1. Pharmacology in Nursing Adrenal Drugs

2. Adrenal Gland Adrenal cortex Adrenal medulla
Each portion has different functions and secretes different hormones
Feedback process of hormone regulation

3. 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

4. Adrenocortical Hormones
Oversecretion leads to Cushing’s syndrome
Undersecretion leads to Addison’s disease

5. Cushing’s Syndrome

6. Addison’s Disease

7. Adrenal Drugs Can be either synthetic or natural
Many different drugs and forms
Glucocorticoids
Topical, systemic, inhaled, nasal
Mineralocorticoid
Systemic
Adrenal steroid inhibitors

8. Adrenocortical Hormones (cont’d)
Glucocorticoids
beclomethasone (several formulations)
fluticasone propionate
hydrocortisone (several formulations)
cortisone
methylprednisolone
prednisone
Many others

9. Adrenocortical Hormones (cont’d)
Mineralocorticoid
fludrocortisone acetate
Adrenal steroid inhibitors
aminoglutethimide
metyrapone

10. 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

11. 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

12. Indications (cont’d) Organ transplant (decrease immune response)
Palliative management of leukemias and lymphomas
Spinal cord injury
Many other indications

13. 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

14. 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

15. 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

16. Contraindications (cont’d)
Cautious use in patients with
Gastritis, reflux disease, ulcer disease
Diabetes
Cardiac/renal/liver dysfunction

17. 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

18. 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

19. Cushing’s Syndrome

20. 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

21. Adverse Effects (cont’d)
Potent effects on all body systems
Ocular
Increased intraocular pressure, glaucoma, others
Other
Weight gain

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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