Exam III Steroids Flashcards
(53 cards)
What is a natural cortisol (glucocorticoid) ?
1) regulates carbohydrate, fat and protein metabolism
2) Maintains vascular reactivity
- response to vasoactive amines
3) Anti-inflammatory effects
4) Maintenance of homeostasis during periods of stress
- maintains stability during emotional/physical stress
What increases the level of endogenous cortisol?
1) Surgery = most potent activator
2) Pain = important to use good pain control
3) Other= illness, trauma, burns, fever, hypoglycemia, emotional upset (periods of stress)
What are disorders of Adrenal Glands?
1) Excessive production of cortisol:
- Cushing disease (primary disorder)
2) Insufficient production of cortisol
- Addison disease (primary disorder)
- Secondary disorder = HPA axis is suppressed due to taking glucocortocids meds
What is a medication induced adrenal insufficiency?
Secondary disorder
-taking glucocorticoids meds
(exogenous steroids) suppresses the boys own production of endogenous steroids.
What is secondary adrenal insufficiency?
1) More common than Addison’s disease
2) ASSOCIATED WITH CHRONIC STEROID USE
3) CONDITION DOES NOT PRODUCE SYMPTOMS UNLESS PATIENT IS SIGNIFICANTLY STRESSED (not enough circulating cortisol)
What is an Adrenal crisis?
1) Medical emergency
2) RARE with secondary adrenal insufficiency
3) EMERGENCY situation
4) LIFE-THREATENING
5) triggered by stress, illness, infection, surgery
6) SEVERE EXACERBATION of PATIENTS SYMPTOMS
What are the signs and symptoms of Adrenal Crisis?
1) Sunken eyes
2) PROFUSE SWEATING
3) HYPOTENSION
4) WEAK PULSE
5) DYSPNEA
6) CYANOSIS
7) nausea/vomiting
8) headache
9) dehydration
10) fever
11) myalgias
12) arthralgias
13) hyponatremia
14) eosinophilia
Without intervention of adrenal crisis, patient will continue to decline how?
1) hypothermia
2) SEVERE HYPOTENSION
3) hypoglycemia
4) circulatory collapse (SHOCK)
5) death
6) EMS for TRANSPORT AND SIGNIFICANT MEDICAL INTERVENTION REQUIRED
What is the TX for ADRENAL CRISIS?
1) Elevate feet above head
2) IV glucocorticoids
3) Fluid and electrolyte replacement therapy
4) Over 24 hr period, slow IV infusion of glucocorticoids every 6 to 8 hours
5) Correction of hypoglycemia
6) Administration of vasopressors (epinephrine)
7) monitor BP
8) resolution of event that triggered crisis
Synthetic Glucocorticoid medications are indicated for what?
1) Autoimmune diseases
2) Immunosuppressive therapy in organ transpant patients
3) Respiratory disease management
What are examples of Autoimmune disease?
1) Type I Diabetes
2) MS
3) Scleroderma
4) Lupus
5) Rheumatoid arthritis
6) Grave’s disease/thyroid disease
7) Sjogren’s syndrome
8) Pernicious anemia
9) Fibromyalgia?
10) Chronic fatigue syndrome?
Which systemic diseases require steroid use?
1) Replacement therapy (adrenal insufficiency, pituitary insufficiency, adrenal hyperplasia)
2) Arthritis (rheumatoid, osteoarthritis)
3) Rheumatic Carditis
4) Renal diseases
5) Collagen Disease (lupus erythematosus)
6) Allergic disease (anti-inflammatory effect)
What is the mechanism of action of steroids?
1) Steroids binds to specific receptors
2) Steroid-receptor complex translocates into the nucleus and alters gene expression
- turns genes off/on
- regulation of many cellular processes
3) Other effects of glucocorticoids are mediated by catecholamines
- producing vasodilation/bronchodilation
4) *Anti-inflammatory effects
5) Effect on #, distribution and function of PERIPHERAL LEUKOCYTES
- increased [ ] in NEUTS and decrease in T and B cells, monocytes, eosinophils and basophils
6) INHIBITION OF PHOSPHOLIPASE A
- decrease production of prostaglandins and leukotrienes from arachidonic acid
7) inhibit IL-2 migration inhibition factor and macrophage inhibition factor (causes therapeutic and adverse effects)
What are the contradictions for steroids?
- Effects for which steroids are used:
1) Anti-inflammatory action
2) suppression of allergic runs
3) suppresses the immune response (desired and undesired effect)
4) Adverse reactions are proportional to dose, frequency, time of administration and duration of TX
5) *TREATMENT is PALLIATIVE RATHER than CURATIVE
How is steroid preparations determined?
1) Each steroid is rated as to potency as COMPARED TO a HYDROCORTISONE EQUIVALENT DOSE
2) More potent the drug, the lower the dose and higher the risk for adrenal suppression.
3) TOPICAL APPLICATIONS LEAST LIKELY to cause adrenal suppression (except those w/ high potency)
4) SYSTEMIC STEROIDS MORE LIKELY to CAUSE adrenal suppression
Corticosteroid products are characterized by what?
- DURATION OF ACTION (short, intermediate, and long)
- relative anti-inflammatory activity and equivalent oral dose, w/ hydrocortisone (value of 1)
- Other agents are then given values in relation to those of hydrocortisone
What are the short acting selected corticosteroids (oral)?
a) What is the anti-inflammatory values in relation to hydrocortisone?
b) equivalent oral dose (mg)
1) Hydrocortisone (Cortisol)
Value: 1 Dose: 20 mg
2) prednisone (Deltasone)
Value: 4 Dose: 5 mg
3) methylprednisolone (Medrol)
Value: 5 Dose: 4 mg
Prednisone = anti-inflammatory of _______. It has ______ times the anti-inflammatory action of hydrocortisone.
_________ as much prednisone is required to produce the same effect produced by ______
- 4
- 4 X
- One fourth 1/4
- hydrocortisone
EQUIVALENT DOSES ARE BASED ON ______ HYDROCORTISONE = __________ NORMALLY SECRETED DAILY BY AN ADULT WITHOUT STRESS.
______mg mg dexamethasone and _____ mg prednisone = ____ mg of hydrocortisone
- 20 MG
- AMOUNT
- 0.75
- 5
- 20
What are the Intermediate acting selected corticosteroids (oral)?
a) What is the anti-inflammatory values in relation to hydrocortisone?
b) equivalent oral dose (mg)
1) triamcinolone
Value: 4 Dose: 4 mg
2) prednisolone
Value: 4 Dose 5 mg
What are the Long acting selected corticosteroids (oral)?
a) What is the anti-inflammatory values in relation to hydrocortisone?
b) equivalent oral dose (mg)
1) dexamethasone
Value: 30 Dose: 0.75 mg
2) betamethasone
Value: 25 Dose: 0.6-0.75 mg
What are the dosing considerations with steroids?
1) Taken in the A.M
2) Alternate day therapy
- lengthening interval between dosing allows for same effects with fewer side effects
3) ALTERNATE DAY THERAPY IS USED FOR PATIENTS WHO MUST TAKE STEROIDS FOR LONGER THAN 1 MONTH
4) Adrenal gland functions normally on “off” day
- HPA axis not suppressed; less risk for adrenal suppression
5) DAILY THERAPY POSES GREATER RISK FOR ADRENAL SUPPRESSION
6) “wean off” steroid in descending doses (tapered)
7) Normal adrenal output of cortisol = 20-30 mg hydrocortisone equivalent
8) ANY MED. DOSAGE that EXCEEDS THIS AMOUNT MAY CAUSE SUPPRESSION
9) During stress, adrenals secrete up to 300 mg of hydrocortisone eq.
What are the adverse events associated with chronic steroid use?
1) Insomnia
2) Peptic ulceration (AVOID ASPIRIN and NSAIDS)
3) osteoporosis
4) hyperglycemia
5) cataract formation
6) glaucoma
7) redistribution of fat pads
8) growth suppression
9) delayed wound healing
What are the oral side effects of steroids?
1) CANDIDIASIS = MOST COMMON
- pt’s using inhalers
- use topical antiphonal therapy
2) POOR WOUND HEALING = long term use
3) MASKING OF ORAL INFECTIONS = anti-inflammatory
4) XEROSTOMIA = inhaled and systemic steroids
- power assisted devices
- fluorides
- chemotherapeutics
