Download Pharmacology and the Nursing Process, 4th ed. Lilley/Harrington

Chapter 33
Adrenal Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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)
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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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Adrenal Drugs (cont’d)
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Glucocorticoids

beclomethasone (several formulations)
 fluticasone propionate
 dexamethasone
 hydrocortisone (several formulations)
 cortisone
 methylprednisolone (Solu-Medrol)
 prednisone (Deltasone, Sterapred, Liquid Pred)
 prednisolone
 triamcinolone
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Adrenal Drugs (cont’d)
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Mineralocorticoid
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fludrocortisone (Florinef)
Adrenal steroid inhibitor
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aminoglutethimide (Cytadren)
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Mechanism of Action
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Most corticosteroids exert their effects by
modifying enzyme activity
Glucocorticoids 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)

Wide variety of indications (cont’d)

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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Classroom Response Question
The nurse should teach a patient taking an oral
corticosteroid to take the medication at what time?
A. 8:00 AM
B. 12 noon
C. 5:00 PM
D. 8:00 PM
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Indications (cont’d)

Antiadrenals (adrenal steroid inhibitors)

aminoglutethimide (Cytadren)
• 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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Classroom Response Question
A patient is receiving prednisone as part of treatment for
severe arthritis. He is also receiving furosemide (a loop
diuretic), levothyroxine (for hypothyroidism), and a proton
pump inhibitor and antacid (for gastroesophageal reflux
disease [GERD]). Which drug does the nurse identify as
most likely to be a concern during the therapy with
prednisone?
A. Furosemide
B. Levothyroxine
C. Proton pump inhibitor
D. Antacid
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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

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

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

Weight gain
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Classroom Response Question
When administering aminoglutethimide (Cytadren)
to a patient, it is most important for the nurse to
monitor:
A. serum electrolytes.
B. cardiac enzymes.
C. liver enzymes.
D. arterial blood gases.
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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-the-counter)
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 subcut)
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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Classroom Response Question
A patient is taking an inhaled corticosteroid for
asthma. After the patient takes a dose of the
inhaler, the nurse’s priority should be to:
A.
B.
C.
D.
listen to the patient’s breath sounds.
have the patient rinse his mouth with warm water.
instruct the patient to cough and deep breathe.
take the patient’s apical pulse for 1 minute.
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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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