Chapter 67 & 68 steroids + thyroid Flashcards
in addisons disease do you need to add or take away steroids
you need to ADD steroids since there is a deficiency (ADDison’s disease)
in cushing’s syndrome do you need to add or reduce the amount of steroids
you need to reduce the amount of steroids since the person has to much
what are two things corticosteroids are frequently used for**
-Suppress the inflammatory process
-decrease the immune responses
What are 3 important patient teachings for pts on long term steroid therapy***
-avoid live vaccines
-report weight gain of over 2 lb in one day
-oral route is the best option for long term use
what are 6 adverse effects of corticosteroids **
-Suppression of the immune system
-Decreased inflammatory response
-GI bleeds/peptic ulcers
-osteoporosis
-behavioural changes
-metabolic changes/fat redistribution (buffalo hump)
what are the two kinds of corticosteroids
Glucocorticoides
Mineralocorticoids
why do you gradually taper off of corticosteroids**
to give time for the adrenal glands to kick back into producing steroids again if you don’t it can result in an adrenal crisis and death
what is the prototype glucocorticoide
hydrocortisone (so if someone needs more glucocorticoides they give them this)
what are 4 drug interactions with glucocorticoids ***
-Potassium-wasting drugs
-anticholinesterase drugs
-toxoids
-insulin and oral hypoglycemic drugs
what drugs do corticosteroids in increase the effectiveness of**
Erythromycin
Ketoconazole
what drugs do corticosteroids decrease the effectiveness of**
Salicylates
barbiturates
phenytoin
rifampin
What is addison’s disease
when the adrenal cortex does not secrete enough aldosterone (mineral corticosteroid)
what is the prototype mineralocorticosteroid**
fludrocortisone
what is the mechanism of action for fludrocortisone***
acts on kidneys to promote water and Na reabsorption and increases K excretion
what do T3 and T4 hormones stimulate
they stimulate basal metabolic rate (rev the engine)
what is the difference between T4 and T3
T4 is the free version and T3 is the more active version
where is TRH produced**
in the hypothalamus
where is TSH produced **
in the anterior pituitary gland
where are T4 and T3 produced **
in the thyroid
what will happen if there is low levels of TRH circulating in the blood***
The hypothalamus will release TRH which will stim the pituitary gland to release TSH which will stim the thyroid to release T3 and T4
what will TSH levels look like in hypothyroidism
TSH will be elevated since the thyroid hormone is requiring lots of stimulation to work
What will TSH levels look like in hyperthyroidism
TSH levels will be low since the thyroid is already very active
is low or high levels of TSH good **
low levels of TSH are good **
in primary hypothyroidism what will levels of T4 and TSH look like**
the PT will have low serum T4 (because its not being produced by the thyroid)
Elevated TSH (because the thyroid is requiring a lot of stimulus)
what is the drug generic name of the T4 replacement drug
Levothyroxine
what is a very important contraindication of levothyroxine***
cardiac disease (because it stimulates the BMR which increases HR which puts more stress on the heart)
what are three drug interactions for levothyroxine **
-calcium or aluminum containing antacids (because calcium will bind to the T4 and you will just poop it out)
-Phenytoin (because it accelerates the metabolism of Levothyroxine)
-catecholamines (just think adrenergics because they will also put stress on the heart and other systems creating an additive effect to levo)
what are some food interactions with levothyroxine **
-Soybean flour
-dairy
-strawberries
what are 2 contraindications of levothyroxine
-if the patient has an aspirin allergy
-if the pt’s heart rate is greater than 100 bpm
