Cushing’s syndrome 4 Alternatives in the treatment of Cushing’s syndrome

Cushing’s syndrome or also known as Hypercorticosolism  Reduce Corticosteroids Use

 A disorder occurs when the body is exposed to high  Surgery

levels of hormone cortisol for a long time. May be
caused by the use of oral corticosteroid medications.  Radiation Therapy
The condition can also occur when the body makes  Medications
too much cortisol on its own.
PHARCOTHERAPHY FOR CUSHING’S SYNDROME
 Normal level of cortisol are 6 to 23 mcg/dL
1. Metyrapone (Metopirone)
 Treatment from medical professional advised 2. Ketoconazole (Nizoral)
 Often requires lab test or imaging 3. Mitotane (Lysodern)
4. Mifepristone
 Common for ages 20-50
• For patients with Cushing’s Syndrome, who are
 More common in females suffering from glucose intolerance or type 2 Diabetes
Mifepristone (Korlym) is highly recommended
 Can be dangerous or life threatening if untreated
PHARCOTHERAPHY FOR CUSHING’S SYNDROME
 Family history may increase likelihood
Generic Name: Metyrapone
 Urgent medical attention recommended in severe
cases Brand Name: (Metopirone)

What is cortisol? Use: Medication which is used in the diagnosis of adrenal

 Cortisol is a hormone that is mainly released at times
of stress
 Having the right cortisol balance is essential for
human health and you can have problems if you
produce too much (Cushing’s Syndrome) or too little
cortisol (Addison’s Disease)
insufficiency and occasionally in the treatment of Cushing's
syndrome (hypercortisolism).
Side Effects: Hypotension, Nausea, Vomitting, Abdominal
Discomfort or pain, Headcahe, Dizziness and Allergic Rash
Precaution: Metyrapone (metopirone) should be given to a
pregnant woman only if needed.

 Cortisol is a steroid hormone that is produced by the Availability:Capsules 250 mg -soft gelatin, white to yellowish-
adrenal glands, which sit on top of each kidney. When white & oblong
released into the bloodstream, cortisol can act on
many different parts of the body and can help: Nursing Responsibilities:

 the body respond to stress or danger
 increase the body’s metabolism of glucose
 control blood pressure
 Assess if the patient have drug allergies or drug
sensitivity
 Instruct the patient that it should be taken with foods
or after a meal.

 reduce inflammation  Also instruct the patient to take it with yogurt or milk.
PHARCOTHERAPHY FOR CUSHING’S SYNDROME
Generic Name: Ketoconazole
Brand Name: Ketozol, Kezo, Nizoral Cream
Use: Is an anti-fungal medication that works to lower the
cortisol level, as well as the production of male sex hormones.
Side Effects: Nausea and Vomitting
Adverse Effects: Potential Hepatotoxicity
Precaution:
• The product may contain inactive ingredients, which
can cause allergic reactions or other problems.
• Do not drink alcoholic beverages while taking this
medication because alcohol increases the risk of
serious liver problems. Avoiding alcoholic beverages
will also decrease the risk of a rare reaction with
ketoconazole that may result in flushing, headache
and nausea
• During pregnancy, this medication should be used
only when clearly needed. It may cause harm to an
unborn baby if taken during the first 3 months of
pregnancy.
Availability: Tablet, Cream and Shampoo
Nursing Responsibilities:
 Assess if the patient have drug allergies or drug
sensitivity
 Instruct the patient that it should be taken with food.
PHARCOTHERAPHY FOR CUSHING’S SYNDROME
Generic Name: Mitotane
Brand Name: (Lysodren)
Use:  used to treat cancer of the adrenal glands. It works by
slowing the growth of or killing adrenal gland cells and also
decreases the amount of hormones made by the adrenal
gland.
Side Effects: Dizziness, drowsiness,nausea, vomitting and
diarrhea loss of appetite, or weakness and Rash (usually not
serious, sign of severe reaction)
Precaution:
• The product may contain inactive ingredients, which
can cause allergic reactions or other problem
• This drug can be absorbed through the skin and lungs
and may harm an unborn baby, women who are
pregnant or who may become pregnant should not
handle this medication or breathe the dust from the
tablets. This medication passes into breast milk and
may harm a nursing infant.
Availability: Tablet
Interaction: May reduce the effects of coumarin anticoagulants,
barbiturates, phenytoin. CNS depression may occur with
alcohol
Nursing Responsibility:
• Assess if the patient have drug allergies or drug
sensitivity
• Instruct the patient that it should be taken with food.
PHARCOTHERAPHY FOR CUSHING’S SYNDROME
Generic Name: Mifepristone
Brand Name: Korlym
Use: For the patients with Cushing’s syndrome who are
suffering from glucose intolerance or type 2 Diabetes,
Mifepristone (Korlym) is highly recommended. This medication
does not reduce the cortisol production but blocks its effect on
body tissues.
Side Effects: nausea,vomitting, loss of appetite, low
potassium, tired feeling,headache, dizziness,pain in your arms
and legs,thickened lining of your uterus,swelling in your arms
and legs, or high blood pressure.
Precaution:
• Should not be taken by pregnant woman
• Avoid Grape Fruit Juice (Graprefruit may interact with
mifepristone and lead to unwanted side effects)
Availability: Tablet

Nursing Responsibility:

• Assess if the patient have drug allergies or drug

sensitivity

• Instruct the patient that it can be taken with or without

food

• Instruct the patient to avoid grape fruit juice