Glucocorticoids
Are endogenous hormones produced by the adrenal glands. In clients with impaired adrenal function, these can be administer as replacement therapy. Commonly used in p.t with decreased function like Addison disease. Used in various inflammatory conditions like asthma, Ibs, organ rejection. Synthetic glucocorticoids 3 groups: short acting: cortisone and hydrocortisone (orally, cortisone converted to hydrocortisone by liver). Intermediate: prednisone (orally), prednisolone, methylprednisolone. Long acting: betamethasone, dexamethasone.
Action of Glucocorticoids
Bind to intracellular glucocorticoid receptors then migrate into nucleus to modify expression genes involved in regulating inflammatory processes. Inhibit release of pro inflammatory molecules like prostaglandins and leukotrienes, increase production and release of anti inflammatory molecules
Side effects
Excess glucocorticoids activity result in iatrogenic Cushing syndrome. S/S: mood changes, moon face, buffalo hump, skin atrophy, stretch marks, muscle weakness, hyperglycaemia, increased risk of infection, osteoporosis, pathological fractures, cataracts, glaucoma, peptic ulcer disease. They can act of mineralocorticoid receptors, causing sodium, water retention causing hypertension and edema. Contraindicated in p.t with systemic fungal infections.
Mineralocorticoids
Treat Addison disease and severe congenital adrenal hyperplasia. Fludrocortisone.
Action of Mineralocorticoids
Act on intracellular mineralocorticoid receptors in the kidney tubules, reabsorption of water, sodium, excretion of potassium and protons.
Side effects of Mineralocorticoids
Hypertension, edema, hypokalemia, hyperglycaemia
Short acting/ regular Insulin
Starts working 30 min after administration, peak at 2-3 hrs, last between 6-8hrs
Care of pt.s taking glucocorticoids and Mineralocorticoids
Fludrocortisone- once daily in the morning. Hydrocortisone- twice each day. Hydrocortisone meant to mimic body’s normal production of cortisol, largest dose in the morning, smaller dose in the early afternoon.
Rapid acting Insulin
Include insulin as part, lisp to, glulisine. Starts working 5-15 min, peak 30 min, lays 3-5 hrs.
Intermediate insulin NPH
Only becomes active 1-2 hrs after administration, peak after4 hrs, lasts 16-24 hrs
Long acting Insulin
Glargine, determine. Once administered, glargine forms a percentage at the injection site before it’s slowly released in the bloodstream. Detroit binds to albumin in the blood before dissociating and becoming active. Onset 1-2 hrs after administration, no peak, lasts 20-24 hrs
Action of Insulin
Insulin binds to its receptors on the surface of cell the insulin responsive tissues like muscle cells and adipose tissues und facilitates their uptake of glucose from the blood. Acts on liver and on muscle to promote glucogenesis, storage of glucose as glycogen. Inhibits break down of glycogen, lipids and proteins, shifts potassium ontracellularly.
Common symptom
Hypoglycemia. S/S: headache, dizziness, anxiety, tachycardia, sweating, hunger, weakness. Take half cup of fruit juice or 3 glucose tablets, or 15grs of sugar and glucose 15 min.
Meds for Parathyroid glands
Hypoparathyroidism treated with active form vitamin D3 called Calcitriol. Acts by binding to PTH receptors and mimicking the actions of PTH. Promoting the absorption of calcium from GI tract, renal tubules, releasing calcium from bones.
Side effects of Calcitriol
Headache, drowsiness, dry mouth, meatllic taste
Hyperparathyroidism
Treated with calcitonin
