Term
| Oversecretion of adrenocortical steroids leads to |
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Definition
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Term
| Undersecretion of adrenocortical steroids leads to |
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Definition
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Term
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Definition
most exert their effects by modifying enzyme activity
glucocorticoids inhibit or help control inflammatory and immune responses |
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Term
| Adrenal Drugs - Indicatins |
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Definition
wide variety of indications
1. adrenocortical deficiency
2. cerebral edema
3. collagen diseases
4. dermatologic diseases
5. GI diseases
6. exacerbations of chronic respiratory illnesses, such as asthma and COPD
7. organ transplant (decrease immune response)
8. palliative management of leukemias and lymphomas
9. spinal cord injury |
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Term
| Glucocorticoids administration |
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Definition
1. by inhalation for control of steroid responsive bronchospastic states
2. nasally for rhinitis and to prevent the recurrence of polyps after surgical removal
3. topically for inflammation of the eye, ear, and skin |
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Term
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Definition
antiadrenal (adrenal steroid inhibitors)
1. used to treat Cushing's syndrome, metastatic breast cancer, and adrenal cancer |
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Term
| Adrenal drugs - contraindications |
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Definition
1. serious infections including septicemia, systemic fungal infections and varicella
2. In presence of tuberculous meningitis, glucocorticoids may be used to prevent inflammatory CNS damage
3. Cautious use in pts with: gastritis, reflux disease, ulcer disease, diabetes, cardiac or renal or liver dysfunction |
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Term
Adrenal Drugs
Adverse Effects - Cardiovascular |
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Definition
1. heart failure
2. cardiac edema
3. hypertension
all of above cause by electrolyte imbalances (hypokalemia, hypernatremia) |
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Term
Adrenal Drugs
Adverse Effects - CNS |
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Definition
| convulsions, headache, vertigo, mood swings, nervousness, insomnia, steroid psychosis |
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Term
Adrenal Drugs Adverse Effects
Endocrine |
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Definition
| growth suppression, Cushing's Syndrome, menstrual irregularities, carbohydrate intolerance, hyperglycemia, others |
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Term
Adrenal Drugs Adverse Effects
GI |
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Definition
| Peptic ulcers with possible perforation, pancreatitis, abdominal distension, others |
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Term
Adrenal Drugs Adverse Effects
Integumentary |
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Definition
| fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria |
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Term
Adrenal Drug Adverse Effects
Musculoskeletal |
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Definition
| muscle weakness, loss of muscle mass, osteoporosis |
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Term
Adrenal Drug Adverse Effects
Ocular and other |
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Definition
Ocular:
increased intraocular pressure, glaucoma, others
other: weight gain |
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Term
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Definition
1. perform physical assessment to determine baseline weight, height, intake and output status, vital signs (especially BP), hydration status, immune status
2. obtain baseline lab studies
3. assess for edema and electrolyte imbalances
4. assess for contraindication to adrenal drugs, especially the presence of peptic ulcer disease
5. assess for drug allergies/ potential drug interactions (prescriptions and OTCs)
6. be aware that these drugs may alter serum glucose and electrolyte levels
7. systemic forms may be given by oral, IM, IV, or rectal routes (not SC)
8. prepare and administer according to manufacturer's directions
9. oral forms should be given with food or milk to minimize GI upset
10. For topical applications follow instructions about use and type of dressing, if any, to apply
11. clear nasal passages before giving a nasal corticosteroid
12. after using an orally inhaled corticosteroid, instruct pts to rinse their mouths to prevent possible oral fungal infections
13. teach pts on corticosteroids to avoid contact with people with infections and to report any fever, increased weakness, lethargy, or sore throat
14. pts should be taught to take all adrenal meds at the same time every day, usually in the morning, with meals or food
15. pts should not take with alcohol, aspirin or NSAIDS
16. sudden discontinuation of these drugs can precipitate an adrenal crisis caused by a sudden drop in serum levels of cortisone
17. doses are usually tapered before discontinued
18. monitor for theraperutic and adverse effects |
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Term
| A pt is receiving prednisone as part of treatmetn for severe arthritis. He is also receiving furosemide (a loop diuretic), levothyroxine (for hypothyroidism), and proton pump inhibitor and antacid (for GERD). Which drug does the nurse identify as most likely to be a concern during the therapy with prednisone |
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Definition
Furosemide
Co- administration of a loop diuretic with a corticosteroid may result in hypokalemia because of the postassium loss caused by both drugs |
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Term
| When administering aminoglutethimide (Cytadren) to a pt, it is important for the nurse to monitor: |
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Definition
Liver enzymes
this therapy may cause hepatotoxicity |
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Term
| A pt is taking an inhaled corticosteroid for asthma. After the pt takes a dose of the inhaler, the nurse's priority should be to: |
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Definition
have pt rinse mouth with warm water
to avoid oral fungal infections or other oral irritations |
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Term
| fludrocortisone (Florinef) |
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Definition
1. mineralocorticoid
2. used as partial replacement therapy for adrenocortical insufficiency in Addison's disease and in the treatment of salt-losing adrenogenital syndrome
3. contraindiacated in cases of systemic fungal infection
4. adverse effects generally relate to water retention and include heart failure, hypertension, elevated intracerebral pressure leading to seizures, skin rash, menstrual irregularities, peptic ulcer, hyperglycemia, hypokalemia, muscle pain and weakness, compression bone fractures, glaucoma, thrombophlebitis
5. interact w/ anabolic steroids, barbituates, hydantoins, rifamycins, estrogens, amphtericin B and tiazide, loop diuretics, anticoagulants, antidiabetic drugs, digoxin, salicylates, vaccines
6. oral form
7. Pregnancy C drug |
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Term
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Definition
1. intermediate acting glucocorticoid
2. longer half life and longer durations of action
3. preferred for antiinflammatory or immunosuppressant purposes
4. used to treat exacerbations of chronic respiratory illnesses such as asthma and chronic bronchitis
5. pregnancy C drug |
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Term
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Definition
1. used in treatment of Cushing's syndrome, metastatic breast cancer, and adrenal cancer
2. only in oral form
3. pregnancy D drug |
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