Class 10 Deck 1 Flashcards
What is the gluccorticoid effect?
-Anti-inflammatory response
What is the mineralocorticoid effect?
-renal tubular absorption of Na excretion of K
How is cortisol released?
-Stress→hypothalamus releases CRH→CRH stimulates pituitary to release ACTH → ACTH stimulates adrenal cortex to release cortisol
When are secretory rates of CRH, ACTH, and Cortisol High? Low?
- High in the morning
- Low at night
Chronic steroid use and HPA axis suppression leads to what? and what needs replaced?
- Secondary adrenocortical insufficiency
- Glucocorticoid
Aldosterone is a what? When is it released?
- mineralcorticoid
- ↑ K
- ↓ Na, BP, fluid volume (in order to retain fluid and Na to raise BP)
Glucocorticoids mainly do what? and have what 3 undesired effects?
- Anti-inflammatory effects
- Suppression of HPA axis, Weight gain, Muscle wasting
What form of corticosteroids can be given IV?
-Water soluble (aka cortisol succinate)
How does IM injection effect corticosteroids?
-Prolonged effects
Can corticosteroids cross the placenta?
-Yes
Which corticosteroid is a prodrug? and what does it rapidly convert to?
-Prednisone is a prodrug repidly converted to prednisolone.
What effects does Prednisone/Prednisolone have?
-glucocortiocoid and mineralocorticoid
What are the uses of Prednisone/Prednisolone?
- Anti inflammatory
- Replacement for adrenal insuffiency
What effects does Methylprednisolone have? and when is it used?
- glucocortiocoid and mineralocorticoid effects
- Used as an antiinflammatory.
What forms of methylprednisolone are there?
- Succinate = Water soluble IV
- Acetate = Intraarticularly or ESI
Betamethasone has what effects? and when is it used?
- Glucocotricoid only
- Used as an anti-inflammatory
What drug is a fluorinated derivative of prednisolone and an isomer of betamethasone?
-Dexamethasone
What effects does dexamethasone have and what are the uses?
- Effects = Glucocorticoid only
- Use = Anti-inflammatory AND replacement for secondary adrenal insufficiency.
What 3 drugs are fluorinated derivatives of prednisolone?
- Betamethasone
- Dexamethasone
- Triamcinolone
What drug can be used for intra-articular injection that can last 3 months? and as an ESI?
Triamcinolone/Hexacetamide
What effects does triamcinolone have and what are the uses?
- Effects = Glucocorticoid only
- Use = Anti-inflammatory AND replacement for secondary adrenal insufficiency.
What kind of replacement therapy is needed for addison’s?
-Doses to mimic normal adrenal secretion
What two drugs can be used to help lumbar disc disease (ESI) and what does it do?
- Triamcinolone and Methylprednisolone
- decrease inflammation and edema at nerve roots
How to treat rheumatoid arthritis? Osetoarthritis?
- Prednisolone (smallest dose possible)
- Intra-articular injection
When should/shouldn’t corticosteroids be used for cerebral edema and what drug is used?
- Should be used = Intracranial tumors / lesions
- Shouldn’t be used = Stroke / Sub-arachnoid hemorrhage
- Dexamethasone (no mineralcorticoid effect)
What drug is combined with corticosteroids to help prevent organ rejection after transplant?
-cyclosporin
Inhaled _______ rapidly enter airway cells and have a ______ _______ effect on many of the cells involved in airway inflammation.
- Glucocorticoids
- direct inhibitory
Oropharyngeal side effects with inhaled corticosteroids?
- Dysphonia
- Oral candidiasis
When are parenteral corticosteroids beneficial with asthma? and whem should they be given?
- Reactive airway and intraop-bronchospasm
- 1-2 hours preop
What does corticosteroid for asthma do?
- Enhance beta-adrenergic response
- Suppress allergic diseases
How does corticosteroids help collagen diseases?
- Treat Lupus, nephrotic syndrome
- Remission of sarcoidosis
- Prevent temporal arteritis blindness
- Suppress rheumatic carditis
To suppress ocular inflammation from ______ and _____ where are corticosteroids applied?
- Uveitis and iritis
- to the Conjunctival sac for aqueaous humor results
When might corticosteroids increase intraocular pressure?
-If therapy lasts longer than 2 weeks
Corticosteroids are not recommended for use with what 3 disease states?
- Herpes simplex
- Ocular abrasions
- Post cardiac arrest
When treating cutaneous disorders with topical corticosteroids, what may lead to adrenal suppression?
-systemic absorption
Severe skin disorders may require what type of corticosteroid treatment?
-Systemic treatment
How do corticosteroids help postintubation laryngeal edema? and what drugs can be used?
- Reduce edema, stridor and risk of reintubation
- Dexamethasone and methylprednisolone
How does corticosteroids effect ulcerative colitis?
-May mask signs of intestional perforation and peritonitis
When should corticosteroids be used in myasthenia gravis patients? and when is it most effective?
- Unresponsive to other medical or surgical therapy
- After thyectomy
When are corticosteroids useful with respiratory distress syndrome (RDS)?
-Unresolving ARDS after ruling out infection or ABX use. (Increased mortality w/ long term use)
How to treat RDS in neonates? and what does it do?
- Administer to mother >24 hours prior to delivery.
- Helps develop lungs of neonates born 24-36 weeks EGA
How to treat low birth weight infants w/ corticosteroids?
- Administer dexamethasone for long periods.
- decreases risk of bronchopulmonary dysplasia and improve outcomes
What 3 types of leukima are corticosteroids used?
- Acute lymphocytic
- Lymphoma
- Multiple myeloma
Shock patients may benefit from what kind of corticosteroids treatment?
-Lower doses (depressed response to ACTH)
_______ secretion remains intact in secondary Adrenal Insufficiency
-Aldosterone
What type of corticosteroid therapy is UNLIKELY to suppress HPA axis?
- Daily prednisone <5mg daily
- Every other day dosing
- Glucocorticoids therapy less than 3 weeks in length
What type of corticosteroid therapy is assumed to suppress HPA axis?
- Prednisone 20mg daily for >3 weeks
- Clinical signs of cushing’s (moon face, buffalo hump)
- prednisone/Dexamethasone given at bedtime
After cessation of steroid use, recovery of HPA may take how long to recover?
-Up to 12 months or longer
After corticosteroid therapy, what returns to normal first? Adrenal function or H-P function?
-HP function
What 2 options do you have if a patient falls falls between the not likely suppressed HPA (>5mg/day) and more than likely suppressed (>20mg/day)?
- Test responsiveness of adrenals w/ Cosyntropin (ACTH) stimulation test
- Just give stress dose
What patients are susceptible to cardiovascular collapse because they cannot release additional endogenous cortisol in response to surgical stress?
-Addison’s
Endogenous cortisol production during stress is NOT greater than what?
-150mg/day
Describe alternative surgical corticosteroid supplementation?
- Minor surgery = 25mg
- Moderate = 50-75mg for 1-2 days
- Major = 100-150 for 2-3 days
What 2 things diseases may need exogenous corticosteroid supplementation?
- Burns
- Sepsis
Mineralcorticoid effect on the distal renal tubules can lead to what PH abnormality?
-Hypokalemic metabolic alkalosis
How does corticosteroids cause hyperglycemia?
- Inhibits use of glucose at peripheral tissues
- Promote hepatic gluconeogensis
Dose of _____ ______ may need to be increased when corticosteroids are administered to Type II diabetics.
-oral hypoglycemics
How does corticosteroids effect body fat?
- Redistributes to back (buffalo hump), supraclavicular, and to face (moon face)
- Loss of fat from extremities
Corticosteroids mobilize amino acids from tissues and cause what 4 things?
- Decreased muscle mass
- Osteoperosis
- Skin thinning
- Negative nitrogen balance
How does corticosteroids effect the CNS?
- Neurosis and psychosis
- Depression and suicidal tendencies
- Cataracts
How do corticosteroids effect the blood?
-Increase hematocrit and leukocytes
What does corticosteroids due to growth and development?
- Stunt growth in children
- inhibits DNA synthesis and cell division
What are the surgeons concerns with corticosteroids?
- Mask infection
- Altering glucose control in diabetics
- Aseptic necrosis in femoral head
- Failure of bone fusion
- Cancer surgery (would rather body fight cancer rather than suppress)
What are the 11 contraindications to corticosteroid use?
- Systemic infection
- Immunosupression
- Psychosis
- Glaucoma
- CHF
- Cushing’s
- Diabetes
- Osteoperosis
- Hypokalemia
- HTN
- Hyperthyroidism
