Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Chapter 33 Adrenal Agents > Flashcards

Chapter 33 Adrenal Agents Flashcards

1
Q

The adrenal gland is an endocrine organ that is located on top of the kidney and is composed of two distinct parts:

A

(1) the adrenal cortex

(2) the adrenal medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The adrenal medulla secretes two important hormones, both of which are catecholamines.

A

Epinephrine accounts for about 80% of the secretion and norepinephrine accounts for 20%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The adrenal cortex secretes two classes of hormones known as?

A

corticosteroids that arise from the cortex and are made
from steroid cholesterol: (1) glucocorticoids and (2)
mineralocorticoids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The biologic functions of glucocorticoids include?

The biologic functions of mineralocorticoids include?

A

-biologic functions of glucocorticoids include: antiinflammatory actions; maintenance of normal blood pressure; carbohydrate, protein, and fat metabolism; and stress effects
-biologic functions of mineralocorticoids include: sodium and water resorption, blood pressure control, and
maintenance of potassium levels and pH of the blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In humans, the only physiologically important mineralocorticoid is?

A

aldosterone. Its primary role is to maintain normal
levels of sodium in the blood by causing sodium to be
resorbed from the urine back into the blood in exchange for potassium and hydrogen ions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Adrenal corticosteroids are synthesized as needed; the body does not store them as it does other hormones. Body levels are regulated by the?

A

hypothalamic-pituitary-adrenal (HPA) axis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The oversecretion (hypersecretion) of adrenocortical hormones can lead to?

A

Cushing’s syndrome, which results in the redistribution of body fat from the arms and legs to the face, shoulders, trunk, and abdomen, leading to the characteristic “moon face.”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The hypersecretion of aldosterone, or primary aldosteronism, leads to?

A

increased retention of water and sodium, which

causes muscle weakness due to the potassium loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The hyposecretion of adrenocortical hormones causes?

A

Addison’s disease, associated with decreased blood sodium and glucose, increased potassium, dehydration, and weight loss.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

All of the naturally occurring corticosteroids are available as?

A

exogenous drugs. There are also higher-potency synthetic analogues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Corticosteroids can be classified by?

A

-whether they are natural or synthetic
-by method of administration (systemic, topical)
-by their salt and water retention potential (mineralocorticoid activity)
-by duration of action (short, intermediate, or
long acting)
-by some combination
-The only exclusive mineralocorticoid activity is fludrocortisone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The action of corticosteroids is related to their?

A

Involvement in the synthesis of specific proteins

  • there are several steps to this process
  • steroid hormone binds to a receptor on the surface of a target cell to form a steroid-receptor complex, which is then transported through the cytoplasm to the nucleus of that target cell
  • once inside the nucleus, the complex stimulates the cells DNA to produce mRNA, which is then used as a template for synthesis of a specific protein. It is these proteins that exert specific effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most corticosteroids exert effects by?

A

Modifying enzyme activity; their role is more intermediary than direct. Naturally occurring aldosterone affects electrolyte and fluid balance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The glucocorticoid drugs hydrocortisone (cortisol in natural form) and cortisone have some?

A

mineralocorticoid activity and some effects of aldosterone (i.e., fluid and water retention).
-The main effect is the inhibition of inflammatory and
immune responses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The glucocorticoids mechanism of action

A
  • promote catabolism of protein, production of glycogen, and redistribution of fat from peripheral to central areas of the body
  • increase levels of blood sugar and breakdown of proteins to amino acids, inducing lipolysis, stimulating bone demineralization, and stabilizing mast cells
  • inhibit or help control inflammatory response by stabalizing the cell membranes of inflammatory cells (lysosomes)
  • decrease permeability of capillaries to the inflammatory cells
  • decrease migration of WBCs to inflammed areas
  • lower fever by reducing release of interleukin-1 from WBC
  • stimulate erythroid cells
  • promote production of glycogenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Glucocorticoids indications

  • All systemically administered glucocorticoids have similar clinical efficacy but differ in potency and duration of action and the extent to which they cause salt and water retention.
  • Indications include?
A

-adrenocortical deficiency
-adrenogenital syndrome
-bacterial meningitis
-cerebral edema
-collagen diseases (systemic lupus erythematosus)
-dermatologic diseases (exfoliative dermatitis, pemphigus)
-endocrine disorders (thyroiditis)
-gastrointestinal (GI) diseases
-exacerbations of chronic respiratory illnesses such as asthma and chronic obstructive pulmonary
disease
-hematologic disorders
-ophthalmic disorders
-organ transplantation
-leukemias and lymphomas
-nephrotic syndrome
-spinal cord injury
*Glucocorticoids are administered by inhalation for the
control of steroid-responsive bronchospastic states but are not used as rescue inhalers for acute bronchospasm
*Nasally administered glucocorticoids are used to manage rhinitis and to prevent the recurrence of polyps after surgical removal
*Topical steroids are used in the management of inflammation of the eye, ear, and skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Prednisone is the most commonly used?

A

oral drug, followed by dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Methylprednisolone is the most commonly used?

A

injectable glucocorticoid, followed by hydrocortisone and dexamethasone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Contraindications to administration of glucocorticoids include?

A

drug allergy, cataracts, glaucoma, peptic ulcer disease, mental health problems, and diabetes mellitus

  • adrenal drugs may intensify these diseases
  • example: one common AE seen in hospitalized pt’s is an increase in blood glucose levels, often requiring insulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Because of the immunosuppressant properties, glucocorticoids are often avoided with?

A

serious infections, including septicemia, systemic fungal infections, and varicella. One exception is tuberculous meningitis, for which glucocorticoids may be used to prevent inflammatory central nervous system damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Glucocorticoids caution

A

Caution in treating patients with gastritis, reflux disease, ulcer disease, because these drugs could cause gastric perforation
-any patient with cardiac, renal, and/or liver dysfunction because of the associated alterations in elimination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Adverse effects: The potent metabolic, physiologic, and pharmacologic effects of the corticosteroids can influence every body system, so there are a wide variety of significant undesirable effects.

A
  • Moon facies is a very common adverse effect of long-term use
  • Two of the adverse effects most commonly seen in hospitalized patients are hyperglycemia and psychosis.
  • most serious adverse effect of glucocorticoids is adrenal (or HPA) suppression
  • Glucocorticoids should be used with caution in patients with heart failure, due to their ability to cause fluid retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Interactions: Systemically administered corticosteroids can interact with many drugs:

A
  • Non-potassium sparing diuretics can lead to severe hypocalcemia and hypokalemia
  • Aspirin, other NSAIDs, and other ulcerogenic drugs produce additive GI effects and an increased chance for gastric ulcer development
  • Anticholinesterase drugs produce weakness in patients with myasthenia gravis
  • Corticosteroids can inhibit immune response when given in combination with immunizing biologics
  • Corticosteroids can reduce the hypglycemic effects of antidiabetic drugs and result in elevated blood glucose levels
  • thyroid hormones and antifungal drugs can interact with glucocorticoids and can decrease renal clearance of the adrenal drug
  • Barbiturates and hydantoins can increase metabolism of prednisone
  • increased effects from warfarin
  • Oral contraceptives can increase half life of adrenal drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Corticosteroids can be secreted in?

A

Breast milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Corticosteroid contraindications

A

Patients who exhibit hypersensitivity reactions to them in the past as well as in patients with fungal or bacterial infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Short or long term use of corticosteroids can lead to?

A

Steroid psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Corticosteroids can cross the placenta and produce?

A

fetal abnormalities; they are pregnancy category C drugs. They can be secreted in breast milk and cause abnormalities in the infant.

28
Q

Long-term steroid use requires a tapering of the daily dose because the?

A

administration of these drugs causes the endogenous production of the hormones to stop, which is referred to as HPA or adrenal suppression. This suppression can cause an impaired stress response and place the patient at risk of developing hypoadrenal crisis (shock, circulatory collapse) during increased stress (i.e., surgery, trauma). Suppression can occur as early as 1 week after a drug is started.

  • Signs and symptoms of partial or complete adrenal insufficiency or Addison’s disease include fatigue, nausea, vomiting, and hypotension. If left untreated, this condition may lead to an adrenal crisis or a life-threatening state of profound adrenocortical insufficiency.
  • HPA suppression typically does not occur in pt’s taking prednisone 5 mg/day (or equivalent) or less
  • tapering of daily doses allows the HPA axis the time to recover and to start stimulating the normal production of the endogenous hormones
  • pt’s taking long term steroid therapy who are taking at least 10 mg/day of prednisone and who undergo trauma or require surgery will need replacement doses of steroids (stress dose)
29
Q

Corticosteroids must NOT be abruptly stopped

A

.

30
Q

Mineralocorticoid: Fludrocortisone (Florinef)

A
  • used as partial replacement therapy for adrenocortical insufficiency in Addison’s disease and in Tx of salt-losing adrenogenital syndrome
  • contraindicated in cases of systemic fungal infection
  • adverse effects: relate to water retention and include heart failure, HTN, elevated intracerebral pressure (leading to seizures), skin rash, menstrual irregularities, peptic ulcer, hyperglycemia, hypokalemia, muscle pain and weakness, compression bone fractures, glaucoma, and thrombophlebitis
31
Q

Mineralocorticoid: Fludrocortisone (Florinef) interactions

A
  • Barbiturates, hydantoins, refamycins (increased fludrocortisone clearance)
  • estrogens (reduced fludrocortisone clearance)
  • amphotericin B and thiazide and loop diuretics (hypokalemia)
  • anticoagulants (enhanced anticoagulant activity)
  • digoxin (increased risk for dysrhythmias due to fludrocortisone-induced hypokalemia)
  • salicylates (reduced efficiacy)
  • vaccines (increased risk for neurologic complications
32
Q

Fludrocortisone form

A

Available only in oral form as a 0.1 mg tablet

-this means the AEs and serious drug interactions secondary to fludrocortisone therapy are uncommon

33
Q

Glucocorticoid: Prednisone (Deltasone)

A
  • one of four intermediate-acting glucocorticoids
  • half lives that are more than double those of the short acting corticosteroids (2-5 hours); therefore have longer durations of actions
  • most commonly used oral glucocorticoid for antiinflammatory or immunosuppressant purposes
  • used to Tx exacerbations of chronic respiratory illnesses along with methylprednisolone
  • has minimal mineralocorticoid properties therefore alone is inadequate for management of adrenocortical insufficiency (Addison’s disease)
  • Prednisolone, a prednisone metabolite, is also the liquid drug form of prednisone. Prednisone comes in solid form
  • pregnancy C
34
Q

Glucocorticoid: Methylprednisolone (Solu-Medrol)

A
  • Injectable glucocorticoid
  • used as an antiinflammatory or immunosuppressant drug
  • given IV
  • available in a long-acting (depot) formulation as well
  • pregnancy C
  • most injectable formations contain a preservative (benzyl alcohol) that cannot be given to children younger than 28 days of age
35
Q

Be careful about sound-alike, look-alike drugs. Solu-Cortef is a trade name for hydrocortisone; Solu-Medrol is a trade name for methylprednisolone. Both are commonly used glucocorticoids and are given intravenously. However?

A

4 mg of Solu-Medrol is equivalent to 20 mg of Solu-Cortef; therefore, Solu-Medrol is five times stronger than Solu-Cortef. Despite the similar names, these drugs are not interchangeable.

36
Q

Nursing Assessment

A

1) determine baseline nutritional, hydration, and immune statuses; document baseline weight, intake and output, vital signs (especially blood pressure ranges), and skin condition (noting bruising, fragility, turgor, and color)
2) baseline lab values include: serum sodium, serum potassium, serum glucose (serum potassium levels usually decrease and serum glucose levels increase when glucocorticoid is given)
3) Assess muscle strength/body stature

37
Q

Nursing assessment for adrenal drugs

A

1) lifespan considerations include concern about their use during pregnancy and lactation
2) Growth suppression may occur in children who are receiving long-term adrenal drug therapy (e.g., glucocorticoids) if the epiphyseal plates of the long bones have not closed. Perform and document baseline height and weight measurements in pediatric patients
3) Elderly patients are more prone to adrenal suppression with prolonged adrenal therapy, so they may require dosage alterations by the prescriber to minimize the impact of the drug on muscle mass, blood pressure, and serum glucose and electrolyte levels
4) Adrenal drugs may exacerbate muscle weakness; produce fatigue; worsen or precipitate osteoporosis, peptic ulcer disease, glaucoma, and cataracts; and increase intraocular pressure. Closely assess patients with edema and cardiac disease for exacerbation of these conditions because adrenal drugs are associated with AEs of sodium retention

38
Q

Patients taking adrenal drugs may receive them by various routes, such as?

A

orally, intramuscularly, intravenously, intranasally, intraarticularly, and by inhalation.

39
Q

Points to remember when giving glucocorticoids

A

1) Hormone production by the adrenal gland is influenced by time of day and follows a diurnal pattern with peak levels occurring early in the morning between 6 and 8 a.m., a decrease during the day, and a lower peak in the late afternoon between 4 and 6 p.m. The best time to give exogenous glucocorticoids, if at all possible, is early in the morning (6 a.m. to 9 a.m.), because this leads to the least amount of adrenal suppression
2) Cortisol levels increase in response to both emotional and physiologic stress and also when endogenous levels decrease due to a physiologic negative feedback system.
3) When exogenous glucocorticoids are given, endogenous levels decrease; for endogenous production to resume, exogenous levels must be decreased gradually so that hormone output responds to the negative feedback system
4) Best time to give exogenous glucocorticoids is early in the morning (6-9am) to minimize the amount of adrenal suppression
- patient must not alter dosing or abruptly discontinue medication

40
Q

In long-term therapy, alternate-day dosing of glucocorticoids will help minimize?

A

suppression

41
Q

Emphasize to patients the importance of avoiding what to minimize gastric irritation and possible gastric bleeding from the compounding ulcerogenic effects.

A

alcohol and caffeine, as well as aspirin and other nonsteroidal anti-inflammatory drugs

42
Q

Prednisone, a synthetic glucocorticoid, and fludrocortisone, a synthetic mineralocorticoid, are given orally. It is recommended that oral dosage forms be given?

A

with milk and/or food to help minimize GI upset
-an order for an H2 receptor antagonist or a proton pump inhibitor may be prescribed to minimize GI upset and to minimize ulcer formation because these drugs are ulcerogenic

43
Q

Because of the immunosuppression with these drugs, monitor patients for?

A

Flulike symptoms, sore throat, and fever

-if incision or wound is present, assess affected area for redness, edema, drainage, and approximation

44
Q

Methylprednisolone, a systemic corticosteroid, is given IV. Mix all parenteral forms per?

A

Manufacturer guidelines, with IV doses administered over the recommended time period and in the proper diluent

45
Q

Long-term or frequent glucocorticoid use produces?

A

increased levels of glucocorticoids, which can lead to Cushing’s syndrome. Abrupt withdrawal of glucocorticoids leads to adrenal insufficiency and negative effects on the patient’s homeostasis.

46
Q

Signs and symptoms of partial or complete adrenal insufficiency or Addison’s disease include?

A

Fatigue, N/V, hypotension

  • if left untreated this condition may lead to an adrenal crisis or a life-threatening state of profound adrenocortical insufficiency requiring immediate medical management
  • s/s: drop in extracellular fluid volume, hyponatremia, hyperkalemia (addisonian crisis)
47
Q

Other adrenal drug dosage forms include those for intraarticular, intrabursal, intradermal, intralesional, and intrasynovial administration. Overuse of intraarticular injections must be avoided, and if a joint is injected with medication, the patients needs to?

A

Rest that area for up to 48 hours after the injection is given. Application of cold packs over injected area may be indicated for up to the first 24 hours to help minimize the discomfort associated with intraarticular injections

48
Q

For dermatologic use, clean and dry the skin before application. Wear gloves, and apply the medication with either a sterile tongue depressor or a cotton-tipped applicator. Use sterile technique if skin is not intact

A

.

49
Q

If patient is receiving long-term maintenance glucocorticoid therapy and requires surgery, recognize the importance of?

A

Reviewing the patient’s medical records for lab values, cautions, contraindications, and drug interactions

  • if preoperative orders do not include maintenance dosage of glucocorticoid therapy, contact the surgeon and/or other prescriber and ensure that they are aware of the situation and the possible need for a rapid-acting corticosteroid
  • after surgery, the dosage of steroid may be increased, with a gradual decrease in dosage over several days until pt returns to baseline
  • be aware of decrease in wound healing in pt’s taking these drugs on long term basis
50
Q

Because of their suppressed immune systems, patients taking corticosteroids need to avoid?

A

Contact with people with known infections and report any fever, increased weakness and lethargy, or sore throat
-Monitoring nutritional status, weight, fluid volume, electrolyte status, skin turgor, and glucose levels during therapy is very important to ensure safe and effective therapy
-The prescriber should be notified if there is any edema,
shortness of breath (possible heart failure), joint pain, fever, mood swings, or other unusual symptoms.

51
Q

A therapeutic response to glucocorticoids includes a resolution of the?

A

underlying manifestations of the disease or pathology, such as a decrease in inflammation, increased feeling of well-being, less pain and discomfort in the joints, decrease in lymphocytes, or other improvement in the condition for which the medication was ordered.

52
Q

Adverse effects include?

A

weight gain; increased blood pressure; sodium increase and potassium loss; mental status changes such as mood swings, psychic impairment, and nervousness; abdominal distention; ulcer-related symptoms; and changes in vision.

53
Q

Cushing’s syndrome occurs with prolonged or frequent use of glucocorticoids and is characterized by?

A

moon face, obesity of the trunk area (belly fat), increase in blood glucose and sodium levels, loss of serum potassium, wasting of muscle mass, and buffalo hump.

54
Q

Cataract formation and osteoporosis may also occur with?

A

long-term use

55
Q

Rapid drops in cortisol levels (e.g., from abrupt withdrawal of medication) may lead to?

A

Addison’s disease and addisonian crisis

56
Q

With any of the adrenal drugs, weight gain of 2 pounds or
more in 24 hours or 5 pounds or more in 1 week needs to
be reported to the prescriber immediately.

A

.

57
Q

Glucocorticoids are to be taken how?

A

Exactly as ordered and NEVER abruptly discontinued. Contact prescriber if there are situations that prevent proper dosing

58
Q

Abrupt withdrawal of adrenal drugs may precipitate?

A

Adrenal crisis or Addison’s disease and/or addisonian crisis

59
Q

If a once a day dose of glucocorticoids is missed, the patient needs to?

A

Take the dose as soon as possible after remembering that the dose was missed
-if they do not remember until close to time for next dose, then usually instructed to skip dose and resume dosing on the next day WITHOUT doubling up

60
Q

Educate patient about the adverse effects of long term therapy, such as changes in?

A

Body appearance including: acne, buffalo hump, obesity of trunk, moon face, thinning of extremeties

61
Q

With glucocorticoid therapy, emphasize the importance of bone health and ways to prevent falls due to the possibility of?

A

Osteoporosis with long-term use.

62
Q

Food high in vitamin D include?

A

Cod liver oil and salmon

63
Q

Foods high in calcium include?

A

milk, cheese, yogurt, and ice cream

-fortified dairy products are high in both vitamin D and calcium

64
Q

Contact prescriber if any s/s of acute adrenal insufficiency appear, such as?

A

Decreased serum sodium and glucose levels, increased potassium levels, dehydration, weight loss

65
Q

Fludrocortisone, a mineralocorticoid, is better taken with?

A

Food or milk to minimize GI upset

66
Q

Emphasize the importance of follow-up appointments with the prescriber so that?

A

Electrolyte levels and adverse effects may be monitored

-also stress the importance of maintaining a low-sodium and high-potassium diet

Pharmacology (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions