drug therapy for addison's and cushing's disease Flashcards
describe the adrenal glands
- located on top of each kidney
- 2 layers: adrenal cortex and adrenal medulla
- adrenal cortex makes 3 coricosteroids and is controlled by hypothalamus (CRH -> ACTH)
- adrenal medulla is part of the SNS (fight or flight)
what 3 corticosteroids are made by the adrenal cortex
- glucocorticoids (immune response)
- mineralcorticoids (water and electrolyte balance)
- androgens (male/female resproductive)
describe addison’s disease
lack of adrenacortical hormones possibly from:
- lack of ACTH
- lack of response of adrenal glands
- damage or removal of adrenal glands
- prolonged use of corticosteroids
what are some signs and symptoms of addison’s disease
- bronze pigmentation of skin
- changes in body hair distribution
- GI upset
- weakness
- hypoglycemia
- postural hypotension
- weight loss
describe adrenal crisis
why, what happens, and what do you do
adrenal insufficiency + extreme stress = adrenal crisis
- body is unable to support SNS response
- effects include hypotension, exhaustion, shock, death
- treatment: massive steroid infusion
what is cushing’s disease
excess adrenocortical hormones that can possibly be related to:
- excessive corticotropin
- usually caused by tumor
what are some signs and symptoms of cushing’s disease
- risk for infection
- personality changes
- moon face
- hyperglycemia
- Na and fluid retention
- gi distress
- thin skin
- easy bruising
whats the treatment for addison’s disease
- replace glucocorticoids
- repce mineralocorticoids
- lifetime replacement necessary
- increase dose in times of stress
whats the treatment for cushing’s disease
- usually surgical treatment
- meds in preparation or surgery contraindicated
- inhibit cortisol synthesis
describe the action of hydrocortisone
combo mineralocorticoid and glucocorticoid, decreases inflammatory response, increases retention of Na
what is hydrocortisone used for
acute and chronic adrenl infucciciency
addison’s
what are some adverse effects of hydrocortisone
- cardiac: HTN, MI
- CNS: dizziness, vertigo, HA
- derm: thin skin, easy bruising
- GI: upset and weight gain
- fluid balance: fluid retention
- metabolic: hyperglycemia
black box warning to avoid live vaccines
what are some nursing considerations for hydrocortisone
- give with food
- give before 0900
- monitor vitals
- monitor fluid volume status
- monitor glucose
describe patient education for hydrocortisone
- take before 0900
- space doses evenly throughout the day
- do not stop abruptly
- increase dose in times of stress
- increase Ca+ diet if long term
- monitor blood glucose
- report s/sx of cushings disease
describe the action of fludrocortisone
strong mineralocorticoid action, Na retention and K excretion (increased BP)
what is fludrocortisone used for
additional mineralocorticoid supplement in Addison’s disease
what are some adverse effects of fludrocortisone
- fluid retention, HTN, HF
- growth suppression
- hyperglycemia
- hypokalemia
what is a contraindication of fludrocortisone
uncontrolled HTN
what are some nursing considerations for fludrocortisone
- many drug to drug interactions
- take along with glucocorticoid
- monitor Na and K levels
- monitor weight
- monitor vitals (BP)
describe patient education for fludrocortisone
- high K diet (bananas, OJ, potatoes)
- low Na diet
- monitor weight, call for 5lb gain
- follow up labs
- report swelling or SOB to MD
describe the action of ketoconazole
inhibits cortisol synthesis
what is ketoconazole used for
treat cushing’s disease
what are some adverse effects of ketoconazole
- itching
- GI upset
- black box warning for liver toxicity
whats a contraindication of ketoconazole
liver failure
what are some nursing considerations for ketoconazole
- give with acidic liquid (OJ, coffee)
- give with food
- monitor liver function
describe patient education for ketoconazole
- take with acidic liquid (OJ, coffee)
- take with food
- reports s/sx liver failure to MD
a man is diagnosed with cushing’s disease. he has an excess of which of the following hormones?
1) luteinizing
2) glucose
3) insulin
4) cortiotropin
4) corticotropin
cushings disease is an excess of adrenal hormones
a patient is taking fludrocortison for adrenal insufficiency. which of the following symptoms indicate the patient is hypokalemic?
1) tetany
2) hypotension
3) heart arrythmias
4) confusion
3) heart arrhythmias
signs and symptoms of hypokalemia include: heart arrythmias, muscle weakness, constipation, and muscle cramps
