Endocrine: Adrenal Flashcards
Define Anabolic.
Constructive phase of Metabolism. Amino Acids form Proteins, “Muscle”
Define Catabolic.
Destructive phase of Metabolism. Complex substances are broken down into simpler substances, with a release of energy
What are some characteristics of steroids?
anti-inflammatory + vasoconstrictive
What are some examples of steroids?
- Topical steroids = Hydrocortisone
- Inhaled steroids= fluticasone, beclomethasone
- Oral steroids= prednisone
- Natural steroids= testosterone, aldosterone, progesterone, etc.
(-sone)
prob don’t need to know
What are the two types of Catabolic Corticosteroids and some examples of each?
Glucocorticoids:
- dexamethasone
- prednisone
- methylprednisolone
- hydrocortisone
Mineralocorticoids:
- fludrocortisone
What are Corticosteroids (“Cortisol”)?
- Cortisol “stress hormone”
- Increases blood glucose during stress for survival- “fuel for brain”
Periphery metabolic effects of Corticosteroid (“Cortisol”)?
Reduced glucose uptake (antagonizes insulin to ensure more blood glucose for brain, other vital organs) STOPS INSULIN SECRETION
Long-term metabolic effects of Corticosteroid (“Cortisol”)?
CATABOLIC- Decreased muscle mass, thinning of skin, hyperglycemia, moon face and buffalo hump, and osteoporosis!
Inflammation effects of Corticosteroid (“Cortisol”)?
- Reduces gene expression of pro-inflammatory markers (prostaglandins, etc.)
- Reduction in neutrophil infiltration in vasculature, and CLINICALLY you will see a rise in WBC!
Describe Mineralocorticoids (“Aldosterone”).
- Primary mineralocorticoid is aldosterone
- Part of RAAS (Renin-Angiotensin-Aldosterone)
- Regulates plasma volume by SODIUM reabsorption and POTASSIUM excretion in the kidneys
Primary and Secondary causes of Adrenal Insufficiency?
- Primary causes- adrenal glands don’t produce corticoids
- Addison’s Disease
- Secondary causes- Pituitary gland unable to produce ACTH
S/S of Adrenal Insufficiency?
- Hypoglycemia
- Fatigue
- Hypotension
- Anorexia
- N/V/D
- LAB WORK: Low cortisol levels
What are the two categories of Corticosteroids used for?
- Glucocorticoids (mimic cortisol)
- Typically used for INFLAMMATION
- Mineralocorticoids (mimic Aldosterone)
- Typically used for Addisons’ Disease
What are low and high dose Glucocorticoids used to treat?
- LOW dose: adrenal insufficiency (CHRONIC)
- HIGH dose: inflammation (ACUTE)
What are some common uses of Glucocorticoids?
- IBS, Crohn’s
- Asthma, COPD
- Poison Ivy, Atopic Dermatitis
- Adrenal Insufficiency
- Rheumatoid Arthritis
- Leukemia/Lymphomas
What are some routes that Glucocorticoids be administered through?
- Topical
- Oral
- IV
- Inhaled
Corticosteroids adverse effects?
C – Cataracts
U – Ulcers (peptic ulcer disease)
S –Skin thinning/Striae, Salt retention
H – Hypertension, Hirsutism
I – Immunosuppression, Infections
N – Necrosis of femoral heads
G – Glucose elevation/Glaucoma
O – Osteoporosis, Obesity
I – Impaired wound healing
D – Depression/mood changes
What are some long-term therapy risks of Corticosteroids?
- TOPICAL: Patients may develop Topical Steroid Withdrawal Syndrome (TSWS)
- SYSTEMIC: Patient’s Adrenal gland may stop producing Steroids= ADRENAL CRISIS
Corticosteroids nursing considerations?
LONG TERM THERAPY= TAPER OFF (NEVER Stop Suddenly)
- Steroids should always be used for shortest duration possible
- MUST TAPER to prevent adrenal atrophy/crisis
- Never stop suddenly, even if symptoms improve or if patients develop severe adverse effects!
What are some other names for Topical Steroid Withdrawal Syndrome (TSWS)?
- Topical Steroid Addiction
- Red Skin Syndrome (RSS)
Topical Steroid Withdrawal Syndrome (TSWS) S/S?
- Erythema
- burning/itching
Describe Adrenal Crisis.
- OCCURS DUE to lack of corticosteroids in the system
- Can lead to SHOCK (steroids help in Stress + Blood pressure/volume)
- Populations impacted:
- Addison’s Disease
- Patients on long term steroids who suddenly stopped therapy
What does High Dose Systemic Steroids cause?
IMMMUNOSUPPRESSION
1) AVOID other people/crowds who may be SICK
2) NO LIVE VACCINES
Who is immunosuppressed?
- Patients on chemotherapy
- Patients on transplant/immunosuppressant drugs
- Patients who are pregnant
- Patients who are on high dose, systemic steroids
What are some non-systemic routes to administer Corticosteroids and what are they used for?
- Topical creams/lotions= Atopic dermatitis/ skin
- Nasal Spray= season allergies
- Inhaler= Asthma/COPD
How should you administer Systemic (Oral, IV) Corticosteroids?
TIMING:
- Take in mornings (mimic natural endogenous release)
- If multiple times per day, space out appropriately
ADMINISTRATION:
- Take with Food to reduce GI irritation
- If on long term therapy, can encourage diet high in Vit D and Calcium
How should you administer Corticoisteroid inhaler?
- Wash mouth out after usage
- Can use spacer to improve absorption and reduce risk of thrush
What patient populations do we need to monitor carefully when taking Corticosteroids?
- Children
- Diabetes or Pre-Diabetes
- Addison’s Disease
Why do we need to monitor Children taking Corticosteroids?
- May delay growth! (Catabolic in nature)
- Measure weight + height
Why do we need to monitor Diabetes or Pre-Diabetic Patients taking Corticosteroids?
- Steroids will increase glucose levels
- Pre-Diabetic patients may need insulin while on steroids
Why do we need to monitor Patients with Addison’s Disease taking Corticosteroids?
- They are dependent upon exogenous steroids
- Will need doses of steroids prior to stressful events
- Such as SURGERY or ILLNESS
- Giving supplemental doses called “STRESS DOSES” can prevent ADRENAL CRISIS
Corticosteroids drug interactions?
- NSAIDS- can increase GI issues, peptic ulcer disease
- NO GRAPEFRUIT JUICE with methylprednisolone (Random, I know)
- Other drugs that can cause hyperglycemia
- Other drugs that can cause hypokalemia
- NO LIVE VACCINES!
What are Mineralocorticoids (fludrocortisone) used to treat?
- Addison’s Disease
- Orthostatic Hypotension
Fludrocortisone mechanism of action?
Mimic aldosterone (hold onto salt and water)
Fludrocortisone adverse effects?
- Fluid retention
- Hypertension
- HYPOKALEMIA
