chapter 33 adrenal drugs copyright © 2014 by mosby, an imprint of elsevier inc

Chapter 33

Adrenal Drugs

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Adrenal cortex Adrenal medulla Each portion has different functions and

secretes different hormones Feedback process of hormone regulation

Adrenal Gland

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

Adrenal medulla secretes catecholamines Epinephrine Norepinephrine

Adrenal cortex secretes corticosteroids Glucocorticoids Mineralocorticoids (primarily aldosterone)

Adrenal Gland (cont’d)


Oversecretion leads to Cushing’s syndrome Undersecretion leads to Addison’s disease

Adrenocortical Hormones


Can be either synthetic or natural Many different drugs and forms Glucocorticoids

Topical, systemic, inhaled, nasal Mineralocorticoid

Systemic Adrenal steroid inhibitors

Systemic

Adrenal Drugs


Glucocorticoids beclomethasone (several formulations) fluticasone propionate dexamethasone hydrocortisone (several formulations) cortisone methylprednisolone (Solu-Medrol) prednisone (Deltasone, Sterapred, Liquid Pred) prednisolone triamcinolone

Adrenal Drugs (cont’d)


Mineralocorticoid fludrocortisone (Florinef)

Adrenal steroid inhibitor aminoglutethimide (Cytadren)

Adrenal Drugs (cont’d)


Most corticosteroids exert their effects by modifying enzyme activity

Glucocorticoids 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

Mechanism of Action


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


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

Indications (cont’d)


Glucocorticoids administration 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



Classroom Response Question

The nurse should teach a patient taking an oral corticosteroid to take the medication at what time?

A. 8:00 AM

B. 12 noon

C. 5:00 PM

D. 8:00 PM


Antiadrenals (adrenal steroid inhibitors) aminoglutethimide (Cytadren)

• Used in the treatment of Cushing’s syndrome, metastatic breast cancer, and adrenal cancer



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


Cautious use in patients with Gastritis, reflux disease, ulcer disease Diabetes Cardiac/renal/liver dysfunction

Contraindications (cont’d)


Potent effects on all body systems Cardiovascular

Heart failure, cardiac edema, hypertension—all caused by electrolyte imbalances (hypokalemia, hypernatremia)

CNS Convulsions, headache, vertigo, mood swings,

nervousness, insomnia, “steroid psychosis,” others

Adverse Effects



A patient is receiving prednisone as part of treatment for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and a proton pump inhibitor and antacid (for gastroesophageal reflux disease [GERD]). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone?

A.Furosemide

B.Levothyroxine

C.Proton pump inhibitor

D.Antacid


Potent effects on all body systemsEndocrine

Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others

GI Peptic ulcers with possible perforation, pancreatitis,

abdominal distention, others

Adverse Effects (cont’d)


Potent effects on all body systemsIntegumentary

Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria

Musculoskeletal Muscle weakness, loss of muscle mass, osteoporosis



Potent effects on all body systemsOcular

Increased intraocular pressure, glaucoma, othersOther

Weight gain




When administering aminoglutethimide (Cytadren) to a patient, it is most important for the nurse to monitor:

A. serum electrolytes.

B. cardiac enzymes.

C. liver enzymes.

D. arterial blood gases.


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


Assess for contraindications to adrenal drugs, especially the presence of peptic ulcer disease

Assess for drug allergies and potential drug interactions (prescription and over-the-counter)

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 subcut)

Prepare and administer according to manufacturer’s directions

Oral forms should be given with food or milk to minimize GI upset



For topical applications, follow instructions about use and type of dressing, if any, to apply

Clear nasal passages before giving a nasal corticosteroid



After using an orally 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




A patient is taking an inhaled corticosteroid for asthma. After the patient takes a dose of the inhaler, the nurse’s priority should be to:A.listen to the patient’s breath sounds.

B.have the patient rinse his mouth with warm water.

C.instruct the patient to cough and deep breathe.

D.take the patient’s apical pulse for 1 minute.


Patients should be taught to take all adrenal medications at the same time every day, usually in the morning, with meals or food

Patients should not take with alcohol, aspirin, or NSAIDs



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



chapter 33 adrenal drugs copyright © 2014 by mosby, an imprint of elsevier inc

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