Ch 72 Glucocorticoids in nonendocrine disorders

Question 1

Glucocorticoids are used in low (physiologic) doses to

treat __ and in high (pharmacologic) doses to treat __.

Answer 1

endocrine disorders

nonendocrine disorders (e.g., arthritis, asthma)

Question 2

Glucocorticoids are beneficial in nonendocrine disorders

primarily because they __.

Answer 2

suppress inflammatory and immune responses.

Question 3

Glucocorticoids produce their effects by:

Answer 3

penetrating the cell membrane and activating cytoplasmic receptors, which then travel to the cell nucleus, where they modulate the activity of genes that code for specific regulatory proteins.

Question 4

Glucocorticoids reduce inflammation by multiple mechanisms, including suppressing the :

Answer 4

(1) synthesis of inflammatory mediators (prostaglandins, leukotrienes, histamine),
(2) infiltration of phagocytes,
(3) release of lysosomal enzymes, and
(4) proliferation of lymphocytes.

Question 5

Important nonendocrine indications for glucocorticoids

include __.

Answer 5

arthritis, allergic disorders, asthma, cancer, and

suppression of allograft rejection.

Question 6

When used in pharmacologic doses, especially for prolonged times, glucocorticoids __.

Answer 6

can cause severe adverse effects.

These are not seen at physiologic doses.

Question 7

Adverse effects of the glucocorticoids include:

Answer 7

adrenal insufficiency, osteoporosis, increased vulnerability to infection, muscle wasting, thinning of the skin, fluid and electrolyte imbalance, glucose intolerance, psychologic disturbances, and peptic ulcer disease.

Question 8

By causing potassium loss, glucocorticoids can increase

the risk for __.

Answer 8

toxicity from digoxin, and they can exacerbate

hypokalemia caused by thiazide and loop diuretics.

Question 9

Concurrent use of __ with glucocorticoids increases

the risk for peptic ulcer disease.

Answer 9

NSAIDs

Question 10

Prolonged glucocorticoid use causes __.

Answer 10

adrenal insufficiency.

Question 11

Patients with adrenal insufficiency must be given higher

doses of glucocorticoids __.

Answer 11

at times of stress (e.g., surgery, trauma). Failure to do so may be fatal!

Question 12

To minimize expression of adrenal insufficiency when glucocorticoids are discontinued, doses should be __.

Answer 12

tapered very gradually

Question 13

Following glucocorticoid withdrawal, supplemental glucocorticoids are needed __.

Answer 13

at times of stress until adrenal function has fully recovered.

Question 14

__ can help minimize development of adrenal insufficiency.

Answer 14

Alternate-day dosing

Question 15

Glucocorticoids should be administered __.

Answer 15

before 9:00 AM
to help minimize adrenal insufficiency and to mimic the
burst of glucocorticoids released naturally by the adrenal
glands each morning.