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Principles Of Respiratory Care II > Chapter 11 - Corticosteroids > Flashcards

Chapter 11 - Corticosteroids Flashcards

1
Q

When would you use an intranasal aerosol corticosteroid?

A

Management of seasonal and perennial allergies and nonallergic rhinitis

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2
Q

What is the name of the group of chemicals released by the adrenal cortex?

A

Adrenal cortical hormones

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3
Q

What chemical does the outer zone of the adrenal cortex release?

A

Corticosteroids

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4
Q

What chemical does the inner zone of the adrenal cortex release?

A

Epinephrine

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5
Q

What are the three types of corticosteroid hormones?

A

Glucocorticoids (cortisol)

Mineralorticoids (aldosterone)

sex hormones (androgens & estrogen)

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6
Q

What does aldosterone do?

A

Regulates body water by increasing amount of sodium reabsorption in kidneys.

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7
Q

What is another term for analogs of cortisol used in pulmonary disease?

A

Hydrocortisone

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8
Q

What is the pathway for release and control of corticosteroids?

A

Hypothalamic-pituitary – adrenal axis

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9
Q

What hormone in the body stimulates the adrenal cortex to secrete glucocorticoids?

A

Adenocorticotropic hormone

ACTH

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10
Q

What are the main functions of glucocorticoids?

A

Metabolism of fats and carbohydrates

Glucose for body energy

lipolysis, redistribution of fat stores

breakdown of tissue protein

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11
Q

What is steroid diabetes?

A

Excessive amounts of glucose in plasma due to overuse of steroid therapy

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12
Q

What is HPA suppression?

A

Significant side effect of using corticosteroids

Adrenal suppression of endogenous glucocorticoids

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13
Q

What does the body not do, with regards to endogenous and exogenous corticosteroids?

A

It cannot distinguish between exogenous and endogenous glucorticoids

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14
Q

What is HPA suppression

A

When the body takes in too much exogenous cortisol that it doesn’t feel the need to create its own.

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15
Q

What is a good way to minimize HPA suppression?

A

By using aerosolized glucocorticoids and localizing the treatment to the lungs

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16
Q

What do you need to do when a patient is on oral corticosteroids and HPA suppression occurs?

A

We need to wean them off in order to let the body create its own again.

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17
Q

What are the clinical indications for use orally inhaled corticosteroids?

A
  • Maintenance, controlled therapy of chronic asthma, (identified as needing step 2 asthma care)
  • can be used with systemic corticosteroids to reduce systemic dose or elimination for asthma control
18
Q

When are endogenous coritsol levels the highest?

A

In the morning

19
Q

What stops the production of endogenous glucocorticoids and ACTH?

A

High levels of cortisol in blood plasma because of the feedback mechanism.

20
Q

What is alternate days steroid therapy?

A

Giving steroid drugs that alternate days in the morning to avoid HPA system suppression

21
Q

What are the four major categories of inflammation activity?

A

Increased vascular permeability

Leukocytic infiltration

Phagocytosis

Mediator cascade

22
Q

What are the two most common inflammatory diseases of the airway?

A

Chronic bronchitis

Asthma

23
Q

What are the two major effector cells of the. Asthmatic inflammatory response?

A

Mast cells

Eocinophils

24
Q

What is shown to cause early phase asthmatic response in airways?

What does symptom does it cause?

A

Immunoglobulin E

Bronchospasm

25
Q

What happens during the late phase inflammatory response?

A

Submucosal edema

Mucus

Hyperreactivity

26
Q

When does the late phase inflammatory response occur?

A

6 - 8 hours after challenge

27
Q

What is a product of persistent shedding of epithelial cells in the respiratory system during inflammatory response?

A

Airway remodeling which can cause thickening in the basement membrane and increase epithelial damage enhancing inflammatory response in the future.

28
Q

How can you classify aerosolized glucocorticoids as a drug?

And how was it absorbed by cells?

A

It is a topically active drug

It is absorbed by lipid diffusion because it is lipid soluble

29
Q

What are the 3 general modes of action for glucocorticoids?

A
  • Upregulation transcription of anti-inflammatory genes
  • suppression of factors that activate transcription of inflammatory genes
  • up regulate the expression of inhibitors of the inflammatory response
30
Q

What is the effect of glucocorticoids on white cell counts?

A

It increases over all white cell count like neutrophils

31
Q

A person with allergic asthma would have what kind of results on a white cell differential?

A

Higher than normal eosinophil count

32
Q

What is a benefit of using glucocorticoids for patients prescribed with beta adrenergic agents?

A

It can restore responsiveness to beta-adrenergic agents

33
Q

How do glucocorticoid drugs enhance receptor stimulation?

A

By increasing number, availability, and affinity of beta receptor cells.

34
Q

What is a good reason why you would take a corticosteroid and beta-adrenergic combo?

A

Because corticosteroids can prolong endogenous circulation of catecholamines prolonging the interaction of beta agonist.

35
Q

What are some hazards associated with systemic administration steroids?

A

F I M H H H

Fluid retention
Immunosuppression
Muscle wasting
HPA suppression
High glucose levels
Hypertension
36
Q

What are 2 side effects of the local topical corticosteroid administration?

A

Oral thrush and dysphonia

37
Q

What is something you should tell the patient after taking an oral topical dose of corticosteroid?

A

Rinse their mouth

38
Q

How would you describe asthma as a disease?

A

It’s a disease of inflammation leading to bronchial hyperresponsiveness

39
Q

What is the use of inhaled corticosteroids for treatment of asthma?

A

It is the first line of treatment

Most effective long-term therapy for persistent asthma

40
Q

Can you use inhaled corticosteroids for acute severe asthma?

A

No, studies have shown that it is not useful due to no bronchodilator effect

But is should be reconsidered

41
Q

What is the use of corticosteroids for COPD?

A

It can relieve symptoms but it has a little effect on FEV1

42
Q

What cell is predominantly involved in inflammation with COPD patients?

A

Neutrophils

Principles Of Respiratory Care II (10 decks)

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