Corticosteroids

Question 1

What is the role of the hypothalamus?

Answer 1

It produces hormones including the Corticotropin releasing hormone
Maintains homeostasis through regulating body temperature, controlling appetite, managing sexual behavior, managing emotional responses

Question 2

What hormones are released from the posterior pituitary?

Answer 2

Oxytocin & ADH (antidiuretic hormone)

Question 3

What hormones are released from the anterior pituitary?

Answer 3

Leutinizing hormone, Folicular stimulating hormone, growth hormone, adrenocorticotropic hormone, thyroid stimulating hormone, prolactin

Question 4

Where is cortisol released from?

Answer 4

zona fasiculata in the adrenal cortex

Question 5

Where is aldosterone released from?

Answer 5

zona glomerulosa in the adrenal cortex

Question 6

What is released from the adrenal medulla?

Answer 6

epinephrine and norepinephrine

Question 7

The zona reticularis releases

Answer 7

sex hormones

Question 8

What is the role of cortisol (hydrocortisone)?

Answer 8

Increases carbohydrate & protein metabolism
suppress immune system
suppression of pro-inflammatory cytokines
mobilization of free fatty acids
inhibits insulin from shuttling into cells

Question 9

When does cortisol peak?

Answer 9

8 am

Question 10

When is cortisol at its lowest concentration?

Answer 10

midnight

Question 11

What is the normal production of cortisol?

Answer 11

15-30 mg/day

Question 12

What causes release of cortisol?

Answer 12

ACTH

Question 13

What are cortisol levels in response to minor procedures?

Answer 13

up to 50 mg/day
return to baseline within 24 hours
ex. hernia repair

Question 14

What are cortisol levels in response to moderate procedures?

Answer 14

up to 75-100 mg/day
return to baseline by 5 days
ex. colectomy

Question 15

What are cortisol levels in response to major procedures?

Answer 15

up to 200 mg/day
usually returns to baseline by 5 days
ex. major trauma

Question 16

What is Cushing’s Sydnrome?

Answer 16

Too much cortisol typically due to increase of corticosteroids

Question 17

What are reasons Cushing’s disease can occur?

Answer 17

Tumor on pituitary gland resulting in increased release of cortisol

Question 18

What are the signs and symptoms of Cushing’s Disease?

Answer 18

moon face, hunch back, thin skin, osteoporosis, amennorhea, Na & fluid and retention, males develop breasts

Question 19

When do we see clinical manifestations of Addison’s Disease?

Answer 19

When 90% of cortical zones are destroyed

Question 20

What is the most common cause of Addison’s disease?

Answer 20

autoimmune destruction

Question 21

What are reasons for secondary adrenal insufficiency?

Answer 21

problems w/ hypothalamus or anterior pituitary
TBI
Chronic glucocorticoid treatment (3-4 weeks)
Topical administration such as aersols for asthma and COPD or creams used for skin problems
Ischemic/hemorrhagic lessons of hypothalamic-pituitary axis

Question 22

What is an adrenal crisis?

Answer 22

It is a life threatening acute deterioration and includes at least two of the following:
hypotension (treating BP that is not going back up), acute abdominal symptoms, N/V, AMS, fatigue, fever, laboratory abnormalities

Question 23

What are the abnormalities found in adrenal crisis?

Answer 23

hyponatremia, hyperkalemia, hypoglycemia, rarely hypercalcemia

Question 24

What are the causes of adrenal crisis?

Answer 24

interruption of gluccorticoid intake, infections, surgery, gastroenteritis, stress

Question 25

How do you manage adrenal crisis?

Answer 25

give them fluid (0.9 NS 1-3 L over 6-12 hours) | want to give hydrocortisone (initial 100 mg)

Question 26

Patients who have surgery at X time have a quicker return to baseline cortisol levels

Answer 26

afternoon

Question 27

What is the mechanism of action of corticosteroids?

Answer 27

stimulates change in transcription of 456 DNA -synthesis of proteins Target cells contain enzyme- 11-beta hydroxysteroid dehydrogenase (think etomidate) turns cortisol (active) into cortisone (inert)

Question 28

What is the classification of corticosteroids?

Answer 28

1) reabsorption of Na+ in exchange for K+ in renal distal tubules (mineralcorticoid effect) 2) anti-inflammatory properties (glucocorticoid effect)

Question 29

Synthetic corticoids are all

Answer 29

glucocorticoids

Question 30

This interferes with the oral absorption of corticosteroids

Answer 30

antaccids

Question 31

The elimination half-time of cortisol is

Answer 31

1.5-3 hours

Question 32

How is cortisol eliminated?

Answer 32

phase II liver- 70% conjugated in liver

Question 33

Cortisol readily

Answer 33

cross the placenta

Question 34

Cortisol is

Answer 34

highly protein bound to corticosteroid-binding globulin

Question 35

What are the clinical uses of corticosteroids?

Answer 35

antiemetic, analgesia, immunosuppression, laryngeal edema, can prolong regional blocks, asthma, cerebral edema, adrenal insufficiency

Question 36

Comment on corticosteroids and covid 19

Answer 36

beneficial for patients who are severely ill and requiring ventilation or oxygen supplementation

Question 37

Research has shown that use of corticosteroids does not cause

Answer 37

does not contribute to wound complications or wound healing or hyperglycemic events

Question 38

What can be used safely for PONV prophylaxis?

Answer 38

4-8 mg dose of dexamethasone

Question 39

What dosage of dexamethasone can be given for postop sore throat?

Answer 39

Prophylactic >0.2 mg/kg

Question 40

What are the perioperative adrenal supplementation guidelines for hydrocortisone?

Answer 40

superficial (dental biopsy)- 0 Minor (colonoscopy, hernia repair)- 25 mg IV Moderate (colon resection, joint replacement)- 50-75 mg IV, taper over 1-2 days Major (CV, Thoracic)- 100-150 mg IV taper over 1-2 days

Question 41

When should we give perioperative steroids?

Answer 41

1. pharmacologic doses of glucocorticoids greater than 5 mg of prednisone equivalent/day 2. The period of treatment with corticosteroids was for 2-3 weeks or longer 3. The treatment occurred during the immediate 12 months before surgery

Question 42

Acute side effects of corticosteroids include

Answer 42

hyperglycemia

Question 43

Chronic side effects of corticosteroids include:

Answer 43

HPA axis suppression, corticosteroid supplementation, electrolyte and metabolic changes, CNS dysfunction, peptic ulcer disease, skeletal muscle myopathy

Question 44

Drugs that cause enzyme inhibition with corticosteroids

Answer 44

ketoconazole, fluconazole, etomidate, metapyrone

Question 45

Drugs that accelerate metabolism with corticosteroids

Answer 45

phenytoin (dilantin), rifampin, phenobarbital, ephedrine

Question 46

Hydrocortisone is also know as

Answer 46

cortisol and is short acting

Question 47

What are the corticosteroids predominantly used in practice:

Answer 47

hydrocortisone, prednisone, prednisolone, methylprednisolone, dexamethasone

Question 48

What corticosteroid is used to produce an intense glucocorticoid affect?

Answer 48

methylprednisolone

Question 49

What corticosteroids rely most on liver function?

Answer 49

prednisolone and prednisone

Question 50

What corticosteroid is the sole replacement therapy for adrenocortical insufficiency?

Answer 50

prednisolone

Question 51

Aldosterone is known for its'

Answer 51

sodium retaining potency; it is a mineralcorticoid

Question 52

What is the duration of action of cortisol?

Answer 52

8-12 hours so we need to give more than one dosage

Question 53

Prednisone can only be given

Answer 53

PO