1. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacology in Nursing Adrenal Drugs

2. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenal Gland  Adrenal cortex  Adrenal medulla  Each portion has different functions and secretes different hormones  Feedback process of hormone regulation

3. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenocortical Hormones  Oversecretion leads to Cushing’s syndrome  Undersecretion leads to Addison’s disease

5. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Cushing’s Syndrome

6. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Addison’s Disease

7. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenal Drugs  Can be either synthetic or natural  Many different drugs and forms  Glucocorticoids  Topical, systemic, inhaled, nasal  Mineralocorticoid  Systemic  Adrenal steroid inhibitors  Systemic

8. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenocortical Hormones (cont’d)  Glucocorticoids  beclomethasone (several formulations)  fluticasone propionate  hydrocortisone (several formulations)  cortisone  methylprednisolone  prednisone  Many others

9. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenocortical Hormones (cont’d)  Mineralocorticoid  fludrocortisone acetate  Adrenal steroid inhibitors  aminoglutethimide  metyrapone

10. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d)  Organ transplant (decrease immune response)  Palliative management of leukemias and lymphomas  Spinal cord injury  Many other indications

13. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Contraindications (cont’d)  Cautious use in patients with  Gastritis, reflux disease, ulcer disease  Diabetes  Cardiac/renal/liver dysfunction

17. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects  Potent effects on all body systems  Cardiovascular Heart failure, cardiac edema, hypertension—all due to electrolyte imbalances (hyperkalemia, hypernatremia) Heart failure, cardiac edema, hypertension—all due to electrolyte imbalances (hyperkalemia, hypernatremia)  CNS Convulsions, headache, vertigo, mood swings, nervousness, insomnia, “steroid psychosis,” others Convulsions, headache, vertigo, mood swings, nervousness, insomnia, “steroid psychosis,” others

18. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects (cont’d)  Potent effects on all body systems  Endocrine Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others  GI Peptic ulcers with possible perforation, pancreatitis, abdominal distention, others Peptic ulcers with possible perforation, pancreatitis, abdominal distention, others

19. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Cushing’s Syndrome

20. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects (cont’d)  Potent effects on all body systems  Integumentary Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria  Musculoskeletal Muscle weakness, loss of muscle mass, osteoporosis Muscle weakness, loss of muscle mass, osteoporosis

21. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects (cont’d)  Potent effects on all body systems  Ocular Increased intraocular pressure, glaucoma, others Increased intraocular pressure, glaucoma, others  Other Weight gain Weight gain

22. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

30. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic responses  Monitor for adverse effects