ch 58

Question 1

glucocorticoid drugs are nearly identical to

Answer 1

glucose-regulating steroids produced by adrenal cortex

Question 2

Physiologic effects of glucocorticoids

Answer 2

low dose (those used to maintain normal function)

Question 3

pharmacologic effects of glucocorticoids

Answer 3

high doses used to treat inflammatory disorders such as asthma, RA and certain cancers.

used to suppress immune responses in organ transplant\

Question 4

if glucocorticoid production is insufficient what happens

Answer 4

hypotension and hypoglycemia

Question 5

if stress is severe with glucocorticoid insufficiency

Answer 5

circulatory failure and death

Question 6

neonatal glucocorticoid

Answer 6

full term infant releases a burst of glucocorticoids during labor and delivery which matures the lungs.

preterm infant production of glucocorticoids is low, resulting in high incidence of resp distress syndrome

Question 7

what is regulated with a negative feedback loop

Answer 7

synthesis and release of glucocorticoids

the loop components are thalamus, ant pituitary and adrenal cortex

Question 8

what does cortisol do

Answer 8

stimulates physiologic responses
acts on hypothalamus and pituitary to suppress further release of CRH and ACTH. By inhibiting these, cortisol suppresses its own production

Question 9

when do you taper glucocorticoids

Answer 9

less than 2 weeks

3 weeks or more - need to taper

Question 10

high dose glucocorticoid has what effects

Answer 10

produce anti-inflammatory and immunosuppressive effects not seen at physiologic levels
glucose levels rise
protein synthesis suppressed
fat deposits mobilized (lipolysis - fat breakdown)
sodium retention
potassium loss
can inhibit absorption of calcium

Question 11

prostaglandins, histamines and pain

Answer 11

histamine stimulates pain receptors, prostaglandins sensitize pain receptors to stim by histamine and other receptors

Question 12

glucocorticoid work on CNS

Answer 12

lower levels ->depression

higher levels ->excitation and even mania

Question 13

glucocorticoids act on kidney

Answer 13

to promote retention of sodium and water while increasing urinary excretion of potassium

Question 14

glucocorticoids act on cardiovascular

Answer 14

hypotension - secondary to vasoconstriction being suppressed
increased number of circulating RBCs and neutrophils
decrease counts of lymphocytes, eosinophils, basophils and monocytes

Question 15

which has better antiinflammatory effects? nsaids or glucocorticoids

Answer 15

glucocorticoids -interrupt the inflammatory process in multiple ways

Question 16

nsaids work on inflammation by inhibiting

Answer 16

prostaglandins

Question 17

RA

Answer 17

reduce inflammation and pain

can be given intra-articular

Question 18

glucocorticoids and kids

Answer 18

chronic use inhibition of bone growth - short stature

Question 19

glucocorticoids preferred in pregnant

Answer 19

inhaled or nonsystemic when possible

hydrocortisone is preffered

Question 20

glucocorticoids administered in pregnancy places neonate at risk for

Answer 20

hypoadrenalism

Question 21

breastfeeding and glucocorticoids

Answer 21

low doses are fine, large doses may cause growth delay and other effects for baby

Question 22

older adults glucocorticoids

Answer 22

osteoporosis
adrenal insufficiency
gi ulceration

Question 23

adverse effects glucocorticoids

Answer 23

osteoporosis
immune compromise 
impaired wound healing
hyperglycemia
myopathy
sodium/water retention
potassium loss
growth delay
psychological disturbances -- insomnia, anxiety, agitation, irritability, delirium, hallucinations, depression, euphoria, mania, suicidal
cataracts 
open angle glaucoma (reverses within 2 weeks of glucocorticoid cessation)
PUD
Iatrogenic Cushing syndrome
adrenal suppression

Question 24

symptoms of cushings

Answer 24

hyperglycemia
glycosuria
fluid and electrolyte disturbances
osteoporosis
muscle weakness
cutaneous striations
lowered resistance to infection
redistribution of fat to abd, face, and posterior neck produces central obesity, rounded face and fat pad at cervical spine

Question 25

drug interactions glucocorticoids

Answer 25

digoxin - low potassium - dysrhythmias
thiazide or loop diuretics both dump K
NSAIDS - both hard on GI
hypoglycemics - this raises so fights insulin
vaccines - reduces antibody response. do not give live vaccines

Question 26

contratindications

Answer 26

systemic fungal infection
people receiving live virus vaccines
HTN
heart failure
renal impairment
esophagitis
gastritis
PUD
DM
Osteoporosis
open angle glaucoma
infections resistant to treatment

Question 27

the time required for glucocorticoids to leave body tissues

Answer 27

biologic half life

Question 28

Biologic half life is generally _____ than plasma half life

Answer 28

longer

Question 29

glucocorticoids with high mineralcorticoid potency can cause significant retention of

Answer 29

sodium and water with depletion of K

Question 30

The differences in ___________ are reflected in the doses required to produce anti-inflammatory effects

Answer 30

glucocorticoid potency

Question 31

Pt ed glucocorticoids

Answer 31

give with milk or snack to decrease GI

dont stop suddenly

medical alert bracelet

increase risk infection

call for fever or malaise - early sign of infection

s/s fluid retention

s/s hypokalemia - muscle weakness, irregular pulses, cramping

eye exams

GI bleed risk - call for black and tarry stools