Week 3- Adrenocorticotropic

Question 1

What are the three adrenocorticoid hormones?

Answer 1

Glucocorticoids, mineralocorticoids, adrenal androgens.

Question 2

Discuss the target of glucocorticoids.

Answer 2

Penetrate the cell membrane and cause transcription of messenger RNA coded for regulatory proteins.

Question 3

Basal levels of cortisol are lowest at what time? Highest when?

Answer 3

Lowest before bedtime. Highest before waking.

Question 4

What is the physiologic dose of prednisone? Of hydrocortisone?

Answer 4

-7 mg/day. 20-30 mg/day.

Question 5

Adverse effects are more common with physiologic or pharmacologic doses?

Answer 5

Pharmacologic

Question 6

When are pharmacological doses of glucocorticoids usually given?

Answer 6

Usually in the early morning (before 9 a.m.) with food.

Question 7

How do glucocorticoids affect

metabolism?

Answer 7

Promote glucose availability and storage as glycogen, catabolize proteins, and promote lipolysis of fats

Question 8

How do glucocorticoids support blood pressure?

Answer 8

Decrease capillary permeability and maintain vasoconstriction.

Question 9

How do glucocorticoids affect infant lungs?

Answer 9

Accelerate lung maturation.

Question 10

Discuss the glucocorticoid effects on mood.

Answer 10

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.

Question 11

What is the cause of Cushing’s

syndrome? Describe the signs and symptoms common in Cushing’s syndrome.

Answer 11

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

Question 12

How do glucocorticoids affect blood sugars?

Answer 12

Glucocorticoids may increase blood sugars, requiring increases in antidiabetic drugs.

Question 13

How does glucocorticoid therapy affect immune function?

Answer 13

Glucocorticoids may impair immune function, predisposing patients to bacterial and fungal infections.

Question 14

How do glucocorticoids affect wound healing?

Answer 14

Impair wound healing

Question 15

Abrupt cessation of high-dose chronic glucocorticoids may result in what?

Answer 15

Adrenal insufficiency

Question 16

Prolonged use of glucocorticoids in a pregnant mother can lead to what disease in the infant?

Answer 16

Fetal adrenal hypoplasia (adrenal insufficiency)

Question 17

Describe methods of administering glucocorticoids which may minimize their adverse effects.

Answer 17

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.

Question 18

Glucocorticoids do not need to be tapered if given for less than how many weeks?

Answer 18

2-3 weeks

Question 19

What drugs administered with glucocorticoids can increase the risk of hypokalemia? GI bleed?

Answer 19

Diuretics, beta-adrenergic agonists.

NSAIDS, ASA, alcohol.

Question 20

Discuss nursing interventions for patients taking glucocorticoids.

Answer 20

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.

Question 21

Discuss the main points to be stressed in patient education for glucocorticoids

Answer 21

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.

Question 22

Explain the 3x3 Rule for mild or febrile illness.

Answer 22

Take three times the usual dose for three days.

Question 23

What are recommended dietary measures for individuals on glucocorticoids?

Answer 23

Low calorie, restricted salt, high potassium foods, increased protein, increased calcium, Vitamin D intake.

Question 24

Aldosterone is what kind of steroid?

Aldosterone retains what? Excretes what?

Answer 24

Mineralocorticoid. Sodium and water. Potassium and hydrogen.

Question 25

Addison’s disease is a deficiency of what two steroids? What are the signs and symptoms of Addison’s disease?

Answer 25

Glucocorticoids and mineralocorticoids. Hypoglycemia, hyponatremia, hypotension, hyperkalemia, GI distress, weakness, circulatory collapse, renal failure, increased skin pigmentation, death.

Question 26

What is the drug of choice for adrenal hormone insufficiency? What two properties does it have? When is it given?

Answer 26

Hydrocortisone. Glucocorticoid and some mineralocorticoid properties. Daily dose before 9 am OR 2/3 dose in AM & 1/3 dose in PM.

Question 27

27. Florinef (Fludrocortisone) causes retention of what? Excretion of what? When is it given?

Answer 27

Sodium and water. Potassium and hydrogen. In the morning.

Question 28

Discuss four things you would monitor to assess a patient’s response to Florinef (Fludrocortisone)?

Answer 28

Weight, blood pressure, hypokalemia, heart size

Question 29

What are the symptoms of acute adrenal insufficiency (adrenal crisis)?

Answer 29

Hypotension, dehydration, weakness, lethargy, vomiting, diarrhea, shock, death.