Week 3- Adrenocorticotropic Flashcards
What are the three adrenocorticoid hormones?
Glucocorticoids, mineralocorticoids, adrenal androgens.
Discuss the target of glucocorticoids.
Penetrate the cell membrane and cause transcription of messenger RNA coded for regulatory proteins.
Basal levels of cortisol are lowest at what time? Highest when?
Lowest before bedtime. Highest before waking.
What is the physiologic dose of prednisone? Of hydrocortisone?
-7 mg/day. 20-30 mg/day.
Adverse effects are more common with physiologic or pharmacologic doses?
Pharmacologic
When are pharmacological doses of glucocorticoids usually given?
Usually in the early morning (before 9 a.m.) with food.
How do glucocorticoids affect
metabolism?
Promote glucose availability and storage as glycogen, catabolize proteins, and promote lipolysis of fats
How do glucocorticoids support blood pressure?
Decrease capillary permeability and maintain vasoconstriction.
How do glucocorticoids affect infant lungs?
Accelerate lung maturation.
Discuss the glucocorticoid effects on mood.
Long-term low-dose glucocorticoids may predispose some individuals to depression and suicide. Short-term high-dose therapy may lead to mania in some individuals.
What is the cause of Cushing’s
syndrome? Describe the signs and symptoms common in Cushing’s syndrome.
Excessive glucocorticoids. Obesity, hyperglycemia, hypertension, hypernatremia, hypokalemia, hypervolemia, decreased resistance to infection, psychiatric changes, muscle wasting, osteoporosis, thinning of skin, fat redistribution, hirsutism, acne, menstrual irregularities
How do glucocorticoids affect blood sugars?
Glucocorticoids may increase blood sugars, requiring increases in antidiabetic drugs.
How does glucocorticoid therapy affect immune function?
Glucocorticoids may impair immune function, predisposing patients to bacterial and fungal infections.
How do glucocorticoids affect wound healing?
Impair wound healing
Abrupt cessation of high-dose chronic glucocorticoids may result in what?
Adrenal insufficiency
Prolonged use of glucocorticoids in a pregnant mother can lead to what disease in the infant?
Fetal adrenal hypoplasia (adrenal insufficiency)
Describe methods of administering glucocorticoids which may minimize their adverse effects.
Lowest dosage for shortest duration; switch from multiple doses to one AM dose; alternate day dosing before 9 am; use of topical, inhalation or local injection instead of systemic doses; therapy for osteoporosis.
Glucocorticoids do not need to be tapered if given for less than how many weeks?
2-3 weeks
What drugs administered with glucocorticoids can increase the risk of hypokalemia? GI bleed?
Diuretics, beta-adrenergic agonists.
NSAIDS, ASA, alcohol.
Discuss nursing interventions for patients taking glucocorticoids.
Monitor height and weight, I & O, VS, electrolytes, CBC, cortisol, LFTs, BUN, creatinine. Encourage an eye exam every 6 months. Discourage breastfeeding if patient is taking more than 5mg of Prednisone per day. Watch neonate for adrenal insufficiency if the mother was on corticosteroids during pregnancy.
Discuss the main points to be stressed in patient education for glucocorticoids
Take oral steroids with food before 9 am. Limit joint movement for 1-2 days after joint injection. Check for bruising & edema. Taper doses. Avoid communicable diseases. Avoid ASA, NSAIDS, and alcohol. Take missed doses when remembered (but do not double doses). Encourage weight bearing exercises. May need to increase dose with stress.
Explain the 3x3 Rule for mild or febrile illness.
Take three times the usual dose for three days.
What are recommended dietary measures for individuals on glucocorticoids?
Low calorie, restricted salt, high potassium foods, increased protein, increased calcium, Vitamin D intake.
Aldosterone is what kind of steroid?
Aldosterone retains what? Excretes what?
Mineralocorticoid. Sodium and water. Potassium and hydrogen.
Addison’s disease is a deficiency of what two steroids? What are the signs and symptoms of Addison’s disease?
Glucocorticoids and mineralocorticoids. Hypoglycemia, hyponatremia, hypotension, hyperkalemia, GI distress, weakness, circulatory collapse, renal failure, increased skin pigmentation, death.
What is the drug of choice for adrenal hormone insufficiency? What two properties does it have? When is it given?
Hydrocortisone. Glucocorticoid and some mineralocorticoid properties. Daily dose before 9 am OR 2/3 dose in AM & 1/3 dose in PM.
- Florinef (Fludrocortisone) causes retention of what? Excretion of what? When is it given?
Sodium and water. Potassium and hydrogen. In the morning.
Discuss four things you would monitor to assess a patient’s response to Florinef (Fludrocortisone)?
Weight, blood pressure, hypokalemia, heart size
What are the symptoms of acute adrenal insufficiency (adrenal crisis)?
Hypotension, dehydration, weakness, lethargy, vomiting, diarrhea, shock, death.
