Mineralocorticoids Flashcards
Example of a Mineralocorticoids
Fludrocortisone
How does Fludrocortisone work
Corticosteroids are thought to act, at least in part, by controlling the rate of synthesis of proteins. Although there are a number of instances in which the synthesis of specific proteins is known to be induced by corticosteroids, the links between the initial actions of the hormones and the final metabolic effects have not been completely elucidated.
The physiologic action of Fludrocortisone acetate is similar to that of hydrocortisone. However, the effects of Fludrocortisone acetate, particularly on electrolyte balance, but also on carbohydrate metabolism, are considerably heightened and prolonged. Mineralocorticoids act on the distal tubules of the kidney to enhance the reabsorption of sodium ions from the tubular fluid into the plasma; they increase the urinary excretion of both potassium and hydrogen ions. The consequence of these three primary effects together with similar actions on cation transport in other tissues appear to account for the entire spectrum of physiological activities that are characteristic of mineralocorticoids. In small oral doses, Fludrocortisone acetate produces marked sodium retention and increased urinary potassium excretion. It also causes a rise in blood pressure, apparently because of these effects on electrolyte levels.
Contraindications for Fludrocortisone (drug.com)
In patients with systemic fungal infections
Those with history of possible/known hypersensitivity
Contraindications for Fludrocortisone (drug.com)
In patients with systemic fungal infections
Warnings:
Those with history of possible/known hypersensitivity
Pregnancy
Category C .
Lactation
Excreted in breast milk.
Children
Safety and efficacy not established.
Addison disease
Patients with Addison disease may exhibit exaggerated adverse reactions; monitor closely for development of edema, significant weight gain, or increases in BP.
Adrenal insufficiency
Adrenal insufficiency may occur. Increased doses may be needed before, during, or after stressful situations.
Electrolyte disturbances
Sodium retention and potassium loss are increased by high sodium intake. Sodium restriction and potassium supplementation may be necessary.
GI
Use with caution in patients with nonspecific ulcerative colitis if there is a possibility of impending perforation, abscess or other pyogenic infection, diverticulitis, fresh intestinal anastomoses, or peptic ulcer.
Infections
Drug may mask signs of infection and may decrease host-defense mechanisms to prevent dissemination of infection.
Immunizations
Because of possible hazards of neurological complications and a lack of antibody response, do not vaccinate patients against smallpox while receiving corticosteroid therapy or undertake other immunization procedures.
Ocular effects
Prolonged use may produce posterior subcapsular cataracts and glaucoma with possible damage to the optic nerves and may enhance the establishment of secondary ocular infections caused by fungi or viruses.
Supplemental measures
Patients receiving fludrocortisone may need supplemental measures (eg, glucocorticoids, electrolyte control) for optimal control of symptoms.
Side effects of Fludrocortisone (drug.com)
Most adverse reactions are caused by the drug’s mineralocorticoid activity (retention of sodium and water) and include hypertension, edema, cardiac enlargement, congestive heart failure, potassium loss, and hypokalemic alkalosis.
When Fludrocortisone is used in the small dosages recommended, the glucocorticoid side effects often seen with cortisone and its derivatives are not usually a problem; however the following untoward effects should be kept in mind, particularly when Fludrocortisone is used over a prolonged period of time or in conjunction with cortisone or a similar glucocorticoid.
Musculoskeletal
Muscle weakness, steroid myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones, and spontaneous fractures.
Gastrointestinal
Peptic ulcer with possible perforation and hemorrhage, pancreatitis, abdominal distention, and ulcerative esophagitis.
Dermatologic
Impaired wound healing, thin fragile skin, bruising, petechiae and ecchymoses, facial erythema, increased sweating, subcutaneous fat atrophy, purpura, striae, hyperpigmentation of the skin and nails, hirsutism, acneiform eruptions, and hives; reactions to skin tests may be suppressed.
Neurological
Convulsions, increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment, vertigo, headache, and severe mental disturbances.
Endocrine
Menstrual irregularities, development of the cushingoid state; suppression of growth in children; secondary adrenocortical and pituitary unresponsiveness, particularly in times of stress (e.g., trauma, surgery, or illness); decreased carbohydrate tolerance; manifestations of latent diabetes mellitus; and increased requirements for insulin or oral hypoglycemic agents in diabetics.
Ophthalmic
Posterior subcapsular cataracts, increased intraocular pressure, glaucoma, and exophthalmos.
Metabolic
Hyperglycemia, glycosuria, and negative nitrogen balance due to protein catabolism.
Allergic Reactions
Allergic skin rash, maculopapular rash, and urticaria.
Other adverse reactions that may occur following the administration of a corticosteroid are necrotizing angiitis, thrombophlebitis, aggravation or masking of infections, insomnia, syncopal episodes, and anaphylactoid reactions.
Interactions of Fludrocortisone (drug.com)
Amphotericin, potassium-losing diuretics
May increase potassium loss.
Anticholinesterase agents (eg, neostigmine) May antagonize the effects of anticholinesterase agents in myasthenia gravis.
Anticoagulants (eg, warfarin)
Dose requirement of anticoagulant may be reduced or effect opposed.
Barbiturates, hydantoins (eg, phenytoin), rifampin
Decreased fludrocortisone activity.
Salicylates
Serum levels may be reduced by corticosteroids, decreasing the effectiveness; in addition, the ulcerogenic effects of both agents may be increased.
Elimination of Fludrocortisone
Renal
Patient information on Fludrocortisone
Instruct patient to take medication exactly as prescribed. If dose is missed, it should be taken as soon as possible. Do not double up if within several hours of next dose. Caution patient not to stop medication abruptly. Instruct patient to notify health care provider if greater than 1 dose is missed or a dosage cannot be taken because of nausea or vomiting.
Advise patient to reduce dietary sodium, which accelerates potassium loss, and to eat foods rich in potassium.
Tell patient to notify health care provider when experiencing a stressful situation (eg, emotional upheavals, dental extractions, trauma, surgery, illness) as increased dosage may be needed.
Instruct patient to report the following symptoms to health care provider: increased or irregular heart beat, high BP, fluid retention, joint pain, muscle weakness, headache, dizziness, fever, unusual weight gain.
Instruct patient to report euphoria, depression, or other changes in mental status.
Tell patient to be alert for spontaneous fractures and impaired wound healing.
