Ch. 49- Drugs Affecting Corticosteroid Levels [fludrocortiSONE]

Maximizing therapeutic effects for fludrocortisone (2)

(1) Assess for drugs that may interact with fludrocortisone and decrease its efficacy (ex: barbituates, cholestyramine, oral contraceptives, and salicylates [BCOcS--> "because"]. (2) Evaluate the need for an increased dose of fludrocortisone during times of injury, stress, or infection, during surgery.

Patient education for fludrocortisone (6)

(1) Instruct client to adhere to drug therapy as prescribed, stressing the importance of regular follow-up visits with the prescriber. (2) Encourage pt to wear a medical ID bracelet. (3) Report unusual wt. gain, (4) Monitor BP, (5) Diet, (6) follow-up visit with Fluid and electrolyters

Minimizing adverse effects for fludrocortisone (3)

(1) Monitor blood pressure, fluid balance, and electrolyte status. (2) Review the importance of intaking foods high in potassium, (3) Importance of a low Na+ diet to reduce the risk for HTN, weight gain, and edema.

fludrocortisone replacement therapy is effective when... (2)

(1)Normal BP, (2) fluid and electrolyte balance is within normal limits.

What happens in larger doses of fludrocortisone (adverse effect)?

It inhibits endogenous adrenal cortical secretion and pituitary corticotropin excretion. It promotes the deposition of liver glycogen which in returns induces a negative nitrogen balance.

Aldosterone medicine is...

the naturally occurring mineralocorticoid, is expensive and requires parenteral administration.

fludrocortisone pharmacokinetics (administered, peak, half-hour)

Administered: oral. Peak: 1.7 hours. Half-time: 3-5 hours.

Drug interactions with fludrocortisone (same as prednisone)

Anticholinesterase (causes muscle depression), oral anticoagulants (may cause an anticoagulant action), theophylline (theophylline toxicity), warfarin (may induce hypercoagulable state)

fludrocortisone is a pregnancy __ drug.

C.

Health status review for fludrocortisone

Diabetes, HTN, Osteoporosis, impaired renal function. Assess fluid and electrolyte balance, nutritional status, and wt. control history.

True or false? Safety and efficacy are established in children with using fludrocortisone.

False

Contraindications and precautions of fludrocortisone

Hypersensitivity and **systemic fungal infections.

Adverse effects for fludrocortisone

In small ORAL doses, it produces marked sodium retention and increased urinary potassium excretion (which increase BP). ; Cardiovasular effects (edema, HTN, etc.); Derma (bruising, diaphoresis, urticaria); Hypokalmic alkalosis.

Ongoing assessment and evaluation for fludrocortisone

Monito for edema, weight gain, HTN, cardiac arrhythmias, or muscular weakness.

fludrocortisone pharmatherapeutics

Partial replacement therapy for a primary & secondary adrenocortical insufficiency to Addison's disease and for treating salt-losing adrenogenital syndrome.

Teach clients to eat food low in __ or high in __.

Sodium; Potassium..

fludrocortisone pharmacodynamics

Works on the distal renal tubule to enhance the reabsorption of Na and to increase the urinary excretion of both K and H ions. which could potentially increase BP

fludocorticosone is a replacement therapy for what?

adrenocortical deficiency, it's a therapeutic effect is the mineralcorticoid activity.

The mineralocorticoid prototype drug is:

fludrocortiSONE

Fludrocortisone hs both high ___ and ___ activity. How much greater is it?

mineralcorticoid and glucocorticoid activity. Its glucocorticoid potency is 15 times greater than that of hydrocortisone.