Adrenocortical agents are used for what?
to suppress the immune system
Mostly short term use
What are some of the goals of suppressing the immune system with adrenal agents?
- Conserving energy
- Relieve inflammation in an acute stage of illness (rheumatoid arthritis)
- Relief of s/s of inflammation
- Relief for the adrenal to allow it to return to WNL
- Organ transplant to prevent rejection
What is the goal of using adrenocortical agents in replacement therapy?
Maintain levels when the adrenal glands are not functioning properly -
Name the inner core of the adrenal gland:
- Adrenal medulla - it is part of the (SNS) sympathetic nervous system (fight/flight)
- Releases Norepinephrine & Epinephrine
What does the adrenal medulla do ?
releases the neurotransmitters epinephrine and norepinephrine when the SNS is stimulated
______ are flattened bodies that sit onto of each kidney.
Describe the adrenal cortex:
- Outer shell
- Produces hormones called corticosteroids
Name the 3 types of corticosteroids:
What do Androgens control?
- Male/Female sex hormones
- Stimulate protein production
- Decrease protein breakdown
Glucocortoids are given for what?
- Stimulate an increase in glucose levels for energy
- Short term treatment of inflammatory disorders
- Relieve discomfort
- Give body a chance to heal from the effects of inflammation
What are Mineralocorticoids given for?
- Affect electrolyte levels and homeostasis
- Usually given with corticoids
What are androgens used to treat?
- Increase protein growth and red blood cell production
What does GHRH stand for and where is it produced and secreated from?
- Growth Hormone-Releasing Hormone
What does TRH stand for and where is it produced and secreated from
- Thyrotropin-Releasing Hormone
What does GnRD stand for and where is it produced and secreated from
- Gonadotropin-Releasing Hormone
What does CRH stand for and where is it produced and secreated from
- Corticoid-Releasing Hormone
What does PRH stand for and where is it produced and secreated from
- Prolactin-Releasing Hormone
What is Simatostain?
- Growth Hormone-INHIBITING Factor
- produced by the Hypothalmus
What does PIF stand for ?
- Prolactin_INHIBITING Factor
- Produced by the hypothalmus
What does ADH stand for?
- Antidiurectic Hormone
- Produced by Hypothalmus
Where is Oxytocin stored/released?
- Posterior pituitary
- It is released when stimulated by the hypothalmus
S/S of adreanal crisis:
- Physiological exhaustion
- Fluid shift
- Shock and even death
Treatment for Adreanal Crisis:
- Massive infusion of replacemnet steriods
- Constant monitoring and life support procedures
What type of drug is Prednisone (Deltasone)?
What cautions should be noted when giving Prednisone?
- Diabetes - insulin dose may need to be increased
- Because this a glucocorticoid that increases the prodiction of glucose
- ALSO peptic ulcers
What are Beclomethasone and Flunisol used for?
Respiratory inhailent and nasal spray
What does the aldosterone affect cause?
Increase blood volume
Glucocorticoids may cause lypogenesis - what is this?
What drugs may increase risk of peptic ulcers?
Giving Glucocorticoids (Prednisone) with what drugs may cause decreased effectivness of the steriod?
- Salicylates (asprin)
- Rifampin (TB)
Predisone should be taken at what time of the day?
How is prednisone administered?
What to monitor while on Glucocorticoids?
- Peptic Ulcers
- Increased glucose levels
- Delayed wound healing
- S/S of Infection
Contraindicated with steroids?
- Live vaccines
- Acute infection
Actions of Mineralcorticoids:
- Hold sodium and with it water
- Casues excretion of patassium by acting on the renal tubule
name potassium rich foods :
- Sunflower seeds
- Lima beans
- Navy beans
- Dried fruits
- Sanka Coffee
Indications for Mineralocorticoids :
Replacemnet therapy for primary / secondary adreanal insufficiency
Fludrocortisone is contraindicated with what disorders?
- CHF - may get more fluid back up
- Cardiac disease - the work load of the heart will be increased due to fluid retention
Cautions while taking Fludrocortisone:
- Presence of infection
- High Sodium Intake = should be avoided, will increase BP
Nursing considerations for Fludrocortisone:
- Monitor for edema
- Lungs for pulmonary edema
- Monitor potassium levels - they are retaining sodium and excreeting potassium
What is the function of dieretic agents?
- Increase sodium excretion
- Increases the amount of urine produced by the kidneys
Indications for diuretics:
- Edema with CHF
- Acute pulmonary edema
- Liver disease
- Renal disease
- Conditions that cause hyperkalemia
- Glaucoma to decrease fluid pressure
Name a Thiazide diuretic:
Site of action for Hydrochlorothiazide:
- Blocks the chloride pump.
- Keeps chloride and sodium in the tubule to be excreted in the urine.
Contraindications for Hydrochlorothiazide:
- Allergy to Sulfonamides
- Exsisting Fluid/electrolyte imbalances, and renal/kidney disease
Caution use of Hydrochlorothiazide with what conditions:
- Lupus (SLE)
- Diabetes or glucose tolerance abnormalities = may increase glucose levels
- Bipolar disorder
Adverse effects of Hydrochlorothiazide:
- Alkalinized (weakness, cramps, cardiac arrythmias)
- Alkalinized urine (increase infection)
- Elevated glucose levels
Normal Potassium levels:
3.5 - 5.3
Name a Loop Diuretic:
High ceiling diuretics =
What are the actions of loop diuretics?
blocks the chloride pump in the acending and descending loops of Henle, and the distal tubule
What time of day should a loop diuretic be taken ?
early in the day with food to avoid GI upset
Patients taking Furosemide should decrease intake of what?
Patients taking Furosemide should INcrease intake of what?
- (orange juice, raisins, banans)
Site of action for Acetazolamide:
what drugs work on the Proximal tubule
Carbonic anhydrase inhibitors
Site of action for Thiazide diuetics:
Distal convoluted tubule
drug = Hydrochlorothiazide
Dose of Furosemide (Lasix):
40 mg - push over 1-2 minutes (2 minutes to be safe)