Pharmacology in Nursing Adrenal Drugs
Adrenal Gland Adrenal cortex Adrenal medulla Each portion has different functions and secretes different hormones Feedback process of hormone regulation
Adrenal Gland (cont’d) Adrenal medulla secretes catecholamines: Epinephrine Norepinephrine Adrenal cortex secretes corticosteroids Glucocorticoids Mineralocorticoids (primarily aldosterone) All adrenal cortex hormones are steroid hormones
Adrenocortical Hormones Oversecretion leads to Cushing’s syndrome Undersecretion leads to Addison’s disease
Cushing’s Syndrome
Addison’s Disease
Adrenal Drugs Can be either synthetic or natural Many different drugs and forms Glucocorticoids Topical, systemic, inhaled, nasal Mineralocorticoid Systemic Adrenal steroid inhibitors
Adrenocortical Hormones (cont’d) Glucocorticoids beclomethasone (several formulations) fluticasone propionate hydrocortisone (several formulations) cortisone methylprednisolone prednisone Many others
Adrenocortical Hormones (cont’d) Mineralocorticoid fludrocortisone acetate Adrenal steroid inhibitors aminoglutethimide metyrapone
Mechanism of Action Most exert their effects by modifying enzyme activity Different drugs differ in their potency, duration of action, and the extent to which they cause salt and fluid retention Glucocorticoids inhibit or help control inflammatory and immune responses
Indications Wide variety of indications Adrenocortical deficiency Cerebral edema Collagen diseases Dermatologic diseases GI diseases Exacerbations of chronic respiratory illnesses, such as asthma and COPD
Indications (cont’d) Organ transplant (decrease immune response) Palliative management of leukemias and lymphomas Spinal cord injury Many other indications
Indications (cont’d) Glucocorticoids given: By inhalation for control of steroid-responsive bronchospastic states Nasally for rhinitis and to prevent the recurrence of polyps after surgical removal Topically for inflammations of the eye, ear, and skin
Indications (cont’d) Antiadrenals (adrenal steroid inhibitors) Aminoglutethimide Used in the treatment of Cushing’s syndrome Metyrapone Used as a diagnostic drug to assess ACTH production
Contraindications Drug allergies Serious infections, including septicemia, systemic fungal infections, and varicella However, in the presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory CNS damage
Contraindications (cont’d) Cautious use in patients with Gastritis, reflux disease, ulcer disease Diabetes Cardiac/renal/liver dysfunction
Adverse Effects Potent effects on all body systems Cardiovascular Heart failure, cardiac edema, hypertension—all due to electrolyte imbalances (hyperkalemia, hypernatremia) CNS Convulsions, headache, vertigo, mood swings, nervousness, insomnia, “steroid psychosis,” others
Adverse Effects (cont’d) Potent effects on all body systems Endocrine Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others GI Peptic ulcers with possible perforation, pancreatitis, abdominal distention, others
Cushing’s Syndrome
Adverse Effects (cont’d) Potent effects on all body systems Integumentary Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria Musculoskeletal Muscle weakness, loss of muscle mass, osteoporosis
Adverse Effects (cont’d) Potent effects on all body systems Ocular Increased intraocular pressure, glaucoma, others Other Weight gain
Nursing Implications Perform a physical assessment to determine baseline weight, height, intake and output status, vital signs (especially BP), hydration status, immune status Obtain baseline laboratory studies Assess for edema and electrolyte imbalances
Nursing Implications (cont’d) Assess for contraindications to adrenal drugs, especially the presence of peptic ulcer disease Assess for drug allergies and potential drug interactions (prescription and OTC) Be aware that these drugs may alter serum glucose and electrolyte levels
Nursing Implications (cont’d) Systemic forms may be given by oral, IM, IV, or rectal routes (not SC) Prepare and administer according to manufacturer’s directions Oral forms should be given with food or milk to minimize GI upset
Nursing Implications (cont’d) For topical applications, follow instructions about use and type of dressing, if any, to apply Clear nasal passages before giving a nasal corticosteroid
Nursing Implications (cont’d) After using an inhaled corticosteroid, instruct patients to rinse their mouths to prevent possible oral fungal infections Teach patients on corticosteroids to avoid contact with people with infections and to report any fever, increased weakness, lethargy, or sore throat
Nursing Implications (cont’d) Patients should be taught to take all adrenal medications at the same time every day, usually in the morning, with meals or food Do not take with alcohol, aspirin, NSAIDs
Nursing Implications (cont’d) Sudden discontinuation of these drugs can precipitate an adrenal crisis caused by a sudden drop in serum levels of cortisone Doses are usually tapered before the drug is discontinued Monitor for therapeutic responses Monitor for adverse effects