HESI Pharmacology Study Guide
Diuretics - ANS-- Interfere with sodium reabsorption in kidney
- Increase urine output, which reduces hypervolemia; decreases preload and after load
- Available in oral and parenteral preparations
Thiazide Diuretics - ANS-- chlorothiazide, hydrochlorothiazide
- Interfere with sodium ion transport at loop of Henle and inhibit carbonic anhydrase activity at
distal tubule sites
- Metolazone is a thiazide-like diuretic.
Potassium-sparing Diuretics - ANS-- Spironolactone, triamterine, amiloride
- Interfere with aldosterone-induced reabsorption of sodium ions at distal nephron sites to
increase sodium chloride excretion and decrease potassium ion loss.
Loop-diuretics - ANS-- ethacrynic acid, furosemide, bumetanide, torsemide
- Interfere with active transport of sodium ions in loop of Henle and inhibit sodium chloride and
water reabsorption at proximal tubule sites.
- May be given IV
Major Side Effects of Diuretics - ANS-- GI irritation
- Hyponatremia (inhibition of sodium reabsorption at the kidney tubule)
- Orthostatic hypotension
- Hyperuricemia (partial blockage of uric acid excretion)
- Dehydration (excessive sodium and water loss)
- All diuretics except potassium-sparers: hypokalemia, increased urinary excretion of mag and
zinc
- Potassium-sparers: hyperkalemia, hypomagnesemia, increased urinary excretion of calcium
- Furosemide competes with aspirin for renal excretion sites and can cause aspirin tox
- Thiazides and loop diuretics may cause hyperglycemia in diabetic clients
Nursing Care - ANS-- Maintain intake and output; daily weights, assess for signs of
fluid-electrolyte imbalance
- Administer the drug in the morning so that the max effect occurs during waking hours
- Monitor pulse and BP, instruct to change positions slowly
- Encourage intake of foods high in calcium, mag, zinc, and potassium (except for
potassium-sparers)
,Treatment for autoimmune disorders consists of: - ANS-- Immunosuppression and control of
clinical manifestations, primarily through systemic corticosteroid therapy.
- Initial doses of 60 mg of oral prednisone often bring about a noticeable decrease in symptoms.
Once symptoms are controlled, dosages are slowly decreased and then discontinued until the
next exacerbation.
- Cytotoxic drugs such as cyclophosphamide, azathioprine, and methotrexate are sometimes
prescribed for patients with severe or persistent manifestations.
Potassium-sparing diuretics: Block the effect of aldosterone on renal tubules - ANS--
Medications: spironolactone (Aldactone) (PO), Triamterene (Dyrenium) (PO)
- Side effects: Menstrual irregularities, impotence, hypotension
- Nursing implications: May be used in combo with other diuretics to reduce potassium loss;
potassium-sparing effects may result in hyperkalemia; NOT used for clients experiencing renal
failure.
Glucocorticoids - ANS-- Widely used for anti-inflammatory and immunomodulating effects.
- Patients receiving systemic corticosteroid preps for non endocrine disorders are at risk for
adverse effects
Two classes of steroids secreted by adrenal cortex - ANS-- Corticosteroids (glucocorticoids and
mineralocorticoids)
- Androgens
Hydrocortisone (cortisol) is the primary glucocorticoid, and aldosterone is the main
mineralocorticoid.
Cortisol - ANS-- Multiple functions in the body, including carbohydrate metabolism.
- Secreted in times of physiological stress.
Aldosterone - ANS-Regulates sodium and other electrolytes and fluid in the body.
Glucocorticoids often administered for their anti-inflammatory activity - ANS-e.g. control of
asthma, inflammation, swelling, and edema.
- Dexamethasone (Decadron) represents an agent with almost pure glucocorticoid activity is
used to treat a number of inflammatory states.
- Most corticosteroids used in clinical practice (prednisone, prednisolone, hydrocortisone)
possess both glucocorticoid and mineralocoritcoid effects, and result in a wide array of short
and long-term adverse effects.
Glucocorticoids are used... - ANS-- in replacement therapy for adrenocortical insufficiency
- To treat: allergic reactions, anaphylactic reactions not responsive to other therapies, collagen
disorders such as SLE, deem conditions, hematologic disorders, neoplastic disease, ophthalmic
disorders, respiratory disorders, rheumatic disorders, and septic shock.
- To reduce inflammation post head trauma, may have negative outcomes.
,Septic Shock - ANS-- Usually results from a gram-negative bacteremia that leads to circulatory
insufficiency. Inadequate tissue perfusion generally results in hypotension, oliguria, tachycardia,
elevated temp, and tachypnea.
- Mechanism:bacterial substances interact with body cell membranes and systems, esp. coag
and the complete system, resulting in injury to cells and alterations in blood flow in the body.
Treatment for Septic Shock - ANS-May consist of:
- Volume replacement
- Antibiotics
- Surgery (if abscessed or necrotic)
- Vasoconstricting agents (dopamine, norepiniphrine, or levarterenol)
- Diuretics
- Glucocorticoids (steroid) (somewhat controversial)
Antiinflammatory actions of glucocorticoids - ANS-Esp. cortisol in > normal dosages, can
stabilize lysosomal membranes and prevent the release of proteolytic enzymes during
inflammation. Can also potentiate vasoconstrictor effects.
Glucocorticoids maintain normal BP - ANS-Potentiate vasoconstrictor action of norepinephrine.
When glucocorticoids are absent, vasoconstriction action of catecholamines is diminished, and
BP falls
Glucocorticoids in carb and protein metabolism - ANS-Help to maintain BG levels and glycogen
content of liver and muscle. Fcilitate protein breakdown in muscle and extra hepatic tissues that
least to increased plasma levels of amino acids. Can produce hyperglycemia and glycosuria.
Effects can aggravate diabetes, bring on latent diabetes, and cause insulin resistance. Inhibition
of protein synthesis can delay wound healing and cause muscle wasting and osteoporosis. May
inhibit growth in young persons.
Glucocorticoids in fat metabolism - ANS-Promote mobilization of fatty acids from adipose
tissue, increasing their concentration in the plasma and their use for energy.
Despite this, client on glucocorticoids may accumulate fat stores (rounded buffalo hump).
Thymolytic, Lympholytic, and Eosinopenic Actions of Glucocorticoids - ANS-- Can cause
atrophy of the thymus and decrease number of lymphocytes, plasma cells, and eosinophils in
the blood. By blocking the production and release of cytokines, coritocsteroids interfere with the
integrated role of T and B lymphocytes, macrophages, and monocytes in the immune response
and thus ultimately interfere with immune and allergic responses.
This response, along with their anti-inflammatory action, makes them useful
immunosuppressants for delaying rejection in clients with organ or tissue transplants, and useful
antiallergenics for treating acute allergic reations such as urticaria, bronchial asthma, and
anaphylactic shock infections.
, Stress Effects of Glucocorticoids - ANS-During stressful situations (e.g. injury, major surgery),
corticosteroids are suddenly released or are necessary to help maintain homeostasis. Sudden
release is believed to be a protective mechanism.
Hypotension and shock may occur w/o steroid admin. During stress, epinephrine and
norepinephrine are released from the adrenal medulla, and these catecholamines have a
synergistic action with the corticosteroids.
Glucocorticoids and the CNS - ANS-Corticosteroids affect mood and behavior and possibly
cause neuronal or brain excitability. Some persons report euphoria, insomnia, anxiety,
depression, or increased motor activity, or the may become psychotic.
Prednisone
(Deltasone, Prednisone Intensol, Apo-Prednisone, Winpred) - ANS-Indications: adrenocortical
insufficiency states, inflammation disorders, and organ transplant.
Used to treat a heat number of respiratory, GI, rheumatologic, dermatologic, ocular, and
neoplastic conditions in which moderate to sever inflammation is a component.
Dosing: Well absorbed orally. Metabolized in the liver to the the active prednisolone and
excreted but he kidneys. Onset is 1-2 hours, Duration is 30-36 hours.
Adverse Effects: insomnia, nervousness, increased appetite, GI upset, dizziness, glucose
intolerance, joint discomfort, seizures, mood changes, hallucinations, edema, HTN, nose bleed,
and potential to aggravate cataracts and glaucoma. Osteoporosis w/ chronic use.
Prednisone metabolism can be accelerated w/ concurrent barbiturate, phenytoin, or rifampin
therapy.
Common Adverse Effects of Glucocorticoids - ANS-Euphoria, increased appetite, insomnia,
restlessness, anxiety, gas, hyper pigmentation, HTN, headache, hirsutism, lowered resistance to
infections, visual disturbances (cataracts), increased urination or thirst, decreased growth in
children.
Anorexia may occur with traimcinolone.
Redness, swelling, rash, pain, tingling, or numbness may occur at the injection site.
Chronic use may result in abd pain, acne, GI bleeding, peptic ulcers, round face (Cushing's),
HTN, edema, weight gain, muscle cramps, weakness, irregular heart rate, N/V, bone pain,
increased bruising, and wounds that are difficult to heal.
Contraindications to corticosteroid use - ANS-Systemic infections (AIDS, HIV, chickenpox,
measles, fungal infection, Strongyloides, TB)
Ocular herpes
DM may be exacerbated
Reactivation of active or latent esophagitis, gastritis, or PUD may be masked, bleed or perf may
occur w/o warning.
Monitor carefully those clients for whom edema may be hazardous (cardiac disease, HF, HTN,
renal function impairment)
Myasthenic crisis my be induced if administered to client w/ myasthenia gravis.
May aggravate acute psychosis.
Diuretics - ANS-- Interfere with sodium reabsorption in kidney
- Increase urine output, which reduces hypervolemia; decreases preload and after load
- Available in oral and parenteral preparations
Thiazide Diuretics - ANS-- chlorothiazide, hydrochlorothiazide
- Interfere with sodium ion transport at loop of Henle and inhibit carbonic anhydrase activity at
distal tubule sites
- Metolazone is a thiazide-like diuretic.
Potassium-sparing Diuretics - ANS-- Spironolactone, triamterine, amiloride
- Interfere with aldosterone-induced reabsorption of sodium ions at distal nephron sites to
increase sodium chloride excretion and decrease potassium ion loss.
Loop-diuretics - ANS-- ethacrynic acid, furosemide, bumetanide, torsemide
- Interfere with active transport of sodium ions in loop of Henle and inhibit sodium chloride and
water reabsorption at proximal tubule sites.
- May be given IV
Major Side Effects of Diuretics - ANS-- GI irritation
- Hyponatremia (inhibition of sodium reabsorption at the kidney tubule)
- Orthostatic hypotension
- Hyperuricemia (partial blockage of uric acid excretion)
- Dehydration (excessive sodium and water loss)
- All diuretics except potassium-sparers: hypokalemia, increased urinary excretion of mag and
zinc
- Potassium-sparers: hyperkalemia, hypomagnesemia, increased urinary excretion of calcium
- Furosemide competes with aspirin for renal excretion sites and can cause aspirin tox
- Thiazides and loop diuretics may cause hyperglycemia in diabetic clients
Nursing Care - ANS-- Maintain intake and output; daily weights, assess for signs of
fluid-electrolyte imbalance
- Administer the drug in the morning so that the max effect occurs during waking hours
- Monitor pulse and BP, instruct to change positions slowly
- Encourage intake of foods high in calcium, mag, zinc, and potassium (except for
potassium-sparers)
,Treatment for autoimmune disorders consists of: - ANS-- Immunosuppression and control of
clinical manifestations, primarily through systemic corticosteroid therapy.
- Initial doses of 60 mg of oral prednisone often bring about a noticeable decrease in symptoms.
Once symptoms are controlled, dosages are slowly decreased and then discontinued until the
next exacerbation.
- Cytotoxic drugs such as cyclophosphamide, azathioprine, and methotrexate are sometimes
prescribed for patients with severe or persistent manifestations.
Potassium-sparing diuretics: Block the effect of aldosterone on renal tubules - ANS--
Medications: spironolactone (Aldactone) (PO), Triamterene (Dyrenium) (PO)
- Side effects: Menstrual irregularities, impotence, hypotension
- Nursing implications: May be used in combo with other diuretics to reduce potassium loss;
potassium-sparing effects may result in hyperkalemia; NOT used for clients experiencing renal
failure.
Glucocorticoids - ANS-- Widely used for anti-inflammatory and immunomodulating effects.
- Patients receiving systemic corticosteroid preps for non endocrine disorders are at risk for
adverse effects
Two classes of steroids secreted by adrenal cortex - ANS-- Corticosteroids (glucocorticoids and
mineralocorticoids)
- Androgens
Hydrocortisone (cortisol) is the primary glucocorticoid, and aldosterone is the main
mineralocorticoid.
Cortisol - ANS-- Multiple functions in the body, including carbohydrate metabolism.
- Secreted in times of physiological stress.
Aldosterone - ANS-Regulates sodium and other electrolytes and fluid in the body.
Glucocorticoids often administered for their anti-inflammatory activity - ANS-e.g. control of
asthma, inflammation, swelling, and edema.
- Dexamethasone (Decadron) represents an agent with almost pure glucocorticoid activity is
used to treat a number of inflammatory states.
- Most corticosteroids used in clinical practice (prednisone, prednisolone, hydrocortisone)
possess both glucocorticoid and mineralocoritcoid effects, and result in a wide array of short
and long-term adverse effects.
Glucocorticoids are used... - ANS-- in replacement therapy for adrenocortical insufficiency
- To treat: allergic reactions, anaphylactic reactions not responsive to other therapies, collagen
disorders such as SLE, deem conditions, hematologic disorders, neoplastic disease, ophthalmic
disorders, respiratory disorders, rheumatic disorders, and septic shock.
- To reduce inflammation post head trauma, may have negative outcomes.
,Septic Shock - ANS-- Usually results from a gram-negative bacteremia that leads to circulatory
insufficiency. Inadequate tissue perfusion generally results in hypotension, oliguria, tachycardia,
elevated temp, and tachypnea.
- Mechanism:bacterial substances interact with body cell membranes and systems, esp. coag
and the complete system, resulting in injury to cells and alterations in blood flow in the body.
Treatment for Septic Shock - ANS-May consist of:
- Volume replacement
- Antibiotics
- Surgery (if abscessed or necrotic)
- Vasoconstricting agents (dopamine, norepiniphrine, or levarterenol)
- Diuretics
- Glucocorticoids (steroid) (somewhat controversial)
Antiinflammatory actions of glucocorticoids - ANS-Esp. cortisol in > normal dosages, can
stabilize lysosomal membranes and prevent the release of proteolytic enzymes during
inflammation. Can also potentiate vasoconstrictor effects.
Glucocorticoids maintain normal BP - ANS-Potentiate vasoconstrictor action of norepinephrine.
When glucocorticoids are absent, vasoconstriction action of catecholamines is diminished, and
BP falls
Glucocorticoids in carb and protein metabolism - ANS-Help to maintain BG levels and glycogen
content of liver and muscle. Fcilitate protein breakdown in muscle and extra hepatic tissues that
least to increased plasma levels of amino acids. Can produce hyperglycemia and glycosuria.
Effects can aggravate diabetes, bring on latent diabetes, and cause insulin resistance. Inhibition
of protein synthesis can delay wound healing and cause muscle wasting and osteoporosis. May
inhibit growth in young persons.
Glucocorticoids in fat metabolism - ANS-Promote mobilization of fatty acids from adipose
tissue, increasing their concentration in the plasma and their use for energy.
Despite this, client on glucocorticoids may accumulate fat stores (rounded buffalo hump).
Thymolytic, Lympholytic, and Eosinopenic Actions of Glucocorticoids - ANS-- Can cause
atrophy of the thymus and decrease number of lymphocytes, plasma cells, and eosinophils in
the blood. By blocking the production and release of cytokines, coritocsteroids interfere with the
integrated role of T and B lymphocytes, macrophages, and monocytes in the immune response
and thus ultimately interfere with immune and allergic responses.
This response, along with their anti-inflammatory action, makes them useful
immunosuppressants for delaying rejection in clients with organ or tissue transplants, and useful
antiallergenics for treating acute allergic reations such as urticaria, bronchial asthma, and
anaphylactic shock infections.
, Stress Effects of Glucocorticoids - ANS-During stressful situations (e.g. injury, major surgery),
corticosteroids are suddenly released or are necessary to help maintain homeostasis. Sudden
release is believed to be a protective mechanism.
Hypotension and shock may occur w/o steroid admin. During stress, epinephrine and
norepinephrine are released from the adrenal medulla, and these catecholamines have a
synergistic action with the corticosteroids.
Glucocorticoids and the CNS - ANS-Corticosteroids affect mood and behavior and possibly
cause neuronal or brain excitability. Some persons report euphoria, insomnia, anxiety,
depression, or increased motor activity, or the may become psychotic.
Prednisone
(Deltasone, Prednisone Intensol, Apo-Prednisone, Winpred) - ANS-Indications: adrenocortical
insufficiency states, inflammation disorders, and organ transplant.
Used to treat a heat number of respiratory, GI, rheumatologic, dermatologic, ocular, and
neoplastic conditions in which moderate to sever inflammation is a component.
Dosing: Well absorbed orally. Metabolized in the liver to the the active prednisolone and
excreted but he kidneys. Onset is 1-2 hours, Duration is 30-36 hours.
Adverse Effects: insomnia, nervousness, increased appetite, GI upset, dizziness, glucose
intolerance, joint discomfort, seizures, mood changes, hallucinations, edema, HTN, nose bleed,
and potential to aggravate cataracts and glaucoma. Osteoporosis w/ chronic use.
Prednisone metabolism can be accelerated w/ concurrent barbiturate, phenytoin, or rifampin
therapy.
Common Adverse Effects of Glucocorticoids - ANS-Euphoria, increased appetite, insomnia,
restlessness, anxiety, gas, hyper pigmentation, HTN, headache, hirsutism, lowered resistance to
infections, visual disturbances (cataracts), increased urination or thirst, decreased growth in
children.
Anorexia may occur with traimcinolone.
Redness, swelling, rash, pain, tingling, or numbness may occur at the injection site.
Chronic use may result in abd pain, acne, GI bleeding, peptic ulcers, round face (Cushing's),
HTN, edema, weight gain, muscle cramps, weakness, irregular heart rate, N/V, bone pain,
increased bruising, and wounds that are difficult to heal.
Contraindications to corticosteroid use - ANS-Systemic infections (AIDS, HIV, chickenpox,
measles, fungal infection, Strongyloides, TB)
Ocular herpes
DM may be exacerbated
Reactivation of active or latent esophagitis, gastritis, or PUD may be masked, bleed or perf may
occur w/o warning.
Monitor carefully those clients for whom edema may be hazardous (cardiac disease, HF, HTN,
renal function impairment)
Myasthenic crisis my be induced if administered to client w/ myasthenia gravis.
May aggravate acute psychosis.
