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NUR 326 > Adrenal > Flashcards

Adrenal Flashcards

1
Q

what are the adrenocortical hormone disorders

A

cushings and addisons

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2
Q

what is cushing syndrome

A

a collection of s/s associated with HYPERcortisolism

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3
Q

what causes cushing syndrome

A

primary hyperfunction: disease of adrenal cortex
secondary hyperfucntion: disease of anterior pituitary
exogenous steroids: used in management of various diseases

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4
Q

what is the difference between cushing syndrome and disease

A

syndrome: inc in hormone level itself
disease: inc in the triggering hormone

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5
Q

what is the function of cortisol

A

raised blood sugar
protects against physiological effects of stress
suppresses immune and infalmmatory porcess
breaks down proteins and fats
inc cholesterol
maintain vascular system by keep BP up

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6
Q

clinical manifestations of cushings: inc glucose

A

glucose intolerance, hyperglycemia

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7
Q

clinical manifestations of cushings: maintain vascular system

A

HTN, capillary friability (ecchymoses)

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8
Q

clinical manifestations of cushings: protein breakdown

A

muscle wasting, muscle weakness, thinning of skin, osteoporosis, bone pain

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9
Q

clinical manifestations of cushings: fat breakdown

A

redistribution of fat to the abdomen, shoulders, face

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10
Q

clinical manifestations of cushings: supper of immune and inflammatory response

A

impaired wound healing and immune response, risk for infection

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11
Q

clinical manifestations of cushings: CNS excitability

A

mood swings, insomnia

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12
Q

other clinical manifesations of cushings

A

hirsutism, buffalo hump, thinning hair, thinning extremites, striae (stretch marks), moon face

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13
Q

drug therapy for cushings

A

remove tumor with surgery, taper off steriods

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14
Q

what drugs help suppress the synthesis of steroids

A

aminoglutethimide
ketoconazole
should not be used by themselves, not primary treatment

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15
Q

aminoglutethimide moa

A

blocks the synthesis of all adrenal steroids

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16
Q

aminoglutethimide indications

A

temporary therapy to dec cortisol production
- typically for ppl waiting for surgery

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17
Q

aminoglutethimide effects

A

reduces cortisol by 50%
does not affect underlying disease process

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18
Q

aminoglutethimide adverse effects

A

drowsy
N
anorexia
rash

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19
Q

ketoconazole moa

A

antifungal drug that inhibits glucocorticoid steroid synthesis

20
Q

ketoconazole indications

A

adjunct therapy to surgery or radiation

21
Q

ketoconazole adverse effects

A

severe liver damage

22
Q

ketoconazole nursing considerations

A

do not take with ETOH or other liver harmers
no for pregnancy (fetal thyroid damage)
monitor liver function tests

23
Q

what is addison disease

A

disease of the adrenal cortex that causes HYPO secretion of cortisol, aldosterone, androgen (male sex hormoes)
* more severe is low cortisol *

24
Q

cause of addison disease

A

idiopathic
autoimmune
other

25
Q

pathogenesis of addison disease

A
  • adrenal gland is destroyed by disease (primary insufficiency)
  • adrenal gland stops secreting cortisol, causes lack of negative feedback
  • anterior pituitary continues to secrete ACTH and MSH to stimulate cortisol production
26
Q

when do symptoms of Addison become evident

A

when adrenal cortex is about 90% destroyed

27
Q

clinical manifestations of addison: early

A

anorexia
wt loss
weakness, malaise, apathy
electrolyte imbalances
hyperpigmentation of skin

28
Q

clinical manifestations of addison: broad

A

hypoaldosteronism –> hypoTN, salt cravings
hypocorticolism –> hypoglycemia, weakness, fatigue,

29
Q

what does hypoaldosterone cause and why

A

hypotension for dec vascular tone, CO, circulating blood volume
salt cravings: dec serum Na levels, inc serum K levels, and dehydration
fluid volume deficit

30
Q

what does hypocortisol cause

A

dec in sugar so hypoglycemia, weakness, fatigue, unsuppressed ACTH production resulting in hyper-pigmentation

31
Q

what is a major complication of addison disease

A

addisonian crisis –> acute adrenal insufficiency
* body has no cortisol to combat stress *

32
Q

cause of addisonian crisis

A

sudden insufficiency of serum corticosteroids resulting from
- sudden loss of adrenal gland
- sudden inc in stress in chronic condition
- sudden cessation of corticosteroid drug therapy

33
Q

addison pharm in general

A

replacement of corticosteroids
- glucocorticoid: hydrocortisone (drug of choice), prednisone, dexamethasone
- some need mineralocorticoid: fludrocortisone

34
Q

steroid replacement therapy information

A
  • dosing needs to mimic natural release of hormones so timing is important and doses are small
  • never abruptly stop
  • doses will need to be inc durign times of stress
  • always maintain emergency supply
  • wear a medical alert bracelet
35
Q

what is the 3x3 rule

A

inc dose for 3 days by 3x then taper back down when stress is no longer present

36
Q

what is pheochromocytoma

A

rare tumor of the adrenal medulla that produces excessive catecholamines (norep, epi)
- benign most of the time

37
Q

who is at risk for pheochromocytoma

A

young to middle age

38
Q

pheochromocytoma pathogenesis

A

tumor cells secrete catecholamines in response to SNS stimulation (on top of adrenal medulla)

39
Q

what does epi stimulate

A

alpha and beta recpetors of heart and lungs and vessels

40
Q

what does norepi stimulate

A

alpha receptors in the vessels

41
Q

clinical manifestations of pheochromocytoma

A

HTN leads to headache, diaphoresis, tachycardia
can be intermittent of persistent

42
Q

drug therapy for pheochromocytoma

A

prefer surgery, but can use alpha adrenergic when tumors are inoperable or preop to reduce HTN

43
Q

what cause HTN in pheochromocytoma

A

activation of alpha 1 receptors on blood vessels

44
Q

phenoxybenzamine HCL moa

A

long lasting irreversible blockage of alpha adrenergic receptors to lower BP
- alpha 1 and 2
- irreverisble –> so will only be free again once new receptors are made

45
Q

pheochromocytoma adveres effects

A

orthostatic hypotension
reflex tachycardia
nasal congestion
sexual side effects in men (inability to ejaculate)

NUR 326 (20 decks)

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