Chap 33 Adrenal Drugs Flashcards
Adrenal Gland**
Adrenal medulla** secretes catecholamines.
Epinephrine*
Norepinephrine*
Adrenal cortex secretescorticosteroids.
Glucocorticoids*
Mineralocorticoids (primarily aldosterone)
Glucocorticoids
adrenocorticotropic hormone
betamethasone
cortisone
dexamethasone
hydrocortisone
methylprednisolone
prednisolone
triamcinolone
Mineralocorticoids
aldosterone
desoxycorticosterone
Fludrocortisone
Catecholamines
Epinephrine, norepinephrine
Adrenal steroid inhibitor
Aminoglutethimide
Glucocorticoid Mechanism of Action
Most corticosteroids exert their effects by** modifying enzyme activity.
Glucocorticoids differ in their potency, duration of action, and the extent to which they cause salt and fluid retention.
Glucocorticoids* inhibit or help control inflammatory** and immune responses.
Glucorticoid Indications**
Adrenocortical deficiency*
Adrenogenital syndrome
Bacterial meningitis
Cerebral edema
Collagen diseases (e.g., systemic lupus erythematosus)
Dermatologic diseases (e.g., exfoliative dermatitis, pemphigus)
Endocrine disorders (thyroiditis)
Gastrointestinal (GI) diseases (e.g., ulcerative colitis, regional enteritis)
Exacerbations of chronic respiratory illnesses** such as asthma and chronic obstructive pulmonary disease
Hematologic disorders (reduce bleeding tendencies)
Ophthalmic disorders **(e.g., nonpyogenic inflammations)
Organ transplantation (decrease immune response to prevent organ rejection)
Leukemias and lymphomas (palliative management)
Nephrotic syndrome (remission of proteinuria)
Spinal cord injury
Glucocorticoid Contraindications
Drug allergies
Serious infections, including septicemia, systemic fungal infections, and varicella
However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory central nervous system (CNS) damage.
Cautious * use in patients with:
Gastritis, reflux disease, ulcer disease
Diabetes**
Cardiac, renal, or liver dysfunction
Glucocorticoid Adverse Effects
Potent effects on all body systems
Cardiovascular: heart failure, cardiac edema, hypertension—all caused by electrolyte imbalances (hypokalemia, hypernatremia)
CNS: convulsions, headache, vertigo, mood swings, nervousness, insomnia
Endocrine: growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, hypothalamic–pituitary–adrenal axis suppression
GI: peptic ulcers, pancreatitis, ulcerative esophagitis, abdominal distension
Integumentary: fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria
Musculoskeletal: muscle weakness, loss of muscle mass, osteoporosis
Ocular: increased intraocular pressure, glaucoma, cataracts
Other: weight gain
Corticosteroids used include: “MAGIC PAUL”
Multiple Sclerosis
Asthma/Allergic rhinitis and hay fever
Giant cell arteritis and polymyalgia rheumatica
Inflammatory bowel disease IBD including crohns and ulc colitis
Chronic Obstructive pulmonary disease
Painful & inflamed joints, muscles and tendons
Atopic eczema
Urticaria(hives)
Lupus
Side effects of corticosteroid
Cushing syndrome
Osteoporosis
Reduced growth
thin skin
immunosuppression
Cataracts
Oedema
Suppressed HPA axis
Teratogenic
Emotional disturbances
Rise in blood pressure
Obesity
Increased hair grow
Diabetes
Common side effects of prednisone**
Increased appetite*
Indigestion*
Nervousness or restless ness*
Methylprednisolone (Solu-Medrol)
Most commonly used injectable glucocorticoid drug
Primary use: antiinflammatory or immunosuppressant drug**
Usually administered intravenously
Available in a long-acting (depot) formulation
Most injectable formulations contain a preservative (benzyl alcohol) that cannot be given to children younger than 28 days of age.
Fludrocortisone (Florinef)**
Mineralocorticoid
Indications: Addison’s** disease and treatment of salt-losing adrenogenital syndrome
Adverse effects:**
Generally, relate to water retention**
Heart failure, hypertension, and elevated intracerebral pressure
Skin rash, peptic ulcers, hyperglycemia, hypokalemia
Muscle pain, weakness, compression bone fractures
Nursing Implications**
Perform a physical assessment to determine baseline *weight, height, intake and output status**, vital signs (especially blood pressure), hydration status, and immune status.
Obtain baseline laboratory studies.
Assess for edema and electrolyte imbalances.
Assess for contraindications to adrenal drugs, especially the presence of peptic ulcer disease.
Assess for drug allergies and potential drug interactions (prescription and over-the-counter drugs).
Be aware that these drugs may alter serum glucose and electrolyte levels.
After using an orally inhaled corticosteroid, instruct patients to rinse their mouths to prevent possible oral fungal infections.**
Teach patients taking corticosteroids to *avoid contact with people** with infections and to report any fever, increased weakness, lethargy, or sore throat.
Patients should be taught to take all adrenal medications at the same time every day, usually in the morning**, with meals or food.
Sudden discontinuation** of these drugs can precipitate an adrenal crisis **caused by a sudden drop in serum levels of cortisone.
Doses are usually tapered** before the drug is discontinued.
The 5’s side effects of steroids
SIck - easier to get sick
Sad - causes depression
Sex- decreased libido
Salt - retains more, cause weight gain
Sugar - raise blood sugar
