Chapter 68: Steroids Flashcards
corticosteroids are used frequently to..
-suppress inflammatory process
-decrease immune response
what are important things to know about long term use of corticosteroids?
-leads to adrenal atropy from lack of stimulation
-never use live vaccines, as this puts the pt at risk for an infection because they have decreased immune reponse
-tell pt to report a few pound weight gain in 3-5 days because this can indicate fluid retention (side effects of mineralocorticoids)
-oral route is better for pt on chronic management, but for acute use IV
-higher doses causes faster atrophy of the adrenal gland (2-4 weeks), which can cause dependency and permanent damage
what are the adverse effects of chronic corticosteroids?
-suppression of immune system
-decreased inflammation
-GI bleeds/peptic ulcers
-osteoporosis
-behaviour changes
-metabolic changes/fat dedistribution & fluid retention
what are drug interactions of glucocosteroids
-potassium wasting drugs: glucocorticoids cause the body to retain sodium and get rid of potassium, and potassium wasting drugs also get rid of potassium, increasing the risk for hypokalemia
-anticholinesterase agents: glucocorticoids can weaken the effects of these agents
-no live vaccines: these suppress the immune system
-toxoids: are inactivated vaccines used to provide immunity, but glucocortoids suppress the immune system
-insulin and oral hypoglycemia drugs: glucocosteroids can increase blood sugar, potentially decreasing the effects of insulin and hypoglycemia
-aloe, senna, cascara, buckthorn: have laxative like properties, if taken with glucocorticoids it can cause dehyration, and electrolyte imbalances
what does glucocorticoids increase and decrease the effects of?
-increase: erythromycin, ketoconazole
-decreaes: salicytes, barbiturates, rifampin, phentoin
what are nrsing considerations for mineralocorticoids?
-weight, intake/output (monitor for fluid accumulation greater than 2lbs.day = MD)
-monitor BP and HR (report HTN to HCP)
-monitor for signs of hypokalemia
-minitor for signs of too much/little of the drug
if there is low t3 and t4, what happens?
-the hypothalamus senses this and secretes TRH (thyrotropine releasing hormone) which travels to the anterior pituitary gland, which secretes TSH (thyroid stimulating gland) which goes to the thyroid and thyroid makes more t3 and t4
is high or low TSH good?
low because that means the thyroid is producing enough t3 and t4
what is primary hypothyroidism and hashimoto thyroiditis caused by?
-primary: there is less t4 (the persecutor to t3), and in response the anterior pituitary gland will increase TSH to stimulate the thyroid to make more hormones
-Hashimoto thyroiditis: abnormal levels of antithyroid antibody, meaning the body is taking the thyroid galnd
what is the indictor for how well the thyroid is working?
TSH
what are contraindications/precautions for taking levothyroxine (t4) supplements?
-cardiac disease: acute MI, angina pectoris, dysrhythmias
-this is because Levothyroxine increases the metabolic rate of the body, which affects many systems, including the cardiovascular system. Specifically, it can increase heart rate (HR), blood pressure (BP), and oxygen demand because it essentially “revvs up” the body’s functions.
For someone with pre-existing cardiac disease (like angina, myocardial infarction (MI), or heart failure), this increased workload on the heart can be dangerous
what is an important drug interaction for levothyroxin?
phenytoin if taken with levothyroxine, increases the metabolism of levothyroxine, leaving the person with hypothryoid s/s
what are food interactions with levothyroxine?
-soybean flour (all soy products)
-dairy
-strawberries
what are nrsg considerations for levothryoxine
-assess for s/s of hypo or hyperhyroidism
-assess Vs and CVS status if catecholamines (NE or E) are used concurrently (both meds increase HR and BP = can lead to HTN and arrhythmias)
- monitor for pts who are taking warfarin for bleeding (hyperthyroidism increases anticougulant effects = increase for bleeding and vice versa)
-monitor monthly height and weight, growth and development, and intellectual function in infants treated for thyroid defiency (thyroid hormone is important for growth, development, and brain function in infants)
-monitor blood glucose levels if the pt is diabetic (hyper=increased insulin resistance=elevated blood glucose levels and vice versa)