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Pharm 2 > Class 10 Deck 1 > Flashcards

Class 10 Deck 1 Flashcards

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
Q

When should/shouldn’t corticosteroids be used for cerebral edema and what drug is used?

A
  • Should be used = Intracranial tumors / lesions
  • Shouldn’t be used = Stroke / Sub-arachnoid hemorrhage
  • Dexamethasone (no mineralcorticoid effect)
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26
Q

What drug is combined with corticosteroids to help prevent organ rejection after transplant?

A

-cyclosporin

27
Q

Inhaled _______ rapidly enter airway cells and have a ______ _______ effect on many of the cells involved in airway inflammation.

A
  • Glucocorticoids

- direct inhibitory

28
Q

Oropharyngeal side effects with inhaled corticosteroids?

A
  • Dysphonia

- Oral candidiasis

29
Q

When are parenteral corticosteroids beneficial with asthma? and whem should they be given?

A
  • Reactive airway and intraop-bronchospasm

- 1-2 hours preop

30
Q

What does corticosteroid for asthma do?

A
  • Enhance beta-adrenergic response

- Suppress allergic diseases

31
Q

How does corticosteroids help collagen diseases?

A
  • Treat Lupus, nephrotic syndrome
  • Remission of sarcoidosis
  • Prevent temporal arteritis blindness
  • Suppress rheumatic carditis
32
Q

To suppress ocular inflammation from ______ and _____ where are corticosteroids applied?

A
  • Uveitis and iritis

- to the Conjunctival sac for aqueaous humor results

33
Q

When might corticosteroids increase intraocular pressure?

A

-If therapy lasts longer than 2 weeks

34
Q

Corticosteroids are not recommended for use with what 3 disease states?

A
  • Herpes simplex
  • Ocular abrasions
  • Post cardiac arrest
35
Q

When treating cutaneous disorders with topical corticosteroids, what may lead to adrenal suppression?

A

-systemic absorption

36
Q

Severe skin disorders may require what type of corticosteroid treatment?

A

-Systemic treatment

37
Q

How do corticosteroids help postintubation laryngeal edema? and what drugs can be used?

A
  • Reduce edema, stridor and risk of reintubation

- Dexamethasone and methylprednisolone

38
Q

How does corticosteroids effect ulcerative colitis?

A

-May mask signs of intestional perforation and peritonitis

39
Q

When should corticosteroids be used in myasthenia gravis patients? and when is it most effective?

A
  • Unresponsive to other medical or surgical therapy

- After thyectomy

40
Q

When are corticosteroids useful with respiratory distress syndrome (RDS)?

A

-Unresolving ARDS after ruling out infection or ABX use. (Increased mortality w/ long term use)

41
Q

How to treat RDS in neonates? and what does it do?

A
  • Administer to mother >24 hours prior to delivery.

- Helps develop lungs of neonates born 24-36 weeks EGA

42
Q

How to treat low birth weight infants w/ corticosteroids?

A
  • Administer dexamethasone for long periods.

- decreases risk of bronchopulmonary dysplasia and improve outcomes

43
Q

What 3 types of leukima are corticosteroids used?

A
  • Acute lymphocytic
  • Lymphoma
  • Multiple myeloma
44
Q

Shock patients may benefit from what kind of corticosteroids treatment?

A

-Lower doses (depressed response to ACTH)

45
Q

_______ secretion remains intact in secondary Adrenal Insufficiency

A

-Aldosterone

46
Q

What type of corticosteroid therapy is UNLIKELY to suppress HPA axis?

A
  • Daily prednisone <5mg daily
  • Every other day dosing
  • Glucocorticoids therapy less than 3 weeks in length
47
Q

What type of corticosteroid therapy is assumed to suppress HPA axis?

A
  • Prednisone 20mg daily for >3 weeks
  • Clinical signs of cushing’s (moon face, buffalo hump)
  • prednisone/Dexamethasone given at bedtime
48
Q

After cessation of steroid use, recovery of HPA may take how long to recover?

A

-Up to 12 months or longer

49
Q

After corticosteroid therapy, what returns to normal first? Adrenal function or H-P function?

A

-HP function

50
Q

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)?

A
  • Test responsiveness of adrenals w/ Cosyntropin (ACTH) stimulation test
  • Just give stress dose
51
Q

What patients are susceptible to cardiovascular collapse because they cannot release additional endogenous cortisol in response to surgical stress?

A

-Addison’s

52
Q

Endogenous cortisol production during stress is NOT greater than what?

A

-150mg/day

53
Q

Describe alternative surgical corticosteroid supplementation?

A
  • Minor surgery = 25mg
  • Moderate = 50-75mg for 1-2 days
  • Major = 100-150 for 2-3 days
54
Q

What 2 things diseases may need exogenous corticosteroid supplementation?

A
  • Burns

- Sepsis

55
Q

Mineralcorticoid effect on the distal renal tubules can lead to what PH abnormality?

A

-Hypokalemic metabolic alkalosis

56
Q

How does corticosteroids cause hyperglycemia?

A
  • Inhibits use of glucose at peripheral tissues

- Promote hepatic gluconeogensis

57
Q

Dose of _____ ______ may need to be increased when corticosteroids are administered to Type II diabetics.

A

-oral hypoglycemics

58
Q

How does corticosteroids effect body fat?

A
  • Redistributes to back (buffalo hump), supraclavicular, and to face (moon face)
  • Loss of fat from extremities
59
Q

Corticosteroids mobilize amino acids from tissues and cause what 4 things?

A
  • Decreased muscle mass
  • Osteoperosis
  • Skin thinning
  • Negative nitrogen balance
60
Q

How does corticosteroids effect the CNS?

A
  • Neurosis and psychosis
  • Depression and suicidal tendencies
  • Cataracts
61
Q

How do corticosteroids effect the blood?

A

-Increase hematocrit and leukocytes

62
Q

What does corticosteroids due to growth and development?

A
  • Stunt growth in children

- inhibits DNA synthesis and cell division

63
Q

What are the surgeons concerns with corticosteroids?

A
  • 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
Q

What are the 11 contraindications to corticosteroid use?

A
  • Systemic infection
  • Immunosupression
  • Psychosis
  • Glaucoma
  • CHF
  • Cushing’s
  • Diabetes
  • Osteoperosis
  • Hypokalemia
  • HTN
  • Hyperthyroidism

Pharm 2 (23 decks)

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