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Which two hormones does the adrenal medulla secrete?
Which specific hormone is secreted by the adrenal cortex?
What are the two types of corticosteriods?
What is the primary function of mineralocorticoids?
regulate electrolytes & water balance in the body
What is the most important natural mineralocorticoids?
What is the function of all glucocorticoids?
- antiinflammatory actions
- carbohydrate/protein/fat metabolism
- maintain normal blood pressure
- stress effects
What is the function of all mineralocorticoids?
- contorl blood pressure
- maintain normal potassium levels
- maintian normal pH levels in the blood
- resorb sodium and water
Which are the main sex hormones secreted by the adrenal cortex?
Which hormone when an hypersecretion is produced causes redistribution of body fat from the arms and legs to the face, shoulders, trunk, and abdomen which cause "moon face"?
Which hormone when an hypersecretion is produced causes an increase retention of water and sodium, which cause muscle weakness due to potassium loss?
What are the different ways in which glucocorticoids are categorized?
- wheter they are natural or synthetic
- method of administration (systemic or topical)
- their salt and water retention potential (mineralocorticoids)
- duration of action
When glucocorticoids are given by inhalation form what is their primary usage?
- contorl of steroid-responsive bronchospatic state
- NOT FOR ACUTE BRONCHOSPAMS
when glucocorticoids are given nasally what is their primary usage?
- manage rhinitis
- prevent recurrence of polyps after surgical removal
When a glucocorticoids is given in a topical form what is its primary usage?
managment of inflammation of the eye, ear, and skin
Which drug is the most common oral form of glucocortcoid used?
Which drug is the most common parenteral form of glucocortcoid used?
Which glucocortoid is the drug of choice for women in premature labor to accelerate fetal lung maturation?
What are contraindications to a patient taking glucocortcoids?
- mental health problems
- diabetes mellitus
- peptic ulcer disease
When a patient with diabetes is ordered to take a glucocortcoids what should the nurse be aware of montioring?
increase in blood glucose levels casued by adverse effect
With the use of long term use of glucocortcoids what is the most common adverse effect?
What are the two most common adverse effects seen in hospatlized patients with the use of glucocortcoids?
Which is the most serious adverse effect of glucocorticoids?
If a patient has been prescribed a corticosteriod for a really long time how should the nurse teach the patient about geting off the medaction?
dont abruptly stop taking. you have to taper yourself off of them. because these drugs cause the endogenous production of the hormone to stop
Which drug is the most commonly perscreibed mineralocorticoids?
What is the main indication for fludrocortisone?
- partial replacment therapy for adrenocortical insufficency in Addison's disease
- treatment of salt-losing adrenogenital syndrome
What are some adverse effects to the usage of fludrocortisone?
- water retention
- heart failure
- elevated intracranial pressure
Before giving a patient any corticosteroid what is the important things the nurse should assess on the patient first?
- patients nutritional and hydration status
- vital signs (BP)
- soidum levels
- potassium levels
- BUN levels
- bloog glucose levels
- hemoglobin/hematocrit levels
What is the main concern with elder patients on these drugs?
If a patient is prescribed a GCS for replacment therapy when is the dosage likely going to be scheduled?
daily in early AM between the hours of 6 and 9 AM
When given a GCS that is in IV form, how should the nurse always give the solution?
dilute the IV because it is very caustic to veins
When given a oral form of GCS how should the drug be taken and why?
- taken with meals or soon after
- to minimize GI irritation
If a patient is taken a GCS what type of imformation should the nurse provide the patient to help minimize gastric irritation and gastric bleeding?
- Take with meals or soon after
- avoid alcohol
- avoid aspirin and other NSAIDs
How does glucocortoids have an effect on inhibiting inflammation?
- stablize the membranes of macrophages so they can't produce the chemical & cell mediated immune response
- with less capillary dilation cause less blood to the area
- with less capillary permeability cause less local edema
How does glucocortoids have an effect on B & T cell reproduction?
- the body is less able to recognize antigens
- antibody reproduction is slowed
- new capillary growth is slowed
- fibroblast growth is slowed
- new collagen growth is slowed
- less histamine is released
How does glucocortoids have an effect on glucose metabolism?
- stimulates gluconeogensis causing liver enzymes to convert amino acids to glucose
- which then increase serum glcose
- and increase glucose stored in the liver
How does glucocortoids have an effect on protein and fat metabolism?
- inhibits protein synthesis which affects wound healing
- causes muscle wasting & atrophy
- increased fat absorption from the gut
- release of adipose tissue to fatty acid in blood
- redistributes to face, upper back, abdomen
- fatty acid in blood causes athersclerosis
- increases appetite
How does glucocortoids have an effect on fluid and electrolytes?
- causes retention of sodium & water (increase in sodium)
- casues a decrease in potassium
- causes hypertension and electrolyte imbalance which cause edema
How does glucocortoids have an effect on GI & muscular skeletal?
- thinning of the mucosa causes an increase risk of ulcers
- cause Pancreatitis
- decrease vitamin D & C absorption which cause bones to weaken, break, and take longer to heal eventually develop osteoporpsis
- causes muscle wasting & weakness
- cause arthralgia
How does glucocortoids have an effect on the immune system and integumentary?
- suppresses immune response
- increases susceptibility to infections
- suppresses signs/symptoms of infections
- impairs wound healing
- causes thin fragile skin
- causes hirsutism, ecchymosis, striae, acne
- cause glaucoma
How does glucocorticoids have an effect on the central nervous system?
- normally GCS maintain nerve excitability
- when there is an increase in GCS it causes decrease nerve excitability
- alter brain wave patterns
- alters mood, irritability, nervousness
- causes insomnia, euphoria, depression, personality & behavior changes
How does glucocorticoids have an effect at the cellular level?
- inhibits capillary permeability which causes reduce leakage of fluid into the effected area
- decreases release of bradykinins, histamine, lysosomal enzymes & phagocytic cells
- decreased lymphoidite & antibody production causes lymphoid tissues to sjrink
- decrease growth of new capillaries, fibroblast & collagen
Which type of drug is used as an anti-inflammatory, anti-allergic, immunosuppressive?
Which type of drug(s) is used for respiratory problems as an oral or nasal inhalation?
Which drug is used to treat acute respiratory conditions?
SoluMedral IV form
Which drug is used to treat problems with cerebral edema such as brain tumors and head injuries and also given during surgery for patients that have been intubated to reduce dilation of the bronchioles?
Which drug(s) is used to treat anaphylactic shock?
Should older patients be medicated with larger doses or smaller doses because of hepatic clearance?
If a patient is given a GCS for short term therapy how should a nurse educate the patient on taking the medication?
large dose for 24-72 hours then tapered down the dose for the next few days