Chapter 10: Endocrine System Medications: Part 1 Answer Key

10.3 Corticosteroids

Case Study 1:

1. The client is at risk for a fracture due to a previous history of osteoporosis that weakens the bones and increases the risk for a fracture when injury occurs. Corticosteroids can cause muscle weakness that can lead to falls and fractures. Corticosteroids also decrease bone matrix by interfering with calcium absorption. For a client with osteoporosis and also on steroid therapy, this can worsen the process and lead to higher risk of bone fractures. This would be a concern especially with long term therapy.
2. Alendronate, a bisphosphonates class of medication, is often used to treat osteoporosis and reduce the client’s risk of fractures.  Other preventative measures can be implemented, such as weight-bearing exercise and calcium/vitamin D supplementation.
3. The client should be instructed to avoid getting up without assistance. The room should be well-lit without loose rugs that can cause tripping.  If the client uses assistive devices like a cane or walker, these devices should be readily available.
4. The use of glucocorticoids can increase glucose levels through the process of gluconeogenesis.  Although the client has not been on insulin previously and was a type 2 diabetic, temporary use of insulin may be required while on corticosteroids.
5. Signs of adrenal suppression include severe fatigue, gastrointestinal upset, and a suppressed immune response that places the client at risk for developing infections. Long term use of steroids can suppress the production of endogenous steroids through negative inhibition. Any abrupt discontinuation of steroid therapy can cause acute adrenal insufficiency. When steroids will be discontinued, always taper the dose so the body can begin to produce endogenous hormones again.

Case Study 2:

1. The client has a large abdominal incision and taking steroids can impact wound healing due to protein catabolism, decreased fibroblast and collagen deposition. The nurse should watch for signs of wound failure and ensure the client splints their incision when moving or coughing. Steroids can also suppress the immune system and have anti-inflammatory effects therefore signs of infection (redness, swelling) may be masked.
2. Prednisone is always taken in the morning to mimic the normal diurnal rhythm. Circulating cortisol levels increase between 2 and 6 am, and peaks between 6-8 am, then gradually decrease throughout the day until midnight.   To protect the gastric mucosa, steroids should be taken with a meal. the prescriber may also order a histamine receptor antagonist such as famotidine to help protect the gastric mucosa.

Case Study 3:

1. Corticosteroids suppress the production of lymphocytes as well as inhibiting their functions such as releasing cytokines. They also are toxic to lymphoma cells, thereby inhibiting the production of cancerous lymphocytes. Another benefit is that steroids can help manage some chemo side effects such as nausea and vomiting and increase appetite.

10.4 Thyroid Medications

1. T4 levels and insulin are intrinsically linked through metabolic regulation. Hypothyroidism or low T4 levels can reduce glucose metabolism efficiency, leading to a decrease in insulin sensitivity, and increase in insulin resistance and higher fasting glucose levels. The client should be checking their glucose levels more frequently once they start Synthroid and their insulin dosages may need to be adjusted.
2. One concern while taking this med is hypocalcemia. One way to assess low calcium levels is when taking the client’s BP. The wrist will start to involuntarily flex, and the fingers will extend. They may also have tingling. Other side effects include hypersensitivity reaction and irritated nasal mucosa.