Drugs Affecting the Endocrine Sys Flashcards
Glucocorticoid or mineralocorticoid action or both
Synthetics mimic corticosteroids
Glucocorticoid (cortisol):
Mineralocorticoid (aldosterone):
Can have actions that mimic both cortisol and aldosterone - where all AE come from
Steroids vast - gluco and mineralcorticoid action varies; DoA, routes varies; equivalent doses vary so steroid’s potency varies sig
Lot steroids that have diff variations and potencies
Used to treat a variety of inflammatory diseases
Used to treat adrenal disorders
Severity of adverse effects varies by duration and route
Corticosteroids
Inhibits inflammatory response/immune response - when provider prescribes corticosteroids most time for inflammatory disorder - trying to treat inflammatory disorder - give pat synthetic corticosteroids can help decrease inflammation associated with disoder; MOA!
Promotes breakdown of proteins; redistribution of fat - AE
Increases bone resorption - AE; resorption is breakdown of bone
Decreases insulin secretion, promotes production of glycogen in liver; results in increases blood glucose - AE; may not be ideal for pats
Glucocorticoid (cortisol):
Reabsorption of sodium (major action) and excretion of potassium in renal tubules
Regulates/plays role in blood volume
Mineralocorticoid (aldosterone):
Chronic lung disease (inhaled - LR drugs): asthma, COPD
Acute lung diseases (oral, IV, inhaled): COPD exacerbation, ARDS
Allergic disorders (nasal - intra/not): rhinitis
Dermatitis (topical - lotion/cream): poison ivy
Joint inflammation (injection - target inflammation in joint): osteoarthritis
Used to treat a variety of inflammatory diseases
Addison’s disease
Used to treat adrenal disorders
Inhaled, nasal, and topical corticosteroids typically have local adverse effects
Oral and IV corticosteroids have systemic effects
Systemic effects seen when taken orally or IV
Severity of adverse effects varies by duration and route
Topical steroid cream to treat skin inflammation: like poison ivy
Decrease local inflammation
MoA: - Topical corticosteroid: Prototype: hydrocortisone
Inflammatory and pruritic skin conditions
Indication: - Topical corticosteroid: Prototype: hydrocortisone
hypersensitivity
Contraindication: - Topical corticosteroid: Prototype: hydrocortisone
contact dermatitis, burning sensations, dryness, skin fragility/thinning, hypopigmentation (lighter color/white), opportunistic infections (working to decrease IR and immune response locally happen is decreases effectiveness of norm flora present on skin that keeps infections at bay and if used for long time and allows secondary infection to form)
AE: - Topical corticosteroid: Prototype: hydrocortisone
if not used according to directions and used for much longer period AE can happen
OTC - Topical corticosteroid: Prototype: hydrocortisone
Use gloves to apply and wash hands; teach – AE more likely with long-term or overuse; low-risk systemic effects; available OTC and prescription; should be used for short term; long term affects can happen locally if cont for long time: skin fragility/thinning, hypopigmentation (lighter color/white), opportunistic infections
Nursing: - Topical corticosteroid: Prototype: hydrocortisone
Are Prescription potencies available
come in ointments –> gels –> creams –> lotions (comes in variety of mediums)
Diff Potency: - Topical corticosteroid: Prototype: hydrocortisone
Inflammatory and allergic disorders
Indication: - Systemic corticosteroids: Prototype: prednisone
Acute infection (immunosuppresion, inhibits IR and potentially makes infection harder to treat), diabetes mellitus (increases BG - makes BG higher and may make it harder to treat), acute peptic ulcers (all GI irritation and probs; intense GI irritation intensify probs), CHF (edema and excess fluid volume with Na reabsorption and extra volume overall), older adult
Contraindications: - Systemic corticosteroids: Prototype: prednisone
gastric irritation - very hard on stomach - irritating (can lead to ulcers, severe cases may have perforation), immunosuppression (part action of cortisol is suppressing immune sys - increase risk for other infections), edema [aldosterone: Na reabsorption and water follows so pat retains more Na and water leading to edema, hypertension and weight gain], insomnia (can occur frequently so imp admin corticosteroids as early in day as possible; release much more cortisol in morning - highest levels in mornings; smaller peak in afternoon but not lot released at night; try give in morning if possible), appetite increase (contributer to weight gain), masks s/s of infection (suppressing IR that is a huge part how body tells infected via IR and by drugs suppressing that response, infections not as apparrent), steroid psychosis (personality changes: moody; severe: confused, seeing things that not there); if other interventions done to treat AE that are occurring; taking corticosteroids for 4-6 weeks; can happen in pats taking for long-term
AE short term: - Systemic corticosteroids: Prototype: prednisone
Cushing’s syndrome; hypernatremia (excess aldosterone), hypokalemia; growth suppression (children - need be monitored more closely for adequate growth); adrenal suppression (giving corticosteroids in most circumstances not replacing cortisol that are missing; giving them excess cortisol to try to reduce inflammation - not that adrenal gland not making cortisol but giving excess but when giving excess exogenously and on for long-term, adrenal glands take note and realize excess cortisol in bloodstream and adrenal glands slow down production of cortisol and senses enough in bloodstream because elevated above normal so over long term adrenal glands make less cortisol over long-term; if on corticosteroids high-dose or for long term must taper off - slowly decrease doses overtime and if do not go into adrenal crisis - like severe Addison’s disease in acute manner; taper off as dose so adrenal glands make more and more to catch off so by time taken off med adrenal glands caught up with producing cortisol levels); taking for 6months-years
AE Long term: - Systemic corticosteroids: Prototype: prednisone
Gastric irritation and GI ulcers (take med with food; medications to reduce acid production; antacid); HTN (anti-hypertensive); Hyperglycemia (insulin/other antidiabetic med; start checking BG levels to see where running even if not on meds); Infection (treat as appropiate; monitor s/s of it as a nurse)
Nursing: - Systemic corticosteroids: Prototype: prednisone
One most common oral corticosteroid prescribed
Vast and see lot in-pats taking this
used for Anti-inflammatory and/or immunosuppressive effects - long-term for pats with COPD and severe bronchitis - and on inhalers and so severe not control symp and frequent exacerbations put on oral corticosteroids to decrease inflammation; may also be used on pats with cancer
MoA: - Systemic corticosteroids: Prototype: prednisone
Lot from action’s of cortisol - get fat pads
Weight gain/redistribution of fat
Hyperglycemia - increases BG; induce T2DM that taking corticosteroids over long term and need to treat that with antidiabetic meds because BG constantly elevated
Osteoporosis - breaking down bone one actions cortisol so have more brittle bones if taking for long term so at higher risk for fractures
Hypertension - aldosterone and it regulates blood volume and BP which leads to HTN over long period of time
Muscle atrophy (arms/legs)
Bruise easily/purpura
Skin thins/poor wound healing - suppressing IR and immune response so not heal as well from wounds as have been
Cushing’s syndrome
