
Thorough patient teaching.