Ch. 33: Adrenal drugs Flashcards
Name the layers of the adrenal glands and the hormone(s) secreted in each layer
Adrenal cortex = outer
outer zona glomerulosa secretes mineralocorticoids = aldosterone
middle zona fasciculata secretes glucocorticoids = cortisol
inner zona reticularis = sex hormones
Adrenal medulla = inner
epinephrine (80%) and norepinephrine (20%)
What type of tissue is the adrenal gland made up of (divide by sections)
adrenal cortex = 80-90% and is endocrine tissue
adrenal medulla = 10-20% and is neurosecretory tissue
What type of hormones are secreted by the adrenal cortex? Adrenal medulla?
Adrenal cortical hormones are all steroid hormones
Adrenal medulla hormones are catecholamines
What are functions of glucocorticoids?
anti-inflammatory
carbohydrate, fat, and protein metabolism
maintenance of normal BP
stress effects
What are the functions of mineralocorticoids?
BP control
maintenance of pH levels in blood
maintenance of serum potassium levels
sodium and water reabsorption
Where are adrenal corticosteroids stored in the body?
Trick question: adrenal corticosteroids are synthesized as needed ie. the body does not store them
How are body levels of adrenal hormones regulated?
Hypothalamic-pituitary-adrenal axis = negative feedback mechanism:
low levels of corticosteroid –> corticotropin-releasing hormone (CRH) from hypothalamus –> adrenocorticotropic hormone (ACTH) from anterior pituitary –> corticosteroids from adrenals
What is hypersecretion of adrenocortical hormones called?
Cushing’s syndrome
What are some manifestations of Cushing’s syndrome?
redistribution of fat from the arms/legs to face, trunk and abdomen –> moon face, buffalo hump, purple striae
primary aldosteronism –> water retention and muscle weakness from sodium retention and potassium loss
What is hyposecretion of adrenocortical hormones called?
Addison’s disease
What are some manifestations of Addison’s disease?
decreased blood sodium and glucose levels increased potassium levels dehydration weight loss hypotension
Which corticosteroid is the only drug with exclusive mineralocorticoid acitivity?
fludrocortisone
What are the effects of corticosteroids?
have some mineralocorticoid activity (similar to aldosterone)
inhibition of inflammatory and immune responses by stabilizing cell membranes of inflammatory cells, decreasing permeability of capillaries to the inflammatory cells, and decreasing the migration of WBC into already inflamed areas
Glucocorticoids promote the SYNTHESIS/BREAKDOWN of protein, production of GLYCOGEN/GLUCOSE in the liver, and redistribution of fat from the PERIPHERAL/CENTRAL areas to the PERIPHERAL/CENTRAL areas of the body
Glucocorticoids may lower fever by reducing the release of ____________ from WBC
They also stimulate __________ cells that eventually become ____________.
breakdown glycogen peripheral central interleukin-1 erythroid RBC
Which of the following are CI's for glucocorticoids: cataracts and glaucoma PUD DM infection tuberculous meningitis heart, kidney, or liver dysfunction
all except tuberculous meningitis
T/F: glucocorticoids can be used to prevent CNS damage in tuberculous meningitis
True
T/F: Prednisone alone is adequate for the management of Addison’s disease
False: it has minimal mineralocorticoid properties and thus must be used in conjunction with fludrocortisone
Hormone production by the adrenal gland is influenced by ___________ and follows a diurnal pattern with peak levels occurring at __________ and ___________.
time of day
0600-0800
1600-1800
In long-term corticosteroid therapy, what modifications can be made to minimize adrenal suppression?
alternate day dosing
What can happen with abrupt withdrawal of adrenal drugs?
Addison’s crisis/adrenal insufficiency
What is a complication of corticosteroids by inhaler? What can be done about it?
fungal/candidiasis infections
prevention by rinsing mouth after inhalation
What is the most important nursing action if preop orders do not include a maintenance dosage of corticosteroid meds?
Contact physician immediately
Which of the following statements is correct regarding corticosteroids?
a. they have few adverse effects
b. they are often used for their anti-inflammatory effects
c. they may be administered only by inhalant dosage forms
d. they may be used long term without major complications
B
Which statement of the patient shows a poor understanding of the teaching about oral corticosteroid therapy that the patient has received?
a. i should take this drug with food or milk
b. i will report any fever or sore throat symptoms
c. i will stay away from anyone who has a cold or infection
d. i can stop this medication if i have severe adverse effects
D
During long-term corticosteroid therapy, the nurse should monitor the patient for Cushing’s syndrome. Which of the following characteristics is usually manifested by this syndrome?
a. weight loss
b. truncal obesity
c. muscle thickening
d. thickened hair growth
B
A patient has been prescribed a daily dose of prednisone. At what time of day should the patient take the medication to help reduce adrenal suppression?
a. in the morning
b. at lunchtime
c. at dinnertime
d. at bedtime
A
Which teaching is appropriate for a patient who is taking an inhaled glucocorticoid for asthma?
a. blow your nose after taking the medication
b. do not rinse the mouth after taking the medication
c. exhale while pushing in on the canister of the inhaler
d. rinse the mouth thoroughly after taking the medication
D
