Chapter 33: Adrenal Drugs

Question 1

The adrenal gland

Answer 1

Located on top of the kidney

Consists of: cortex (outer portion) and medulla (inner portion)

Each portion has different functions and secretes different hormones

Utilizes the negative feedback process of hormone regulation

Question 2

Adrenal medulla

Answer 2

Secretes catecholamines: epinephrine and norepinephrine

Question 3

Adrenal cortex

Answer 3

Secretes corticosteroids: glucocorticoids and mineralcorticoids (primarily aldosterone)

Aldosterone is a mineralocorticoid produced by the adrenal cortex that acts on the renal tubule, regulating sodium and potassium levels. This hormone would not be effective in a patient with renal failure

Question 4

Oversecretion of adrenocortical hormones

Answer 4

Leads to Cushing’s syndrome

S/S: moon face, hump back, hirsutism, ecchymosis, hypertension, hypokalemia, hypernatremia, abnormal glucose tolerance, and muscle atrophy

Question 5

Undersecretion of adrenocortical hormones

Answer 5

Leads to Addison’s disease

S/S: decreases blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss

Question 6

Adrenal Drugs

Answer 6

Can be synthetic or natural

Glucocorticoids: topical, systemic, inhaled, nasal

Mineralocorticoid: systemic

Adrenal steroid inhibitors: systemic

Question 7

Glucocorticoid Examples

Answer 7

Adrenocoticotropic hormone
Betamethasone 
Cortisone
Dexamethasone 
Hydrocortisone 
Methylprednisolone 
Prednisolone 
Triamcinolone

Question 8

Mineralocorticoid Examples

Answer 8

Aldosterone
Desoxycorticosterone
Fludrocortisone

Question 9

Adrenal Steroid Inhibitor Example

Answer 9

Aminoglutethimide

Question 10

Corticosteroids Mechanism of Action

Answer 10

Related to the involvement in the synthesis of certain proteins

Most exert their effects by modifying enzyme activity

Glucocorticoids inhibit/ help control inflammatory and immune responses

Question 11

Corticosteroids indications

Answer 11

Adrenocortical deficiency
Adrenogenital syndrome
Bacterial meningitis
Cerebral edema
Collagen diseases (e.g., SLE)
Dermatological diseases (e.g., exfoliative dermatitis, pemphigus)
Endocrine disorders (thyroiditis)
GI diseases (e.g., ulcerative colitis, regional enteritis)
Exacerbations of chronic resp. illnesses like asthma & COPD
Hematologic disorders (reduce bleed tendency)
Ophthalmic disorders (e.g., nonpyogenic inflammation)
Organ transplant (decrease immune response to prevent rejection)
Leukemias & lymphomas (palliative management)
Nephrotic syndrome (remission of proteinuria)
Spinal cord injury

Question 12

Glucocorticoids Administration

Answer 12

By inhalation for control of steroid responsive bronchospastic states

Nasally for rhinitis & to prevent the recurrence of polyps after surgical removal

Topically for inflammation of the eye, ear, and skin

Question 13

Corticosteroids Contraindications

Answer 13

Drug allergy

Serious infections, including septicemia, systemic fungal infections, and varicella

However, in the presence of TB meningitis, glucocorticoids may be used to prevent inflammatory CNS damage

Question 14

Use Corticosteroids with Caution in Patients With:

Answer 14

Gastritis, reflux disease, ulcer disease

Diabetes

Cardiac, renal, or liver dysfunction

Question 15

Corticosteroids adverse effects

Answer 15

Hypokalemia

Hypernatremia

Mood swings/ nervousness

Cushing’s syndrome

Fatigue

Hyperglycemia

Peptic ulcers

Poor wound healing

Osteoporosis

Weight gain

Question 16

Corticosteroids interactions

Answer 16

Non-K soaring diuretics can lead to severe hypocalcemia and hypokalemia

NSAIDs and other ulcerogenic drugs can increase the risk for a gastric ulcer to develop

Antidiabetic drugs can result in elevated blood glucose levels

Question 17

Corticosteroids

Answer 17

Systemic corticosteroids consist of 13 chemically different but pharmacologically similar drugs= don’t switch manufacturers

Pregnancy category C

Do NOT stop abruptly= can lead to adrenal suppression

Question 18

Fludrocortisone (Florinef)

Answer 18

A mineralocorticoid indicates for Addison’s disease and Tx of salt-losing adrenogenital syndrome

Adverse effects: (relate to water retention) HF, HTN, increased intracerebral pressure; skin rash, peptic ulcers, hyperglycemia, hypokalemia; muscle pain, weakness, compression bone fractures

Question 21

Prednisone

Answer 21

Most common oral glucocorticoid for anti inflammatory or immunosuppressant purposes

Also used to treat exacerbations of chronic resp. Illnesses

Inadequate for management of adrenocortical insufficiency (Addisons disease)

Question 22

Methylprednisolone (Solu-Medrol)

Answer 22

Most common injectable glucocorticoid used for anti inflammatory or immunosuppressive purposes

Usually administered IV

Available in a long acting (depot) formulation

Most injectable forms contain a preservative (benzl alcohol) that cannot be given to children younger than 28 days of age

Question 23

NRSG Implications: what to assess

Answer 23

Perform a physical to determine weight, height, I&O, VS (esp, BP), hydration status, nutritional status, and immune status

Obtain baseline labs

Edema and electrolyte imbalances and skin conditions

Contraindications esp. PUD

Be aware that these drugs may alter serum glucose and electrolyte levels

Sudden D/C of these can precipitate an adrenal crisis caused by a sudden drop in serum levels of cortisone (doses are usually tapered)

Question 24

NRSG Implications: teachings

Answer 24

Systemic forms: oral, IM, IV, or rectal (NOT SQ)

Oral should be given with food or milk to decrease GI upset

Take all adrenal meds at the same time Q day (usually in the morning)

Do not take with alcohol or NSAIDs

Clear nasal passages before using nasal corticosteroid

After orally inhaled corticosteroid use, rinse mouth with lukewarm water to prevent possible oral fungal infections

Avoid contact with people with infections & report fever, increased weakness, lethargy, or sore throat