Pharmacology in Nursing Adrenal Drugs

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Presentation transcript:

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