Adrenal Agents Uses, Effects, Nursing Care

Adrenocortical Agents
Chapter 36
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Indications 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

Anatomy 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

Controls and Actions of the Adrenal
Glands

Types of Corticosteroids
• Androgens
– Male and female sex hormones
• Glucocorticoids
– Stimulate an increase in glucose levels for e nergy
• Mineralocorticoids
– Affect electrolyte levels and homeostasis

Site of Action of the Adrenocortical Agents

Actions 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)

Causes 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

Adrenal Crisis
• Signs
– Physiological exhaustion
– Hypotension
– Fluid shift
– Shock and even death
• Treatment
– Massive infusion of replacement steroids
– Constant monitoring and life support procedures

Question
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.

Answer
True
Rationale: There are contraindications and cautions
associated with prolonged use of corticosteroid
hormones.

Glucocorticoids
• 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

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

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

Mineralocorticoids
• 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

Mineralocorticoids (cont.)
• Contraindications
– Known allergy
– Hypertension
– CHF
– Cardiac disease
• Caution
– Pregnancy
– Presence of any infection
– High sodium intake

Mineralocorticoids (cont.)
• Adverse Reactions
– Increase fluid volumes
– Allergic reactions
• Drug-to-Drug Interaction
– Decrease effectiveness with salicylates, barbiturates,
hydantoins, rifampin, and anticholinesterases

Use of Adrenocortical Agents Across the
Lifespan

Prototype Glucocorticoids

Prototype Mineralocorticoids

Nursing Considerations for
Glucocorticoids
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Nursing Considerations for
Mineralocorticoids
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Question
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

Answer
A. Stimulate fat deposition
Rationale: The glucocorticoids increase glucose production,
stimulate fat deposition and protein breakdown, and
inhibit protein formation.

Adrenal Agents Uses, Effects, Nursing Care

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