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Drugs for DIsorders of the Adrenal Cortex/Glucocorticoids in Nonendocrine Diseases
Terms in this set (23)
Physiologic effects of Glucocorticoids
1. carbohydrate metabolism
2. protein metabolism
3. fat metbolism
4. decreased inflammatory process
Process of glucocorticoids
secreted when needed by negative feedback.. hypothalamus --> CRF --> anterior pitutitary --> ACTH --> Adrenal cortex --> cortisol, glucocorticoids
Adrenal Hormone Excess (Crushing's syndrome)
1. truncal obesity, thinning of extremities, hyperglycemia, glycosuria, edema, HTN, decreased resistance to infection, moon face, buffalo hump, mood changes
Treatment of Adrenal Hormone Excess (Crushing syndrome)
Surgical removal of tumor
betamethasone, dexamethasone, hydrocortisone, methylprednisolone, prednisone Indications
chronic replacement therapy (adrenocortical insufficiency) & nonendocrine diseases (anti-inflammatory properties)
1. rheumatoid arthritis
2. SLE (lupus.. chronic infectious disease)
3. ulcerative colitis, Crohn's disease (inflammatory bowel disease)
4. allergic reactions.
6. skin conditions.
7. neoplasms (abnormal growth of tissue)
8. suppression of organ/tissue rejection
9. general inflammatory conditions
Actions of Glucocorticoids Drugs: Stablize proteins in WBC, inhibit synthesis of chemical mediators that produce redness, pain
Effects: anti-inflammatory properties
Nursing Implications: excellent for allergic and auto-immune diseases
Actions of Glucocorticoids Drugs: Vasoconstriction of norepinephrine
Effects: increase BP, heart failure
Nursing Implications: ...
Actions of Glucocorticoids Drugs: facilitating gluconeogenesis and decrease peripheral glucose utilization --> diabetogenic (DM) (on steroids can cause diabetes)
Effects: increase BG
Nursing Implications: increase insulim amounts if diagnosed for diabetes
Actions of Glucocorticoids Drugs: decrease potassium due to increase urinary excretion of potassium
Effects: prone to hypokalemia
Nursing Implications: K supplements, do not give w/ digoxin and diuretics
Actions of Glucocorticoids Drugs: Breaks down protein, thinning of the skin
Effects: decreased wound healing, thinning of extremities (steroids to prevent rejection of organ transplants...decreased wound healing and causes infection)
Nursing Implications: monitor wounds and incisions (bottom of feet), actively avoid pressure ulcers
Actions of Glucocorticoids Drugs: Osteoporosis, decreased intestinal absorption of Ca --> hypocalcemia --> Ca pulled from bone
Effects: compression fractures
Nursing Implications: calcium supplements, perform weight-bearing exercises
Actions of Glucocorticoids Drugs: fat stores develop
Effects: altered fat distribution (round/mood face), thickening of torso (Cushing's syndrome)
Nursing Implications: ..
Actions of Glucocorticoids Drugs: Sodium and water retaining
Effects: edema, weight gain (causes moon face), hypernatremia
Nursing Implications: daily weights, I&O, sodium restriction diet.
Actions of Glucocorticoids Drugs: Decrease lymphocytes, decreased eosinophils, inhibition of antibody response (don't give vaccinations)
Effects: decrease immune system, decrease allergic response (good)
Nursing Implications: do not give to pt w/ fungal infections, Tb, AIDS....report signs of infection, good hand washing, indicated for transplant patients to prevent organ rejection
Actions of Glucocorticoids Drugs: Changes in mood
Nursing Implications: ..
Actions of Glucocorticoids Drugs: Inhibit naturally occurring steroids
Effects: Drugs must be gradually reduced..effects last long after steroid withdrawn
Nursing Implications: doses in the AM to mimick the body's natural daily pattern, best with every other day admin to allow the adrenal gland to continue functioning, taper doses to allow body's natural release of steroids to begin
Actions of Glucocorticoids Drugs: Acne, facial hair
Nursing Implications: ..
Actions of Glucocorticoids Drugs: Increase gastric acid
Effects: risk of gastric distress/PUD
Nursing Implications: monitor for gastric bleeding, admin oral steroids w/meals and antacids, do not give with NSAIDs or ASA
Actions of Glucocorticoids Drugs: Eye problems, cataracts
Nursing Implications: eye exam
Actions of Glucocorticoids Drugs: increased circulation or RBC
Nursing Implications: monitor for bleeding or DVT
Actions of Glucocorticoids Drugs: Increase steroids released in response to stress to maintain homeostasis
Effects: decrease output on steroids in response to stress
Nursing Implications: increase steroid dose during stress
pormotes sodium reabsorption; secretion of potassium, increases water reabsoprtion.
For Addison's disease.
Treatment: fludrocortison (only mineralocorticoid avaliable)
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