Pharmacology in Nursing Adrenal Drugs Adrenal Gland Adrenal

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Pharmacology in Nursing Adrenal Drugs

Pharmacology in Nursing Adrenal Drugs

Adrenal Gland �Adrenal cortex �Adrenal medulla �Each portion has different functions and secretes different

Adrenal Gland �Adrenal cortex �Adrenal medulla �Each portion has different functions and secretes different hormones �Feedback process of hormone regulation

Adrenal Gland (cont’d) �Adrenal medulla secretes catecholamines: � Epinephrine � Norepinephrine �Adrenal cortex secretes

Adrenal Gland (cont’d) �Adrenal medulla secretes catecholamines: � Epinephrine � Norepinephrine �Adrenal cortex secretes corticosteroids � Glucocorticoids � Mineralocorticoids (primarily aldosterone) � All adrenal cortex hormones are steroid hormones

Adrenocortical Hormones �Oversecretion leads to Cushing’s syndrome �Undersecretion leads to Addison’s disease

Adrenocortical Hormones �Oversecretion leads to Cushing’s syndrome �Undersecretion leads to Addison’s disease

Cushing’s Syndrome

Cushing’s Syndrome

Addison’s Disease

Addison’s Disease

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

Adrenal Drugs �Can be either synthetic or natural �Many different drugs and forms �Glucocorticoids �Topical, systemic, inhaled, nasal �Mineralocorticoid �Systemic �Adrenal steroid inhibitors �Systemic

Adrenocortical Hormones (cont’d) �Glucocorticoids �beclomethasone (several formulations) �fluticasone propionate �hydrocortisone (several formulations) �cortisone �methylprednisolone

Adrenocortical Hormones (cont’d) �Glucocorticoids �beclomethasone (several formulations) �fluticasone propionate �hydrocortisone (several formulations) �cortisone �methylprednisolone �prednisone �Many others

Adrenocortical Hormones (cont’d) �Mineralocorticoid �fludrocortisone acetate �Adrenal steroid inhibitors �aminoglutethimide �metyrapone

Adrenocortical Hormones (cont’d) �Mineralocorticoid �fludrocortisone acetate �Adrenal steroid inhibitors �aminoglutethimide �metyrapone

Mechanism of Action �Most exert their effects by modifying enzyme activity �Different drugs differ

Mechanism of Action �Most exert their effects by modifying enzyme activity �Different drugs 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

Indications �Wide variety of indications �Adrenocortical deficiency �Cerebral edema �Collagen diseases �Dermatologic diseases �GI

Indications �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 (cont’d) �Organ transplant (decrease immune response) �Palliative management of leukemias and lymphomas �Spinal

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

Indications (cont’d) �Glucocorticoids given: �By inhalation for control of steroid-responsive bronchospastic states �Nasally for

Indications (cont’d) �Glucocorticoids given: �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

Indications (cont’d) Antiadrenals (adrenal steroid inhibitors) �Aminoglutethimide �Used in the treatment of Cushing’s syndrome

Indications (cont’d) Antiadrenals (adrenal steroid inhibitors) �Aminoglutethimide �Used in the treatment of Cushing’s syndrome �Metyrapone �Used as a diagnostic drug to assess ACTH production

Contraindications �Drug allergies �Serious infections, including septicemia, systemic fungal infections, and varicella �However, in

Contraindications �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 (cont’d) �Cautious use in patients with �Gastritis, reflux disease, ulcer disease �Diabetes �Cardiac/renal/liver

Contraindications (cont’d) �Cautious use in patients with �Gastritis, reflux disease, ulcer disease �Diabetes �Cardiac/renal/liver dysfunction

Adverse Effects �Potent effects on all body systems � Cardiovascular � Heart failure, cardiac

Adverse Effects �Potent effects on all body systems � Cardiovascular � Heart failure, cardiac edema, hypertension—all due to electrolyte imbalances (hyperkalemia, hypernatremia) � CNS � Convulsions, headache, vertigo, mood swings, nervousness, insomnia, “steroid psychosis, ” others

Adverse Effects (cont’d) �Potent effects on all body systems �Endocrine � Growth suppression, Cushing’s

Adverse Effects (cont’d) �Potent effects on all body systems �Endocrine � Growth suppression, Cushing’s syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others �GI � Peptic ulcers with possible perforation, pancreatitis, abdominal distention, others

Cushing’s Syndrome

Cushing’s Syndrome

Adverse Effects (cont’d) �Potent effects on all body systems �Integumentary � Fragile skin, petechiae,

Adverse Effects (cont’d) �Potent effects on all body systems �Integumentary � Fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria �Musculoskeletal � Muscle weakness, loss of muscle mass, osteoporosis

Adverse Effects (cont’d) �Potent effects on all body systems �Ocular � Increased intraocular pressure,

Adverse Effects (cont’d) �Potent effects on all body systems �Ocular � Increased intraocular pressure, glaucoma, others �Other � Weight gain

Nursing Implications �Perform a physical assessment to determine baseline weight, height, intake and output

Nursing Implications �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 (cont’d) �Assess for contraindications to adrenal drugs, especially the presence of peptic

Nursing Implications (cont’d) �Assess for contraindications to adrenal drugs, especially the presence of peptic ulcer disease �Assess for drug allergies and potential drug interactions (prescription and OTC) �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

Nursing Implications (cont’d) �Systemic forms may be given by oral, IM, IV, or rectal routes (not SC) �Prepare and administer according to manufacturer’s directions �Oral forms should be given with food or milk to minimize GI upset

Nursing Implications (cont’d) �For topical applications, follow instructions about use and type of dressing,

Nursing Implications (cont’d) �For topical applications, follow instructions about use and type of dressing, if any, to apply �Clear nasal passages before giving a nasal corticosteroid

Nursing Implications (cont’d) �After using an inhaled corticosteroid, instruct patients to rinse their mouths

Nursing Implications (cont’d) �After using an 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

Nursing Implications (cont’d) Patients should be taught to take all adrenal medications at the

Nursing Implications (cont’d) Patients should be taught to take all adrenal medications at the same time every day, usually in the morning, with meals or food Do not take with alcohol, aspirin, NSAIDs

Nursing Implications (cont’d) �Sudden discontinuation of these drugs can precipitate an adrenal crisis caused

Nursing Implications (cont’d) �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