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Ppt chapter 36
- 1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Adrenocortical Agents
Chapter 36
- 2. 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
- 3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
- 4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Controls and Actions of the Adrenal
Glands
- 5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
- 6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Site of Action of the Adrenocortical Agents
- 7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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)
- 8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
- 9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Adrenal Crisis
• Signs
– Physiological exhaustion
– Hypotension
– Fluid shift
– Shock and even death
• Treatment
– Massive infusion of replacement steroids
– Constant monitoring and life support procedures
- 10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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.
- 11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True
Rationale: There are contraindications and cautions
associated with prolonged use of corticosteroid
hormones.
- 12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
- 13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
- 14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
- 15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
- 16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mineralocorticoids (cont.)
• Contraindications
– Known allergy
– Hypertension
– CHF
– Cardiac disease
• Caution
– Pregnancy
– Presence of any infection
– High sodium intake
- 17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Mineralocorticoids (cont.)
• Adverse Reactions
– Increase fluid volumes
– Allergic reactions
• Drug-to-Drug Interaction
– Decrease effectiveness with salicylates, barbiturates,
hydantoins, rifampin, and anticholinesterases
- 18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Use of Adrenocortical Agents Across the
Lifespan
- 19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Glucocorticoids
- 20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Mineralocorticoids
- 21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for
Glucocorticoids
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
- 22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for
Mineralocorticoids
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
- 23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
- 24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
A. Stimulate fat deposition
Rationale: The glucocorticoids increase glucose production,
stimulate fat deposition and protein breakdown, and
inhibit protein formation.