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• Mineralocorticoids• GlucocorticoidsDrug Class: Mineralocorticoids actions•Florinef (fludrocortisone)•ACTIONS•Adrenal corticosteroid that affects fluid and electrolyte balance by acting on the distal renal tubules, causing sodium and water retention and potassium and hydrogen excretion.Mineralocorticoids •USES•Used in combination with glucocorticoids to replace mineralocordicoid activity in patients who suffer from adrenocortical insufficiency (Addison’s disease) and to treat salt-losing adrenogenital syndromeMineralocorticoids: Therapeutic outcomes•Control of blood pressure•Restoration of fluid and electrolyte balanceConsiderations•Steroid therapy can mask symptoms of an infection•Keep accurate I&O, daily weights, and vital signsMineralocorticoids •Evaluation of therapy•Because fludrocortisone is a natural hormone, adverse effects reflect fludrocotisone excess, such as sodium accumulation and potassium depletion.Drug Class: Glucocorticoids •Cortisone actions•Diminishes secretion of cortisol from the adrenal cortex.Glucocorticoids uses•Relieve the symptoms of tissue inflammation•Immunosuppression in the treatment of certain cancers, organ transplantation, autoimmune diseases•Relief of allergic manifestations•Treatment of shock•Nausea and vomiting secondary to chemotherapyGlucocorticoids •Therapeutic outcomes•Reduced pain and inflammation•Minimized shock syndrome and faster recovery•Reduced nausea and vomiting associated with chemotherapyGlucocorticoids Considerations•Do not discontinue therapy abruptly.•S/S of abrupt withdrawal:•Fever, malaise, fatigue•Weakness, anorexia, nausea•Hypotension, fainting, dyspnea•Hypoglycemia, muscle and joint pain•Possible exacerbation of the disease processCorticosteroids •Common and serious adverse effects•Electrolyte imbalance – hypokalemia is most common•Fluid accumulation•Susceptibility to infection – often masks the symptoms of infection.•Behavioral changes – psychotic behaviors are more likely to occur in patients with hxCorticosteroids •Common and serious adverse effects•Hyperglycemia – monitor blood glucose levels•Peptic ulcer formation – monitor stool for blood•Delayed wound healing – monitor for dehiscence•Visual disturbances – may produce cataracts•OsteoporosisCorticosteroids: Drug Interactions•Diuretics – may enhance the loss of K+•Monitor for electrolyte imbalance•Warfarin – may enhance or decrease the effects of warfarin. Observe for S/S of bleeding. Monitor PT/INR.•May require adjustment of warfarin•Hyperglycemia – oral hypoglycemic agents and insulin dosages may need to be adjusted.Drug Class: Estrogens actionsPremarin (conjugated estrogen), Estrace (estradiol), Vivelle, Estrasorb, EstrogelACTIONSMaturation of the sex organsResponsible for characteristics such as growth of hair, texture of skin, distribution of body fatCause capillary dilationCause fluid retention and protein metabolismInhibit ovulation and postpartum breast engorgementEstrogens USESRelieving hot flash symptoms of menopauseContraceptionHormone replacement therapy after oophorectomyTreatment of osteoporosisTreatment of severe acne in femalesTo slow the disease process in patients with certain cancersEstrogens: Therapeutic outcomes: