Adrenal Gland Drugs

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Glucocorticoids

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sugar hormone from the adreanal cortex
potent anti-inflammatory agents
suppress immune system function
mimics body cortisol (sugar hormone)

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Systemic Glucocotrticoids

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short acting-low potency
Intermediate acting-medium potency
Long acting-high poetency
All compared to natural cortisol in body

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Short Acting

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low potency
Hydrocortisone (Cortef, Solu-Cortef)po/iv/IM

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Intermediate acting

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Medium potency
Methylprednisolone (solu-medrol) IV/IM, (medrol)-po
Prednisolone (prelone, pediapred)- PO/IV/IM

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Long acting

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High Potency
Dexamethasone (decadron)- PO/IM/IV

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Nursing Implications related to Systemic Glucocorticoid Administration

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Administered for more than 14 days can suppress the adrenal glands secretion of glucocorticoids and therefore must be weaned off to prevent adrenal insufficiency.

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Nursing Implication Glucocorticoid Administration p2

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Patient should be taught about the potential adverse effects of glucocorticoids and that they may need supplemental amounts when under stress situations.

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Nursing Implication Glucocorticoid Administration p3

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Administer the medication first thing in the morning with food will help minimize adverse effects

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Nursing Implication Glucocorticoid Administration p4

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Watch for thrush when patient is using oral or nasal forms. Teach patient to rinse mouth after using the oral and nasal forums to prevent thrush

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Nursing Implications Glucocorticoid Administraton p5

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Contraindicated for patients with a history of TB, or patients undergoing skin testing or vaccinations-no skin test

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Adverse Effects related to Systemic Glucocorticoid Administration

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Cushing syndrome- women facial hair, men lose hair

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Cushing Syndrome

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Abnormal fat distribution: moon face buffalo hump, truncal obesity

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Cushing Syndrome p2

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Protein catabolism: decreased muscle mass, slow wound healing, fragile skin, easy bruising-leave wounds sutures, prone to illness

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Cushing Syndrome p3

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Hyperglycemia
Increased susceptibility to infections and masking of signs and symptoms of infection

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Cushing Syndrome p4

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Osteoporosis
GI irritation/ulcers
Electrolyte imbalance (sodium retaing and potassium wasting) uf gas nuberkicirtuciud cinoibebt (eg, prednisone, hydrocortisone, prednisolone)
Personality changes/mood shifts

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Drug Interactions Related Systemic Glucocorticoid Administration

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Diminished response to vaccines and toxoids (can reactive TB)
Enhanced when combined with: ketoconazole(increase metabolism of drug) and oral contrceptives

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Drug Interactions Glucocorticoid p2

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Dimished with phyenytoin barbituates
Potassium wasting when glucocoticoids are administered with diuretics or medications that deplete potassium
superinfections when patient is on glucocorticoids and antibiotics

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Mineralocorticoid Drugs variables related to fludrocortisone

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Raise blood pressure more specific to mineral corticoid thats missing

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Mineralococorticoid Planning and Intervention

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Look for cushings

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Mineralcocorticoid Drugs Minimizing effects

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Obtain serum electrolyte levels as indicated, similar to glucocorticoids

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Pharmacotherapeutics Mineralocorticoid Drugs

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Fludrocortisone
Aldosterone-Increased
Flornet-Blood
Primary adrenocortical insufficency

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Pharmacodynamics Mineralcocorticoid pharmacodynamics

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Increased blood pressure secondary to above effects-Aldosterone

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Contraindications and precautions Mineralcocorticoid

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Contraindications
Hypersensitvity
Conditions not requiring intense mineralocorticoid activity
Systemic fungal infection

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Adverse Effects Mineralococorticoid

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Cardiovascular Effects
Edema, Hypertension, CHF, Cardiomegaly
Dematologic effects
Bruising, Diaphoresis, urticara, allergic skin rash.
Hypokalemic alkalosis
Glucocorticoid effects

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Drug Interactions Minerolocorticoid

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Barbiturates
Hydantonins
Rifampin
Anticholinesterases
Salicylates

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Drugs used to treat Hypothyroidism

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slow moving, slaping, cold intolerant, weight gain, sleepy.
Levothyrozine (t4, Levothyroid, Synthroid, Levoxyl)

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Levothyrozine Use

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To normalize Thyroid Hormone level

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Levothyroxine Contraindications

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Recent heart attack, unstable angina, thyrotoxocosis

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Levothyroxine Adverse Effects

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tachycardia, irritablility, insomnia, nervousness angina-hyperthyroid

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Levothyroxine drug interactions

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Increase in diabetic agents

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Nursing Implications levothyroxine

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Thyroid function testing will be required to be monitored for as long as patient remains on the medication

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Nursing Implications Levothyroxine p2

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Monitor for signs and symptoms of toxicity (tachycardia, chestpain, nervousness, insomnia, diaphoresis, tremors, weight loss)

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Nursing Implications Levothyroxine p3

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hold dose if thier pulse is greater than 100 beats per minute

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Nursing Implications Levothyroxine p4

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Teach the patient to avoid OTC remedies without checking with their health care provider

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Nursing Implications Levothyroxine p5

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Diabetic patients should monitor thier blood sugar level more frequently until stabilized on their thyroid medication

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Nursing Implications Levothyroxine p6

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Teach the patient to avoid changing brands because potency can vary.
Teach the patient that may take several months for therapy to improve sypmtoms of hypothroidism

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Levothyroxine other

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Litothyronine (cytomel, T3 active form)
Liotrix (T3/T4(stored form), Tyrolar)
Thyrar, Thyroid Strong, Westhroid-Not precise dose as synthroid

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Drugs used to treat Hyperthyroidism.

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Loss of energy, heat intolerent, hyperactive.

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Thioamides

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Propylthiouracil (PTU); and Methimazole (Tapazole)

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Thioamides action

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Both inhibit thyroid and hormone synthesis, PTU also inhibits conversion of T$ to T3

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Thioamides Use

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To normalize thyroid hormone levels

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Thioamides Adverse effects:

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rash, agranulocytosis, leukopenia, hepatotoxicity (with PTU)

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Thioamides Drug interactions

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bone marrow suppression with other therapies that cause bone marrow suppression such as radiation therapy or antieoplastic drug therapy; additive antithyroid effect when given with lithium or iodines/iodides

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Thioamides Nursing Implications

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Caution patients to report signs and symptoms of agranulocytosis: sore throat, fever, chills, headache, malaise, weakness, easy bruising.
Signs and symptoms of hypothyroidism.
4-8 weeks for the drug to normalize hormone levels.

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Iodides

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Lugol's Solution, SSKI, Thyro-Block

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Iodides Action

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Inhibits synthesis and release of T3 & T4 into circulation; decreases size and vascularity of the thyroid gland, prior to surgery

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Iodides Use

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Thyroid suppressant used, treatment of thyrotoxicosis

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Iodides Usual does

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2-6 drops tid po for 10 days

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Iodides adverse effects

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iodism, nasal congestion

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Iodides Drug interaction

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can cause severe hypothyroidism

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Iodides nursing implications

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a bad taste, mix with a full glass of water, juice, milk or broth.
Stain teeth, use a straw to administer
No longer than 7-10 days
Preoperatively for hyperthyroid patient; in emergenicies (thyrotoxocosis); after radioactive iodine therapy

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Beta blockers

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reduce sympathetic nervous system symptoms, stage fright symptoms

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Radioactive iodide (RAI)

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Destroy hyperactive thyroid cells.
Orderless, colorless, tastelesss solution.
High doses (>30mCi) require hospitalization.
Low doses (<30 mCi) are safe to go home.

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Radioactive iodide (RAI)
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All antithyroid, thyroid, or iodine-containing medications are stopped 5-7 days before and after treatment.
Take 6-8 weeks to normalize hormone levels.
Half of patients that recieve RAI will become hypothyroid after treatment.
Half of patients that recieve RAI will become hypothyroid after treatment.
After treatment thyroiditisi may occur: thyroid tenderness and swelling, fever, malaise, genetically transmissible chromosomal abnormalities, and blood dyscrasis

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Antidiuretic Hormone

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Vasopressin- Tannate
Oxytocin
Oily not given IV

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Vasopressin Action

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increases reabsorption of water in the kidney; causes constriction of splanchic (chest and esophagel vessels)

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Vasopressin Use

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Antidiuretic to treat diabetes insibpidus;
Gi hemmorrhage related to esophageal varices- associated with liver disease

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Vasopressin Contraindications

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chest pain, recent MI, migraines, pregnancy

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Vasopressin Nursing implications

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Vasopressin tannate is only given Im, Never IV!!!
Monitor for signs and symptoms of water intoxication (confusion, lethargy, seizures, coma, increased urine specific graity, decreased serum osmolarity, decreased and concentrated urine, weight gain)
Monitor blood pressure for hypertension and assess for chest pain.
Monitor for relief of polyuria and thirst.

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Desmopressin Acetate (DDAVP)Action

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synthetic analong of the posterior pituitary hormone vasopressin

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Desmopressin Acetate Use

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to treat diabetes insipidus to increase factor VIII for patients with hemophilia A and von Willebrand's disease to treat enuresis in children.

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Desmopressin Acetate Administration

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Intranasal

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Desmopressin Acetate Contraidications

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Adverse effects and nursing implications as for vasopressin.