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Pharm 2 > Class 10 Deck 1 > Flashcards

Class 10 Deck 1 Flashcards

(64 cards)

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1
Q

What is the gluccorticoid effect?

A

-Anti-inflammatory response

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2
Q

What is the mineralocorticoid effect?

A

-renal tubular absorption of Na excretion of K

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3
Q

How is cortisol released?

A

-Stress→hypothalamus releases CRH→CRH stimulates pituitary to release ACTH → ACTH stimulates adrenal cortex to release cortisol

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4
Q

When are secretory rates of CRH, ACTH, and Cortisol High? Low?

A
  • High in the morning

- Low at night

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5
Q

Chronic steroid use and HPA axis suppression leads to what? and what needs replaced?

A
  • Secondary adrenocortical insufficiency

- Glucocorticoid

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6
Q

Aldosterone is a what? When is it released?

A
  • mineralcorticoid
  • ↑ K
  • ↓ Na, BP, fluid volume (in order to retain fluid and Na to raise BP)
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7
Q

Glucocorticoids mainly do what? and have what 3 undesired effects?

A
  • Anti-inflammatory effects

- Suppression of HPA axis, Weight gain, Muscle wasting

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8
Q

What form of corticosteroids can be given IV?

A

-Water soluble (aka cortisol succinate)

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9
Q

How does IM injection effect corticosteroids?

A

-Prolonged effects

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10
Q

Can corticosteroids cross the placenta?

A

-Yes

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11
Q

Which corticosteroid is a prodrug? and what does it rapidly convert to?

A

-Prednisone is a prodrug repidly converted to prednisolone.

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12
Q

What effects does Prednisone/Prednisolone have?

A

-glucocortiocoid and mineralocorticoid

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13
Q

What are the uses of Prednisone/Prednisolone?

A
  • Anti inflammatory

- Replacement for adrenal insuffiency

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14
Q

What effects does Methylprednisolone have? and when is it used?

A
  • glucocortiocoid and mineralocorticoid effects

- Used as an antiinflammatory.

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15
Q

What forms of methylprednisolone are there?

A
  • Succinate = Water soluble IV

- Acetate = Intraarticularly or ESI

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16
Q

Betamethasone has what effects? and when is it used?

A
  • Glucocotricoid only

- Used as an anti-inflammatory

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17
Q

What drug is a fluorinated derivative of prednisolone and an isomer of betamethasone?

A

-Dexamethasone

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18
Q

What effects does dexamethasone have and what are the uses?

A
  • Effects = Glucocorticoid only

- Use = Anti-inflammatory AND replacement for secondary adrenal insufficiency.

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19
Q

What 3 drugs are fluorinated derivatives of prednisolone?

A
  • Betamethasone
  • Dexamethasone
  • Triamcinolone
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20
Q

What drug can be used for intra-articular injection that can last 3 months? and as an ESI?

A

Triamcinolone/Hexacetamide

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21
Q

What effects does triamcinolone have and what are the uses?

A
  • Effects = Glucocorticoid only

- Use = Anti-inflammatory AND replacement for secondary adrenal insufficiency.

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22
Q

What kind of replacement therapy is needed for addison’s?

A

-Doses to mimic normal adrenal secretion

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23
Q

What two drugs can be used to help lumbar disc disease (ESI) and what does it do?

A
  • Triamcinolone and Methylprednisolone

- decrease inflammation and edema at nerve roots

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24
Q

How to treat rheumatoid arthritis? Osetoarthritis?

A
  • Prednisolone (smallest dose possible)

- Intra-articular injection

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25
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)
26
What drug is combined with corticosteroids to help prevent organ rejection after transplant?
-cyclosporin
27
Inhaled _______ rapidly enter airway cells and have a ______ _______ effect on many of the cells involved in airway inflammation.
- Glucocorticoids | - direct inhibitory
28
Oropharyngeal side effects with inhaled corticosteroids?
- Dysphonia | - Oral candidiasis
29
When are parenteral corticosteroids beneficial with asthma? and whem should they be given?
- Reactive airway and intraop-bronchospasm | - 1-2 hours preop
30
What does corticosteroid for asthma do?
- Enhance beta-adrenergic response | - Suppress allergic diseases
31
How does corticosteroids help collagen diseases?
- Treat Lupus, nephrotic syndrome - Remission of sarcoidosis - Prevent temporal arteritis blindness - Suppress rheumatic carditis
32
To suppress ocular inflammation from ______ and _____ where are corticosteroids applied?
- Uveitis and iritis | - to the Conjunctival sac for aqueaous humor results
33
When might corticosteroids increase intraocular pressure?
-If therapy lasts longer than 2 weeks
34
Corticosteroids are not recommended for use with what 3 disease states?
- Herpes simplex - Ocular abrasions - Post cardiac arrest
35
When treating cutaneous disorders with topical corticosteroids, what may lead to adrenal suppression?
-systemic absorption
36
Severe skin disorders may require what type of corticosteroid treatment?
-Systemic treatment
37
How do corticosteroids help postintubation laryngeal edema? and what drugs can be used?
- Reduce edema, stridor and risk of reintubation | - Dexamethasone and methylprednisolone
38
How does corticosteroids effect ulcerative colitis?
-May mask signs of intestional perforation and peritonitis
39
When should corticosteroids be used in myasthenia gravis patients? and when is it most effective?
- Unresponsive to other medical or surgical therapy | - After thyectomy
40
When are corticosteroids useful with respiratory distress syndrome (RDS)?
-Unresolving ARDS after ruling out infection or ABX use. (Increased mortality w/ long term use)
41
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
42
How to treat low birth weight infants w/ corticosteroids?
- Administer dexamethasone for long periods. | - decreases risk of bronchopulmonary dysplasia and improve outcomes
43
What 3 types of leukima are corticosteroids used?
- Acute lymphocytic - Lymphoma - Multiple myeloma
44
Shock patients may benefit from what kind of corticosteroids treatment?
-Lower doses (depressed response to ACTH)
45
_______ secretion remains intact in secondary Adrenal Insufficiency
-Aldosterone
46
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
47
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
48
After cessation of steroid use, recovery of HPA may take how long to recover?
-Up to 12 months or longer
49
After corticosteroid therapy, what returns to normal first? Adrenal function or H-P function?
-HP function
50
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
51
What patients are susceptible to cardiovascular collapse because they cannot release additional endogenous cortisol in response to surgical stress?
-Addison's
52
Endogenous cortisol production during stress is NOT greater than what?
-150mg/day
53
Describe alternative surgical corticosteroid supplementation?
- Minor surgery = 25mg - Moderate = 50-75mg for 1-2 days - Major = 100-150 for 2-3 days
54
What 2 things diseases may need exogenous corticosteroid supplementation?
- Burns | - Sepsis
55
Mineralcorticoid effect on the distal renal tubules can lead to what PH abnormality?
-Hypokalemic metabolic alkalosis
56
How does corticosteroids cause hyperglycemia?
- Inhibits use of glucose at peripheral tissues | - Promote hepatic gluconeogensis
57
Dose of _____ ______ may need to be increased when corticosteroids are administered to Type II diabetics.
-oral hypoglycemics
58
How does corticosteroids effect body fat?
- Redistributes to back (buffalo hump), supraclavicular, and to face (moon face) - Loss of fat from extremities
59
Corticosteroids mobilize amino acids from tissues and cause what 4 things?
- Decreased muscle mass - Osteoperosis - Skin thinning - Negative nitrogen balance
60
How does corticosteroids effect the CNS?
- Neurosis and psychosis - Depression and suicidal tendencies - Cataracts
61
How do corticosteroids effect the blood?
-Increase hematocrit and leukocytes
62
What does corticosteroids due to growth and development?
- Stunt growth in children | - inhibits DNA synthesis and cell division
63
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)
64
What are the 11 contraindications to corticosteroid use?
- Systemic infection - Immunosupression - Psychosis - Glaucoma - CHF - Cushing's - Diabetes - Osteoperosis - Hypokalemia - HTN - Hyperthyroidism

Pharm 2 (23 decks)

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