NR 567 Week 5 Discussion; Case Scenario Discussion; Addison’s
Disease Medication
Trina Pullman is a 24-year old female with a history of
... [Show More] hypothyroidism, with a 3-month history
of persistent vomiting, followed by the gastroenterology service, thought to have gastritis based
on the upper endoscopy report. She continued to have vomiting and weight loss, presented to the
emergency department, found to be hypotensive, tachycardic and thin. Her serum labs
demonstrated hyponatremia, normal potassium levels, and a random cortisol level that was very
low. Thyroid stimulating hormone was normal. CBC was unremarkable, UA normal, negative
pregnancy test. Serum glucose, liver function tests and renal function were normal. She was
thought to have Addison's disease, with a plan to admit to the hospital for further workup and
treatment. You are the hospitalist AGACNP admitting the patient. What one medication would
you initiate on this admission to treat the Addison's disease?
Past Medical History:
Hypothyroid
Gastritis
Social History:
o Smoker 2-3 cigarettes socially on weekends
o Recreational drug use-none
o ETOH-none
o Single, no children
o Employed as hairdresser
Medications
Protonix 40mg po daily
Levothyroxine 100 mcg po daily
Allergies
None
Physical Exam
Vitals: Pulse 104; Resp 18; BP 96/50; SpO2 98%; Temp 37 °C (98.6 °F); Wt. 65kg; Ht.
5'6".
Constitutional: Alert, no acute distress. Thin.
HEENT: Head is normocephalic and atraumatic. Eyes without icterus or injection.
Mucous membranes pink and dry. Neck is supple, nontender without adenopathy. No
JVD. No meningismus.
Resp: Lungs clear to auscultation bilaterally without wheezes, rales or rhonchi. No
increased work of breathing.
Cardiovasc: S1S2 without murmur, rub or gallop. Regular rate and regular rhythm. Pedal
pulses 2+ and equal. No edema.
Abd/GI: Soft, non-tender, nondistended. No masses.
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Skin: Pink, warm, dry. No rashes or bruising.
Ext: Movement all extremities without limitation.
Back: Normal inspection. Nontender.
Psych: Affect normal. Appropriate attention, cooperation.
Neuro: Alert and oriented x 4. No focal motor or sensory deficits.
Addison's Disease Medication
1. Write out the order including the pharmaceutical agent, dose, route and when it should be
given.
Large amounts of parenteral hydrocortisone in addition to correction of fluid and
electrolyte abnormalities. Hydrocortisone sodium succinate or phosphate in doses of
100mg IV can be given every 8 hours until stable. The dose is gradually reduced to
achieve maintenance dosage in approximately 5 days.
Hydrocortisone 100 mg IV bolus, followed by 50 mg IV every 6 hours. Patient can also
receive 200 mg/24 hours as a continuous IV infusion for the first 24 hours. IV bolus of
NS %0.9 is recommended as well. Hydrocortisone 50 mg IV bolus is administered every
six hours until vital signs are within normal limits (WNL) and ability to eat and take
medication per oral (PO).
For long-term: Fludrocortisone: Oral: Initial: 0.05 to 0.1 mg once daily in the morning (in
combination with hydrocortisone or cortisone). Usual maintenance dose: 0.05 to 0.2 mg
once daily.
2. Justify the rationale on why this medication was selected in this particular situation.
It rapidly decreases the inappropriate vasopressin production with increased clearance of
free water and correction of hyponatremia. A glucocorticoid is the first choice for the
management of adrenal insufficiency. Hydrocortisone is a shirt-acting glucocorticoid and
is generally considered to be the better choice for a short-acting glucocorticoid regimen,
according to Nieman (2021).
3. Discuss the class/schedule of medication chosen.
Drug class: Corticosteroid
Schedule: Not controlled. [Show Less]