Adrenal Drugs

Question 1

Adrenal Medulla

Answer 1

Secretes catecholamines (epinephrine and norepinephrine)

Question 2

Adrenal Cortex

Answer 2

Secretes corticosteroids (glucocorticoids, mineralocorticoids, androgens)

Glucocorticoids affect blood sugar

Mineralocorticoids pair with salt

Androgens are male sex hormones

Question 3

Adrenocortical Hormones

Answer 3

Oversecretion leads to Cushing’s Syndrome

Undersecretion leads to Addison’s disease/Adrenal insufficiency

Question 4

Cushing’s Syndrome

Answer 4

Causes hypersecretion of ACTH and glucocorticoids

Presents with obesity, hyperglycemia, glycosuria, hypertension, and fluid/electrolyte disturbances (hypernatremia)

NANDA: disturbed body image

Question 5

Addison’s Disease

Answer 5

Adrenocortical Insufficiency

Presents with weakness, hypotension, emaciation, hypoglycemia, bronze skin pigmentation

Treated with hydrocortisone

Question 6

Normal Potassium Level

Answer 6

3.5-5

Question 7

Addison’s Crisis

Answer 7

ADRENAL CRISIS; CAN LEAD TO DEATH

Presents with hypotension, dehydration, weakness, lethargy, GI symptoms

Caused by adrenal failure, pituitary failure, or inadequate doses of corticosteroids or abrupt withdrawal (mostly due to inadequate therapy)

Question 8

Corticosteroids

Answer 8

Exert effects by modifying enzyme activity

Question 9

Indications for Adrenal Drugs

Answer 9

ADRENOCORTICAL DEFICIENCY
CEREBRAL EDEMA
GI DISEASES
ASTHMA AND COPD
ORGAN TRANSPLANTATION

Question 10

Contraindications for Adrenal Drugs

Answer 10

SERIOUS INFECTIONS, INCLUDING SEPTICEMIA, SYSTEMIC FUNGAL INFECTIONS, AND VARICELLA

Watch for infections and avoid severe immunosuppressants

If infection occurs, gradually taper off

CAUTIOUS USE IN PATIENTS WITH:
GASTRITIS, REFLUX DISEASE, ULCER DISEASE
DIABETES
CARDIAC, RENAL, OR LIVER DYSFUNCTION

Question 11

Adverse Effects

Answer 11

ELECTROLYTE IMBALANCES (HYPOKALEMIA, HYPERNATREMIA)

HYPERGLYCEMIA

PEPTIC ULCERS

FRAGILE SKIN, ECCHYMOSIS, POOR WOUND HEALING, OSTEOPOROSIS

WEIGHT GAIN

Question 12

Interactions

Answer 12

LOOP DIURETICS–>Hypokalemia

ULCEROGENIC DRUGS–>Additive GI effects and gastric ulcer development

Question 13

Hydrocortisone

Answer 13

Primarily used to treat Addison’s Disease

Also used for allergic reactions to inflammation and cancer

Adverse effects include adrenal suppression and Cushing’s syndrome

Question 14

Prednisone

Answer 14

Most commonly used oral glucocorticoid for anti-inflammatory or immunosuppressant purposes

Treats exacerbations of chronic respiratory illnesses

Does not treat adrenocortical insufficiency alone, must be paired with a glucocorticoid

Tablet, must gradually taper off

Question 15

Methylprednisone

Answer 15

Anti-inflammatory or immunosuppressant drug

Most commonly used injectable glucocorticoid drug

Used for Crohn’s and COPD

MOST INJECTABLE FORMULATIONS CONTAIN A PRESERVATIVE (BENZYL ALCOHOL) THAT CANNOT BE GIVEN TO CHILDREN YOUNGER THAN 28 DAYS OF AGE

Question 16

Fludrocortisone (Florinef)

Answer 16

Potent mineralocorticoid

Only oral corticosteroid used

Treats Addison’s disease, primary hypoaldosteronism, and congenital adrenal hyperplasia

Adverse effects include hypertension, edema, cardiac enlargement, and hypokalemia

Question 17

Nursing Implications

Answer 17

MEASURE BLOOD PRESSURE FREQUENTLY

ASSESS FOR EDEMA AND ELECTROLYTE IMBALANCES

SYSTEMIC FORMS SHOULD NOT BE GIVEN SUBCUTANEOUSLY

ORAL FORMS SHOULD BE GIVEN WITH FOOD OR MILK

CLEAR NASAL PASSAGES BEFORE NASAL DOSES

RINSE MOUTHS TO PREVENT ORAL FUNGAL INFECTIONS

TAKE MEDICATIONS AT THE SAME TIME

DO NOT TAKE WITH ASPIRIN, ALCOHOL, OR NSAIDS

SUDDEN DISCONTINUATION CAN PRECIPITATE AN ADRENAL CRISIS