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pharmacology > Corticosteroids > Flashcards

Corticosteroids Flashcards

1
Q

Functions of Hypothalamus

A

produces hormones (Corticotropin releasing hormone)
regulates body temperature
daily physiological cycles- melatonin and cortisol
control appetite
manages sexual behavior
managing emotional responses

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2
Q

Functions of Anterior Pituitary

A 
Adrenocorticotropic hormone
thyroid stimulating hormone
follicle stimulating hormone
leutinizing hormone
growth hormone
prolactin
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3
Q

Adrenal Cortex

A

Zona glomerulosa
zona fasiculata
zona reticularis

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4
Q

Zona glomerulosa

A

aldosterone

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5
Q

zona fasiculata

A

cortisol

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6
Q

zona reticularis

A

sex hormones

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7
Q

Adrenal medulla

A

epinephrine

norephinephrine

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8
Q

Actions of Cortisol

A

carbohydrate metabolism
increases protein catabolism
inhibits insulin from shuttling into cells
mobilized free fatty acids
suppression of pro-inflammatory cytokines
suppress immune system

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9
Q

Cortisol is also known as

A

hydrocortisone

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10
Q

Cortisol Levels synthesized goverened by

A

ACTH

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11
Q

Max Cortisol concentrations

A

around 8am

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12
Q

Minimal cortisol concentrations

A

around midnight

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13
Q

Stress induced changes in cortisol levels include

A

superimposed on baseline cortisol

normal production is 15-30mg/day

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14
Q

Cortisol levels the day of a minor surgery

A

up to 50mg/day

returns to baseline within 24 hours

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15
Q

Cortisol levels the day of moderate procedures

A

up to 75-100mg/day

returns to baseline by day 5

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16
Q

cortisol levels the day of major procedure

A

up to 200mg/day

usually returns to baseline by day 5

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17
Q

Symptoms of Cushing Syndrome include

A 
personality changes
hyperglycemia
moon face
CNS irritability
increase susceptilibilty to infection
NA/Fluid retention
thin extremities
fat deposits on back
gynecomastia
GI distress increase acid
amenrrhea
hirsutism
purple stria
bruises and petechiae
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18
Q

Cushing Syndrome causes

A 
overuse of corticosteroids
adrenal gland abnormality or tumor
tumors of the pit gland
familial cushing syndrome
ectopic adrenocorticotopic hormone (ACTH) releasing tumors in the lungs, pancreas,   thyroid gland
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19
Q

Addison’s Disease

A

destruction of all cortical zones

Autoimmune destruction

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20
Q

Secondary Adrenal Insufficiency

A

TBI
Ischemic/hemorrhagic lesions of hypothalamic-pituitary axis
chronic glucocorticoid treatment (3-4 weeks)
topical administeration such as aerosols for asthma and COPD or creams used for skin problems

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21
Q

Adrenal Crisis

A 
hypotension
acute abdominal symptoms
N/V
Altered mental state
fatigue
fever
lab abnormalities (hyponatremia, hyperkalemia, rarely hypercalcemia)
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22
Q

Causes of adrenal crisis

A

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

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23
Q

Absolute HTN

A

SBP <100mmHg

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24
Q

Relative HTN

A

SBP reduction greater then 20mmHG

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25
Q

Mineralcorticosteroids

A

reabsorption of Na in exchange for K in renal distal tubules

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26
Q

Glucocorticoid effect

A

anti-inflammatory effect

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27
Q

MOA mineralcorticosteroids

A

stimulates changes in transcription of 456 DNA

synthesis of proteins

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28
Q

MOA of glucocorticosteroids

A

target cell enzymes
11-beta hydroxysteroid dehydrogenase
cortisol to cortisone

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29
Q

PK of corticosteroids

A

antacids interfere with oral absorption
highly protein bound
readily crosses the placenta

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30
Q

Elimination 1/2 of cortisol

A

1.5-3 hours

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31
Q

Metabolism of corticosteroid

A

70% conjugated in liver to inactive/poorly active metabolites

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32
Q

Clinical uses of Corticosteroids

A 
antiemetic
anaglesia
asthma
cerebal edema
adrenal insufficiency
immunosuppression
larygneal edema
regional blocks
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33
Q

hydrocortisone

A

cortisol

short acting

34
Q

prednisolone

A

sole replacement therapy in adrenocortical insufficiency

35
Q

prednisone

A

rapidly converted to prednisolone after absorption from GI tract

36
Q

methylprednisolone

A

used to produce intense glucocorticoid effect

37
Q

Cortisol Dose

A

20mg

38
Q

DOA of cortisol

A

8-12

39
Q

Cortison Dose

A

25mg

40
Q

DOA of Cortisone

A

8-36

41
Q

Elimination 1/2 Time of Cortisone

A

0.5

42
Q

Prednisolone Dose

A

5mg

43
Q

Prednisolone Elimination 1/2 Time

A

2-4

44
Q

Prednisolone Duration of Action

A

12-36

45
Q

Prednisone Dose

A

5

46
Q

Prednisone DOA

A

12-36

47
Q

Prednisone Elimination 1/2 time

A

2-4

48
Q

Methyprednisolone Dose

A

4mg

49
Q

Methylprednisolone Elimination 1/2 time

A

2-4

50
Q

DOA Methylprednisolone

A

12-36

51
Q

Dexamethasone Antiinflammatory Potency

A

25

52
Q

Dexamethasone Dose

A

0.75

53
Q

Dexamethasone Elimination Half Time

A

3.5-5

54
Q

Dexamethasone DOA

A

36-54

55
Q

Enzyme Inhibition

A

ketoconazole
fluconazole
etomidate
metapyrone

56
Q

Accelerate Metabolism

A

phenytoin
rifampin
phenobarbital
ephedrine

57
Q

Side Effects of Chronic Usage

A 
HPA Axis Suppression
Corticosteroid Supplementation
Electrolyte and Metabolic changes
CNS dysfunction
peptic ulcer disease
skeletal muscle myopathy
58
Q

Side effects of Acute uses

A 
hyperglycemia
delayed wound healing
infection
cancer recurrence
CNS disturbances
GI disturbances
affects on sugamedex
59
Q

When do you replace steroids perioperatively?

A

pharmacologic doses of glucocorticoids greater then 5mg of prednisone/day
the period of treatment with corticosteroids was for 2-3 weeks or longer
the treatment occured during the immediate 12 month before surgery

60
Q

Minor Surgery patient will receive

A

25mg IV hydrocortisone

61
Q

Moderate surgery patient will receive

A

50-75 mg IV of hydrocortisone, taper over 1-2 days

62
Q

major surgery patient will receive

A

100-150mg IV hydrocortisone taper 1-2 days

63
Q

Covid 19 Considerations

A 
severly ill
supplemental O2/ventilator
dexamethasone dose: 6mg for 10 days
equivalent doses
not recommended for preventative or mild to moderate cases
64
Q

Protein Binding of Dexamethasone

A

77%

65
Q

Bioavailability of Dexamethasone

A

80-90%

66
Q

Metabolism of Dexamethasone

A

liver

67
Q

Excretion of Dexamethasone

A

urine

68
Q

Elimination 1/2 life of Dexamethasone

A

36-54 hours

69
Q

Dexamethasone Dose for PONV

A

4-10mg

peds: 0.2-0.5mg/kg

70
Q

Onset of dexamethasone

A

2 hours

71
Q

Peak of dexamethasone

A

5-10mins

72
Q

Metabolism of dexamethasone

A

hepatic (no adjustment needed for renal or liver failure)

73
Q

Half life of Dexamethasone

A

1-5 hours

74
Q

DOA of Dexamethasone

A

Short

75
Q

C/A of dexamethasone

A

uncontrolled infections, known hypersensitivity, cerebral malaria, systemic fungal infection, concurrent treatment with live virus vaccine

76
Q

Relative C/A of dexamethasone

A

diabetic patients

77
Q

Dose of Methylprednisone for PONV

A

40mg IV

78
Q

Protein Binding of Methylprednisone

A

78%

79
Q

Metabolism of Methylprednisone

A

kidney, tissues and liver

80
Q

Half life of methylprednisone

A

18-26 hours

81
Q

Excretion of Methylprednisone

A

urine

pharmacology (14 decks)

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