Ch. 33: Adrenal drugs

Question 1

Name the layers of the adrenal glands and the hormone(s) secreted in each layer

Answer 1

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%)

Question 2

What type of tissue is the adrenal gland made up of (divide by sections)

Answer 2

adrenal cortex = 80-90% and is endocrine tissue

adrenal medulla = 10-20% and is neurosecretory tissue

Question 3

What type of hormones are secreted by the adrenal cortex? Adrenal medulla?

Answer 3

Adrenal cortical hormones are all steroid hormones

Adrenal medulla hormones are catecholamines

Question 4

What are functions of glucocorticoids?

Answer 4

anti-inflammatory
carbohydrate, fat, and protein metabolism
maintenance of normal BP
stress effects

Question 5

What are the functions of mineralocorticoids?

Answer 5

BP control
maintenance of pH levels in blood
maintenance of serum potassium levels
sodium and water reabsorption

Question 6

Where are adrenal corticosteroids stored in the body?

Answer 6

Trick question: adrenal corticosteroids are synthesized as needed ie. the body does not store them

Question 7

How are body levels of adrenal hormones regulated?

Answer 7

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

Question 8

What is hypersecretion of adrenocortical hormones called?

Answer 8

Cushing’s syndrome

Question 9

What are some manifestations of Cushing’s syndrome?

Answer 9

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

Question 10

What is hyposecretion of adrenocortical hormones called?

Answer 10

Addison’s disease

Question 11

What are some manifestations of Addison’s disease?

Answer 11

decreased blood sodium and glucose levels
increased potassium levels
dehydration
weight loss
hypotension

Question 12

Which corticosteroid is the only drug with exclusive mineralocorticoid acitivity?

Answer 12

fludrocortisone

Question 13

What are the effects of corticosteroids?

Answer 13

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

Question 14

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 ____________.

Answer 14

breakdown
glycogen
peripheral
central
interleukin-1
erythroid 
RBC

Question 15

Which of the following are CI's for glucocorticoids:
cataracts and glaucoma
PUD
DM
infection
tuberculous meningitis
heart, kidney, or liver dysfunction

Answer 15

all except tuberculous meningitis

Question 16

T/F: glucocorticoids can be used to prevent CNS damage in tuberculous meningitis

Answer 16

True

Question 17

T/F: Prednisone alone is adequate for the management of Addison’s disease

Answer 17

False: it has minimal mineralocorticoid properties and thus must be used in conjunction with fludrocortisone

Question 18

Hormone production by the adrenal gland is influenced by ___________ and follows a diurnal pattern with peak levels occurring at __________ and ___________.

Answer 18

time of day
0600-0800
1600-1800

Question 19

In long-term corticosteroid therapy, what modifications can be made to minimize adrenal suppression?

Answer 19

alternate day dosing

Question 20

What can happen with abrupt withdrawal of adrenal drugs?

Answer 20

Addison’s crisis/adrenal insufficiency

Question 21

What is a complication of corticosteroids by inhaler? What can be done about it?

Answer 21

fungal/candidiasis infections

prevention by rinsing mouth after inhalation

Question 22

What is the most important nursing action if preop orders do not include a maintenance dosage of corticosteroid meds?

Answer 22

Contact physician immediately

Question 23

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

Answer 23

B

Question 24

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

Answer 24

D

Question 25

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

Answer 25

B

Question 26

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

Answer 26

A

Question 27

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

Answer 27

D