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Pharm 2 via Jeff > Corticosteriods > Flashcards

Corticosteriods Flashcards

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1
Q

What is the HPA axis?

A

Hypthalmus
pituitary gland
adrenal cortex

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2
Q

What are the three layers of the adrenal cortex?

A
  • Zona glomerulosa : mineralcorticoids
  • Zona fasiculata - glucocorticoids

Zona reticularis - Glucocorticoids

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3
Q

Glucocorticoids play an important role in maintaining what body functions?

A
  • Carbohydrate, gat, protein metabolism
  • Gluid and electrolyte regulation
  • inhibits inflammatory response
  • Gluconeogenisis
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4
Q

What steroid mediates 95% of all glucocorticoids in the body?

A

Cortisol

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5
Q

What is the process of corticosteroidogenesis?

A
  • Begins in the hypothalamus. Hypothalmus releases Corticotropin Releasing Hormone into the pituitary gland.
  • The pituitary gland is stimulated to release ACTH into the adrenal cortex.
  • The adrenal cortex is stimulated to release cortisol from the zona fascicularis and zona retiulosa
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6
Q

What hormone is produced in the adrenal cortex and released due to stress response by the HPA axis?

A

Cortisol

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7
Q

What metabolic effects are initiated by cortisol in order to releive stress on the body?

A
  • Gluconeogenisis
  • Carbs, protein, fat metabolism
  • Control of fluid and electrolytes
  • Inhibit inflammatory response
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8
Q

According to the normal circadian rhythm when are cortisol levels highest and lowest?

A

Cortisol levels are highest in the morning and lowest in the evening.

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9
Q

Will changes in sleep habits alter the cycle of cortisol production?

A

Yes, Changes in sleep habits will cause a change in cortisol production cycle

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10
Q

The main regulator of cortisol production is?

A

Negative feedback - high levels of cortisol in the blood signal the hypothalamus to stop producing CRH. It also signals the pituitary gland to stop producing ACTH.

Low cotisol levels will reverse the process

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11
Q

What is primary adrenocortical insufficiency?

A

Also known as Addison’s Deseases.

Adrenal do not secrete cortisol or aldosterone

Replacement therapy must include both glucocorticoids and mineral corticoids

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12
Q

What is secondary adrenocortical insufficiency?

A

Adrenals do not secret cortisol

Aldosterone secretion is maintained

Replacement of glucocorticoid (cortisol) only.

Due to chronic steroid use and HPA axis suppression.

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13
Q

What are the physiologic effects of glucocorticoids?

A 
Increase cardiac output
Increase Respiratory rate
Increase gluconeogenesis
Decrease inflammation
Decrease immune response
Inhibit digestion
Enhanced analgesia
Redistribution of CNS blood flow
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14
Q

What mineralcorticoid is also reeased from the adreanl cortex?

A

Aldosterone is also released for the adrenal cortex -specifically the zona glomerulosa

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15
Q

What is the function of aldosterone?

A

Increases Na+ and water aabsorbtion thus increasing blood volume, and promotes K+ excretion

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16
Q

What feedback is associated with the secretion of aldosterone?

A

Increased K+ levels
Decreased Na+ levels
Decreased blood volume/blood pressure

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17
Q

What is the path of secretion for aldosterone?

A

Increased renin levels converts angiotensenoigin to angiotensin I. Angiotensin I is converted in the lungs to Angiotensin II. Angiotensin II stimulates the adrenal cortex (zona glomerulosa) to secret adldosterone

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18
Q

Glucocorticoids are classified according to their?

A

Potency

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19
Q

What are the most potent aniinflammatory steroids?

A

Dexmethasone

Betamethasone

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20
Q

What is the least potent steroid?

A

Cortisone

Cortisol

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21
Q

Which steroid has the most sodium retaining potency

A

Fludrocortisone

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22
Q

Which steroid has the longest elimination half life?

A

Betamethasone - hours

Dexamethasone - 3.5 - 5 hours

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23
Q

Which steroid has the shortest eimination half-life?

A

Cortisone - 0.5 hours

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24
Q

Which steroid has the longest duration of action?

A

Dexmethasone and Betamethasone

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25
Which steroid has the shortest duration of action
Cortisol 8-12 hours
26
Do steroids cross the placenta?
YES
27
What side effects to glucocorticoids have on the endocrine system?
Adrenal atrophy HPA axis suppression Cushing's syndrom Hyperglycemia/diabetes
28
What side effects do steroids have on the crdiovascular system?
Hypertension Dyslipidemia Thrombosis
29
What side effects do steroids have on the CNS?
``` Psychosis Manic depression Suicidal tendencies Cataracts/glucoma Mood changes ```
30
What side effects do steroids have on the immune system?
Immunosupression | Increase risk of infection
31
What side effects do steroids have on the renal system?
Increased Na+ and water retention (edema) | Increased K+ and H+ excretion
32
What electrolyte and metabolic changes are associated with steroid use?
Hypokalemic Metaboic Alkalosis - due to increased K+ and H+ secretion Inhibits glucose use in the perphery and results in hyperglycemia Redistribution of body fat - hump back or buffalo hump and moon face as seen with cushing's synddrome
33
Long term use of steroidshas what effect on the blodd?
Hematocit and leukocytes are increased 70% reduction in lymphcytes 90% reduction in monocytes These cells are sequestered and NOT Destroyed
34
What are some relative contraindications to the use of steroids?
``` Systemic infection immunosuppression Glaucoma Hypokelemia CHF Cushing's syndrome diabetes Hypertension Hyperthyroidism compounds Osteoporosis ```
35
When steroids are used for acute adrenal insufficiency when should higher doses be given?
In the morning
36
When considering steroid replacement as a stress does prior to surgery wheat factors must be considered?
Dose of previous steroid therapy Duration of previous therapy Time since previous therapy
37
When given as a antiemetic Dexamethsone should be administered early or late in the perioperative period?
Dexamethasone should be administered early in the intraoperative period just after induction.
38
Which steroids have no Na+ retention qualities?
Betamethasone Dexamethasone Triamcinalone
39
When used for asthma relief what is the most common side effet of inhaled steroids??
Oral candidiasis (Thrush)
40
Are corticosteroids good for acute asthma attacks | No, it usually take steroid 4-6 hours to reach an anti inflamatory afffec
No, it usually take steroid 4-6 hours to reach an anti inflammatory affect
41
When topical steroids are administered does heat increase or decrease the rate of absorption?
Heat increases the rate of absorption for topical steroids
42
When are patient more at risk for post intubation laryngeal edema?
When intubated for more then 6 days
43
When is the use of steroids NOT recommended?
Septic shock Cardia arrest Aspiration pneumonitis
44
What factors infuence the degree of HPA axis suppression associated with steroid use?
Dose and duration of gluocorticoid therapy | Cause a reduction in the stress response of HP axis
45
What therapies are unlikely to produce a suppression of the HPA axis?
Prednisone 5 mg/day or less Long term every other day does Dose therapy <3 weeks
46
True of False: Steroids such as prednisone or dexamethasone administered at any does on a dailty basis is associated with suppression of HPA axis.
TRUE
47
After cessation of steroid therapy recovery of the HPA axis may take how many months to recover?
12 months | HP funcction returns to normal before adrenal function in the HPA axis
48
What is a good rule of thumb to assum HPA axis suppression
If steroid dose is greater than 10 mg/day and given for more than 3 weeks Any sign of Cushing'ssyndrome moon face, buffalo hump, weight gain (edema)
49
For patients receiving chronic steroid therapy how should plasma cortisol levels be maintained for major surgery
Cortisol levels should be above normal during major surgeries and stress doeses should be administered. No additional ceverage should be needed for minor operations
50
When considering stress doses prior to surgery what doeses should be administered according the level of surgery to be performed
Minor - 25 mg cortisol IV Moderate 50 - 75 mg cortisol Major 100 - 150 mg cortisol
51
What are some signs of acute adrenal crisis?
``` Hypotension unresponsive to vasopressors Hyperdynamic circulation hypoglycemia hyperkalemia hypoatremia hypovolemia metabolic alkalosis Decreased level of consciousness ```
52
Where are thyroid hormone levels controlled
Hypothalamus
53
How is T4 and ultimately T3 secreted?
Hypothalamus releases thyroid releasing hormone into the anterior pituitary gland. The anterior pituitary gland releases thyroid stimulating hormone into the thyroid gland. The thyroid gland releases T4 which is changed to T3 which is the active hormone Level are controlled by feedback from the thyroid gland inhibiting the release of TRH from the hypotalamus
54
Describe the presentation of Hashimoto Desease
``` Hypothyroid Cold Intolerance Dry skin Gatigue Weight gain Bradycardia Slow reflexes Coarse skin and hair Periobital swelling Painful menstration Myxedema coma ```
55
Describe the presentation of Graves Desease
``` Hyperthyroid Weight loss with increased appetite Heat intolerance Goiter Gine hair Tachycardia Nervous, anxiety insomnia Lighter menstration Sweating warm moist skin Exophthalmus Thyroid storm ```
56
What are the two hypothyroid medication and what hormone do they replace?
Levothyroxine T4 Later converted to T3 by deiodination Liothyronine T3 stronger than levothyroxine
57
What is the perferred route of administration for levothyroxine
Oral is preferred but IV is available
58
A euthyroid state is maintained with hypothyroid with what does of levothyroxine
100 - 200 mcg/day
59
What is the half life of leveothyroxine and will replacement of missed dose be required on the day of surgery?
Half life is 7 days A missed dose on the day of surgery is not required after 7 days administer half the required dose for euthyroid (50 - 100 mcg)
60
Which is the stronger medication for hypothyroid - levothyroxine or liothyronine?
Liothyronine - T3 is stronger
61
Which replacement medication is better for long term use for hypothyroid?
Levothyroxine is better than liotyronine for long term use
62
Which hypothyroid medication has greater cardiac side effects?
Liothyronine
63
What are the anesthetic implication for hypthyroidism?
``` Hyponatremia hypthermia hypoglycemia delayed gastric emptying slowed metabolis of drugs decreased CO, HR, SV More sensitive to inhaled gases Unresponsive baroreceptor reflex ```
64
What drug is given as an antithyroid drug and inhibits the formation of thyroid hormone by blocking T4 and T3?
Propylthiouracil(PTU)
65
What drug treates hyperthyroidism and thyroid storm
Propylthiouracil (PTU)
66
How is propylthyiouriacil administered?
Only in the PO form. Takes several days for effect
67
What is the oldest medication used for the treatment of hypothyroidism
Lugols solution inhibits the release of the thyroid hormone
68
Excessive release of thyroid hormone by the pituitary gland can cause what disorder?
Thyroid storm
69
What conditions are seen with a thyroid storm
``` Hyperthermia Tachycardia CHG Dehydration Shock Symptoms resemble MS ```
70
When is a thyroid storm most likely to develop?
6 - 19 hours post op
71
How is thyroid storm treated?
``` IV crystalloids IV sodium iodide Cortisol Propranolol - alleviates cardio side effects Propylthiouracil PO ```
72
During a thyroid storm hyperthermia occurs and may result in a fever. Should ASA be given for the fever?
NO. ASA should be avoided as thyroxin levels may increase and worsen the effects of thyroid storm

Pharm 2 via Jeff (2 decks)

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