Mod 8- Adrenocortical Agents Flashcards
How long should Adrenal Agents be used for?
SHORT TERM use to relieve inflammation during acute stages of illness
Which disease is associated with an excess of adrenals?
Cushings disease- moon face, central obesity, HTN, osteoporosis, hirsutism
What disease is caused by an adrenal insufficiency?
Addison Disease- confusion, hypotension, CV collapse, fatigue, limited ability to respond to infection
How are adrenocortical agents dosed for children?
Determined by severity
What should be monitored very closely for children taking Adrenocortical Agents?
Growth and development b/c can cause retardation
When should Adrenocortical Agents be taken?
In the mornings between 8 & 9 am
T/F Alternative feeding methods should be implemented for breastfeeding mothers on Adrenocortical Agents
TRUE- can cross placenta & enter breastmilk and harm baby
What are signs of an Adrenal Crisis
physiological exhaustion
hypotension
fluid shift
shock and even death
Tx for an adrenal crisis
massive infusion of replacement steroids
constant monitoring & life support procedures
What are common Glucocorticoid medications?
Also referred to as steroids
end in "-sone" Betamethasone budesonide cortisone dexamethasone hydrocortisone methylprednisolone prednisolone prednisone
What is the action of Glucocorticoids?
Initiate many complex reactions responsible for anti-inflammatory and immunosuppressive effects
Which Glucocorticoids have some mineralocorticoid activity?
Hydrocortisone
cortisone
prednisone
What are Glucocorticoids indicated for?
Short term tx of many inflammatory disorders- RA, COPD
relief of discomfort
give body a chance to heal from effects of inflammation
Contraindications for Glucocorticoids
known allergy
acute infection- b/c have immunosupressant effects
lactation- enters breast milk
Cautions for Glucocorticoids
diabetes- will increase blood glucose levels
acute peptic ulcer- they are stress hormones and can exacerbate a peptic ulcer
ADE of Glucocorticoids
H/A, insomnia, psychosis, GI upset, HF, fluid retention, increase blood glucose, osteoporosis, frail skin, growth retardation in children, diabetes, Cushing syndrome, impaired wound healing, aggravating/ masking of infections
Drug/ Drug interactions of Glucocorticoids
increase in drug when combined with erythromycin, ketoconazole, troleandomycin
DECREASE in drug when given w/ salicylates, barbiturates, phenytoin, rifampin
What needs to be assessed for a pt taking Glucocorticoids?
weight- fluid retention
temp- infection
orientation and affect- CNS
serum electrolytes
T/F Stop Glucocorticoids abruptly to minimize ADE
FALSE- taper in order to allow adrenal glands to wake back up
Why can’t pts taking Glucocorticoids have live virus vaccines?
b/c increase risk for infection d/t immunosuppression
Prototype for Glucocorticoids
Prednisone
Common Mineralocorticoids
cortisone
fludrocortisone
hydrocortisone
Action of Mineralocorticoids
effects on electrolytes, works very similarly to aldosterone but not given as a medication
hold sodium & water in the body
Causes excretion of potassium by action on the renal tubule
When are Mineralocorticoids indicated?
replacement therapy in primary and secondary adrenal insufficiency [addisons]
Contraindications of Mineralocorticoids
b/c it acts like aldosterone, anything that can exacerbate CV diseases
known allergy, hypertension, CHF, cardiac disease
Cautions for Mineralocorticoids
pregnancy, infection, high sodium intake- hypernatremia will occur since it keeps sodium and water in the body
ADE of Mineralocorticoids
increase fluid volume d/t sodium retention
hypokalemia d/t too much potassium secretion
Drug/ drug interactions with Mineralocorticoids
decrease effectiveness with salicylates, barbituates, hydantoins, rifampin, and anticholinesterases
Why are Mineralocorticoids used only in conjunction with appropriate glucocorticoids
To maintain proper electrolyte balance
What are signs of Mineralocorticoids overdose?
excessive weight gain, edema, hypertension, cardiomegaly
Why do you increase the Mineralocorticoids dose during times of stress?
Because there is a demand for stress hormones?
Mineralocorticoid prototype
Fludrocortisone
