Basic Indications of
Adrenal Agents
- Suppress the immune system
- Short-term use to relieve inflammation during acute stage of illness
- Replacement therapy for adrenal insufficiency
- NOT used in long-term therapy if there is a safer alternative
What hormones does the Adrenal Medulla
produce?
Norepinephrine
Epineprhine
What hormones does the
Adrenal Cortex
produce?
- Adrenal Androgens
- Glucocorticoids
- Mineralocorticoids
What do the adrenal glands do?
☀️ With the hypothalmus and pituitary gland, control diurnal rhythm (corticoids released around 6-9am)
😱 Stress reaction through SNS
🟢 Other Hormone actions:
* Increases blood volume
* causes release of glucose for energy
* slows the rate of protein production and increases protein breakdown
* Mobilizes fatty acids into plasma
* Decreases the activities of the inflammatory and immune systems
What is Adrenal Excess or Cushing Syndrome?
Symptoms:
* moon-like face
* central obesity
* HTN
* protein breakdown
* Osteoporosis
* Hirsutism (excessive male pattern hair on women)
Causes: adrenal hyperplasia or tumor, ACTH-secreting tumor, early sign of excessive administration of exogenous sterioids
(AKA Cushing Disease when the cause is a pituitary tumor causing too much cortisol to be produced)
What is Adrenal Insufficiency or Addison’s Disease?
Symptoms:
* hyperpigmentation
* HYPOtension
* confusion
* extreme fatigue
* weight loss
* limited ability to respond to infection
* CV collapse
Causes: not producing enough ACTH, adrenal glands not responding to ACTH, when a gland is damaged or removed, or the after effects of prolonged use of corticosteroid hormones
(Addison’s disease = primary adrenal insufficiency)
What is an Adrenal Crisis?
Life threatening state caused by insufficient levels of cortisol (ie someone with adrenal insufficiency encounters additional physical stress)
Symptoms:
* Profound weakness
* lightheadedness/dizziness
* Nausea & vomiting
* Low blood pressure (fluid shift)
* High fever
* back pain
* hair loss
* hypoglycemia
* joint pain
* confusion and psychosis
* loss of consciousness
* Shock… leading to death
Treatment: Massive infusion of replacement steroids
Lifespan considerations for Adrenocortical Agents
In Children
- Dose is determined by severity of condition (not age or weight)
- Monitor growth and development (discontinue if growth is severely stunted)
- Protect against infection and injury
Lifespan considerations for Adrenocortical Agents
In Adults
- Take in the morning
- Taper the medication, DO NOT STOP abruptly
- Check OTC preparations for corticosteroids
- Protect against infection and injury
- Crosses the placenta and breastmilk –> adverse effects for fetus and infant
Lifespan considerations for Adrenocortical Agents
In Older Adults
- More likely to experience adverse effects
- Reduce dose and monitor carefully
- More likely to have conditions that are negatively affected by corticosteroids (Diabetes, heart failure, osteoporosis)
Types of Corticosteroids
- Androgens (male and female sex hormones)
- Glucocorticoids (break down protein and stimulate increase in glucose levels for energy)
- Mineralocorticoids (affect electrolyte levels and homeostasis)
Some adrenocortical agents belong to multiple categories!
Glucocorticoids
Drug names
- Budesonide
- Betamethasone
- Dexamethasone
- Cortisone*
- Prednisone*
- Hydrocortisone*
- Methylprednisolone
- Prednisolone*
*Also a mineralcorticoid
Glucocorticoids
Mechanism of Action
- Enters the target cells and binds to cytoplasmic receptors
- Initiates many complex reactions responsible for anti-inflammatory and immunosuppressive effects
Glucocorticoids
Indications
- Short-term treatment of many inflammatory and autoimmune disorders (asthma, COPD, MS, arthritis, IBD)
- To relieve discomfort
- Used in conjunction with other immunosuppressants to inhibit transplant rejection
- Treatment of some cancers, cancer associated disorders, and some forms of meningitis
- allergic reactions
Glucocorticoids
Contraindications
Absolute:
* Allergy
Caution:
* Acute infection not controlled by antibiotics
* Diabetes (because it increases glucose)
* Acute peptic ulcer (because it decreases prostaglandins)
* Pregnancy and lactation
Glucocorticoids
Adverse Effects
- 🧠 Headache, insomnia, pyschosis
- 💩 GI upset
- 💓 Heart failure, fluid retention (BP)
- Increased blood glucose, diabetes
- Stunted growth in children
- osteoporosis
- frail skin
- Cushing Syndrome
- impaired wound healing
- aggravating or masking infections
Glucocorticoids
Drug Interactions
Numerous
- NSAIDs & Alcohol: ⬆️ risk of peptic ulcers
- Vaccines: ⬇️ effect of vaccine
- Diuretics: monitor for electrolyte imbalances
(these were the ones mentioned in class)
Glucocorticoids
Nursing Diagnoses
- Risk of hypertension r/t fluid retention
- Risk of fluid overload r/t water retention
- Risk of altered skin and tissue integrity r/t decreased protein synthesis
- Infection risk r/t immunosuppression
- Ineffective coping r/t body changes caused by drug
- Risk of self harm r/t possible mood changes and cognitive disturbances
- Risk of hyperglycemia r/t metabolic changes
- Knowledge deficit
Glucocorticoids
Implementation/Patient Teaching
- Administer in the morning (8-9am)
- Space multiple doses throughout the day
- Use the minimal dose for the minimal amount of time
- Taper doses when discontinuing drug from high doses or long term therapy
- Arrange for increased dose when pt is under temporary stress
- Do not give LIVE vaccines
- Protect from infection and injury
Glucocorticoids
Assessment
History:
* Assess for any contraindications/cautions
Physical:
* Assess baseline weight and daily weights when on therapy
* Temperature for signs of infection
* Orientation and affect
* Grip Strength
* Eye examination
* Blood pressure, pulse, peripheral perfusion
* Respiration and lung sounds
Labs:
* Glucose, renal, hepatic, electrolytes and endocrine function tests
Mineralcorticoids
Drug names
- Fludrocortisone
- Cortisone*
- Hydrocortisone*
- Prednisone*
- Prednisolone*
*Also glucocorticoids
Mineralcorticoids
Mechanism of Action
- Holds sodium, and with it, water, in the body
- Causes the excretion of potassium by acting on the renal tubule
Mineralcorticoids
Indications
- Hormone replacement therapy in primary (Addison’s) and secondary adrenal insufficiency
- Treatment of salt-wasting adrenogenital syndrome
Mineralcorticoids
Contraindications
Absolute:
* Allergy
Caution:
* Pregnancy & lactation
* Severe hypertension, heart failure, or cardiac disease
* High sodium intake (hypernatremia)
* Presence of any infection
-
Drug Names Exam #280
-
GI Secretions59
-
GI Motility52
-
Antiemetic Agents34
-
Anticholinergics16
-
Cholinergics35
-
Adrenocortical Agents29
-
Immune Modulators51
-
Anti-Inflammatory, Antiarthritis, and Related Agents49
-
Blood Pressure Agents99
-
Coagulation Modifiers57
-
Antianginal Agents39
-
Agents for treating Heart Failure45
-
Antiarrhythmic Agents33
