Chapter 5 - Corticosteroids / Meds to Manage Diabetes Flashcards
During normal sleep pattern (diurnal rhythm) or during stress, the __________ release _____________, which are _________ and ____________
Adrenal glands; corticosteroids; glucocorticoids; mineralocorticoids
Essential for fluid and electrolyte balance
Mineralocorticoids
Major mineralocorticoid that is important in the regulation of the concentration of sodium and potassium ions in the body
Aldosterone
Hypothalamus signals to -> Anterior Pituitary which signals to -> ACTH (Adrenocorticotropic Hormone) which signals to -> Adrenal Glands = spits out Glucocorticoids & Mineralocorticoids
Hypothalamic-Pituitary-Adrenal Axis
Effect and Overexpression of GLUCOCORTICOIDS
Increase Calcium Excretion -»> Hypocalcemia (may excrete too much)
Glucose Metabolism -»> Diabetes (hyperglycemia)
Suppression of Immune System -»> Too much suppression of immune system (mask signs of infection, illness)
Reduce Inflammation -»> Too much suppression leads to inadequate immune response
Decrease bone formation and increase bone breakdown -»> Too much bone breakdown
Influence Sleep Pattern/Mood -»> Insomnia (the time you take the pill may put you at risk for insomnia, should be taking in morning with breakfast-take with food, very hard on gut)
Cause Lipogenesis (formation and storage of fat) -»> Weight gain (excess fat formation and storage) – fat pads that sit on back (rounded back), fat on face (moon face)
Powerful metabolic effects and stress response
Effect and Overexpression of Mineralocorticoids
Aldosterone:
retention of sodium and water, excretion of potassium;
essential for maintenance of fluid and electrolyte balance, blood pressure, and blood volume
Sodium/Water Retention -»> increased water retention (weight gain)
Sodium Retention -»> hypernatremia (too much sodium retention)
Retention of fluid volumes -»> hypertension
Excretion of Potassium -»> hypokalemia
Classification: Steroidal Anti-inflammatories; immune modifiers; majorly glucocorticoid (minimal mineralocorticoid effects)
Action: SUPPRESSION OF IMMUNE RESPONSE/INFLAMMATION; numerous intense metabolic effects; suppresses adrenal function at chronic doses of 5mg/day; replaces endogenous cortisol in deficiency states
Why take it: Systemic Lupus Erythematosus (SLE), allergies, inflammatory, hematologic, neoplastic, autoimmune disorders
Overexpression: Deficient immune response, adrenal suppression, poor wound healing, Cushing’s Syndrome
Administration: Never abruptly stop corticosteroid therapy; use the lowest dose possible to control disorder and taper when feasible; may require concurrent treatment for osteoporosis or elevated blood glucose levels; Regularly monitor for development of symptoms of adrenal suppression; Contraindicated in patients with untreated systemic infections
Follow up: Pain levels, do they feel it is working, experiencing any illness
Education: Taper (Adrenal glands on vacation while we are on corticosteroids; need to ween off so they get back to work), take doses as directed, advise doctor of contact with anyone with dangerous/contagious illness
Prednisone (Winipred/Sterapred)
When is inflammation not good?
Long-term inflammation is not good; think arthritis and COPD.
A patient is taking a medication that has a role in inhibiting PROSTAGLANDINS, they are more at risk for:
Clotting or bleeding
Bleeding (overexpression)
; a patient with a history of bleeding / GI bleeds should not be on NSAIDs
Which of the following would be a reason to take Ibuprofen? Select all that apply.
; Temperature greater than 38.8
; Abdominal pain caused by ruptured spleen
; Ankle injury from hockey
; Child with an ear ache
; Arthritis
; Temp greater than 38.8 -> YES, inhibits prostaglandins = inhibits fever
; Abdominal pain caused by ruptured spleen -> NO, increased risk for bleeding
; Ankle injury from hockey -> YES, reduces pain and inflammation
; Child with an ear ache -> YES, reduces pain and inflammation
; Arthritis -> YES, reduces inflammation
Classification: NSAIDs, Antipyretic, Nonopioid Analgesics
Action: Inhibits prostaglandin synthesis by blocking COX 1 (function in blood clotting) and COX 2 (more active at trauma sites); blocks fever, pain, inflammation.
Why take it: Pain, fever, menstrual cramps (reduces inflammation), inflammation
Overexpression: Increased bleeding, peptic ulcers/stomach irritation, renal failure/toxicity
Administration: assess for allergies, assess for skin rash and signs of GI bleed after use, monitor BUN/Creatinine levels,
Follow Up: Pain levels, stomach symptoms (nausea, irritation, pain), urination (any changes)
Education: May take with food or milk if stomach upset occurs; stay well hydrated to prevent renal failure, do not exceed dose
Ibuprofen
- play a role in chain of events leading to inflammation
- production of pain and fever
- blood clotting
Prostaglandins
BETA cells release ______ to ______ blood glucose
; insulin
; lower
ALPHA cells release _____ to ______ blood glucose.
; glucagon
; increase
Patient education involved in insulin therapy
- What to do if insulin is low
- What to do to manage low sugars
- Regular blood work
- Teach client and family how to use glucagon
- Diet (understand carbs and counting carbs)
- DKA, hypo, hyperglycemia (symptoms -> what to do)
- Illness, infection, surgery - body needs more glucose
- Differences in insulins - how to take them/how they work
- Site rotation
- Safe sharps disposal
- Explore DOH (money for strips, etc.)
- If unsure, treat for hypoglycemia
- Storage (keep in fridge until opened, keep at room temp once opened, use for 30 days)
- If skipping a meal, don’t take Humalog
