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Chapter 33
Adrenal Drugs
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Adrenal Gland
Adrenal cortex
Adrenal medulla
Each portion has different functions and secretes different hormones
Feedback process of hormone regulation
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3. Adrenal Gland (cont’d)
Adrenal medulla secretes catecholamines
Epinephrine
Norepinephrine
Adrenal cortex secretes corticosteroids
Glucocorticoids
Mineralocorticoids (primarily aldosterone)
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4. Adrenocortical Hormones
Oversecretion leads to Cushing’s syndrome
Undersecretion leads to Addison’s disease
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Adrenal Drugs
Can be either synthetic or natural
Many different drugs and forms
Glucocorticoids
Topical, systemic, inhaled, nasal
Mineralocorticoid
Systemic
Adrenal steroid inhibitors
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6. Adrenal Drugs (cont’d)
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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7. Adrenal Drugs (cont’d)
Mineralocorticoid
fludrocortisone (Florinef)
Adrenal steroid inhibitor
aminoglutethimide (Cytadren)
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Mechanism of Action
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
Wide variety of indications
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)
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
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12. Classroom Response Question
The nurse should teach a patient taking an oral corticosteroid to take the medication at what time?
8:00 am
12 noon
5:00 pm
8:00 pm
Correct answer: A
Rationale: Oral corticosteroids should be taken in the morning to minimize adrenal suppression.
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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
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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15. Contraindications (cont’d)
Cautious use in patients with
Gastritis, reflux disease, ulcer disease
Diabetes
Cardiac/renal/liver dysfunction
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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
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17. 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?
Furosemide
Levothyroxine
Proton pump inhibitor
Antacid
Correct answer: A
Rationale: Co-administration of a loop diuretic with a corticosteroid may result in hypokalemia because of the potassium loss caused by both drugs.
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Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

18. 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
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19. 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
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20. Adverse Effects (cont’d)
Potent effects on all body systems
Ocular
Increased intraocular pressure, glaucoma, others
Other
Weight gain
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21. Classroom Response Question
When administering aminoglutethimide (Cytadren) to a patient, it is most important for the nurse to monitor:
serum electrolytes.
cardiac enzymes.
liver enzymes.
arterial blood gases.
Correct answer: C
Rationale: Aminoglutethimide therapy may cause hepatotoxicity, so it is important to monitor liver enzymes.
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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
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23. 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
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24. Nursing Implications (cont’d)
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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25. 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
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26. 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
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27. 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:
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.
Correct answer: B
Rationale: The patient should rinse his mouth with water immediately after taking an inhaled corticosteroid to avoid oral fungal infections and other oral irritations.
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Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

28. 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
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29. 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
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30. Nursing Implications (cont’d)
Monitor for therapeutic responses
Monitor for adverse effects
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