06 - Endocrine II Flashcards by Helen Wang

Corticosteroids are ___ with receptors ____ throughtout the body. Example?

anti-inflammatory
widely distributed

glucocorticoids (cortisol)

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Secretion of endogenous cortisol increases in response to ___. What is baseline episodic secretion?

stress

~20 mg/day

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What are the anti-insulin effects of corticosteroids?

gluconeogenesis
inhibition of glucose utilization
hyperglycemia

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Corticosteroid interaction with catecholamines?

vascular smooth muscle response

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Corticosteroids have some sodium ___ and potassium

retention

excretion (mineral corticoid effect)

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Exogenous glucocorticoids are primarily used to replace

glucocorticoid deficiency (Addison’s disease)

25-37.5 mg daily replacement

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Inhaled exogenous glucocorticoids are used for

asthma

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Inhaled steroids have a ___ effect and little

local effect

systemic absorption

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Examples of inhaled steroids?

Azmacort - triamcinolone
Beclovet - beclomethasone
Flovent - fluticasone
Pulmicort - budesonide
Advair - flutocasone + salmetrol

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Inhaled steroids can cause significant ____ deposition leading to

pharyngeal

dysphonia, candidiasis

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Exogenous systemic steroids are typically used for ___ of asthma given ___ hours before anesthesia

acute exacerbations

1-2 hours

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Exogenous glucocorticoid given as an antiemetic? It has similar efficacy to ____. Is there data to support giving more?

4 mg IV dexamethasone
odansetron or droperidol
no

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Dexamethasone is best if given near the

beginning of surgery

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Dexamethasone prevents surgery-induced ____ and increases release of

inflammation

endorphins?

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Why is dexamethasone used in caution with diabetics?

consider the risks of hyperglycemia vs benefits of therapy

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Given for cerebral edema?

dexamethasone

larger doses required (10-20 mg)

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Dexamethasone is effective for ____ due to global ischemic injury by decreasing ____ for intracranial surgery

elevated ICP

cerebral volume

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What are the other uses of exogenous glucocorticoids?

anti-inflammatory - postop pain, lumbar disc disease, collagen diseases, arthritis, skin disorders, ulcerative colitis, acute spinal cord injury
immunosuppressiob (transplant) - respiratory distress syndrome, leukemia, myasthenia gravis

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All patients you want to administer exogenous glucocorticoids to should be evaluated for

past/current steroid use

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Many people give ____ for post-intubation laryngeal edema but there is no evidence of efficacy

dexamethasone

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Side effects of glucocorticoid therapy

suppression of hypothalamic-putitary-adrenal (HPA) axis
electrolyte/metabolic changes
osteoporosis
peptic ulcer disease
CNS: psychosis (steroid rage), depression; cataracts
immunosupression: bacterial/fungal infection

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Suppression of the HPA axis can occur only ___ after taking 20 mg/day ___ and take ___ to fully recover

5 days
prednisone
9-12 months

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When corticosteroid therapy suppresses the HPA axis, the ____ no longer secrets ____ in response to stress (illness, injury) which causes risk of ____ with stress

adrenal gland, cortisol

acute adrenal insufficiency (cardiovascular collapse)

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Risk of HPA axis suppression increases with

dose and duration of therapy
every other day therapy is better than daily
topical/inhaled/local treatment is better than systemic

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How is "stress-dose" corticosteroid administered?

1. Continue daily basal maintenance dosing 2. Supplementation with hydrocortisone It is a subject of much debate

What is the low and high dose for stress-dose corticosteroid?

25 mg Q12h | 100 mgQ6h

Stress doses vary based on ____ of the surgical procedure as well as the perceived rush of this patient developing

magnitude | acute renal insufficiency

Is tapering needed when giving a steroid for colonoscopy?

No, 25 mg bolus

What is the dosing of steroids for a moderate surgery such as hysterectomy?

50-75 mg | 25 mg q8h x3 doses

Dose of steroids for a major surgery (cardiac)?

100-150 mg | 50 mg q8h x3, 50 mg q12h x2, 25 mg q12h x 2

Glucocorticoid therapy can cause a ____ effect that leads to hypokalemic metabolic acidosis (think ____)

mineralcorticoid aldosterone binds at renal tubules "save sodium, pee potassium" edema, weight gain, HTN

Electrolyte/metabolic changes associated with glucocorticoid therapy?

mineralcorticoid effect hyperglycemia buffalo hump, moon facies, abdominal striae, tissue-paper skin

Which steroid causes the most sodium retention?

Fludrocortisone - 250

Which steroid causes the least amount of sodium retention?

Dexamethasone - 0

Cyclooxygenase (COX) enzymes convert ____ to

arachidonic acid | prostaglandins

COX-1 activity is constitutive or at a ____ level

constant

COX-1 is involved in maintenance and protection of

gastric mucosa platelet aggregation (depends on generation of thromboxane A2) renal blood flow

COX-2 activity is ___, expressed at the site of injury

inducible

COX-2 up regulates sensitivity of peripheral ____ to cause ___ mediated by PGE2

nociceptors pain, inflammation fever

Which COX crosses the BBB to facilitate spinal nociception?

COX-2

Desirable features of NSAIDs

9 features

Aspirin is a ____ COX inhibitor that causes anti platelet function due to ____ acetylation of platelet COX-1

nonselective | irreversible

Used for the prevention of thrombosis in coronary stents?

aspirin

How long should invasive procedures be avoided for a patient taking aspirin?

7-10 days | life of the platelet

Which patients are especially sensitive to aspirin?

uremic patients

Common side effects of aspirin?

bleeding | GI irritation/ulceration

Aspirin causes ____ in 8-20% of all ____ adults

bronchoconstriction/asthma | asthmatic

Aspirin is no longer used in children, especially due to

Reyes Syndrome

Overdose on aspirin causes CNS stimulation (hyperventilation, seizures) leading to

respiratory alkalosis + metabolic acidosis

When taken orally, ibuprofen has

first pass effect consider IV use - does not accumulate over time, use Q6h

Side effects of ibuprofen

GI irritation/ulceration | some platelet dysfunction

Ibuprofen that is twice daily dosing

Naproxen

Ketorolac is a ____ analgesic that can be used as a ___ drug or to supplement

post-operative | sole, opiates

30 mg IM ketolorac =

10 mg morphine

Ketorolac causes ____ inhibition of platelet aggregation

reversible

Why should ketorolac be used with caution in renal patients?

Decreases renal blood flow on compromised patients (CHF, hypovolemia)

NSAIDs are not recommended in

pregnancy and children especially during third trimester, linked the premature birth and miscarriage OK in children >6 months

NSAIDs may cause premature closure of fetal ___ and limit renal blood flow

ductus arteriosus

COX-2 inhibitor used for pain/inflammation of arthritis, surgery

Celecoxib (Celebrex)

Celebrex is well absorbed from ___ with little

GI tract | first pass effect

Safer NSAID for patient with gastritis/gastric ulcers

Celebrex

NSAID with lack of antiplatelet effects

Celebrex

NSAID that is better tolerated by patients with asthma

Celebrex

Rofecoxib (vioxx) and valdecoxib (bextra) are COX-2 inhibitors that seems to cause ____ events and were ____ due to risk of MI and CVA

pro-thrombic | withdrawn from market

Acetaminophen is not a true NSAID because it is not

anti inflammatory

The mechanism of acetaminophen is ____ but some COX-2 or ____ inhibition

Not completely understood | COX-3?

Provides excellent synergy with opioids

Acetaminophen

T or F. Acetaminophen causes gastric irritation and affects platelets

False

Hepatic metabolism of acetaminophen produces ___ metabolites that are scavenged by

Inactive | Glutathione

High doses of acetaminophen leads to the formation of ___ which are nephrotoxic

P-aminophenol | N-acetyl-p-benzoquinone

Overdose of acetaminophen can cause ____ which is increased in people who are

Hepatic necrosis | Chronic alcoholics - increased P450 activity and decreased glutathione stores

With large alcohol consumption, a single dose of acetaminophen ___ is probably OK

The next day

Antioxidant used to prevent hepatic damage if given within 8 hours of acetaminophen overdose

Acetylcysteine

IV acetaminophen causes a rapid spike in plasma concentration without

First pass effect Use q6h scheduled to maintain plasma concentration

06 - Endocrine II Flashcards

(74 cards)