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Exam 1 Flashcards

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1
Q

Fludrocortisone

A

affects fluid and electrolytes, causes sodium and water retention, treats adrenal insufficiency and Addison’s disease, aims to help control BP and restore fluid and electrolyte balance

adverse affects: sodium accumulation, potassium depletion

the only drug that has true mineralocorticoid effects.

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2
Q

Fludrocortisone is used in combination with glucocorticoids to replace

A

mineralocorticoid activity in patients who suffer from adrenocortical insufficiency (Addison disease) and to treat salt-losing adrenogenital syndrome.

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3
Q

The primary therapeutic outcomes expected from fludrocortisone therapy are

A

control of bp
and
restoration of fluid and electrolyte balance

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4
Q

Premedication assessments for fludrocortisone include

A

indications of electrolyte imbalance
acurate I/O and vitals
signs of infection
baseline assessment for alertness, oriented
ask about previous heartburn, ulcer, or stomach pain
regularly test stools for blood occult

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5
Q

fludrocortisone dosage

A

PO 0.1 mg daily

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6
Q

Cortisone or hydrocortisone are also usually administered with fludrocortisone to

A

provide additional glucocorticoid effect

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7
Q

Fludrocortisone produces marked ______ retention and ________ depletion, which could lead to high blood pressure

A

sodium and water retention
and
potassium depletion

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8
Q

The major glucocorticoid of the adrenal cortex is

A

cortisol

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9
Q

Glucocorticoids

A

Antiinflammatory, antiallergenic, immunosuppression

used for certain cancers, organ transplant, autoimmune diseases, allergies, shock

Common and serious adverse effects: Electrolyte imbalance, fluid accumulation; susceptibility to infection; behavioral changes for those with a history of mental illness; hyperglycemia; peptic ulcer formation; delayed wound healing; visual disturbances; osteoporosis in the long term

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10
Q

Corticosteroids can mask symptoms of

A

infection, this means that the typical symptoms of an infection (fever for example) may not be seen

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11
Q

When glucocorticoids are used to control rheumatoid arthritis, symptom relief is noted within

A

a few days

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12
Q

Glucocorticoids are also effective for immunosuppression in the treatment of

A

certain cancers, organ transplantation, and autoimmune diseases (e.g., lupus erythematosus, dermatomyositis, rheumatoid arthritis); relief of allergic manifestations (e.g., serum sickness, severe hay fever, status asthmaticus); and treatment of shock. They also may be used to treat nausea and vomiting secondary to chemotherapy.

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13
Q

The primary therapeutic outcomes expected from glucocorticoid therapy are

A
  • Reduced pain and inflammation
  • Minimized shock syndrome and faster recovery
  • Reduced nausea and vomiting associated with chemotherapy
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14
Q

Glucocorticoids are effective in the treatment of certain cancers because of their

A

immunosuppressive properties.

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15
Q

Corticotropin-releasing factor stimulates the release of ____________ from the pituitary gland.

A

adrenocorticotropic hormone

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16
Q

Adrenocorticotropic hormone stimulates the adrenal cortex to secrete ________.

A

cortisol

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17
Q

As serum levels of cortisol increase, the amount of corticotropin-releasing factor secreted by the hypothalamus is __________.

A

decreased

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18
Q

Abrupt discontinuation of glucocorticoids may result in ____________ if higher dosages are being received.

A

adrenal insufficiency

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19
Q

Corticosteroid therapy should be withdrawn _______

A

gradually (steroid taper)

  • Patients who have received corticosteroids for at least 3 weeks must not abruptly discontinue therapy.
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20
Q

The time required to decrease glucocorticoids depends on the

A

o Duration of treatment
o Dosage amount
o Mode of administration
o Glucocorticoid being used

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21
Q

Symptoms of abrupt discontinuation of corticosteroids include:

A

 Fever
 Malaise
 Fatigue
 Weakness
 Anorexia
 Nausea
 Orthostatic hypotension
 Dizziness
 Fainting
 Dyspnea
 Hypoglycemia
 Muscle and joint pain
 Possible exacerbation of the disease process

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22
Q

Common and serious adverse effects of glucocorticoids therapy are

A

fluid and electrolyte disturbances
susceptibility to infection
behavioral changes
hyperglycemia
peptic ulcer formation
delayed wound healing
visual disturbances (cataracts)
osteoporosis

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23
Q

drug interactions associated with glucocorticoids

A

diuretics (furosemide, bumetanide, thiazides)
warfarin (may alter anticoagulant effects)
oral hypoglycemic agents (may cause hyperglycemia)
rifampin (may enhance metabolism of corticosteroids, reducing therapeutic effect)

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24
Q

Synthetic glucocorticoids, also commonly known as _____________, are medications that can be used in clients with decreased adrenal function, such as in adrenal insufficiency; this is also known as Addison disease, and specifically occurs when the adrenal glands don’t make enough endogenous glucocorticoids, so these clients need hormone replacement therapy with synthetic glucocorticoids.

A

corticosteroids

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25
__________ and ___________ are endogenous hormones normally produced by the adrenal glands. In clients with impaired adrenal function, these hormones can be administered as replacement therapy.
Glucocorticoids and mineralocorticoids
26
glucocorticoids are used in the treatment of numerous inflammatory conditions, such as
asthma, rheumatoid arthritis, and inflammatory bowel disease, as well as preventing organ rejection in transplant recipients
27
short-acting glucocorticoids
cortisone and hydrocortisone
28
intermediate-acting glucocorticoids
prednisone, prednisolone, and methylprednisolone
29
Cortisone needs to be converted into hydrocortisone in the liver in order to be active, so it can only be taken
orally
30
hydrocortisone can be given
orally, IV, IM, topically
31
Prednisone can only be taken
orally
32
prednisolone can be administered
orally, IV, or topically
33
methylprednisolone can be given
orally, IV, IM, or IA (intra-articularly injected)
34
long-acting glucocorticoids
betamethasone and dexamethasone
35
betamethasone and dexamethasone can be taken
orally, IV, IM, IA (intra-articularly injected) betamethasone is also available for topical use
36
Most side effects are related to excess glucocorticoid activity, which can result in iatrogenic Cushing syndrome:
mood changes; weight gain predominantly in the back of the neck between the shoulder blades and face, respectively termed buffalo hump and moon facies; skin atrophy and stretch marks; muscle weakness; hyperglycemia; and increased risk of infections.
37
synthetic mineralocorticoids are used to treat conditions where mineralocorticoid levels are low, such as
Addison disease and severe congenital adrenal hyperplasia.
38
Fludrocortisone should be used with caution in clients with
uncontrolled hypertension, congestive heart failure, hypokalemia, and DM
39
during periods of high stress or illness, the patent will often need to increase their _____________ dose adjustments in order to remain asymptomatic
hydrocortisone
40
hydrocortisone therapy is meant to mimic the body’s normal production of cortisol, so they should take the largest dose __________, take the smaller dose __________, and avoid taking the medication in the late afternoon or evenings, when cortisol levels normally decrease.
largest dose first thing in the morning smaller dose in the early afternoon
41
hydrocortisone can lead to
hypertension and hypokalemia because of its mineralcorticoid activity
42
Prednisone and other glucocorticoids increase the patient’s risk for developing
peptic ulcers
43
early onset adverse associated with the use of prednisolone
Hyperglycemia
44
Mineralocorticoids
Maintain fluid and electrolyte balance and are used to treat adrenal insufficiency caused by hypopituitarism or Addison’s disease Fludrocortisone Aldosterone
45
Glucocorticoids
Regulate carbohydrate, protein, and fat metabolism Glucocorticoids have antiinflammatory, antiallergenic, and immunosuppressant activity. Cortisone Hydrocortisone Prednisone
46
Diseases associated with adrenal glands are
Addison’s disease, pheochromocytoma, and hyperpituitarism
47
Premedication assessments for steroids:
electrolyte imbalance i/o, vitals signs of infection - General malaise, sore throat, low-grade fever baseline assessment of alertness hydration previous treatment for ulcer, heartburn, stomach pain test stools for occult blood
48
Nursing processes for steroid admin
monitor glucose levels, may require insulin follow body's normal circadian rhythm (corticosteroids: half dose before 9am, half of dose late afternoon, mineralcorticoids: once daily in evening) monitor daily weight, i/o additional dosies may be needed if stress, injury; wear ID bracelet
49
patient education
when to call hcp (before a dental procedure, stress dosing) skin care stress coping avoid infections good nutrition regular exercise health maintenance document
50
All corticosteroids (glucocorticoids and mineralocorticoids) share varying degrees of
mineralocorticoid and glucocorticoid effects
51
Should steroids be stopped abruptly?
no, may result in adrenal insufficiency
52
Carefully monitor corticosteroid therapy patients with:
Diabetes mellitus - for hyperglycemia Heart failure Hypertension Peptic ulcer disease Mental disturbance - psychotic behavior Suspected infections - may mask infection signs
53
Corticosteroid Therapy Drug Interactions
Diuretics: Corticosteroids may enhance the loss of potassium Warfarin: Corticosteroids may enhance or decrease the anticoagulant effects of warfarin Oral hypoglycemic agents or insulin: Diabetics/prediabetic patients must be monitored for hyperglycemia
54
Corticosteroids do cause a ________ in blood sugar, requiring insulin to _______ the blood sugar level.
cause an increase to lower the blood sugar level
55
rapid acting insulin
lispro (Humalog), aspart (NovoLog, Fiasp), glulisine (Apidra), duration 3-5 hours administered IV or SQ
56
short acting insulin
regular, duration 5-8 hours administered IV or SQ
57
intermediate acting insulin
NPH (N) duration 12-18 hours administered SQ
58
long acting insulin
glargine (Lantus, Toujeo, Basaglar), detemir (Levemir), degludec (Tresiba), duration 16-24 hours SQ just before meals, do not mix with other insulins
59
fixed combination insulins
Novolin 70/30 has 70% intermediate-acting and 30% short-acting insulin, 2 different insulins with fixed combinations, 1 intermediate acting and 1 rapid or short acting, Patients often take a combination of rapid-acting insulin for surges in glucose after meals and an intermediate for the period between meals, Fixed combos were developed to simplify dosing
60
Basal-Bolus/sliding scale insulins CLO 2
Preferred method of treatment for hospitalized patients with DM, Mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus, Basal insulin is a long-acting insulin (insulin glargine), Bolus insulin is rapid (insulin lispro or insulin aspart,), The basal insulin is a long-acting insulin administered constantly to keep the blood glucose from fluctuating Bolus insulin is broken up into meal and correction boluses. Meal boluses are given to reduce blood glucose with the intake of carbohydrates. Correction boluses are any boluses given to bring blood glucose levels back to normal. Requires frequent monitoring of blood glucose levels
61
metformin (Glucophage)
OA biguanides decreases glucose in the blood, treats type 2DM, can cause lactic acidosis
62
glipizide (Glucotrol)
OA sulfonylureas lowers blood sugar by causing the pancreas to produce insulin, treats type 2D
63
repaglinide (Prandin)
OA meglitinides decreases the amount of glucose by stimulating the pancreas to release insulin, treats type 2D
64
pioglitazone (Actos)
OA thiazolidinediones increasing sensitivity of muscle and fat tissue to insulin, treats type 2D
65
acarbose (Precose)
OA Alpha-glucosidase inhibitor inhibits/slows enzymes working to digest sugars. Slowing food digestion helps keep blood glucose from rising very high after meals, treats type 2D
66
sitagliptin (Januvia)
OA dipeptidyl petidase IV (DPP-IV) inhibitor Prolong life of active GLP-1 and GIP incretin hormones. Treats type 2D
67
canagliflozin (Invokana)
OA sodium-glucose contransporter II Inhibitor drops glucose reabsorbtion, It lowers blood sugar by causing the kidneys to get rid of more glucose in the urine, treats type 2D
68
dulaglutide (Trulicity)
OA incretin mimetic agents (Glucagon-like peptide - I agonists) Increases serum insulin and reduces glucose concentrations, delays gastric emptying, reduces appetite, treats type 2D, associated with thyroid tumors in animals
69
glucagon
OA antihypolycemic agent Breaks down stored glycogen to glucose, It works by causing the liver to release stored sugar to the blood, Administer SC, IM, or IV. Should respond in 5 to 20 minutes; if not, 1 to 2 additional doses
70
The average rate of insulin secretion in an adult is
30 to 50 units a day

Pharm 2 (5 decks)

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