3-Drugs For Adrenal Cortex Disorders

Front 1

What are the three adrenocorticoid hormones?

Back 1

Glucocorticoids, mineralcorticoids, and adrenal androgens

Front 2

Discuss the target of glucocorticoids?

Back 2

Penetrate the cell membrane and cause transcription of messenger RNA coded for regulatory proteins

Front 3

Basal levels of cortisol are lowest at what time?

Back 3

Lowest before bedtime. Highest before waking

Front 4

What is the physiologic dose of prednisone? of hydrocortisone?

Back 4

5-7 mg/day. 20-30mg/day

Front 5

Are adverse effects are more common w/physiologic or pharmacologic doses?

Back 5

Pharmacologic

Front 6

When are pharmacological doses of glucocorticoids usually given?

Back 6

Usually in the early morning (before 9 a.m.) w/ food

Front 7

How do glucocorticoids affect metabolism?

Back 7

Promote glucose availability and storage as glycogen, catabolize proteins, and promote lipolysis of fats

Front 8

How do glucocorticoids support bp?

Back 8

Decrease capillary permeability and maintain vasoconstriction

Front 9

How do glucocorticoids affect infant lungs?

Back 9

Accelerate lung maturation

Front 10

Discuss the glucocorticoid effects on mood

Back 10

Long-term low-dose glucocorticoids may predispose some individ to depression and suicide. short-term high-dose therapy may lead to mania in some individ

Front 11

What is the cause of Cushing's syndrome? Describe the signs and symptoms common in Cushing's syndrome

Back 11

Excessive glucocorticoids. obesity, hyperglycemia, hypertension, hypernatremia, hypokalemia, hypervolemia, decreased resistance to infection, psychiatric changes, muscle wasting, osteoporosis, thinning of skin, fat redistribution, hirsutism, acne, menstrual irregularities

Front 12

How do glucocorticoids affect blood sugar?

Back 12

Glucocorticoids may increase blood sugars, requiring increases in anti-diabetic drugs

Front 13

How does glucocorticoid therapy affect immune function?

Back 13

Glucocorticoids may impair immune function, predisposing patients to bacterial and fungal infections

Front 14

How do glucocorticoids affect wound healing?

Back 14

Impair wound healing

Front 15

Abrupt cessation of high-dose chronic glucocorticoids may result in what?

Back 15

Adrenal insufficiency

Front 16

Prolonged use of glucocorticoids in a prego mother can lead to what disease in the infant?

Back 16

Fetal adrenal hypoplasia (adrenal insufficiency)

Front 17

Describe methods of administering glucocorticoids which may minimize their adverse effects

Back 17

Lowest dosage for shortest duration; switch from multiple doses to one AM dose; alternate day dosing before 9 am; use of topical, inhalation or local injection instead of systemic doses; therapy for osteoporosis

Front 18

Glucocorticoids do not need to be tapered if given for less than how many weeks?

Back 18

2-3 weeks

Front 19

What drugs administered w/glucocorticoids can increase the risk of hypokalemia? GI bleed?

Back 19

Diuretics, beta-adrenergic agonists.
NSAIDS, ASA, alcohol

Front 20

Discuss nursing intervention for patients taking glucocorticoids

Back 20

monitor height and weight, I&O, VS, electrolytes, CBC, cortisol, LFTs, BUN, creatinine. Encourage an eye exam every 6 months. Discourage breastfeeding if patient is taking more than 5mg of prednisone per day. Watch neonate for adrenal insufficiency if the mother was on cortocosteroids during prego

Front 21

Discuss the main points to be stressed in patient education for glucocorticoids

Back 21

take oral steroids w/food before 9 am. limit joint movement for 1-2 days after joint injection. check for bruising & edema. Taper doses. avoid communicable disease. avoid ASA, NSAIDS, and alcohol. take missed doses when remembered (but don't double dose) Encourage weight bearing exercises. may need to increase dose with stress.

Front 22

Explain the 3x3 rule for mild of febrile illness

Back 22

Take 3 times the usual dose for 3 days

Front 23

What are recommended dietary measures for individuals on glucocorticoids?

Back 23

Low calorie, restricted salt, high potassium foods, increased protein, increased calcium, and vitamin D intake

Front 24

Aldosterone is what kind of steroid? aldosterone retains what? excretes what?

Back 24

mineralocorticoid. sodium and water. potassium and hydrogen.

Front 25

Addison's disease is a deficiency of what two steroids? What are the signs and symptoms?

Back 25

glucocorticoids and mineralocorticoids. hypoglycemia, hyponatremia, hypotension, hyperkalemia, GI distress, weakness, circulatory collapse, renal failure, increased skin pigmentation, death

Front 26

What is the drug of choice for adrenal hormone insufficiency? what two properties does it have? when is it given?

Back 26

Hydrocortisone. Glucocorticoid and some mineralocorticoid properties. daily dose before 9 am OR 2/3 dose in am and 1/3 dose in pm

Front 27

Florinef (fludrocortisone) causes retention of what? Excretion of what? when is it given?

Back 27

sodium and water. potassium and hydrogen. given in the morning

Front 28

Discuss four things you would monitor to assess a patient's response to Florinef (fludrocorticone)?

Back 28

Weight, BP, hypokalemia, and heart size

Front 29

What are the symptom of acute adrenal insufficiency (adrenal crisis)?

Back 29

Hypotension, dehydration, weakness, lethargy, vomiting, diarrhea, shock, death