Glucocorticoids - Ch. 63 & Ch. 76

Question 1

Where are glucocorticoids secreted from?

Answer 1

Adrenal gland–> Adrenal cortex

Question 2

What does the adrenal medulla secrete?

Answer 2

Epinephrine and norepinephrine

Question 3

What stimulates glucocorticoid release?

Answer 3

Anterior pituitary ACTH

Question 4

What do glucocorticoids do physiologically?

Answer 4

Promote glucose availability
Protein metabolism
Fat metabolism
Supports SNS activity on blood vessels

Question 5

Oversecretion of adrenocortical hormones leads to what?

Answer 5

Cushing’s syndrome

Question 6

Under secretion of adrenocortical hormones leads to what?

Answer 6

Addison’s disease

Question 7

What are some glucocorticoids drugs?

Answer 7

Prednisone (prodrug)
prednisolone
cortisone
dexamethasone

Question 8

What is prednisone?

Answer 8

Drug of choice of oral glucocorticoids for anti-inflammatory purposes and hormone replacement

Question 9

How are glucocorticoids administered?

Answer 9

inhalation
Nasally
Topically
Systemic (IV, PO)

Question 10

What are inhaled glucocorticoids used for?

Answer 10

Asthma,COPD

Question 11

What are nasal glucocorticoids used for?

Answer 11

Rhinitis
Prevent the recurrence of polyps after surgical removal

Question 12

What are topical glucocorticoids used for?

Answer 12

Inflammations of the eye, ear and skin

Question 13

What are systemic (IV, PO) glucocorticoids used for?

Answer 13

Hormone replacement
Immunosupression

Question 14

What is the mechanism of action of glucocorticoids?

Answer 14

Alter gene expression of many proteins
-Help control inflammatory and immune responses

Question 15

What are glucocorticoids used for?

Answer 15

Adreneocortical deficiency (lifelong replacement therapy)
Anti-inflammatory/immune suppression
-Chronic resp. illnesses
-Organ transplant
-Derm. diseases
-GI diseases
Leukemia and lymphoma (kill malignant cells)
Spinal cord injury
Cerebral edema

Question 16

When is glucocorticoid use contraindicated?

Answer 16

Serious infections
-systemic fungal infections

Question 17

When are glucocorticoid to be used cautiously?

Answer 17

Gastritis, reflect disease, peptic ulcer disease
Diabetes mellitus (leads to hyperglycemia)
Hypertension, HF, renal impairment
Pregnancy

Question 18

What adverse effects are associated with glucocorticoid use?

Answer 18

Mimic Cushing’s syndrome
Significant effects on all body systems

Question 19

What Cushing syndrome symptoms can glucocorticoids mimic?

Answer 19

-moon face
-buffalo hump (fat deposits on neck)
-abdominal fat
-thin arms and legs
-stria (red markings)

Question 20

What Cardiovascular adverse effects are associated with glucocorticoids?

Answer 20

HF
Cardiac edema
hypertension

Question 21

What CNS adverse effects are associated with glucocorticoids?

Answer 21

convulsions
headache
vertigo
mood swings
nervousness
insomnia
steroid psychosis

Question 22

What endocrine adverse effects are associated with glucocorticoids?

Answer 22

Growth supression
Cushing’s
menstrual irregularities
carbohydrate intolerance
hyperglycemia

Question 23

Why do glucocorticoids cause hyperglycemias?

Answer 23

Increase plasma glucose levels

Question 24

What GI adverse effects are associated with glucocorticoids?

Answer 24

peptic ulcers with possible perforation
pancreatitis
abdominal distention

Question 25

What integumentary adverse effects are associated with glucocorticoids?

Answer 25

Fragile skin Petechiae Ecchymoses Facial erythema Poor wound healing Hirsutism Urticaria

Question 26

What musculoskeletal adverse effects are associated with glucocorticoids?

Answer 26

Muscle weakness Loss of muscle mass Osteoporosis

Question 27

What ocular adverse effects are associated with glucocorticoids?

Answer 27

Increased intraocular pressure Glaucoma

Question 28

Usually replacement therapy via glucocorticoids does not cause what adverse effect?

Answer 28

Cushing's syndrome

Question 29

During what use of glucorticoids are major adverse effects more common?

Answer 29

Inflammation suppression uses Immune suppression uses -depends on dosage

Question 30

During times of stress what may need to happen with glucocorticoid replacement therapy?

Answer 30

Increase dosage stressors = infections, surgery, traumas e.g, 3 by 3 rule for febrile illness

Question 31

What is the 3 by 3 rule for febrile illness?

Answer 31

take 3 time the usual dose of glucocorticoids for 3 days

Question 32

What do glucorticoids do during immunosuppressant therapy?

Answer 32

Drug inhibits physiological control of cortisol secretion -reduces ACTH Cortex atrophy -allows adrenal cortex to recover

Question 33

Sudden discontinuation of glucocorticoids can cause what?

Answer 33

Adrenal crisis

Question 34

What is adrenal crisis?

Answer 34

Adrenal incapacity to synthesis glucocorticoids -not enough cortisol

Question 35

Symptoms of adrenal crisis?

Answer 35

Abdominal pain Low BP Dehydration (syncope, dizziness) Shock, fatal Nausea, vomiting Extreme fatigue Confusion, convulsions

Question 36

How is Adrenal crisis avoided?

Answer 36

Drug doses are tapered before being discontinued

Question 37

What should patients taking adrenal medications be taught?

Answer 37

Take all adrenal meds at the same time every day, usually in the morning, with food

Question 38

What drugs should be taken with caution when the patient is on glucocorticoids?

Answer 38

NSAIDs -stomach ulcers

Question 39

What should the patient be taught to do after used inhaled glucocorticoids?

Answer 39

Rinse mouth to prevent oral fungal infections

Question 40

Who should patients taking glucocorticoids avoid contact with?

Answer 40

People with infections -report fever, weakness, lethargy, sore throat