Week 14: Endocrine- Adrenal drugs (12 Mueller)

Question 1

Glucocorticoids: Dexamethasone, prednisone, methylprednisolone and hydrocortisone

Low dose used to treat?
High dose used to treat?

Answer 1

Adrenal insufficiency (Addison’s disease) or CHRONIC condition

Treat inflammation or ACUTE condition

Question 2

Corticosteroids

adverse effects? 12

Taper off!!!!

Answer 2

Edema + Hypertension
Weight gain
Mood swings (roid rage)

Hyperglycemia
Growth suppression
Cushing’s syndrome

Thinning of the skin (striae)
Poor wound healing

Hirsutism
Osteoporosis
glaucoma and Cataracts

Question 3

Long term therapy risk

How should you stop taking it?

Answer 3

MUST TAPER to prevent adrenal atrophy/crisis

Never stop suddenly, even if symptoms improve!

Never stop suddenly, even if patients develop severe adverse effects!

SYSTEMIC: Patient Adrenal gland may stop producing Steroids= ADRENAL CRISIS!!!

Question 4

Topical Steroid Withdrawal Syndrome (TSWS)

Signs/ symptom?

Answer 4

Erythema, burning/itching

Question 5

How does ADRENAL CRISIS occur?

Can lead to?

Populations impacted? 2

Answer 5

OCCURS DUE to lack of corticosteroids in the system

Can lead to SHOCK (steroids help in Stress + Blood pressure/volume)

Addison’s Disease

Patients on long term steroids who suddenly stopped therapy (NEVER STOP SUDDENLY)

Question 6

HIGH DOSE SYSTEMIC STEROIDS cause IMMUNOSUPPRESSION

Who should those people avoid?

Giving supplemental doses of steroids before surgery can?

Answer 6

AVOID other people/crowds who may be SICK

NO LIVE VACCINES

Giving supplemental doses called “STRESS DOSES” can prevent ADRENAL CRISIS

Question 7

What patients are immunocompromised?

Answer 7

Patients on chemotherapy

Patients on transplant /immunosuppressant drugs

Patients who are pregnant

Patients who are on high dose, systemic steroids

Question 8

Steroids ADMINISTRATION:

SYSTEMIC (ORAL, IV):
When to take?
How to take?
If on long term therapy?

INHALER:
Do what after usage?
Can use what to improve absorption and reduce risk of thrush?

Answer 8

Take in morning
Take with food to reduce GI irritation
encourage diet high in vitamin D and calcium

Wash mouth
Use spacers

Question 9

Glucocorticoids Nursing considerations?

Avoid grapefruit juice with what medicine?

Can delay?

Careful with who?

Answer 9

Methylprednisolone

Can Delay Growth in Children,

Careful with Diabetes

Question 10

Mineralocorticoids:fludrocortisone

Used to treat?
What does fludrocortisone do?

People with addison’s disease don’t make what?

Answer 10

Addison’s Disease
Orthostatic Hypotension

Mimics aldosterone: Builds up salt and water in the body

Enough cortisol or aldosterone