Notes on ADH and Corticosteroids

Examples

• Desmopressin: Available in oral (PO) and nasal forms.
• Vasopressin: Given subcutaneously (SubQ).

Uses

• ADH Replacement: Used when patients don't have enough ADH, leading to excessive urination.
  • Mechanism: Promotes water reabsorption to maintain water balance.
  • Indication: Diabetes insipidus (deficiency of ADH) & bed wetting (nocturnal enuresis).

Medications for ADH Excess

• Demecyclocycline: Used to treat ADH excess.
  • Indication: SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion), characterized by excessive ADH and swelling.

Glucocorticoids

• Examples: Prednisone, Cortisone, Methylprednisolone, Dexamethasone.
  • Action: Anti-inflammatory response.

Nursing Interventions for ADH-related Medications

• Monitoring: Urine output and electrolyte levels (especially sodium).
  • Expected Outcome: Decreased urine output and increased urine concentration.
  • Rationale: To monitor effectiveness and prevent complications.

Side Effects (SE)

• Orthostatic hypotension (ortho-hypotension) and hypernatremia.

Important Consideration

• Taper: Gradual reduction of dosage is necessary to discontinue the medication.
• Side Effects: Review all possible side effects due to medication.

Fludrocortisone

• Class: Mineralocorticoid.
• Use: Adrenocortical insufficiency.
  • Mechanism: Promotes sodium and water retention while promoting potassium excretion.
  • Indications: Hypotension in some patients.

Monitoring for Mineralocorticoids

• Urine output and Electrolytes