Ppt chapter 36-1

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Adrenocortical AgentsAdrenocortical Agents

Chapter 36


Indications for Use of Adrenal AgentsIndications 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 GlandsAnatomy 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

Controls and Actions of the Adrenal Glands


Types of CorticosteroidsTypes 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

Site of Action of the Adrenocortical Agents


Actions of Adrenocortical HormonesActions 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 InsufficiencyCauses 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 CrisisAdrenal Crisis

• Signs

– Physiological exhaustion

– Hypotension

– Fluid shift

– Shock and even death

• Treatment

– Massive infusion of replacement steroids

– Constant monitoring and life support procedures


QuestionQuestion

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.


AnswerAnswer

True

Rationale: There are contraindications and cautions associated with prolonged use of corticosteroid

hormones.


GlucocorticoidsGlucocorticoids• 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.)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.)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


MineralocorticoidsMineralocorticoids

• 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.)Mineralocorticoids (cont.)

• Contraindications

– Known allergy

– Hypertension

– CHF

– Cardiac disease

• Caution

– Pregnancy

– Presence of any infection

– High sodium intake


Mineralocorticoids (cont.)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

Use of Adrenocortical Agents Across the Lifespan


Prototype GlucocorticoidsPrototype Glucocorticoids


Prototype MineralocorticoidsPrototype Mineralocorticoids


Nursing Considerations for Glucocorticoids

Nursing Considerations for Glucocorticoids

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation


Nursing Considerations for Mineralocorticoids

Nursing Considerations for Mineralocorticoids

• Assessment: History and Physical Exam

• Nursing Diagnosis

• Implementation

• Evaluation


QuestionQuestion

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


AnswerAnswer

A. Stimulate fat deposition

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

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Ppt chapter 36-1