corticosteroids Flashcards
name the hormones:
hypothalamus releases _____
anterior pituitary releases _____
adrenal cortex releases ____
hypothalamus releases corticotropin releasing hormone
(CRH)
ant pit releases adrenocorticotropic hormone (ACTH)
adrenal cortex releases cortisol
the negative feed back loop mechanism works at which two spots on the HPA Axis?
hypothalamus and anterior Pituitary
GFR —> ___ ____ ____
zona Glomerulosa
zona Fascicula
zona Reticularis
salt, sugar, sex
why does it take so long for cortisol to take effect?
it binds to the MRNA in the cell and changes the way that proteins are made within the cell.
also why you have a long DOA
what is the primary mineralcorticold
in the Outer layer, Zona glomerulosa
aldosterone
aldosterone’s effects on:
K
Na
water
increases K excretion
(LOSE K)
increases Na retention
(KEEP Na)
increases water retention, inc blood volume.
aldosterone makes you hang on to salt and water at the expense of K.
If you have first degree adrenocortical insufficiency, you need to replace with…..?
why
glucocorticoid AND mineralcorticold.
like florinef: fludrocortisone + prednisone
because the adrenals do not secrete cortisol or aldosterone
if you have second degree adrenocortical insufficiency (cushings) you need to replace with…..?
why
only glucocorticoid
because aldosterone secretion is maintained.
what causes second degree adrenocortical insufficiency?
chronic steroid use and suppression of the HPA axis.
because if youre taking a lot of steroids, the negative feedback loop will tell your body that youre good and dont need to make any more.
what happens if you d/c steroids someone on long term use
send them into adrenal crisis
release of cortisol in response to stress could be blunted or absent and lead to hypotensive shock
T/F long term steriod use causes increased CO, increased RR, increased gluconeogenesis
TRUE
glucocorticoids are used for their ____ response
anti-inflammatory
which synthetic corticosteroids do not have sodium retaining effects?
beta dex tria
betamethasone
dexmethasone
trimincalone
which synthetic corticosteroids steroid is a true mineralocorticoid and has 125x potenty for retaining sodium and water
fludrocortisone
if youre supplementing someone with addisons disease, should be giving something like ___ or ___ because they have both anti-infalmmaroy and sodium retaining effects
cortisol
prednisone
T/F Steriods are approved for a wide list of clinical uses like anti-emetic, asthma, sepsis, post intubation edema….
FALSE. There is no true approval for all those things.
Only approved for: replacement therapy for deficiency states.
what is the acid base disturbance associated with steroids
hypokalemic metabolic alkalosis
mineralocorticoid effect of cortisol on distal renal tubules leading to enhanced absorption of Na and loss of K
steroids have catabolic effects.
peripherally, corticosteroids mobilize amino acids from tissues, so this causes..
dec skeletal muscle mass
osteoporosis
thinning of skin
negative nitrogen balance
long term use of corticosteroids increases which two lab values?
hematocrit and leukocytes
what do hyperthyroidism and chronic steroid use have in common
put people in a hyperdynamic state
T/F Aldosterone secretion remains intact in 2nd degree adrenal insufficiency
true
T/F Prednison or Dex (even physiologic doses) given as a single daily dose at bedtime is associated more commonly with HPA Axis suppression
TRUE
in which 2 instances do you assume a patient is HPA suppressed
pred 20mg/day for >3w within the previous year
patient with clinical signs of cushings from any steroid use
T/F After cessation of steroid therapy, recovery of the HPA axis happens fairly quickly.
FALSE - can take 12mo or longer
why are addisons patients more susceptible to CV collapse
because they cannot release additional endogenous cortisol in response to stress
T/F Endogenous cortisol production during stress is >150mg/day
FALSE
Endogenous cortisol production during stress is NOT >150mg/day
T/F Burn and sepsis patients have an exaggerated need for exogenous corticosteroid supplementation
TRUE
s/s of acute adrenal crisis
\_\_\_\_glycemia \_\_\_kalemia \_\_\_\_natremia \_\_\_\_volemia metabolic \_\_\_\_
hypoglycemia hyperkalemia hyponatremia hypovolemia metabolic acidosis
