Pharmacology · chapter 26 · Hypothalamus, Pituitary, and Adrenal Disorder Drugs
Glucocorticoids and Mineralocorticoids
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.
Key points
Why cortisol is used as a drug
Cortisol helps regulate glucose uptake in other tissues—such as muscles and fat—and has an anti-inflammatory and immunosuppressive effect, making it an important medication in the treatment of many inflammatory and autoimmune disorders and in preventing transplantation rejection.
Toxicity limits long-term use
Although glucocorticoids can be effective at treating certain conditions, they can have significant toxic effects over time that limit use.
Tapering and HPA suppression
Short-term use is tapered quickly to avoid rebound symptoms. Long-term use also requires tapering due to HPA axis suppression resulting in inadequate cortisol production.
Give systemic steroids in the morning
Systemic administration of steroids is often recommended to take place in the morning to avoid insomnia (Hodgens Sharman, 2023).
Dexamethasone suppression test
This drug is also used in the diagnosis of Cushing’s syndrome as a suppressive test.
Short- and long-term adverse effects
Short-term adverse effects include insomnia, hunger, and mood changes. Long-term adverse effects include weight gain, high blood pressure, osteoporosis, hyperglycemia, skin atrophy (topical application), iatrogenic Cushing’s syndrome, and increased risk of infection.
Glucocorticoid contraindications
Glucocorticoids are contraindicated in clients with hypersensitivity to any component of the formulation, those who have an active systemic fungal infection, or those with uncontrolled hyperglycemia.
Excess aldosterone
An excess of aldosterone causes an increase in blood pressure and serum sodium levels along with a decrease in serum potassium levels.
Too little aldosterone
Hypoaldosteronism leads to a decrease in blood pressure and serum sodium levels along with an increase in serum potassium levels.
How aldosterone acts on the kidneys
Aldosterone works by binding to mineralocorticoid receptors in the cells of the kidneys, which increases the reabsorption of sodium ions and the excretion of potassium ions. This leads to an increase in blood volume and blood pressure.
Fludrocortisone for Addison's disease
This medication is used to treat primary and secondary adrenocortical insufficiency in Addison’s disease. Adverse effects include hyperglycemia, hypokalemia, hypertension, muscle weakness, and impaired wound healing.
Heart failure and kidney impairment
Mineralocorticoids can suppress the immune system and worsen systemic fungal infections; heart failure is contraindicated because these drugs can cause fluid retention and lead to worsening of fluid volume overload; and severe kidney impairment can occur in clients with kidney disease as these drugs are excreted through the urine and can cause further renal insufficiency.
Avoid sick contacts
If using the drug systemically, avoid people who are sick—especially those who have chickenpox, measles, or tuberculosis—because they are at an increased risk of contracting the condition.
Report fluid overload, limit salt
Report signs of fluid volume overload such as a weight gain of 2 pounds in 3 days or 5 pounds in a week. Limit salt intake.
Terms to know
- Glucocorticoids
- Glucocorticoids are produced in response to stress and help regulate metabolism and the immune system.
- Mineralocorticoids
- Mineralocorticoids are a type of steroid hormones that are produced by the adrenal cortex and are involved in regulating the body’s fluid balance and electrolyte levels.
- hyperaldosteronism
- The first is hyperaldosteronism, which is characterized by excess aldosterone production.
- RAAS
- The RAAS is a complex hormonal system that helps to regulate blood pressure by controlling the balance of sodium and water in the body.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
The graded version needs JavaScript. Every question is below anyway, with the answer and why.
Every question here, with the answer
A client is prescribed oral prednisone once daily. When should the nurse schedule the dose?
- In the morning
- In the middle of the night
- At bedtime
- Only when symptoms flare
Answer: In the morning
Systemic steroids are often given in the morning to avoid insomnia, a short-term adverse effect. A bedtime or nighttime dose makes insomnia worse, and the drug is taken as prescribed rather than only during flares.
A client who has taken methylprednisolone for a year wants to stop it now. What is the main reason the nurse advises against stopping abruptly?
- Long-term use suppresses the HPA axis, so the body may not make enough cortisol.
- The drug has no effect after one year.
- Stopping causes immediate hypertension only.
- Stopping is safe once symptoms are gone.
Answer: Long-term use suppresses the HPA axis, so the body may not make enough cortisol.
Long-term use requires tapering because HPA axis suppression leads to inadequate cortisol production. The drug must be tapered with the provider rather than stopped.
A client on long-term glucocorticoid therapy is being assessed. Which findings are expected long-term adverse effects? Select all that apply.
- Weight gain
- Low blood pressure
- Hyperglycemia
- Increased risk of infection
- Osteoporosis
Answer: Weight gain, Hyperglycemia, Increased risk of infection, Osteoporosis
Long-term adverse effects include weight gain, high blood pressure, osteoporosis, hyperglycemia, and increased infection risk. Glucocorticoids raise, not lower, blood pressure.
A client with Addison's disease takes fludrocortisone. Which lab result should the nurse watch most closely for an adverse effect?
- Serum potassium
- Hemoglobin A1c only
- Platelet count
- Serum amylase
Answer: Serum potassium
Fludrocortisone increases potassium excretion, and hypokalemia is a listed adverse effect, so potassium is monitored closely along with sodium. The other labs are not the main concern here.
A client is going home on a systemic glucocorticoid. Which teaching points should the nurse include? Select all that apply.
- Stop the drug if you feel better.
- Report a fever greater than 100.4°F.
- Limit salt intake.
- Report a weight gain of 2 pounds in 3 days.
- Avoid people who are sick, especially with chickenpox or measles.
Answer: Report a fever greater than 100.4°F., Limit salt intake., Report a weight gain of 2 pounds in 3 days., Avoid people who are sick, especially with chickenpox or measles.
Clients avoid sick contacts, report rapid weight gain and signs of infection such as fever above 100.4°F, and limit salt. The drug must be tapered with the provider, not stopped on one's own.
A client with heart failure has a new order for fludrocortisone. Why should the nurse question it?
- Heart failure makes the drug ineffective.
- Fludrocortisone lowers blood pressure dangerously.
- Fludrocortisone causes excessive urination.
- Mineralocorticoids cause fluid retention that can worsen fluid volume overload.
Answer: Mineralocorticoids cause fluid retention that can worsen fluid volume overload.
Heart failure is a contraindication because mineralocorticoids promote sodium and water retention, which can worsen fluid volume overload. They raise blood pressure and retain fluid rather than causing diuresis.
Where every quote comes from
Section 26.4 Glucocorticoids and Mineralocorticoids of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.