ppt chapter 36-1
DESCRIPTION
TRANSCRIPT
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Adrenocortical AgentsAdrenocortical Agents
Chapter 36
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Indications for Use of Adrenal AgentsIndications for Use of Adrenal Agents
• Widely used to suppress the immune system
• Short-term use to relieve inflammation during acute stages of illness
– Do not cure any inflammatory disorders
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anatomy of the Adrenal GlandsAnatomy of the Adrenal Glands
• Location
– Flattened bodies which sit on top of each kidney
• Composition
– Adrenal medulla: An inner core; part of the SNS
– Adrenal cortex: An outer shell; produces hormones called corticosteroids
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Controls and Actions of the Adrenal Glands
Controls and Actions of the Adrenal Glands
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of CorticosteroidsTypes of Corticosteroids
• Androgens
– Male and female sex hormones
• Glucocorticoids
– Stimulate an increase in glucose levels for e nergy
• Mineralocorticoids
– Affect electrolyte levels and homeostasis
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Site of Action of the Adrenocortical Agents
Site of Action of the Adrenocortical Agents
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Actions of Adrenocortical HormonesActions of Adrenocortical Hormones
• Increase blood volume (aldosterone effect)
• Cause the release of glucose for energy
• Slow rate of protein production (reserves energy)
• Block activities of the inflammatory and immune systems (reserves a great deal of energy)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Causes of Adrenal InsufficiencyCauses of Adrenal Insufficiency
• A patient does not produce enough ACTH
• Adrenal glands are not able to respond to ACTH
• Adrenal gland is damaged
• Secondary to surgical removal of the gland
• Prolonged use of corticosteroid hormones
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Adrenal CrisisAdrenal Crisis
• Signs
– Physiological exhaustion
– Hypotension
– Fluid shift
– Shock and even death
• Treatment
– Massive infusion of replacement steroids
– Constant monitoring and life support procedures
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Please answer the following statement as true or false.
The glucocorticoids are used systemically in endocrine disorders. There are multiple contraindications and
cautions associated with their use.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
True
Rationale: There are contraindications and cautions associated with prolonged use of corticosteroid
hormones.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
GlucocorticoidsGlucocorticoids• Actions
– Enter target cells and bind to cytoplasmic receptors
– Initiate many complex reactions responsible for anti-inflammatory and immunosuppressive effects
– Hydrocortisone, cortisone, and prednisone have some mineralocorticoid activity
• Indications
– Short-term treatment of many inflammatory disorders
– To relieve discomfort
– To give the body a chance to heal from the effects of inflammation
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Glucocorticoids (cont.)Glucocorticoids (cont.)
• Pharmacokinetics
– Well absorbed from many sites
– Metabolized by natural systems; mostly within the liver
– Excreted in the urine
• Contraindications
– Known allergy
– Acute infection
– Lactation
• Caution
– Diabetes
– Acute peptic ulcer
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Glucocorticoids (cont.)Glucocorticoids (cont.)
• Adverse Reactions
– Related to route of administration
– Systemic use is associated with endocrine disorders
• Drug-to-Drug Interaction
– Increase in drug when given with erythromycin, ketoconazole, or troleandomycin
– Decrease in drug when given with salicylates, barbiturates, phenytoin, or rifampin
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
MineralocorticoidsMineralocorticoids
• Actions
– Holds sodium, and with it, water in the body
– Causes the excretion of potassium by acting on the renal tubule
• Indications
– Replacement therapy in primary and secondary adrenal insufficiency
• Pharmacokinetics
– Absorbed slowly and distributed throughout the body
– Hepatic metabolism
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mineralocorticoids (cont.)Mineralocorticoids (cont.)
• Contraindications
– Known allergy
– Hypertension
– CHF
– Cardiac disease
• Caution
– Pregnancy
– Presence of any infection
– High sodium intake
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mineralocorticoids (cont.)Mineralocorticoids (cont.)
• Adverse Reactions
– Increase fluid volumes
– Allergic reactions
• Drug-to-Drug Interaction
– Decrease effectiveness with salicylates, barbiturates, hydantoins, rifampin, and anticholinesterases
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Use of Adrenocortical Agents Across the Lifespan
Use of Adrenocortical Agents Across the Lifespan
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype GlucocorticoidsPrototype Glucocorticoids
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype MineralocorticoidsPrototype Mineralocorticoids
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Glucocorticoids
Nursing Considerations for Glucocorticoids
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Mineralocorticoids
Nursing Considerations for Mineralocorticoids
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Mineralocorticoids are used to block inflammation and the immune response. Which of the following is another example of their use?
A. Stimulate fat deposition
B. Decrease protein formation
C. Increase protein breakdown
D. Inhibit fat deposition
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
A. Stimulate fat deposition
Rationale: The glucocorticoids increase glucose production, stimulate fat deposition and protein breakdown, and inhibit protein formation.