This drug is an anti-inflammatory that may slow activity of leukocytes, suppress tissue repair and granulation, reducing ESR.

Glucocorticoids

Prednisone (Deltasone)

prednisone (Deltasone) has an Immunosuppressive action that is due to suppression of _____(1)____, and the decrease in the # of ____(2)_____, and lymphocytes

 (1) phagocytosis

 (2) eosinophils

Glucocorticoid

prednisone (Deltasone) results in increased gluconeogenesis and decreased glucose use--

hence an increase in_________

blood glucose

What Glucocorticoid drug decreases antigen-antibody reactions, and decreases the # of plasma immunoglobulins?

prednisone (Deltasone)

Glucocorticoid activity may cause salt and water retention, resulting in ______ and ______.

edema and hypertension

If a glucocorticoid is used as a topical for a localized action for a prolonged or excessive time it can lead to _______ effects.

SYSTEMIC EFFECTS

True or False

 (1) Glucocorticoids can be given orally?

(2) Cannot be given IV?

(1)  True

(2) False, they can also be given by IV

Prednisone requires what (organ) to be healthy in order to have effective utilization?

The (Liver)

because prednisone is activated with metabolism in the Liver to prednisolone.

What part of the endocrine system can cause slow metabolism?

 when (the thyroid) is not producing enough T3 and T4

(hypothyroidism)

True or False?

Prednisone should not be given with food?

False, may cause GI upset, so food is recommended with dosage

What are the uses for prednisone (Deltasone)?

*Asthma, allergies, inflammatory bowel disease

*Immunosuppressive to prevent organ transplant rejection

*As a replacement for adrenal insufficiency

Glucocorticoid

You should not take prednisone (Deltasone) if.....

*Hypersensitivity

 * Systemic fungal infection or administered live viruses(immune suppression)

*People allergic to -Sulfites- may develop severe allergic or anaphylactic reactions

Closely Monitor Patients that take

prednisone(Deltasone)with:

                           (Pre-existing illnesses)                      

DM, or GI disorders, HTN, or myasthenia gravis

they may have exacerbations

Common adverse effect for pednisone(Deltasone)

CNS?

CNS complaints: anxiety mood swings, insomnia, and headache

Common adverse effects prednisone(Deltasone)

GI ?

GI complaints: N/V, increased appetite, weight gain, and dyspepsia

Common adverse effects for the endocrine system while using

prednisone (Deltasone)?

hyperglycemia, menstrual irregularities, suppression of pituitary ACTH release

Patients on prednisone (Deltasone) because of immune suppression have an increased risk for:

-INFECTION-

  prednisone also may suppress bone growth

Acne, and delaying healing of wounds is increased with what drug?

prednisone (Deltasone)

Long term use of prednisone (Deltasone) can lead to:

*Cushingoid characteristics such as buffalo hump, moon face and trance obesity

*May also see loss of muscle mass and thinning extremities

*Hyperlipidemia and thrombus formation

prednisone (Deltasone) results in increased parathyroid activity which causes what to happen?

Calcium loss from bones which increase risk of osteoporosis

Patients should be weened off prednisone (Deltasone) to prevent......

acute adrenal insufficency caused by abrupt withdrawl

Acute Adrenal Insufficiency signs and symptoms:

anorexia, hypoglycemia, lethargy, restlessness

if this happens pt. needs to call provider ASAP

What must be taught to a Patient on prednisone (Deltasone) besides.......

*Eat with meals or antacids

*Teach to avoid infections and how to recognize S/S

*Wear Medical Identification

*Discuss alterations in appearance

*Take-1500 mg Calcium and 510 of Vit D

*Admin at an establishes schedule

Fludrocortisones (Florinef Acetate) is what kind of catagory Drug?

Mineralocorticoids

What does Fludrocortisones (Florinef Acetate) do on a cellular level?

Acts on distal renal tubule to enhance reabsorption of Na and to increase the urinary excretion of both K+

and H+ ions

Orally

absorbed in GI, metabolized in Liver

What drug gives partial replacement therapy for primary adrenocortical insufficency?

Fludrocortisones (Florinef Acetate)

What are Contraindications to Fludrocortisones (Florinef Acetate)?

*Hypersensitivy

*Systemic Fungal Infections

Why would B/P rise in a person taking Fludrocortisones (Florinef Acetate)?

Because of the sodium retention and potassium excretion

Patients need sufficient protien intake while on Fludrocortsones (Florinef Acetate) other wise......

the drug can produce a negative nitrogen balance

Edema, HTN, CHF and cardiomegaly

bruising, diaphoresis, Urticaria, allergic skin rash

Hypokalemic alkalosis

 All SERIOUS sides effects that are from what drug?

Fludrocortisones (Florinef Acetate)

mineralocorticoid

What needs to be taught with a Patient on Fludrocortisones (Florinef Acetate)?

Follow a diet high in K+ and low in Na to reduce the risk for HTN, weight gain, and edema

Wear medication ID bracelet and regular F/U's

Report unusual weight gain, lower extremity edema, muscle weakness and severe or continuing HA, also monitor their own B/P

electrolyte status, fluid balance, and B/P

What is  the med Aminoglutethimide (Cytadren) used  to treat?

 *Used to treat Hypercortisolism (Cushings Syndrome)

*Non FDA approved but used also for breast cancer in postmeopausal Women and metastic prostate cancer in Men

What drug inhibits enzymatic conversion of cholesterol to pregnenolone.

Reduces synthesis of all adrenal steroids.

Aminoglutethimide (Cytadren)

Steroid Hormone Antagonist

The decrease in adrenal steroids induces a compensatory increase in secretion of ______

ACTH

What is necessary to maintain aminoglutehimide's effect?

hydrocortisone

What are the contraindications of

Aminoglutethimide (Cytadren)?

Hypersensitivity

and

Pregnancy Category D

Common Adverse effects in

Aminoglutethimide (Cytadren)

Drowsiness, dizziness, skin rash, nausea, and anorexia.

What happens with the adverse effects of

Aminoglutethide (Cytadren)?

They usually disappear spontaniously in 1-2 weeks

What is a Serious Adverse effect from suppression of aldosterone production by the adrenal cortex

when taking

Aminoglutethimide (Cytadren)

Hypotension and tachycardia

What kind of Blood dyscrasias can happen as a Serious Adverse Effect with the Med

Aminoglutethimide (Cytadren)

 granulocytosis, leucopenia, neutropenia, and pancytopenia

(Also rare but may cause elevated liver enzymes)

What kind of drugs may interact with

Aminoglutethimide  (Cytadren)?

Oral Anticoagulants

Caution clients

will need increased monitoring.

What are the Nursing Interventions with a patient taking

Aminoglutethimide (Cydadren)?

Change positions slowly, prevent injury

Take meds with small frequent meals to lessen GI effects

Do not drive or perform other tasks that require alertness- until effects known.

Report rash, drowsiness, HA's or severe nausea

This drug is used for Hypothyroidism?

levothyroxine (Synthroid)

Sythroid has increased absorption when-

on an empty stomach

(it is taken at the same time each day

usually before breakfast)

Common Adverse Effects for

levothyroxine (Synthyroid)?

 hyperthyroidism symtoms (increased sweating, HTN, tachycardia, hyperreflexia, anxiety)

Alopecia with intial Therapy

What history of the Patient would be a Contraindication to taking levothyroxine (Synthroid)?

*Acute MI

*Thyrotoxicosis

"Be cautious with hypoadrenalism"

What must a nurse monitor for a Patient on

levothyroxine (Synthroid)?

Monitor:

drug response carefully

cardiac reponse

weight and pulse

(suggest wearing a Med ID bracelet)

Which drug inhibits thyroid sythesis

 treating  Hyperthyroidism?

methamazole (Tapozole)

What kind of a patient should not take methamazole (Tapazole)?

Hypersensitivity to drug or properties of

OR

Someone who is pregnant or lactating

What are some common adverse effects you might see

with a patient taking

methamazole (Tapazole)?

GI:  N/V, epigastric pain

Itching

Rash

Hives

Arthralgia

Aplastic anemia, Liver Damage, Agranulocytosis, and Vasculitis

Serious Adverse Effects of this Drug?

methamazole (Tapazole)

What are Nursing Interventions when taking methamazole (Tapazole)?

Administer around the _____

Periodic ____ ____ (CBC, thyroid function)

Report to provider with:____ ____, unusual _____ or _____, malaise

Clock

sore throat

unusual bleeding or bruising

What drug regulates Calcium and bone metabolism,

therefore inhibiting bone reabsorbtion?

calcitonin, salmon (Miacalcin)

Parathyroid Medication

Antihypercalcemic, Calcium Regulator Drug

T or F

calcitonin, salmon (Miracalcin)

has a Direct effect and action on the GI tract

True

How can calcitonin, salmon (Miacalcin)

be

administered: (3 ways)

SQ, intramuscularly, or intranasally

What drug is used for:

*Pagets disease of the bone

*Tx of postmenopausal osteoporosis and hypercalcemia

*Inhibiting bone absorbtion

calcitonin, salmon (Miacalcin)

Why a patient could not use

calcitonin, salmon (Miacalcin)

Allergies 2ndary to salmon antigens.

If a person has multiple allergies (skin testing)

No serious allergies with nasal spray

What are some common Adverse Effects of

calcitonin, salmon (Miacalcin)

GI disturbances: mild and decrease with use

Skin site reactions: flushing of face and hands, and nasal irritation or rhinitis with nasal spray.

Allergic-anaphylaxis can result with __(1)___ calcitonin, salmon.

Persons allergic to __(2)__ products are more at risk

(1) injectible

(2) fish

calcitonin, salmon (Miracalcin)

Clients using:

nasal spray should_____nostrils

SQ injections should use ____ ____

alternate nostrils

sterile technique

Nursing Interventions calcitonin, salmon (Miracalcin)

 (1)How should nasal formula be stored?

(2)Small frequent meals may decrease what?

(3)Observe Urine periodically for what?

Store unopened bottle in fridge

N/V

urine sediments-can indicate renal calculi

What are the uses of

Calcitril (Rocaltrol) oral

Calcijex-parenteral

Both used to manage hypocalcemia and bone disorders

associated with Chronic Renal Falure/dialysis,

hypoparathyroidism

Increasing bone mass in osteoporosis

Calcitriol can be administered 2 ways

Name them

Orally

and

IV

hypercalcemia can happen with Calcitriol or Calcijex

if given:

in excessive doses

What Patients CANNOT or should use CAUTION taking

Calcitriol(Rocaltrol) oral

or

Calcijex parenteral

*Pts taking Digoxin can have cardiac arrhythmias

*Pts with end-stage renal disease are unable to adequatly synthesize

USE CAUTION IN ELDERLY PTS with CORONARY or RENAL DISEASE

Weakness, HA, N/V, dry mouth, constipation and bone pain are all common adverse effects due to what Vitamin associated with

Calcitriol (Rocaltrol)

Calcijex

Vitamin D

Calcitriol (Rocaltrol) oral

Calcijex parental

Meds have most active for of Vitamin _(1)_

Stimulates intestinal CA and _(2)_ transport

Helps to maintain _(3)_ homeostasis, bone growth and maintenance

(1) Vitamin D

(2) Phosphate

(3) CA (calcium)

Chronic hypercalcemia can lead to:

generalized vascular calcification,

nephorcalcinosis,

other soft tissue calcifications

What dietary supplement is necessary for a clinical response in

Calcitriol (Rocaltrol) or Calcijex?

Adequate dietary Calcium or Calcium Supplement

What should a Patient Avoid while taking

Calcitriol (Rocaltrol)

or Calcijex?

Avoid us of nonprescription drugs, including magnesium containing antacids.

Avoid dehydration, take in adequate fluid.

Calcitriol (Rocaltrol) or Calcijex

Encourage pts to eat-

Encourage pt to keep-

Monitor-

Eat- small frequent meals to decrease GI nausea

Keep- Follow Up appointments

Monitor- blood levels

What drug stimulates cell growth and cellular mitosis, promoting use of fatty acid for energy?

(Equilvalent to pituitary GH)

Somatropin (Humatrope)

How can

Somatropin (Humatrope)

be administered?

SC and IM

Somatropin (Humatrope)

is used for children who have growth failure

only if what?

(Contraindications)

The epiphyses is not closed

(also pts with intracranial tumors and pediatric pts with endocrine disorders)

Patients with these issues should be cautious to take

Somatropin (Humatrope):

*Patients with renal and hepatic disorders

*Diabetics may become hyperglycemic

What are commom Adverse Effects with

Somatropin (Humatrope)?

*HA, joint and back pain, muscle aches, rhinitis

*Peripheral edema

*Hypertension

*Hyperglycemia

Antibodies to GH, Hypothyroidism, and Insulin Resistance may Happen in this drug as

Serious Side Effects?

Somatropin (Humatrope)

Nursing Interventions for

Somatropin (Humatrope)?

Take baseline Height and Weight

Monitor thyroid, blood glucose and levels of GH therapy

Pts on dialysis dose according to their shedule

Monitor Nutrition Balance

Teach appropriate technique (Drug only injection)

Refrigerate-reconstituted and stable for 14 days

Should be reconstituted w/ bacteriostatic water

What drug interacts with V1 and V2 receptors found on the renal tubles and can mediate antidiuresis by stimulating resorption?

Desmopressin (DDAVP)

Dessmopressin (DDAVP) has a _____ half life and can be administered 4 different ways?

Long Half Life

Can be aministered:

intranasally, orally, IV or SC

What are the reasons for Dessmopressin (DDAVP)

to be used?

*Diabetes Insipidus

*Primary nocturnal enuresis

*Trauma-induced bleeding

*Hemophilia A and Von Wilebrand disease

Use Caution with Desmopressin (DDAVP)

with Patients who have:

CAD or HTN

clients with fluid and electrolyte imbalanced

cystic fibrosis

renal disease-can experience Hyponatremia

Adverse Effects of

Desmopressin (DDAVP):

Mild abd pain and cramps

HAs, nasal congestions, nausea, rhinitis and facial flushing

Injections associated with-erythema, burning, pain and swelling

Watch Out!!!

Serious Side Effects for

Dessmopressin (DDAVP):

Hyponatremia

Changes in BP either high or low

Nursing Interventions for

Dessmopressin (DDAVP):

Pregnacy Category B-no breast feeding

Establish baseline for weight, BP, electrolytes, urine specific gravity

Protect med for excessive heat or freezing

Refridgerate intranasal and parenteral solutions

Limit fluid intake 1 hr before and 8 hrs after dose to decrease the risk of Hyponatremia and water intoxication

Monitor urine volume and Osmolality as well as pt electrolyte levels.

Alcohol can alter therapeutic reponse