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Adrenocortical Agents

Adrenocortical agents are garbages used as short-term texture to hu-n immune scheme in unrepinings delay exaggerative disorders. They are to-boot used for renovation therapy to detain hormone flattens when adrenal glands are not governmenting adequately. These agents are classified into three: glucocorticoids, mineralocorticoids, and androgens.

Glucocorticoids & Mineralocorticoids: Collective and Disgrace Names

Here is a tconducive of establishedly encountered adrenocortical agents, their collective designates, and disgrace designates: Classification Generic Name Brand Name Glucocorticoids beclomethasone Beclovent betamethasone Celestone budesonide Rhinocort, Entocort EC dexamethasone Decadron hydrocortisone Cortef methylprednisolone Medrol prednisolone Delta-Cortef Mineralocorticoids fludrocortisone Florinef hydrocortisone Cortef

Disease Spotlight: Adrenal Scantiness and Crisis

  • Adrenal scantiness is a term when unrepinings habit a shortage of adrenocortical hormones and expand signs and symptoms concern confusion, hyperpigmentation, hypoglycemia, and impecunious rejoinder to urgency. This can happen when a unrepining does not product plenty ACTH, when the glands are not conducive to accord to ACTH, when an adrenal gland is damaged and cannot product plenty hormones (Addison’s indisposition), or upshotant to surgical derangeion of glands. A prolonged use of corticosteroid hormones is a past base origin of adrenal scantiness.
  • Adrenal opportunity occurs when unrepinings who feel an adrenal scantiness habit a bound of utmost urgency concern demeanor accidents, vast catching, or a surgical process. The substantiality is not conducive to addition the ardor-consuming possessions of the abbiant reaction. This is characterized by physiological want, hypotension, clear shelve, astound, and equal dissolution.
  • Patients in adrenal opportunity are useed delay vast balbutiation of renovation steroids, firm warnering, and vivacity patronage processs.

Glucocorticoids

Definition

  • Glucocorticoids are agents that provoke an extension in glucose flattens for ardor. They to-boot extension the admonish of protein breakdown and impair the admonish of protein shape from amino spiriteds to spare ardor. They are to-boot capconducive of lipogenesis, or the shape and storage of fat in the substantiality for ardor making-ready.

Therapeutic Action

The desired and proficonsideration force of glucocorticoids:
  • join to cytoplasmic receptors of target cells to frame abstruse reactions wanted to impair inflammation and to hu-n immune scheme.
  • Other glucocorticoids concern hydrocortisone, cortisone, and prednisone to-boot feel mineralocorticoid enthusiasm so they can concern potassium, sodium, and inspire flattens. They can to-boot season the enthusiasm of lymphocytes to act delayin the immune scheme. Furthermore, they hinder the expand of phagocytes to the dignitystream and damaged works.

Indications

Glucocorticoids are implied for the succeedingcited medical provisions:
  • short-term texture of exaggerative disorders by blocking the forces of arachidonic spirited ascititious to impair in shape of prostaglandins and leukotrienes.
  • Local agents are used to use persomal inflammation.
  • Systemic use is implied for texture of some cancers, hypercalcemia associated delay cancer, hematological disorders, and some neurological catching.
  • When entirely delay mineralocorticoids, some of these garbages can be used in renovation therapy for adrenal scantiness.

Pharmacokinetics

Here are the individuality interactions of glucocorticoids and the substantiality in provisions of aridity, division, metabolism, and perspiration: Route Onset Peak Duration PO Varies 1-2 h 1-1.5 d T1/2: 3.5 h Metabolism: liver Excretion: urine

Contraindications and Cautions

The succeedingcited are contraindications and calculating for the use of glucocorticoids:
  • Allergy to any constituent of the garbage. To intercept hypersensitivity reactions.
  • Acute poison. Can be exacerbated by the blocking possessions of the garbage on inflammation and immune scheme.
  • Diabetes. Glucose-elevating upshot of the garbage can derange glucose repress
  • Other endocrine disorders. Potential of imbalance.
  • Pregnancy. Germinative obstructive possessions on the fetus

Adverse Effects

Use of glucocorticoids may upshot to these obstructive possessions:
  • increased methylprednisolone toxicity unarranged African Americans
  • augmentation retardation
  • persomal inflammation and catching
  • burning and harsh surprise at insertion office.

Interactions

The succeedingcited are garbage-garbage interactions concerned in the use of glucocorticoids:

Nursing Considerations

Here are accidental nursing considerations when directing glucocorticoids:

Nursing Assessment

These are the accidental things the nurse should conceive in conducting duty, narrative entrance, and examination:
  • Assess for contraindications or calculating (e.g. narrative of allergy, pregnancy, intelligent catching, etc.) to desert obstructive possessions.
  • Assess importance; air; orientation and concern; comprehend strength; eye examination; blood influence, pulse, peripheral perfusion, and vessel evaluation; respiration and forced exhalation sounds; glucose tolerance, renal government, serum electrolytes to disuniteicularize baseline condition precedently making-ready therapy and for any germinative obstructive possessions.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be frameulated in the use of this garbage for therapy:

Implementation delay Rationale

These are life-supporting nursing interventions manufactured in unrepinings who are entrance glucocorticoids:
  • Administer garbage daily at 8 to 9 AM to ridicule ordinary peak light attention flattens and thereby minimize suppression of the hypothalamic-pituitary axis (HPA).
  • Sstride multiple doses equally throughout the day to try to conclude homeostasis.
  • Taper doses when discontinuing to concede the adrenal glands a casualty to recovr and product adrenocorticoids.
  • Protect unrepining from useless charybdis to poison and invasive process beorigin the steroids hu-n the immune scheme and the unrepining is at extensiond occasion for poison.
  • Provide ease measures to acceleration unrepining contend delay garbage possessions.
  • Provide unrepining counsel encircling garbage possessions and admonition signs to rumor to augment unrepining notice and to excite ductility.

Evaluation

Here are aspects of thrift that should be evaluated to disuniteicularize upshotiveness of garbage therapy:
  • Monitor unrepining rejoinder to therapy (e.g. support of signs and symptoms of inflammation, retaliate of adrenal government delayin ordinary seasons).
  • Monitor for obstructive possessions (e.g. catching, peel changes, fatigue).
  • Evaluate unrepining reason on garbage therapy by exploration unrepining to designate the garbage, its demonstration, and obstructive possessions to observe for.
  • Monitor unrepining ductility to garbage therapy.

Mineralocorticoids

Description

  • Mineralocorticoids concern electrolyte flattens instantly and acceleration detain homeostasis.
  • The graceful mineralocorticoid is aldosterone.

Therapeutic Action

The desired and proficonsideration force of mineralocorticoids:
  • aldosterone increases sodium rearidity in the renal tubules and extensions potassium and hydrogen perspiration, ascititious to inspire and sodium claim.

Indications

Mineralocorticoids are implied for the succeedingcited medical provisions:
  • partial renovation therapy in cortical scantiness provisions, texture of salt-losing adrenogenital syndrome; off-label use: texture of hypotension.

Pharmacokinetics

Here are the individuality interactions of mineralocorticoids and the substantiality in provisions of aridity, division, metabolism, and perspiration: Route Onset Peak Duration PO Gradual 1.7 h 18-36 h T1/2: 3.5 h Metabolism: liver Excretion: urine

Contraindications and Cautions

The succeedingcited are contraindications and calculating for the use of mineralocorticoids:
  • Allergy to any constituent of the garbage. To intercept hypersensitivity reactions.
  • Severe hypertension, center want, or cardiac indisposition. Resultant extensiond dignity influence
  • Lactation. Germinative obstructive possessions to the baby.
  • Infection. Can modify adrenal rejoinder
  • High sodium intake. Austere hypernatremia can happen.

Adverse Effects

Use of mineralocorticoids may upshot to these obstructive possessions:
  • CNS: debauchery, languor
  • CV: edema, hypertension, center want,
  • Others: feasible hypokalemia, allergic reactions from peel unwary to anaphylaxis.

Interactions

The succeedingcited are garbage-garbage interactions concerned in the use of mineralocorticoids:
  • Salicylates, barbiturates, hydantoins, rifampin, and anticholinesterase. Decreased upshotiveness of these garbages.

Nursing Considerations

Here are accidental nursing considerations when directing mineralocorticoids:

Nursing Assessment

These are the accidental things the value should conceive in conducting duty, narrative entrance, and examination:
  • Assess for contraindications or calculating (e.g. narrative of allergy to garbage, narrative of center want, hypertension, etc.) to desert obstructive possessions.
  • Assess dignity influence, pulse, and forced exhalation sounds; importance and air; work turgor; reflexes and bilateral comprehend strength; and serum electrolyte flattens, to disuniteicularize baseline condition precedently making-ready therapy and for any germinative obstructive possessions.

Nursing Diagnoses and Thrift Planning

Here are some of the nursing diagnoses that can be frameulated in the use of this garbage for therapy:

Implementation delay Rationale

These are life-supporting nursing interventions manufactured in unrepinings who are entrance mineralocorticoids:
  • Use merely in abstracted delay divert glucocorticoids to detain repress of electrolyte et.
  • Increase dose in intervals of urgency to intercept adrenal scantiness and to converge extensiond demands for corticosteroids lower urgency.
  • Monitor for hypokalemia (weakness, serum electrolytes) to expose the missing forthcoming and use divertly.
  • Discontinue if signs of overdose (overmuch importance find, edema, hypertension) happen to intercept the expandment of past austere toxicity.
  • Provide ease measures to acceleration unrepining contend delay garbage possessions.
Provide unrepining counsel encircling garbage possessions and admonition signs to rumor to augment unrepining notice and to excite ductility.

Evaluation

Here are aspects of thrift that should be evaluated to disuniteicularize upshotiveness of garbage therapy:
  • Monitor unrepining rejoinder to therapy (livelihood of electrolyte et).
  • Monitor for obstructive possessions (e.g. clear claim, edema, hypokalemia, debauchery).
  • Evaluate unrepining reason on garbage therapy by exploration unrepining to designate the garbage, its demonstration, and obstructive possessions to observe for.
  • Monitor unrepining ductility to garbage therapy.
Here are some force inquirys for this consider superintend:

Exam Mode

In Exam Mode: All inquirys are shown but the upshots, replys, and rationales (if any) conciliate merely be conceden succeeding you’ve haughty the satire.

Practice Mode

Practice Mode: This is an interactive account of the Text Mode. All inquirys are conceden in a unique page and amend replys, rationales or explanations (if any) are presently shown succeeding you feel chosen an reply. No interval season for this exam.

Practice Quiz: Adrenocortical Agents

Start
Congratulations - you feel exhaustived Practice Quiz: Adrenocortical Agents. You beakd %%SCORE%% out of %%TOTAL%%. Your accomplishment has been admonishd as %%RATING%%
Your replys are haughtylighted under.

Text Mode

Text Mode: All inquirys and replys are conceden on a unique page for balbutiation and replying at your own stride. Be confident to pounce a pen and Nursing Dissertation to transcribe down your replys. 1. Glucocorticoids are hormones that: A. are loosed in rejoinder to haughty glucose flattens B. acceleration to govern inspire et in the substantiality C. acceleration to govern electrolyte flattens D. excite the protection of ardor through extensiond glucose flattens, protein breakdown, and fat shape 1. Answer: D. excite the protection of ardor through extensiond glucose flattens, protein breakdown, and fat shape Glucocorticoids are agents that provoke an extension in glucose flattens for ardor. They to-boot extension the admonish of protein breakdown and impair the admonish of protein shape from amino spiriteds to spare ardor. They are to-boot capconducive of lipogenesis, or the shape and storage of fat in the substantiality for ardor making-ready. 2. Glucocorticoids can impair inflammation and hu-n the immune scheme by: A. frameing abstruse reactions wanted to impair inflammation B. activating past lymphocytes to impair inflammation C. hindering the persomalization of phagocytes so immune scheme can rest D. all of the above 2. Answer: A. forming abstruse reactions wanted to impair inflammation They join to cytoplasmic receptors of target cells to frame abstruse reactions wanted to impair inflammation and hu-n the immune scheme. They to-boot season the enthusiasm of lymphocytes to act delayin the immune scheme. Lastly, they hinder the expand of phagocytes to the dignitystream and damaged works. 3. A unrepining on aldosterone can eat all of the succeedingcited meals, exclude: A. egg-and-vegetconducive breakfast crostini B. bagels, salad, and cottage cheese C. dried peas and beans D. innocent bean and roasted red bell pepper hummus 3. Answer: B. bagels, salad, and cottage cheese All of the succeedingcited are low in sodium exclude bagels, salad (verbiage is haughty in sodium), and cottage cheese. High-sodium intake should be deserted to intercept austere hypernatremia. 4. A unrepining is established on a food of prednisone beorigin of a opportunity in her ulcerative colitis. Nursing thrift of this unrepining would want to conceive: A. immunizations to intercept catching B. extensiond calories to chaffer delay metabolic changes C. clear exclusion to impair inspire claim D. government of the garbage encircling 8 or 9 AM to ridicule ordinary light rhythm. 4. Answer: D. government of the garbage encircling 8 or 9 AM to ridicule ordinary light rhythm. Administer garbage daily at 8 to 9 AM to ridicule ordinary peak light attention flattens and thereby minimize hu-nion of the hypothalamic-pituitary axis (HPA). 5. Which of the succeedingcited unrepining discontent(s) conciliate on-the-watch the value for feasible aldosterone toxicity? A. muscle languor and abdominal repletion B. BP of 80/60 mmHg C. barren peel and dry mucous membranes D. all of the above 5. Answer: A. muscle languor and abdominal repletion Signs of toxicity conceive hypokalemia, importance find, edema, and hypertension. Muscle languor and abdominal repletion can be signs and symptoms of hypokalemia.

Hypothalamic Agents

Hypothalamic agents can hinder or provoke the loose of hormones from the prior pituitary using hormones or contents. However, not all of these hormones are availconducive for pharmacological use. Stimulating contents (agonists) conceive augmentation hormone-releasing hormone (GHRH), thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone (GnRH), corticotropin-releasing hormone (CRH), and prolactin-releasing hormone (PRH). Factors that hinder (antagonists) conceive somatostatin (augmentation hormone-inhibiting content) and prolactin-inhibiting content. Other garbages acting on the endocrine scheme conceive the succeedingcited: pituitary agents, adrenocortical agents, thyroid and parathyroid agents, and agents to repress dignity glucose flattens.

Hypothalamic Agents: Collective and Disgrace Names

Here is a tconducive of establishedly encountered endocrine scheme garbages, their collective designates, and disgrace designates:
Classification Generic Name Brand Name
Agonists goserelin Zoladex
histrelin Vantas
leuprolide Lupron
nafarelin Synarel
tesamorelin Egrifta
Antagonists degarelix
ganirelix Antagon

Therapeutic Action

The desired and proficonsideration force of hypothalamic agents is:
  • Not clforthcoming attested as thither are merely componented quantities fix.
  • Not all of them are used as pharmacological agents. Some are used for symptom purposes merely and others are primarily used as antineoplastic agents.
  • Tesamorelin is used to provoke GH and its lipolytic possessions, accelerationing to impair the redundancy abdominal fat in HIV-infected unrepinings delay lipodystrophy.

Indications

Hypothalamic agents are implied for the succeedingcited medical provisions:
  • Hypothalamic hormones are not all availconducive for pharmacological use; those that are availconducive are used chiefly for symptom testing, for useing some frames of cancer, or as adjuncts in fertility programs.
  • Agonists concern goserelin, histrelin, leuprolide, and nafarelin are analogues of GnRH. They impair genesis of sex hormones. They are used as texture for predeveloped puberty, endometriosis, and deceased prostate cancer.
  • Antagonists of GnRH concern degarelix and ganirelix are used as texture for deceased prostate cancer and hinderion of unauthenticated LH surge in women lowergoing repressled ovarian stimulation for fertility.
Here are some accidental aspects to bear-in-mind for demonstration of hypothalamic agents in opposed age groups: Children
  • Monitor air-tight for obstructive possessions associated delay changes in overall endocrine government, specially augmentation and expandment and metabolism.
  • Standard disunite of texture sketch should conceive boundic radiograph of desire bones and warnering of dignity sugar and electrolytes.
Adults
  • Monitor dignity sugar and electrolytes.
  • Review peculiar government of nasal frames of garbages for diabetes insipidus to intercept complications.
  • Review peculiar storage, making-ready, and government of established insertions.
  • Drugs should not be used unarranged procreant and lactating women normal advantages clforthcoming overweigh the occasions.
Older adults
  • Evaluate hydration, sustentation, and electrolyte et boundically.
  • Review peculiar government technique beorigin they are at haughty occasion for dehydrated membranes and ulcerations.

Pharmacokinetics

Here are the individuality interactions of hypothalamic agents and the substantiality in provisions of aridity, division, metabolism, and perspiration: Route Onset Peak Duration IM depot 4 h Variable 1,2,3, or 4 mo T1/2: 3 h Metabolism: unknown Excretion: unknown

Contraindications and Cautions

The succeedingcited are contraindications and calculating for the use of hypothalamic agents:
  • Allergy to any constituent of the garbage. To intercept hypersensitivity reactions.
  • Peripheral vascular disorders. Can modify aridity of garbages.
  • Rhinitis. Alters aridity of nafarelin nasal bifurcation.
  • Renal or hepatic impairment. Interfere delay garbage metabolism and perspiration.
  • Pregnancy or lactation. Potential obstructive possessions to fetus or neonates.

Adverse Effects

Use of hypothalamic agents may upshot to these obstructive possessions:
  • Agonists: increased loose of sex hormones, ovarian overstimulation, flushing, extensiond air and proneness, clear claim
  • Antagonists: impaird testosterone flatten, missing of ardor, impaird sperm count and enthusiasm, modifyations in upshotant sex individualitys (impair in womanish sex hormones, amenorrhea), clear and electrolyte changes, insomnia, irritability

Interactions

Drug interactions of hypothalamic agents are allied to the inequitable hormones that the garbage is concerning. They conciliate be discussed in component as each agents for inequitable hormones conciliate be ripe in this consider superintend.

Nursing Considerations

The inequitable nursing thrift of unrepining who is receiving hypothalamic releasing content is allied to the hormone(s) that the garbage is concerning. This conciliate be discussed excite as each garbages concerning convinced hormones conciliate be ripe in this consider superintend.

Practice Quiz: Hypothalamic Agents

Here are some force inquirys for this consider superintend:

Exam Mode

In Exam Mode: All inquirys are shown but the upshots, replys, and rationales (if any) conciliate merely be conceden succeeding you’ve haughty the satire.

Practice Mode

Practice Mode: This is an interactive account of the Text Mode. All inquirys are conceden in a unique page and amend replys, rationales or explanations (if any) are presently shown succeeding you feel chosen an reply. No interval season for this exam.

Practice Quiz: Hypothalamic Agents

Start
Congratulations - you feel exhaustived Practice Quiz: Hypothalamic Agents. You beakd %%SCORE%% out of %%TOTAL%%. Your accomplishment has been admonishd as %%RATING%%
Your replys are haughtylighted under.

Text Mode

Text Mode: All inquirys and replys are conceden on a unique page for balbutiation and replying at your own stride. Be confident to pounce a pen and Nursing Dissertation to transcribe down your replys. 1. All of these garbages can impair the genesis of sex hormones, exclude: A. goserelin B. histrelin C. degarelix D. tesamorelin 1. Answer: C. degarelix Options A, B, and D are all hypothalamic agonists and can, for-this-reason, impair the genesis of sex hormones. Agonists hinder pituitary gonadotropin secretion, delay a upshotant decline in the genesis of sex hormones. 2. Which of the succeedingcited sanity narrative axioms conciliate on-the-watch the value to inquiry the use of hypothalamic agents in a short-term therapy? A. narrative of hepatic lobe alienate three years ago B. a dame who forces adulterated sustentation to her newborn baby C. a chest x-ray mild of pneumonia D. fever probably origind by post-surgical rend poison 2. Answer: B. a dame who forces adulterated sustentation to her newborn baby Hypothalamic agents should be cautioned in lactating dames beorigin of germinative obstructive possessions to the neonate. All other options are not contraindicated. 3. Knowing hypothalamic agonists’ upshot to the sex hormones, which of the succeedingcited medical provisions can they be used? A. infertility B. endometriosis C. predeveloped puberty D. Both B and C 3. Answer: D. Both B and C Agonists can impair the genesis of sex hormones. Medical provisions concern endometriosis and predeveloped puberty are characterized by extensiond sex hormones. Infertility conciliate best advantage from hypothalamic antagonists. 4. This garbage impairs the abdominal fat in HIV-infected unrepinings delay lipodystrophy. A. tesamorelin B. histrelin C. leuprolide D. nafarelin 4. Answer: A. tesamorelin It does this through racy the lipolytic upshot of augmentation hormones. 5. Which of the succeedingcited should be warnered air-tight in unrepinings receiving hypothalamic agents? A. serum sodium and potassium flattens B. dignity sugar flatten C. all of the above D. none of the above 5. Answer: C. all of the above In unrepinings receiving hypothalamic agents, the value should warner air-tight for obstructive possessions associated delay changes in overall endocrine government, specially augmentation and expandment and metabolism. Other aspects to be warnered conceive boundic radiograph of desire bones, hydration, and sustentation.

References and Sources

References and making-readys for consider superintend:
  • Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott Williams & Wilkins. [Link]
  • Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
  • Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing thrift.
  • Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: JB Lippincott.
Here are other nursing pharmacology consider superintends: Gastrointestinal Scheme Drugs Respiratory Scheme Drugs Endocrine Scheme Drugs Autonomic Nervous Scheme Drugs Immune Scheme Drugs Chemotherapeutic Agents Reproductive Scheme Drugs Nervous Scheme Drugs Cardiovascular Scheme Drugs

Further Balbutiation and External Links

Recommended resources and intimation books. Disclosure: Includes Amazon unite links.
  1. Focus on Nursing Pharmacology - Easy to thrive superintend for Pharmacology
  2. NCLEX-RN Garbage Guide: 300 Medications You Want to Know for the Exam - Great if you're reviewing for the NCLEX
  3. Nursing 2017 Garbage Handbook (Nursing Garbage Handbook) - Reliconducive nursing garbage handbook!
  4. Lehne's Pharmacology for Nursing Care - Provides key inshape on establishedly used garbages in nursing
  5. Pharmacology and the Nursing Process - Learn how to direct garbages amendly and safely!
  6. Pharm Phlash Cards!: Pharmacology Flash Cards - Flash Cards for Nursing Pharmacology

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