Show:
Adrenal Gland & Corticosteroids
Replacement Therapy with Corticosteroids
Mineralcorticoids
Antiadrenal Agents
Miscellaneous
100
Which 3 steroid hormones are secreted by the adrenal cortex?
mineralcorticoids - glucocorticoids - gonadocorticoids
100
What is Addison's disease?
primary adrenocortical insufficiency, - (when pathology of the adrenal glands is the cause of hyposecretion)
100
Define hypoaldosteronism.
lack of adequate aldosterone secretion
100
Define Cushing's syndrome.
high levels of corticosteroids are present in the body over a prolonged time period
100
What should the nurse monitor with use of fludrocortisone?
blood pressure & signs of hypokalemia
200
Which of the following is NOT an effect of glucocorticoids? a) increased blood glucose b) suppression of inflammatory and immune responses c) decreased breakdown proteins into amino acids d) increased breakdown of lipids e) promotion of brochodilation
c) decreased breakdown proteins into amino acids
200
Name the symptoms of Addison's disease
nausea - vomiting - lethargy - confusion - coma - low plasma cortisol (accompanied by high plasma ACTH[adrenocorticotropic hormone] levels)
200
True or False: There are several mineralcorticoids used to treat hypoaldosteronism.
False: Fludrocortisone is the only mineralcorticoid in its class
200
Select all that apply. Which of the following are signs and symptoms of Cushing's syndrome? a) adrenal atrophy, osteoporosis, HTN b) mood and personality changes c) acne, peptic ulcers, obesity d) decreased risk of infections, increased wound healing e) redistribution of fat
a) adrenal atrophy, osteoporosis, HTN b) mood and personality changes c) acne, peptic ulcers, obesity e) redistribution of fat
200
What should the nurse do if a patient is subject to severe stress while on hydrocortisone (Cortef)? a) notify the physician b) adjust the dose c) discontinue use d) administer an opioid
b) adjust the dose
300
What happens when cortisol levels rise?
negative-feedback mechanism shuts off further release of glucocorticoids
300
Which labs should be monitored with use of hydrocortisone (Cortef)?
serum sodium and potassium levels - hematocrit - hemoglobin - blood glucose - BUN - creatinine
300
List the adverse effects and serious adverse effects of fludrocortisone
(adverse effects) sodium and fluid retention - (serious adverse effects) edema - cardiomegaly - HTN - HF - hypokalemia
300
Which of the following is NOT a clinical manifestation of Cushing's syndrome? a) hyperpigmentation b) thin, wrinkled skin c) abdominal striae d) moon face (redistribution of fat around face)
a) hyperpigmentation
300
True or False: Corticosteroids are frequently used to stimulate the inflammatory and immune responses
False: Corticosteroids are frequently used to suppress the inflammatory and immune responses
400
Which of the following is true about corticosteroids? a) All are unbound to plasma proteins. b) All have same MOA and dose-dependent adverse effects. c) All are pregnancy category B. d) All are administered orally.
b) All have same MOA and dose-dependent adverse effects.
400
List the adverse effects and the most serious adverse effect of hydrocortisone (Cortef)
(adverse effects) sodium and fluid retention - CNS effects [insomnia, anxiety, headache, vertigo, depression, confusion] --- (serious adverse effect) hyperglycemia
400
With use of fludrocortisone, precaution should be taken with which type of patients?
patients with disorders where fluid accumulation may be hazardous (ex: F, HTN, renal impairment/hepatic impairment)
400
Which antifungal drug has become the preferred drug for long-term therapy of Cushing's syndrome and why?
ketoconazole (Nizoral), because it rapidly blocks glucocorticoid synthesis
400
What happens to the adrenal glands after corticosteroid therapy is initiated?
the adrenal glands atrophy
500
List the 7 most significant adverse events from long-term corticosteroid therapy.
immune response - peptic ulcer - osteoporosis - behavioral changes - eye changes - metabolic changes - myopathy
500
A nurse is admitting a client to an acute care facility for a total hip arthroplasty. The client takes hydrocortisone for Addison’s disease. Which of the following the priority nursing action? A. Administering a supplemental dose of hydrocortisone B. Instructing the client about coughing and deep breathing C. Collecting addition information from the client about his history of Addison’s disease D. Inserting an indwelling urinary catheter
A. Administering a supplemental dose of hydrocortisone
500
List the 3 categories of hypoaldosteronism and what causes them.
1) decreased stimulation of the adrenal cortex (beta-blockers, NSAIDs, and CCBs) 2) hyposecretion of aldosterone (Addison's disease or heparin) 3) aldosterone resistance (disease of the renal tubules)
500
Why should ketoconazole (Nizoral) not be used during pregnancy?
ketoconazole (Nizoral) has been shown to be teratogenic and embryotoxic at high doses
500
Why should corticosteroids be discontinued gradually?
to prevent adrenal crisis, allowing the adrenal glands to resume normal function