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Pharm 2 via Jeff > Corticosteriods > Flashcards

Corticosteriods Flashcards

1
Q

What is the HPA axis?

A

Hypthalmus
pituitary gland
adrenal cortex

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2
Q

What are the three layers of the adrenal cortex?

A
  • Zona glomerulosa : mineralcorticoids
  • Zona fasiculata - glucocorticoids

Zona reticularis - Glucocorticoids

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3
Q

Glucocorticoids play an important role in maintaining what body functions?

A
  • Carbohydrate, gat, protein metabolism
  • Gluid and electrolyte regulation
  • inhibits inflammatory response
  • Gluconeogenisis
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4
Q

What steroid mediates 95% of all glucocorticoids in the body?

A

Cortisol

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5
Q

What is the process of corticosteroidogenesis?

A
  • Begins in the hypothalamus. Hypothalmus releases Corticotropin Releasing Hormone into the pituitary gland.
  • The pituitary gland is stimulated to release ACTH into the adrenal cortex.
  • The adrenal cortex is stimulated to release cortisol from the zona fascicularis and zona retiulosa
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6
Q

What hormone is produced in the adrenal cortex and released due to stress response by the HPA axis?

A

Cortisol

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7
Q

What metabolic effects are initiated by cortisol in order to releive stress on the body?

A
  • Gluconeogenisis
  • Carbs, protein, fat metabolism
  • Control of fluid and electrolytes
  • Inhibit inflammatory response
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8
Q

According to the normal circadian rhythm when are cortisol levels highest and lowest?

A

Cortisol levels are highest in the morning and lowest in the evening.

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9
Q

Will changes in sleep habits alter the cycle of cortisol production?

A

Yes, Changes in sleep habits will cause a change in cortisol production cycle

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10
Q

The main regulator of cortisol production is?

A

Negative feedback - high levels of cortisol in the blood signal the hypothalamus to stop producing CRH. It also signals the pituitary gland to stop producing ACTH.

Low cotisol levels will reverse the process

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11
Q

What is primary adrenocortical insufficiency?

A

Also known as Addison’s Deseases.

Adrenal do not secrete cortisol or aldosterone

Replacement therapy must include both glucocorticoids and mineral corticoids

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12
Q

What is secondary adrenocortical insufficiency?

A

Adrenals do not secret cortisol

Aldosterone secretion is maintained

Replacement of glucocorticoid (cortisol) only.

Due to chronic steroid use and HPA axis suppression.

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13
Q

What are the physiologic effects of glucocorticoids?

A 
Increase cardiac output
Increase Respiratory rate
Increase gluconeogenesis
Decrease inflammation
Decrease immune response
Inhibit digestion
Enhanced analgesia
Redistribution of CNS blood flow
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14
Q

What mineralcorticoid is also reeased from the adreanl cortex?

A

Aldosterone is also released for the adrenal cortex -specifically the zona glomerulosa

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15
Q

What is the function of aldosterone?

A

Increases Na+ and water aabsorbtion thus increasing blood volume, and promotes K+ excretion

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16
Q

What feedback is associated with the secretion of aldosterone?

A

Increased K+ levels
Decreased Na+ levels
Decreased blood volume/blood pressure

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17
Q

What is the path of secretion for aldosterone?

A

Increased renin levels converts angiotensenoigin to angiotensin I. Angiotensin I is converted in the lungs to Angiotensin II. Angiotensin II stimulates the adrenal cortex (zona glomerulosa) to secret adldosterone

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18
Q

Glucocorticoids are classified according to their?

A

Potency

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19
Q

What are the most potent aniinflammatory steroids?

A

Dexmethasone

Betamethasone

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20
Q

What is the least potent steroid?

A

Cortisone

Cortisol

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21
Q

Which steroid has the most sodium retaining potency

A

Fludrocortisone

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22
Q

Which steroid has the longest elimination half life?

A

Betamethasone - hours

Dexamethasone - 3.5 - 5 hours

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23
Q

Which steroid has the shortest eimination half-life?

A

Cortisone - 0.5 hours

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24
Q

Which steroid has the longest duration of action?

A

Dexmethasone and Betamethasone

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25
Q

Which steroid has the shortest duration of action

A

Cortisol 8-12 hours

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26
Q

Do steroids cross the placenta?

A

YES

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27
Q

What side effects to glucocorticoids have on the endocrine system?

A

Adrenal atrophy
HPA axis suppression
Cushing’s syndrom
Hyperglycemia/diabetes

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28
Q

What side effects do steroids have on the crdiovascular system?

A

Hypertension
Dyslipidemia
Thrombosis

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29
Q

What side effects do steroids have on the CNS?

A 
Psychosis
Manic depression
Suicidal tendencies
Cataracts/glucoma
Mood changes
30
Q

What side effects do steroids have on the immune system?

A

Immunosupression

Increase risk of infection

31
Q

What side effects do steroids have on the renal system?

A

Increased Na+ and water retention (edema)

Increased K+ and H+ excretion

32
Q

What electrolyte and metabolic changes are associated with steroid use?

A

Hypokalemic Metaboic Alkalosis - due to increased K+ and H+ secretion

Inhibits glucose use in the perphery and results in hyperglycemia

Redistribution of body fat - hump back or buffalo hump and moon face as seen with cushing’s synddrome

33
Q

Long term use of steroidshas what effect on the blodd?

A

Hematocit and leukocytes are increased

70% reduction in lymphcytes
90% reduction in monocytes

These cells are sequestered and NOT Destroyed

34
Q

What are some relative contraindications to the use of steroids?

A 
Systemic infection immunosuppression
Glaucoma 
Hypokelemia
CHF Cushing's syndrome
diabetes Hypertension
Hyperthyroidism compounds
Osteoporosis
35
Q

When steroids are used for acute adrenal insufficiency when should higher doses be given?

A

In the morning

36
Q

When considering steroid replacement as a stress does prior to surgery wheat factors must be considered?

A

Dose of previous steroid therapy
Duration of previous therapy
Time since previous therapy

37
Q

When given as a antiemetic Dexamethsone should be administered early or late in the perioperative period?

A

Dexamethasone should be administered early in the intraoperative period just after induction.

38
Q

Which steroids have no Na+ retention qualities?

A

Betamethasone
Dexamethasone
Triamcinalone

39
Q

When used for asthma relief what is the most common side effet of inhaled steroids??

A

Oral candidiasis (Thrush)

40
Q

Are corticosteroids good for acute asthma attacks

No, it usually take steroid 4-6 hours to reach an anti inflamatory afffec

A

No, it usually take steroid 4-6 hours to reach an anti inflammatory affect

41
Q

When topical steroids are administered does heat increase or decrease the rate of absorption?

A

Heat increases the rate of absorption for topical steroids

42
Q

When are patient more at risk for post intubation laryngeal edema?

A

When intubated for more then 6 days

43
Q

When is the use of steroids NOT recommended?

A

Septic shock
Cardia arrest
Aspiration pneumonitis

44
Q

What factors infuence the degree of HPA axis suppression associated with steroid use?

A

Dose and duration of gluocorticoid therapy

Cause a reduction in the stress response of HP axis

45
Q

What therapies are unlikely to produce a suppression of the HPA axis?

A

Prednisone 5 mg/day or less
Long term every other day does
Dose therapy <3 weeks

46
Q

True of False: Steroids such as prednisone or dexamethasone administered at any does on a dailty basis is associated with suppression of HPA axis.

A

TRUE

47
Q

After cessation of steroid therapy recovery of the HPA axis may take how many months to recover?

A

12 months

HP funcction returns to normal before adrenal function in the HPA axis

48
Q

What is a good rule of thumb to assum HPA axis suppression

A

If steroid dose is greater than 10 mg/day and given for more than 3 weeks
Any sign of Cushing’ssyndrome moon face, buffalo hump, weight gain (edema)

49
Q

For patients receiving chronic steroid therapy how should plasma cortisol levels be maintained for major surgery

A

Cortisol levels should be above normal during major surgeries and stress doeses should be administered.

No additional ceverage should be needed for minor operations

50
Q

When considering stress doses prior to surgery what doeses should be administered according the level of surgery to be performed

A

Minor - 25 mg cortisol IV
Moderate 50 - 75 mg cortisol
Major 100 - 150 mg cortisol

51
Q

What are some signs of acute adrenal crisis?

A 
Hypotension unresponsive to vasopressors
Hyperdynamic circulation 
hypoglycemia
hyperkalemia
hypoatremia
hypovolemia
metabolic alkalosis
Decreased level of consciousness
52
Q

Where are thyroid hormone levels controlled

A

Hypothalamus

53
Q

How is T4 and ultimately T3 secreted?

A

Hypothalamus releases thyroid releasing hormone into the anterior pituitary gland. The anterior pituitary gland releases thyroid stimulating hormone into the thyroid gland. The thyroid gland releases T4 which is changed to T3 which is the active hormone

Level are controlled by feedback from the thyroid gland inhibiting the release of TRH from the hypotalamus

54
Q

Describe the presentation of Hashimoto Desease

A 
Hypothyroid
Cold Intolerance
Dry skin 
Gatigue
Weight gain
Bradycardia 
Slow reflexes
Coarse skin and hair
Periobital swelling Painful menstration
Myxedema coma
55
Q

Describe the presentation of Graves Desease

A 
Hyperthyroid 
Weight loss with increased appetite
Heat intolerance
Goiter
Gine hair
Tachycardia
Nervous, anxiety insomnia
Lighter menstration 
Sweating warm moist skin
Exophthalmus
Thyroid storm
56
Q

What are the two hypothyroid medication and what hormone do they replace?

A

Levothyroxine T4 Later converted to T3 by deiodination

Liothyronine T3 stronger than levothyroxine

57
Q

What is the perferred route of administration for levothyroxine

A

Oral is preferred but IV is available

58
Q

A euthyroid state is maintained with hypothyroid with what does of levothyroxine

A

100 - 200 mcg/day

59
Q

What is the half life of leveothyroxine and will replacement of missed dose be required on the day of surgery?

A

Half life is 7 days

A missed dose on the day of surgery is not required

after 7 days administer half the required dose for euthyroid (50 - 100 mcg)

60
Q

Which is the stronger medication for hypothyroid - levothyroxine or liothyronine?

A

Liothyronine - T3 is stronger

61
Q

Which replacement medication is better for long term use for hypothyroid?

A

Levothyroxine is better than liotyronine for long term use

62
Q

Which hypothyroid medication has greater cardiac side effects?

A

Liothyronine

63
Q

What are the anesthetic implication for hypthyroidism?

A 
Hyponatremia
hypthermia
hypoglycemia
delayed gastric emptying
slowed metabolis of drugs
decreased CO, HR, SV
More sensitive to inhaled gases
Unresponsive baroreceptor reflex
64
Q

What drug is given as an antithyroid drug and inhibits the formation of thyroid hormone by blocking T4 and T3?

A

Propylthiouracil(PTU)

65
Q

What drug treates hyperthyroidism and thyroid storm

A

Propylthiouracil (PTU)

66
Q

How is propylthyiouriacil administered?

A

Only in the PO form. Takes several days for effect

67
Q

What is the oldest medication used for the treatment of hypothyroidism

A

Lugols solution inhibits the release of the thyroid hormone

68
Q

Excessive release of thyroid hormone by the pituitary gland can cause what disorder?

A

Thyroid storm

69
Q

What conditions are seen with a thyroid storm

A 
Hyperthermia
Tachycardia
CHG
Dehydration
Shock
Symptoms resemble MS
70
Q

When is a thyroid storm most likely to develop?

A

6 - 19 hours post op

71
Q

How is thyroid storm treated?

A 
IV crystalloids
IV sodium iodide
Cortisol
Propranolol - alleviates cardio side effects
Propylthiouracil PO
72
Q

During a thyroid storm hyperthermia occurs and may result in a fever. Should ASA be given for the fever?

A

NO. ASA should be avoided as thyroxin levels may increase and worsen the effects of thyroid storm

Pharm 2 via Jeff (2 decks)

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