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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
Mineralcorticosteroids
reabsorption of Na in exchange for K in renal distal tubules
26
Glucocorticoid effect
anti-inflammatory effect
27
MOA mineralcorticosteroids
stimulates changes in transcription of 456 DNA | synthesis of proteins
28
MOA of glucocorticosteroids
target cell enzymes 11-beta hydroxysteroid dehydrogenase cortisol to cortisone
29
PK of corticosteroids
antacids interfere with oral absorption highly protein bound readily crosses the placenta
30
Elimination 1/2 of cortisol
1.5-3 hours
31
Metabolism of corticosteroid
70% conjugated in liver to inactive/poorly active metabolites
32
Clinical uses of Corticosteroids
``` antiemetic anaglesia asthma cerebal edema adrenal insufficiency immunosuppression larygneal edema regional blocks ```
33
hydrocortisone
cortisol | short acting
34
prednisolone
sole replacement therapy in adrenocortical insufficiency
35
prednisone
rapidly converted to prednisolone after absorption from GI tract
36
methylprednisolone
used to produce intense glucocorticoid effect
37
Cortisol Dose
20mg
38
DOA of cortisol
8-12
39
Cortison Dose
25mg
40
DOA of Cortisone
8-36
41
Elimination 1/2 Time of Cortisone
0.5
42
Prednisolone Dose
5mg
43
Prednisolone Elimination 1/2 Time
2-4
44
Prednisolone Duration of Action
12-36
45
Prednisone Dose
5
46
Prednisone DOA
12-36
47
Prednisone Elimination 1/2 time
2-4
48
Methyprednisolone Dose
4mg
49
Methylprednisolone Elimination 1/2 time
2-4
50
DOA Methylprednisolone
12-36
51
Dexamethasone Antiinflammatory Potency
25
52
Dexamethasone Dose
0.75
53
Dexamethasone Elimination Half Time
3.5-5
54
Dexamethasone DOA
36-54
55
Enzyme Inhibition
ketoconazole fluconazole etomidate metapyrone
56
Accelerate Metabolism
phenytoin rifampin phenobarbital ephedrine
57
Side Effects of Chronic Usage
``` HPA Axis Suppression Corticosteroid Supplementation Electrolyte and Metabolic changes CNS dysfunction peptic ulcer disease skeletal muscle myopathy ```
58
Side effects of Acute uses
``` hyperglycemia delayed wound healing infection cancer recurrence CNS disturbances GI disturbances affects on sugamedex ```
59
When do you replace steroids perioperatively?
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
Minor Surgery patient will receive
25mg IV hydrocortisone
61
Moderate surgery patient will receive
50-75 mg IV of hydrocortisone, taper over 1-2 days
62
major surgery patient will receive
100-150mg IV hydrocortisone taper 1-2 days
63
Covid 19 Considerations
``` severly ill supplemental O2/ventilator dexamethasone dose: 6mg for 10 days equivalent doses not recommended for preventative or mild to moderate cases ```
64
Protein Binding of Dexamethasone
77%
65
Bioavailability of Dexamethasone
80-90%
66
Metabolism of Dexamethasone
liver
67
Excretion of Dexamethasone
urine
68
Elimination 1/2 life of Dexamethasone
36-54 hours
69
Dexamethasone Dose for PONV
4-10mg | peds: 0.2-0.5mg/kg
70
Onset of dexamethasone
2 hours
71
Peak of dexamethasone
5-10mins
72
Metabolism of dexamethasone
hepatic (no adjustment needed for renal or liver failure)
73
Half life of Dexamethasone
1-5 hours
74
DOA of Dexamethasone
Short
75
C/A of dexamethasone
uncontrolled infections, known hypersensitivity, cerebral malaria, systemic fungal infection, concurrent treatment with live virus vaccine
76
Relative C/A of dexamethasone
diabetic patients
77
Dose of Methylprednisone for PONV
40mg IV
78
Protein Binding of Methylprednisone
78%
79
Metabolism of Methylprednisone
kidney, tissues and liver
80
Half life of methylprednisone
18-26 hours
81
Excretion of Methylprednisone
urine

Pharmacology (14 decks)

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