Adrenocortical Agents ppt Flashcards
(78 cards)
1
Q
Why do we use Adrenal agents?
A
To suppress the immune system.
In short term illnesses to relieve inflammation during the acute stage.
Replacement therapy for adrenal insufficiency.
Not in ling-term therapy as there are other safer alternatives.
2
Q
What is the Adrenal Cortex?
A
The outer layer of the adrenal gland.
3
Q
What is the Adrenal Medulla?
A
The inner layer of the adrenal gland.
4
Q
What are corticosteroids?
A
Steroid hormones produced in the Adrenal Cortex.
5
Q
Where in the body do we find the Adrenal Glands?
A
Superior aspect of the kidneys.
6
Q
Explain what diurnal rhythm is
A
The regular release of corticotropin releasing factor (CRF) in a 24 hr period. Not the same, but similar to the circadian rhythm.
7
Q
What are Glucocorticoids?
A
A steroid hormone that increases the glucose levels.
8
Q
What are Mineralocorticoids?
A
A steroid hormone affecting electrolyte levels.
9
Q
What is the composition of the adrenal glands?
A
Adrenal medulla: inner core - part of the SNS
Adrenal cortex: outer “shell” produces the hormones collectively called corticosteroids.
10
Q
What does the adrenal glands control?
A
Control the diurnal rhythm.
Activates the stress reaction though the SNS.
11
Q
Why would we use Adrenal agents / corticosteroids to treat patients?
A
- They may dampen the immune system which reduces inflammation and discomfort.
- When patients have damaged adrenal glands, they may take these drugs to replace missing hormones (safety risk with long-term use)
12
Q
Where in the adrenal gland are the corticosteroids produced?
A
In the adrenal cortex which is the outer part of the adrenal gland.
13
Q
What are the 3 types of corticosteroids that are produced in the adrenal cortex?
A
Glucocorticoids
Androgens
Mineralcorticoids
14
Q
What does the Adrenal Medulla produce?
A
Epinephrine & Norepinephrine.
15
Q
When is the Adrenal Cortex and the Adrenal Medulla activated?
A
When the body is under stress.
16
Q
What does the Adrenal gland control?
A
Diurnal rhythm and the activation of stress reaction through the SNS/Sympathetic Nervous System.
17
Q
What is ACTH?
A
Adrenocorticotropic hormone released by the pituitary gland.
18
Q
What is CRH?
A
Corticotropin- releasing hormone released by the Hypothalamus.
19
Q
What time is the ACTH and CRH released in a person with a normal wake/sleep cycle? And when is their peak time?
A
Released around midnight and peak around 6-9am
20
Q
What is the cycle of the release of ACTH and CRH called?
A
Diurnal rhythm.
21
Q
What is the Diurnal rhythm affected by?
A
Daylight.
22
Q
What type of job schedule may have increased level of stress?
A
Nighttime workers because the diurnal rhythm is activated by daylight.
23
Q
Why should corticosteroids NOT be used long term to treat inflammation?
A
There may be severe consequences for long term use. The drugs also does not CURE the underlying cause of the inflammation. The provide relief and needs to be tapered off once the cause of the problem have been found.
24
Q
what route may corticosteroids be given?
A
Topical, Oral, Injections, or as Ophthalmic agents.
25
What are the actions of the corticosteroids?
*Increases blood volume (may damage vessels)
*Causes release of glucose for energy during fight or flight (may lead to diabetes)
*Slows down the rate or protein production while increasing
protein breakdown.
*Mobilizes fatty acids into plasma.
*Decreases the activity of the inflammatory & immune system.
26
What diseases/symptoms can be caused by Adrenal Excess, too much or corticosteroids?
* Cushing Disease (excess Glucocorticoids) - may result from pituitary or adrenal gland tumor, or early sign of excessive administration of steroids (why long term use is not recommended)
* Osteoporosis (excess Glucocorticoids) - occur because the excessive steroids affect bone formation and calcium absorption.
* Moon-face - Increase in fluid retention.
* Central obesity
* Hirsutism - (increased growth of coarse hair occur due to increased androgens.).
27
what diseases/symptoms may happen with Adrenal Insufficiency, too little corticosteroids ?
* Addison Disease - may happen when a person doesn't produce enough ACTH in the pituitary gland, if Adrenal glands do not respond to ACTH or damaged gland due to surgical removal or prolonged use of corticosteroid hormones.
Confusion, hypotension, CV collapse, fatigue, limited ability to respond to infection.
28
What may long term use of steroids due to the feedback system?
It may make the natural feedback system stop working because the body gets used to the external source of the hormone and decreases the secretion of ACTH and the adrenal glands start to atrophy (waste away).
29
If you have been using steroids for more than two weeks and want to stop taking them, can you stop immediately?
No.
The body needs to wean off the medication so that the adrenal glands can start building back up.
30
Why/How does and Adrenal crisis happen?
When a patient who already have adrenal insufficiency goes through an extremely stressful experience such as a surgery, car crash, or serious infection.
The sympathetic nervous system activates which requires a large amount of energy. It is normally accompanied with the adrenal gland accompanying the body for the increased energy demand. When the body is not prepared for that energy demand the Sympathetic system is activated yet the body cannot accommodate.
31
What are the signs & symptoms of an Adrenal crisis?
* Physiological exhaustion, confusion and/or psychosis, loss of consciousness.
* Hypotension
* Fluid shift
* Hypoglycemia
* Hair loss
* Back pain, Joint pain
* Fever
* Vomiting
* Shock - may lead to death.
32
What's the treatment for an Adrenal Crisis?
* Massive infusion of replacement steroids.
* Constant monitoring and life support procedures.
It is a medical emergency and a person experiencing and adrenal crisis needs to get to a hospital immediately.
33
Lifespan consideration when children are prescribed Adrenocortical agents.
Dose = determined by severity and not weight or age.
Monitor growth & development closely to adjust and/or discontinue if severe growth retardation occur.
Take cautions to protect the child from infection and injuries because they are at a higher risk of adrenal crisis and more severe infections.
34
Lifespan consideration when adults are prescribed Adrenocortical agents.
* Medications should be taken in the morning, because it will stimulate the same pattern as the diurnal rhythm.
* Medications should be tapered off and not abruptly stopped (risk of adrenal crisis)
* See if they are using any OTC medications for corticosteroids.
* They should protect themselves against infection and injuries due to the risk of adrenal crisis and more severe infections.
* Medication may cross placenta and cause adverse effects to fetus.
* May enter breastmilk and affect baby so formula or donated milk must be used.
35
Lifespan consideration when older adults are prescribed Adrenocortical agents
* Older adults are more likely to experience adverse effects - if adverse effects occur, reduce dose and monitor.
* More likely to have conditions or at higher risk of developing conditions that are impacted by corticosteroids such as osteoporosis, diabetes and fluid imbalances.
Close monitoring is important.
36
What are some types of Corticosteroids?
Androgens - Sex hormones
Glucocorticoids - Stimulates increase in glucose levels
Mineralocorticoids - affect electrolyte levels & homeostasis.
37
What are Androgens responsible for?
Male and Female Sec Hormones. Especially present in puberty and may cause hirsutism, acne, oily skin, weight gain and other secondary male characteristics.
Anabolic steroids derived from androgens and made to have more muscle tissue building effects.
38
What are Glucocorticoids responsible for?
* To put more Glucose in the blood to prepare body for fight or flight which requires more energy.
* They also break down protein and prevent protein from being formed. Can prepare fatty acids for use of energy.
* Large doses may suppress the immune system as well as suppress inflammation.
39
What are Mineralocorticoids responsible for?
Control the flow of electrolytes that are being excreted. Specifically sodium due to aldosterone. Aldosterone causes the body to hold on to sodium. This is why patients with adrenal insufficiency may have issues with Hypotension due to the body not holding onto enough sodium and water.
40
Corticosteroids may belong to more than one category.
TRUE/FALSE
True - depending on the dosage.
41
What are the most common Glucocorticoids?
"-one"
Betamethasone
Cortisone
Dexamethasone
Hydrocortisone
Methylprednisolone
Prednisolone
Prednisone
"-ide"
Budesonide
42
How does Prednisone work on the body?
Glucocorticoids enters target cells and bind to the cytoplasmic receptors which initiate several reactions responsible for anti-inflammatory and immunosuppressive effects.
Prednisone, cortisone, prednisolone also have some mineralocorticoid actions.
43
Why would we give a patient Betamethasone?
The Anti-inflammatory and immunosuppressant effect of Glucocorticoids makes them helpful of managing allergic reactions, and help reduce the risk of transplant rejections when used with other immunosuppressant agents.
They may also be given to treat some cancers, cancer associated disorders and some forms of meningitis.
44
Are there any contraindications to Glucocorticoids? If so what are they?
Allergy.
45
What patients and/or conditions should we be cautious of before administering Dexamethasone?
We should be careful giving Glucocorticoids to patients who have an acute infection which is not controlled by antibiotics. Increased severity of infection may lead to sepsis or necrosis.
* Diabetes - may worsen due to increased blood glucose levels.
* GI Ulcers - May increased acid formation and reduce prostaglandin whihc helps protect stomach lining.
* pregnancy and lactation - Babies have low immunity and ingesting steroids may increase their risk of infection.
46
What are some adverse reactions to glucocorticoids?
* Headache,
* Insomnia - r/t Diurnal rhythm disturbance
* psychosis,
* GI upset,
* HF - r/t prolonged increase in BP in relation to prolonged water and sodium in the blood may lead to heart failure.
* fluid retention,
* increased blood glucose/diabetes
* osteoporosis,
* frail skin - r/t lack of collagen production
* growth retardation (children),
* Cushing syndrome,
* impaired wound healing,
* aggravating or masking of infections
47
Are there any drug-drug interactions to glucocorticoids?
yes, there are many
*Alcohol and NSAIDs are a few.
NSAIDs may increase the risk of peptic ulcers (effect on lining of stomach)
*Vaccinations may be less effective du to the body not being able to produce the antibodies needed in response to the vaccine.
*Diuretics may lead to increased risk of hypokalemia.
48
What nursing assessment should we do prior to administering Methylprednisolone?
Methylprednisolone is a glucocorticoid.
*contraindications and cautions.
* Physical assessment for : Assess weight (to ensure fluid overload doesn't occur, may hear crackles in lungs.
* Electrolytes may be imbalanced due to excessive fluid.
* Temperature; orientation and affect.
* Grip strength
* Eye examination
* Blood pressure & pulse (may be induced by hyperglycemia),
* Peripheral perfusion
* Respiration and adventitious breath sounds (fluid overload).
Monitor glucose tolerance, renal function, serum electrolytes, and endocrine function tests.
49
What nursing diagnosis could we make before giving a patient Glucocorticoids?
HTN & fluid overload due to fluid retention.
Altered skin and tissue integrity risk due to decreased protein synthesis.
Infection risk due to immunosuppressant.
Ineffective coping due to body changes.
Self- harm risk due to hormonal changes.
Hyperglycemia
Knowledge deficit.
50
What are important implementation when taking Glucocorticoids?
* Administer drug in the am (8-9)
* Space out other drugs throughout the day to mimic diurnal rhythm.
* Use minimal dose for minimal amount of time minimize adrenal atrophy).
* Taper doses when discontinuing (longer than two weeks).
* Increase dose when patient is under stress (ex expected surgery).
* Do not give live virus injection when the patient is immunosuppressed (may be ineffective) .
* Protect patient from infection.
* Assess for drug-drug reactions.
* Education.
51
What are the Mineralocorticoids that we need to know?
Cortisone
Fludrocortisone
Hydrocortisone
Prednisone
Prednisolone
52
What does mineralocorticoids do?
* They affect the level of electrolytes being held in the body.
* Holds sodium, therefore the body retains water which increases blood pressure.
* May be used for salt-wasting adrenogenital syndrome
* Excretion of potassium by action on the renal tubules.
* May be used for hormone replacement therapy along with glucocorticoids.
53
Explain Salt-Wasting Adrenogenital Syndrome.
The body doesn't make enough aldosterone which causes hyponatremia because we lose too much sodium in the urine.. We may give mineralocorticoids to treat this.
54
Why would we give a patient Fludrocortisone?
Fludrocortisone is a Mineralocorticoid and we would give this to treat salt-wasting adrenogenital syndrome and as replacement therapy for primary and secondary adrenal insufficiency.
55
Are there any contraindications to mineralocorticoids? If so, which ones?
There are many.
Hypertension may be increased and may lead to heart failure, or cardiac disease.
56
What are some things that we should be cautious of when giving patients mineralcorticoids?
* HTN (may worsen due to increased blood volume)
* Pregnancy and Lactation
* High Sodium Diet - May develop hypernatremia
* Presence of an infection due to he immune system being suppressed with these meds.
57
What are some adverse reactions that may happen when giving patients Prednisone?
* Mineralocorticoids may have adverse reactions such as increased fluid volumes due to sodium retention which may cause headache, hypertension and heart failure.
*Hypokalemia due to potassium excretion which may cause muscle weakness, cramps and fatigue.
58
Are there any drug-drug interactions with mineralcorticoids?
May be less effective if given with barbiturates or phenytoin (seizure medications)
May also make antidiabetic drugs less effective.
59
What should we be assessing for before administering mineralocorticoids?
Contraindications and cautions
Physical assessment: BP, Pulse (electrolytes), adventitious breath sounds (fluid buildup in lungs), temperature (infection), weight (fluid balance), tissue, turgor, reflexes (electrolyte imbalances) and bilateral grip strength.
Serum and electrolyte levels.
60
What nursing diagnosis can we anticipate prior to administering mineralocorticoids?
Hyperglycemia related to metabolic changes
Fluid overload and urine retention risk due to sodium retention.
Knowledge deficit.
61
What implementations should we have in place when a patient is given mineralocorticoids?
* Increase does in time of anticipated stress
* Monitor for hypokalemia
* Discontinue if signs of overdose
* Thorough patient teaching.
62
Where is ACTH (Adrenocorticotropic hormone) released from?
Pituitary gland
63
Where is CRH (Corticotropin-releasing hormone) released from?
The hypothalamus.
64
What is Cushing's disease caused by?
Adrenal excess that may be caused by a pituitary gland tumor, adrenal gland tumor or long term use of steroids.
65
What are the symptoms of Cushing's disease?
Moon like face, buffalo hump, upper body weight gain, red stretch marks, weak muscles and bones.
66
what causes osteoporosis?
Excessive steroids affect bone formation and calcium absorption.
67
What causes Addison Disease?
Adrenal insufficiency. Caused by insufficient secretion of HCTH from the pituitary gland, damaged or removed adrenal glands or if the adrenal glands do not respond to HCTH or prolonged steroid use.
68
What are the symptoms of Addison Disease?
Hypotension, CV collapse, fatigue, limited ability to respond to infection, darkening of skin, weight loss and salt craving.
69
TRUE/FALSE
Corticosteroid use may stunt the growth in children.
True
70
What are anabolic steroids derivates of?
Androgens.
71
Which Corticosteroid is breaks down proteins and prevents proteins from being formed?
Glucocorticoids
72
What does large doses of Glucocorticoids do to the immune system and inflammation ?
Suppress them
73
Does an Adrenal Crisis cause Hypotension or Hypertension?
Hypotension
74
Does an Adrenal Crisis cause Hyperglycemia or Hypoglycemia?
Hypoglycemia.
75
What suffix does most glucocorticoids have?
"sone"
76
Which Corticosteroid may cause fluid overload?
Glucocorticoids & Mineralocorticoids
77
Why would we assess the reflexes of a patient?
Reflexes may indicate electrolyte imbalances.
78
What do you want to do with the dosage of mineralocorticoids in an anticipated time of stress?
Increase the dosage and monitor for adverse reactions.
