Transcript Pharmacology and the Nursing Process, 4th ed. Lilley

CHAPTER 33
Adrenal Drugs
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Adrenal Gland
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Adrenal cortex
Adrenal medulla
Each portion has different functions and
secretes different hormones
Feedback process of hormone regulation
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Adrenal Gland (cont’d)
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Adrenal medulla secretes catecholamines
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Epinephrine
Norepinephrine
Adrenal cortex secretes corticosteroids
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Glucocorticoids
Mineralocorticoids (primarily aldosterone)
All adrenal cortex hormones are steroid hormones
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Adrenocortical Hormones
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Oversecretion leads to Cushing’s syndrome
Undersecretion leads to Addison’s disease
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Adrenal Drugs
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Can be either synthetic or natural
Many different drugs and forms
Glucocorticoids
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Mineralocorticoid
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Topical, systemic, inhaled, nasal
Systemic
Adrenal steroid inhibitors
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Systemic
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Adrenocortical Hormones (cont’d)
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Glucocorticoids
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beclomethasone (several formulations)
fluticasone propionate
hydrocortisone (several formulations)
cortisone
methylprednisolone
prednisone
Many others
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Adrenocortical Hormones (cont’d)
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Mineralocorticoid
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fludrocortisone acetate
Adrenal steroid inhibitor
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aminoglutethimide
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Mechanism of Action
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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
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Indications
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Wide variety of indications
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Adrenocortical deficiency
 Cerebral edema
 Collagen diseases
 Dermatologic diseases
 GI diseases
 Exacerbations of chronic respiratory illnesses,
such as asthma and COPD
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Indications (cont’d)
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Wide variety of indications (cont’d)
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Organ transplant (decrease immune response)
Palliative management of leukemias and
lymphomas
Spinal cord injury
Many other indications
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Indications (cont’d)
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Glucocorticoids administration
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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
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Indications (cont’d)
Antiadrenals (adrenal steroid inhibitors)
 aminoglutethimide
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Used in the treatment of Cushing’s syndrome,
metastatic breast cancer, and adrenal cancer
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Contraindications
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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
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Contraindications (cont’d)
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Cautious use in patients with
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Gastritis, reflux disease, ulcer disease
Diabetes
Cardiac/renal/liver dysfunction
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Adverse Effects
Potent effects on all body systems
 Cardiovascular
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Heart failure, cardiac edema, hypertension—all
caused by electrolyte imbalances (hypokalemia,
hypernatremia)
CNS
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Convulsions, headache, vertigo, mood swings,
nervousness, insomnia, “steroid psychosis,”
others
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Adverse Effects (cont’d)
Potent effects on all body systems
 Endocrine
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Growth suppression, Cushing’s syndrome,
menstrual irregularities, carbohydrate intolerance,
hyperglycemia, others
GI
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Peptic ulcers with possible perforation,
pancreatitis, abdominal distention, others
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Adverse Effects (cont’d)
Potent effects on all body systems
 Integumentary
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Fragile skin, petechiae, ecchymosis, facial
erythema, poor wound healing, hirsutism, urticaria
Musculoskeletal
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Muscle weakness, loss of muscle mass,
osteoporosis
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Adverse Effects (cont’d)
Potent effects on all body systems
 Ocular
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Increased intraocular pressure, glaucoma, others
Other
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Weight gain
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Nursing Implications
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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
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Nursing Implications (cont’d)
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Assess for contraindications to adrenal drugs,
especially the presence of peptic ulcer
disease
Assess for drug allergies and potential drug
interactions (prescription and over-thecounter)
Be aware that these drugs may alter serum
glucose and electrolyte levels
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Nursing Implications (cont’d)
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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
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Nursing Implications (cont’d)
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For topical applications, follow instructions
about use and type of dressing, if any, to
apply
Clear nasal passages before giving a nasal
corticosteroid
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Nursing Implications (cont’d)
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After using an orally 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
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Nursing Implications (cont’d)
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Patients should be taught to take all adrenal
medications at the same time every day,
usually in the morning, with meals or food
Patients should not take with alcohol, aspirin,
or NSAIDs
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Nursing Implications (cont’d)
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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
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Nursing Implications (cont’d)
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Monitor for therapeutic responses
Monitor for adverse effects
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