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Pharmacology Sem 1 > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

What is the role of the hypothalamus?

A

It produces hormones including the Corticotropin releasing hormone
Maintains homeostasis through regulating body temperature, controlling appetite, managing sexual behavior, managing emotional responses

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2
Q

What hormones are released from the posterior pituitary?

A

Oxytocin & ADH (antidiuretic hormone)

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3
Q

What hormones are released from the anterior pituitary?

A

Leutinizing hormone, Folicular stimulating hormone, growth hormone, adrenocorticotropic hormone, thyroid stimulating hormone, prolactin

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4
Q

Where is cortisol released from?

A

zona fasiculata in the adrenal cortex

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5
Q

Where is aldosterone released from?

A

zona glomerulosa in the adrenal cortex

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6
Q

What is released from the adrenal medulla?

A

epinephrine and norepinephrine

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7
Q

The zona reticularis releases

A

sex hormones

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8
Q

What is the role of cortisol (hydrocortisone)?

A

Increases carbohydrate & protein metabolism
suppress immune system
suppression of pro-inflammatory cytokines
mobilization of free fatty acids
inhibits insulin from shuttling into cells

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9
Q

When does cortisol peak?

A

8 am

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10
Q

When is cortisol at its lowest concentration?

A

midnight

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11
Q

What is the normal production of cortisol?

A

15-30 mg/day

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12
Q

What causes release of cortisol?

A

ACTH

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13
Q

What are cortisol levels in response to minor procedures?

A

up to 50 mg/day
return to baseline within 24 hours
ex. hernia repair

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14
Q

What are cortisol levels in response to moderate procedures?

A

up to 75-100 mg/day
return to baseline by 5 days
ex. colectomy

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15
Q

What are cortisol levels in response to major procedures?

A

up to 200 mg/day
usually returns to baseline by 5 days
ex. major trauma

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16
Q

What is Cushing’s Sydnrome?

A

Too much cortisol typically due to increase of corticosteroids

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17
Q

What are reasons Cushing’s disease can occur?

A

Tumor on pituitary gland resulting in increased release of cortisol

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18
Q

What are the signs and symptoms of Cushing’s Disease?

A

moon face, hunch back, thin skin, osteoporosis, amennorhea, Na & fluid and retention, males develop breasts

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19
Q

When do we see clinical manifestations of Addison’s Disease?

A

When 90% of cortical zones are destroyed

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20
Q

What is the most common cause of Addison’s disease?

A

autoimmune destruction

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21
Q

What are reasons for secondary adrenal insufficiency?

A

problems w/ hypothalamus or anterior pituitary
TBI
Chronic glucocorticoid treatment (3-4 weeks)
Topical administration such as aersols for asthma and COPD or creams used for skin problems
Ischemic/hemorrhagic lessons of hypothalamic-pituitary axis

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22
Q

What is an adrenal crisis?

A

It is a life threatening acute deterioration and includes at least two of the following:
hypotension (treating BP that is not going back up), acute abdominal symptoms, N/V, AMS, fatigue, fever, laboratory abnormalities

23
Q

What are the abnormalities found in adrenal crisis?

A

hyponatremia, hyperkalemia, hypoglycemia, rarely hypercalcemia

24
Q

What are the causes of adrenal crisis?

A

interruption of gluccorticoid intake, infections, surgery, gastroenteritis, stress

25
Q

How do you manage adrenal crisis?

A

give them fluid (0.9 NS 1-3 L over 6-12 hours)

want to give hydrocortisone (initial 100 mg)

26
Q

Patients who have surgery at X time have a quicker return to baseline cortisol levels

A

afternoon

27
Q

What is the mechanism of action of corticosteroids?

A

stimulates change in transcription of 456 DNA -synthesis of proteins
Target cells contain enzyme- 11-beta hydroxysteroid dehydrogenase (think etomidate) turns cortisol (active) into cortisone (inert)

28
Q

What is the classification of corticosteroids?

A

1) reabsorption of Na+ in exchange for K+ in renal distal tubules (mineralcorticoid effect)
2) anti-inflammatory properties (glucocorticoid effect)

29
Q

Synthetic corticoids are all

A

glucocorticoids

30
Q

This interferes with the oral absorption of corticosteroids

A

antaccids

31
Q

The elimination half-time of cortisol is

A

1.5-3 hours

32
Q

How is cortisol eliminated?

A

phase II liver- 70% conjugated in liver

33
Q

Cortisol readily

A

cross the placenta

34
Q

Cortisol is

A

highly protein bound to corticosteroid-binding globulin

35
Q

What are the clinical uses of corticosteroids?

A

antiemetic, analgesia, immunosuppression, laryngeal edema, can prolong regional blocks, asthma, cerebral edema, adrenal insufficiency

36
Q

Comment on corticosteroids and covid 19

A

beneficial for patients who are severely ill and requiring ventilation or oxygen supplementation

37
Q

Research has shown that use of corticosteroids does not cause

A

does not contribute to wound complications or wound healing or hyperglycemic events

38
Q

What can be used safely for PONV prophylaxis?

A

4-8 mg dose of dexamethasone

39
Q

What dosage of dexamethasone can be given for postop sore throat?

A

Prophylactic >0.2 mg/kg

40
Q

What are the perioperative adrenal supplementation guidelines for hydrocortisone?

A

superficial (dental biopsy)- 0
Minor (colonoscopy, hernia repair)- 25 mg IV
Moderate (colon resection, joint replacement)- 50-75 mg IV, taper over 1-2 days
Major (CV, Thoracic)- 100-150 mg IV taper over 1-2 days

41
Q

When should we give perioperative steroids?

A
  1. pharmacologic doses of glucocorticoids greater than 5 mg of prednisone equivalent/day
  2. The period of treatment with corticosteroids was for 2-3 weeks or longer
  3. The treatment occurred during the immediate 12 months before surgery
42
Q

Acute side effects of corticosteroids include

A

hyperglycemia

43
Q

Chronic side effects of corticosteroids include:

A

HPA axis suppression, corticosteroid supplementation, electrolyte and metabolic changes, CNS dysfunction, peptic ulcer disease, skeletal muscle myopathy

44
Q

Drugs that cause enzyme inhibition with corticosteroids

A

ketoconazole, fluconazole, etomidate, metapyrone

45
Q

Drugs that accelerate metabolism with corticosteroids

A

phenytoin (dilantin), rifampin, phenobarbital, ephedrine

46
Q

Hydrocortisone is also know as

A

cortisol and is short acting

47
Q

What are the corticosteroids predominantly used in practice:

A

hydrocortisone, prednisone, prednisolone, methylprednisolone, dexamethasone

48
Q

What corticosteroid is used to produce an intense glucocorticoid affect?

A

methylprednisolone

49
Q

What corticosteroids rely most on liver function?

A

prednisolone and prednisone

50
Q

What corticosteroid is the sole replacement therapy for adrenocortical insufficiency?

A

prednisolone

51
Q

Aldosterone is known for its’

A

sodium retaining potency; it is a mineralcorticoid

52
Q

What is the duration of action of cortisol?

A

8-12 hours so we need to give more than one dosage

53
Q

Prednisone can only be given

A

PO

Pharmacology Sem 1 (14 decks)

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