Exam 1 Flashcards
Fludrocortisone
affects fluid and electrolytes, causes sodium and water retention, treats adrenal insufficiency and Addison’s disease, aims to help control BP and restore fluid and electrolyte balance
adverse affects: sodium accumulation, potassium depletion
the only drug that has true mineralocorticoid effects.
Fludrocortisone is used in combination with glucocorticoids to replace
mineralocorticoid activity in patients who suffer from adrenocortical insufficiency (Addison disease) and to treat salt-losing adrenogenital syndrome.
The primary therapeutic outcomes expected from fludrocortisone therapy are
control of bp
and
restoration of fluid and electrolyte balance
Premedication assessments for fludrocortisone include
indications of electrolyte imbalance
acurate I/O and vitals
signs of infection
baseline assessment for alertness, oriented
ask about previous heartburn, ulcer, or stomach pain
regularly test stools for blood occult
fludrocortisone dosage
PO 0.1 mg daily
Cortisone or hydrocortisone are also usually administered with fludrocortisone to
provide additional glucocorticoid effect
Fludrocortisone produces marked ______ retention and ________ depletion, which could lead to high blood pressure
sodium and water retention
and
potassium depletion
The major glucocorticoid of the adrenal cortex is
cortisol
Glucocorticoids
Antiinflammatory, antiallergenic, immunosuppression
used for certain cancers, organ transplant, autoimmune diseases, allergies, shock
Common and serious adverse effects: Electrolyte imbalance, fluid accumulation; susceptibility to infection; behavioral changes for those with a history of mental illness; hyperglycemia; peptic ulcer formation; delayed wound healing; visual disturbances; osteoporosis in the long term
Corticosteroids can mask symptoms of
infection, this means that the typical symptoms of an infection (fever for example) may not be seen
When glucocorticoids are used to control rheumatoid arthritis, symptom relief is noted within
a few days
Glucocorticoids are also effective for immunosuppression in the treatment of
certain cancers, organ transplantation, and autoimmune diseases (e.g., lupus erythematosus, dermatomyositis, rheumatoid arthritis); relief of allergic manifestations (e.g., serum sickness, severe hay fever, status asthmaticus); and treatment of shock. They also may be used to treat nausea and vomiting secondary to chemotherapy.
The primary therapeutic outcomes expected from glucocorticoid therapy are
- Reduced pain and inflammation
- Minimized shock syndrome and faster recovery
- Reduced nausea and vomiting associated with chemotherapy
Glucocorticoids are effective in the treatment of certain cancers because of their
immunosuppressive properties.
Corticotropin-releasing factor stimulates the release of ____________ from the pituitary gland.
adrenocorticotropic hormone
Adrenocorticotropic hormone stimulates the adrenal cortex to secrete ________.
cortisol
As serum levels of cortisol increase, the amount of corticotropin-releasing factor secreted by the hypothalamus is __________.
decreased
Abrupt discontinuation of glucocorticoids may result in ____________ if higher dosages are being received.
adrenal insufficiency
Corticosteroid therapy should be withdrawn _______
gradually (steroid taper)
- Patients who have received corticosteroids for at least 3 weeks must not abruptly discontinue therapy.
The time required to decrease glucocorticoids depends on the
o Duration of treatment
o Dosage amount
o Mode of administration
o Glucocorticoid being used
Symptoms of abrupt discontinuation of corticosteroids include:
Fever
Malaise
Fatigue
Weakness
Anorexia
Nausea
Orthostatic hypotension
Dizziness
Fainting
Dyspnea
Hypoglycemia
Muscle and joint pain
Possible exacerbation of the disease process
Common and serious adverse effects of glucocorticoids therapy are
fluid and electrolyte disturbances
susceptibility to infection
behavioral changes
hyperglycemia
peptic ulcer formation
delayed wound healing
visual disturbances (cataracts)
osteoporosis
drug interactions associated with glucocorticoids
diuretics (furosemide, bumetanide, thiazides)
warfarin (may alter anticoagulant effects)
oral hypoglycemic agents (may cause hyperglycemia)
rifampin (may enhance metabolism of corticosteroids, reducing therapeutic effect)
Synthetic glucocorticoids, also commonly known as _____________, are medications that can be used in clients with decreased adrenal function, such as in adrenal insufficiency; this is also known as Addison disease, and specifically occurs when the adrenal glands don’t make enough endogenous glucocorticoids, so these clients need hormone replacement therapy with synthetic glucocorticoids.
corticosteroids
__________ and ___________ are endogenous hormones normally produced by the adrenal glands. In clients with impaired adrenal function, these hormones can be administered as replacement therapy.
Glucocorticoids and mineralocorticoids
glucocorticoids are used in the treatment of numerous inflammatory conditions, such as
asthma, rheumatoid arthritis, and inflammatory bowel disease, as well as preventing organ rejection in transplant recipients
short-acting glucocorticoids
cortisone and hydrocortisone
intermediate-acting glucocorticoids
prednisone, prednisolone, and methylprednisolone
Cortisone needs to be converted into hydrocortisone in the liver in order to be active, so it can only be taken
orally
hydrocortisone can be given
orally, IV, IM, topically
Prednisone can only be taken
orally
prednisolone can be administered
orally, IV, or topically
methylprednisolone can be given
orally, IV, IM, or IA (intra-articularly injected)
long-acting glucocorticoids
betamethasone and dexamethasone
betamethasone and dexamethasone can be taken
orally, IV, IM, IA (intra-articularly injected)
betamethasone is also available for topical use
Most side effects are related to excess glucocorticoid activity, which can result in iatrogenic Cushing syndrome:
mood changes; weight gain predominantly in the back of the neck between the shoulder blades and face, respectively termed buffalo hump and moon facies; skin atrophy and stretch marks; muscle weakness; hyperglycemia; and increased risk of infections.
synthetic mineralocorticoids are used to treat conditions where mineralocorticoid levels are low, such as
Addison disease and severe congenital adrenal hyperplasia.
Fludrocortisone should be used with caution in clients with
uncontrolled hypertension, congestive heart failure, hypokalemia, and DM
during periods of high stress or illness, the patent will often need to increase their _____________ dose adjustments in order to remain asymptomatic
hydrocortisone
hydrocortisone therapy is meant to mimic the body’s normal production of cortisol, so they should take the largest dose __________, take the smaller dose __________, and avoid taking the medication in the late afternoon or evenings, when cortisol levels normally decrease.
largest dose first thing in the morning
smaller dose in the early afternoon
hydrocortisone can lead to
hypertension and hypokalemia because of its mineralcorticoid activity
Prednisone and other glucocorticoids increase the patient’s risk for developing
peptic ulcers
early onset adverse associated with the use of prednisolone
Hyperglycemia
Mineralocorticoids
Maintain fluid and electrolyte balance and are used to treat adrenal insufficiency caused by hypopituitarism or Addison’s disease
Fludrocortisone
Aldosterone
Glucocorticoids
Regulate carbohydrate, protein, and fat metabolism
Glucocorticoids have antiinflammatory, antiallergenic, and immunosuppressant activity.
Cortisone
Hydrocortisone
Prednisone
Diseases associated with adrenal glands are
Addison’s disease, pheochromocytoma, and hyperpituitarism
Premedication assessments for steroids:
electrolyte imbalance
i/o, vitals
signs of infection - General malaise, sore throat, low-grade fever
baseline assessment of alertness
hydration
previous treatment for ulcer, heartburn, stomach pain
test stools for occult blood
Nursing processes for steroid admin
monitor glucose levels, may require insulin
follow body’s normal circadian rhythm (corticosteroids: half dose before 9am, half of dose late afternoon, mineralcorticoids: once daily in evening)
monitor daily weight, i/o
additional dosies may be needed if stress, injury; wear ID bracelet
patient education
when to call hcp (before a dental procedure, stress dosing)
skin care
stress coping
avoid infections
good nutrition
regular exercise
health maintenance
document
All corticosteroids (glucocorticoids and mineralocorticoids) share varying degrees of
mineralocorticoid and glucocorticoid effects
Should steroids be stopped abruptly?
no, may result in adrenal insufficiency
Carefully monitor corticosteroid therapy patients with:
Diabetes mellitus - for hyperglycemia
Heart failure
Hypertension
Peptic ulcer disease
Mental disturbance - psychotic behavior
Suspected infections - may mask infection signs
Corticosteroid Therapy Drug Interactions
Diuretics: Corticosteroids may enhance the loss of potassium
Warfarin: Corticosteroids may enhance or decrease the anticoagulant effects of warfarin
Oral hypoglycemic agents or insulin: Diabetics/prediabetic patients must be monitored for hyperglycemia
Corticosteroids do cause a ________ in blood sugar, requiring insulin to _______ the blood sugar level.
cause an increase
to lower the blood sugar level
rapid acting insulin
lispro (Humalog), aspart (NovoLog, Fiasp), glulisine (Apidra), duration 3-5 hours
administered IV or SQ
short acting insulin
regular, duration 5-8 hours
administered IV or SQ
intermediate acting insulin
NPH (N) duration 12-18 hours
administered SQ
long acting insulin
glargine (Lantus, Toujeo, Basaglar), detemir (Levemir), degludec (Tresiba), duration 16-24 hours
SQ just before meals, do not mix with other insulins
fixed combination insulins
Novolin 70/30 has 70% intermediate-acting and 30% short-acting insulin, 2 different insulins with fixed combinations, 1 intermediate acting and 1 rapid or short acting, Patients often take a combination of rapid-acting insulin for surges in glucose after meals and an intermediate for the period between meals, Fixed combos were developed to simplify dosing
Basal-Bolus/sliding scale insulins CLO 2
Preferred method of treatment for hospitalized patients with DM, Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus, Basal insulin is a long-acting insulin (insulin glargine), Bolus insulin is rapid (insulin lispro or insulin aspart,), The basal insulin is a long-acting insulin administered constantly to keep the blood glucose from fluctuating
Bolus insulin is broken up into meal and correction boluses. Meal boluses are given to reduce blood glucose with the intake of carbohydrates. Correction boluses are any boluses given to bring blood glucose levels back to normal.
Requires frequent monitoring of blood glucose levels
metformin (Glucophage)
OA
biguanides
decreases glucose in the blood, treats type 2DM, can cause lactic acidosis
glipizide (Glucotrol)
OA
sulfonylureas
lowers blood sugar by causing the pancreas to produce insulin, treats type 2D
repaglinide (Prandin)
OA
meglitinides
decreases the amount of glucose by stimulating the pancreas to release insulin, treats type 2D
pioglitazone (Actos)
OA
thiazolidinediones
increasing sensitivity of muscle and fat tissue to insulin, treats type 2D
acarbose (Precose)
OA
Alpha-glucosidase inhibitor
inhibits/slows enzymes working to digest sugars. Slowing food digestion helps keep blood glucose from rising very high after meals, treats type 2D
sitagliptin (Januvia)
OA
dipeptidyl petidase IV (DPP-IV) inhibitor
Prolong life of active GLP-1 and GIP incretin hormones. Treats type 2D
canagliflozin (Invokana)
OA
sodium-glucose contransporter II Inhibitor
drops glucose reabsorbtion, It lowers blood sugar by causing the kidneys to get rid of more glucose in the urine, treats type 2D
dulaglutide (Trulicity)
OA
incretin mimetic agents (Glucagon-like peptide - I agonists)
Increases serum insulin and reduces glucose concentrations, delays gastric emptying, reduces appetite, treats type 2D, associated with thyroid tumors in animals
glucagon
OA
antihypolycemic agent
Breaks down stored glycogen to glucose, It works by causing the liver to release stored sugar to the blood,
Administer SC, IM, or IV. Should respond in 5 to 20 minutes; if not, 1 to 2 additional doses
The average rate of insulin secretion in an adult is
30 to 50 units a day
