Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 33 Adrenal Drugs

2 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenal Gland  Adrenal cortex  Adrenal medulla  Each portion has different functions and secretes different hormones  Feedback process of hormone regulation

3 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

4 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenocortical Hormones  Oversecretion leads to Cushing’s syndrome  Undersecretion leads to Addison’s disease

5 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenal Drugs  Can be either synthetic or natural  Many different drugs and forms  Glucocorticoids  Topical, systemic, inhaled, nasal  Mineralocorticoid  Systemic  Adrenal steroid inhibitors  Systemic

6 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenocortical Hormones (cont’d)  Glucocorticoids  beclomethasone (several formulations)  fluticasone propionate  hydrocortisone (several formulations)  cortisone  methylprednisolone  prednisone  Many others

7 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adrenocortical Hormones (cont’d)  Mineralocorticoid  fludrocortisone acetate  Adrenal steroid inhibitor  aminoglutethimide

8 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

9 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

10 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

11 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d)  Glucocorticoids administration  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

12 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d) Antiadrenals (adrenal steroid inhibitors)  aminoglutethimide  Used in the treatment of Cushing’s syndrome, metastatic breast cancer, and adrenal cancer

13 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

14 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Contraindications (cont’d)  Cautious use in patients with  Gastritis, reflux disease, ulcer disease  Diabetes  Cardiac/renal/liver dysfunction

15 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects Potent effects on all body systems  Cardiovascular  Heart failure, cardiac edema, hypertension—all caused by electrolyte imbalances (hypokalemia, hypernatremia)  CNS  Convulsions, headache, vertigo, mood swings, nervousness, insomnia, “steroid psychosis,” others

16 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

17 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

18 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Adverse Effects (cont’d) Potent effects on all body systems  Ocular  Increased intraocular pressure, glaucoma, others  Other  Weight gain

19 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

20 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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 over-the- counter)  Be aware that these drugs may alter serum glucose and electrolyte levels

21 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

22 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

23 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  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

24 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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  Patients should not take with alcohol, aspirin, or NSAIDs

25 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. 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

26 Mosby items and derived items © 2011, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic responses  Monitor for adverse effects