Glucocorticoids

Prednisone (Deltasone)

(1) phagocytosis

 (2) eosinophils

Glucocorticoid

prednisone (Deltasone) results in increased gluconeogenesis and decreased glucose use--

hence an increase in_________

True or False

 (1) Glucocorticoids can be given orally?

(2) Cannot be given IV?

(1)  True

(2) False, they can also be given by IV

The (Liver)

because prednisone is activated by the  metabolism of the Liver 

What part of the endocrine system

can cause slow metabolism?

when (the thyroid) is not producing enough T3 and T4

(hypothyroidism)

True or False?

Prednisone should not be given with food?

Asthma, allergies, inflammatory bowel disease

*Immunosuppressive to prevent organ transplant rejection

*As a replacement for adrenal insufficiency

Glucocorticoid

You should not take prednisone (Deltasone) if.....

Hypersensitivity

 * Systemic fungal infection or administered live viruses(immune suppression)

*People allergic to -Sulfites- may develop severe allergic or anaphylactic reactions

Closely Monitor Patients that take

prednisone(Deltasone)with:

 (Pre-existing illnesses)             

Diabetes mellitus, or GI disorders, HTN,

or myasthenia gravis: they may have exacerbations

Common adverse effect for pednisone(Deltasone)

CNS?

Common adverse effects prednisone(Deltasone)

GI ?

Common adverse effects for the endocrine system while using

prednisone (Deltasone)?

-INFECTION-

  prednisone also may suppress bone growth

Cushingoid characteristics such as buffalo hump, moon face and trance obesity

*May also see loss of muscle mass and thinning extremities

*Hyperlipidemia and thrombus formation

anorexia, hypoglycemia, lethargy, restlessness

if this happens pt. needs to call provider ASAP

What must be taught to a Patient on prednisone (Deltasone) besides.......

*Eat with meals or antacids

*Teach to avoid infections and how to recognize S/S

Wear Medical Identification

*Discuss alterations in appearance

*Take-1500 mg Calcium and 510 of Vit D

*Admin at an establishes schedule

Acts on distal renal tubule to enhance reabsorption of Na and to increase the urinary excretion of both K+

and H+ ions

Orally

absorbed in GI, metabolized in Liver

What are Contraindications toFludrocortisones

(Florinef Acetate)?

*Hypersensitivy

*Systemic Fungal Infections

Edema, HTN, CHF and cardiomegaly

bruising, diaphoresis, Urticaria, allergic skin rash

Hypokalemic alkalosis

 All SERIOUS sides effects that are from what drug?

Fludrocortisones (Florinef Acetate)

mineralocorticoid

Follow a diet high in K+ and low in Na to reduce the risk for HTN, weight gain, and edema

Wear medication ID bracelet and regular F/U's

Report unusual S/S

monitor their own B/P

What  F/U's  are needed with pts  on

Fludrocortisones (Florinef Acetate)?

Hypercortisolism (Cushings Syndrome)

*Non FDA approved but used also for breast cancer in postmeopausalWomen and metastic prostate cancer in Men

What drug inhibits enzymatic conversion of cholesterol to pregnenolone.

Reduces synthesis of all adrenal steroids.

Aminoglutethimide (Cytadren)

Steroid Hormone Antagonist

What are the contraindications of

Aminoglutethimide (Cytadren)?

Hypersensitivity

and

Pregnancy Category D

Common Adverse effects in

Aminoglutethimide (Cytadren)

What happens with the adverse effectsof

Aminoglutethide (Cytadren)?

Hypotension and tachycardia 

headache, myalgia

What kind of Blood dyscrasias can happen as a Serious Adverse Effectwith the Med

Aminoglutethimide (Cytadren)

granulocytosis, leucopenia, neutropenia, and pancytopenia

(Also rare but may cause elevated liver enzymes)

on an empty stomach

(it is taken at the same time each day

usually before breakfast)

Common Adverse Effects for

levothyroxine (Synthyroid)?

hyperthyroidism symtoms (increased sweating, HTN, tachycardia, hyperreflexia, anxiety)

Alopecia with intial Therapy

*Acute MI

*Thyrotoxicosis

"Be cautious with hypoadrenalism"

What must a nurse monitor for a Patient on

levothyroxine (Synthroid)?

drug response carefully

cardiac reponse

weight and pulse

(suggest wearing a Med ID bracelet)

Which drug inhibits thyroid sythesis

 treating  Hyperthyroidism?

Hypersensitivity to drug or drug properties 

Someone who is pregnant or lactating

What are some common adverse effects you might see

with a patient taking

methamazole (Tapazole)?

GI:  N/V, epigastric pain

Itching

Rash

Hives

Arthralgia (joint pain)

Aplastic anemia, Liver Damage, Agranulocytosis, Vasculitis

Sweating, HTN, tachycardia

Of this list which are Serious Adverse Effects

 of methamazole (Tapazole)

What are Nursing Interventions when taking methamazole (Tapazole)?

Administer around the _____

Periodic ____ ____ (CBC, thyroid function)

Clock

blood tests 

sore throat

unusual bleeding or bruising

malaise

What drug regulates Calcium and bone metabolism,

therefore inhibiting bone reabsorbtion?

alcitonin, salmon (Miacalcin)

Parathyroid Medication

Antihypercalcemic, Calcium Regulator Drug

T or F

calcitonin, salmon (Miracalcin)

has a Direct effect and action on the GI tract

How can calcitonin, salmon (Miacalcin)

be

administered: (3 ways)

Pagets disease of the bone

*Tx of postmenopausal osteoporosis

hypercalcemia

*Inhibiting bone absorbtion

Why a patient could not use

calcitonin, salmon (Miacalcin)

Allergies 2ndary to salmon antigens.

If a person has multiple allergies (skin testing)

***No serious allergies with nasal spray

What are some common Adverse Effects of

calcitonin, salmon (Miacalcin)

GI disturbances: mild and decrease with use

Skin site reactions: flushing of face and hands, 

nasal irritation or rhinitis with nasal spray.

Allergic-anaphylaxis can result with __(1)___ calcitonin, salmon.

Persons allergic to __(2)__ products are more at risk

(1) injectible

(2) fish

calcitonin, salmon (Miracalcin)

Clients using:

nasal spray should_____nostrils

SQ injections should use ____ ____

alternate nostrils

sterile technique

calcitonin, salmon (Miracalcin)

How should nasal formula be stored?

1. N/V

2. urine sediments-  can indicate renal calculi

What are the uses of

Calcitril (Rocaltrol) oral

Calcijex-parenteral

Both used to manage hypocalcemiaand bone disorders

associated with Chronic Renal Falure/dialysis,

hypoparathyroidism

Increasing bone mass in osteoporosis

Calcitriol can be administered 2 ways

Name them

Orally

and

IV

hypercalcemia can happen with Calcitriol or Calcijex

if given:

What Patients CANNOT or should use CAUTION taking

Calcitriol(Rocaltrol) oral

or

Calcijex parenteral

Pts taking Digoxin can have cardiac arrhythmias

*Pts with end-stage renal disease are unable to adequatly synthesize

USE CAUTION IN ELDERLY PTS with CORONARY or RENAL DISEASE

Weakness, HA, N/V, dry mouth, constipation and bone pain are allcommon adverse effects due to what Vitamin associated with

Calcitriol (Rocaltrol)

Calcijex

Calcitriol (Rocaltrol) oral

Calcijex parental

Meds have most active for of Vitamin _(1)_

Stimulates intestinal CA and _(2)_ transport

Helps to maintain _(3)_ homeostasis, 

(1) Vitamin D

(2) Phosphate

(3) CA (calcium)

generalized vascular calcification,

nephorcalcinosis,

other soft tissue calcifications

What dietary supplement is necessary for a clinical response in

Calcitriol (Rocaltrol) or Calcijex?

What should a Patient Avoid while taking

Calcitriol (Rocaltrol)

or Calcijex?

Avoid us of nonprescription drugs, including magnesium containing antacids.

Avoid dehydration, take in adequate fluid.

Calcitriol (Rocaltrol) or Calcijex

Encourage pts to eat-

Encourage pt to keep-

Monitor-

eat- small frequent meals to decrease GI nausea

Keep- Follow Up appointments

Monitor- blood levels

Wich of the following is not a side effect for Viagra.

a. HA

b. Facial flushing

c. Heartburn

d. Dizziness

e. Nasal congestion

• Hypersensitivity

Caution in clients with CAD, CHF, CVA, arrhythmias in the past 6 months.

patient is using nitrates 

• Drug inhibits PDE the isoenzyme that metabolizes cGMP.  This allows increased smooth muscle relaxation and increased inflow of blood.

For use with pulmonary hypertension it increases exercise capacity and function of the right ventricle.  The drug causes vasodilatation of the pulmonary vascular bed.

False 

• Men 65 and older may require lower doses.

• Increased risk of cardiovascular death

Rare: anterior ischemic optic neuropathy,

patient has a sudden loss of vision.- may be permanent

a. Hypogonadism

b. Delayed puberty

c. Decreased androgens

d. Breast cancer treatment (metastatic

• Serious cardiac, hepatic or renal disease due to increased edema with drug.
• Hypersensitivity
• Men with carcinomas of breast or prostate

Hx of MI or CAD due to increase hypercholesteremia

  Radiographs every 6 months

Ø  Serum cholesterol

Ø  Liver function

Ø  Hgb and Hct

Ø  Serum levels

Ø  Urine calcium levels.

testosterone Transdermal patches should be changed every 24 hours.

T/F?

Testosterone is never administered IV

T/F?

no

• Pregnancy Category X

Transdermal testosterone patches should be changed every 24 hours

T/F

The drug finasteride (proscar) is use to treat?

a. Baldness

b. prostate hypertrophy

c. impotency

a. Male pattern baldness

b. prostate hypertrophy

• Inhibits the steroid 5 alpha reductase, which consequently blocks the peripheral conversion of testosterone to DHT.  DHT is necessary for prostate gland growth.  Lack leads to decreased size, increased urinary flow and decrease in BPH symptoms.

T/F

DHT is responsible for patterned hair loss.

For females nurse and in patient’s family should not handle crushed or broken tablets.

Ø  Teach patient of adverse effects

these are generally transient.

True 

Rare: erectile dysfunction, decreased libido, and decreased volume of ejaculate.

What types of pts need to use caution while on 

Finasteride (Proscar)?

·         Pregnancy in the home (Category X)

·         Hypersensitivity

Caution with liver impairment.

Male pattern baldness

Women thinning hair

What was Minoxidil (Rogaine) originally developed as?

a peripheral vasodilator for treating hypertension.

 Topical applications require at least 4 months of twice –daily application before the patient can expect evidence of hair growth.

After the hair has grown in pts should stop the  use of Minoxidil (Rogaine).

True or False?

Fales

Patients who respond will need to continue therapy to maintain therapeutic effects.

·         Hypersensitivity

·         Pregnancy category C

Safety in younger than 18 not established

What Common Adverse Effects can a pt get from

using Minoxidil (Rogaine) topicly?

·         Irritant dermatitis and allergic contact dermatitis.

·         Eczema, erythema, pruritus, dry skin and scalp flaking, and exacerbated hair loss.

What Common Adverse Effects can a pt get from

using Minoxidil (Rogaine) orally?

edema, decreased blood pressure,

increased or decreased pulse, and chest pain.

What Serious Adverse Effects can a pt get from

using Minoxidil (Rogaine)?

Do not use Minoxidil (Rogaine) if

scalp is ______ or not ______

irritated 

intact

Pharmacodynamic of Somatropin (humatrope)?

(What does it do?)

1. Stimulates cell growth and cellular mitosis, promotes the use of fatty acids for energy.

2. Equivalent to pituitary GH.

1. Long term replacement for children who have growth failure due to inadequate GH.

2. Given when epiphysis is not closed.

3. Idiopathic short stature.

1. Children with closed epiphyses.

2. Pts with intracranial tumors.

3. Pediatric pts with endocrine disorders (can develop slipped-capital epiphysis).

4. Caution in renal and hepatic disorders.

5. Diabetics may be hyperglycemic.

HA, joint and back pain, muscle aches, rhinitis.

Peripheral edema.

HTN.

Hyperglycemia.

Antibodies to GH.

Hypothyroidism.

Insulin resistance.

What should a nurse moniter while a pt is on 

Somatropin (Humatrope)?

Monitor thyroid, blood glucose and levels of GH during therapy

• Monitor nutritional balance

What should a nurse teach a pt using 

Somatropin (Humatrope)?

• Drug only given by injection- teach appropriate technique
• Refrigerate reconstituted, it is stable for 14 days

Should be reconstituted with bacteriostatic water

Pharmacodynamics for Desmopressin (DDAVP)?

(How does it work?)

Interacts with V1 and V2 receptors which have a presser response and an antidiuretic response.

- V2 receptors are foud on the renal tubule and can mediate antidiuretics by stimulating resorption in the collecting tubules.

- Release or increase in circulating levels of factor VIII.

Can be administered intranasally, orally, IV or SQ.

Drug has a long half life.

1. Diabetes Insipidus.

2. Primary nocturnal enuresis.

3. Trauma induced bleeding.

4. Hemophilia A and von Willebrand disease. 

1. Hypersensitivity.

2. Intranasal may not be appropriate for pt with impaired LOC.

3. Caution in pts with CAD or HTN.

4. Caution in pts with fluid and electrolyte imbalances - cystic fibrosis, renal disease as they can experience hyponatremia.

Mild abdominal pain and cramps, HA, nasal congestion, nausea, rhinitis and facial flushing.

- Injections associated with erythema, burning, pain or swelling.

Hyponatremia

- Changes in BP, either high or low.

B 

breast feeding

Monitor urine volume and Osmolality as well as

patient electrolyte levels