corticosteroids

Question 1

name the hormones:
hypothalamus releases _____
anterior pituitary releases _____
adrenal cortex releases ____

Answer 1

hypothalamus releases corticotropin releasing hormone
(CRH)

ant pit releases adrenocorticotropic hormone (ACTH)

adrenal cortex releases cortisol

Question 2

the negative feed back loop mechanism works at which two spots on the HPA Axis?

Answer 2

hypothalamus and anterior Pituitary

Question 3

GFR —> ___ ____ ____

zona Glomerulosa
zona Fascicula
zona Reticularis

Answer 3

salt, sugar, sex

Question 4

why does it take so long for cortisol to take effect?

Answer 4

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

Question 5

what is the primary mineralcorticold

in the Outer layer, Zona glomerulosa

Answer 5

aldosterone

Question 6

aldosterone’s effects on:

K
Na
water

Answer 6

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.

Question 7

If you have first degree adrenocortical insufficiency, you need to replace with…..?

why

Answer 7

glucocorticoid AND mineralcorticold.

like florinef: fludrocortisone + prednisone

because the adrenals do not secrete cortisol or aldosterone

Question 8

if you have second degree adrenocortical insufficiency (cushings) you need to replace with…..?

why

Answer 8

only glucocorticoid

because aldosterone secretion is maintained.

Question 9

what causes second degree adrenocortical insufficiency?

Answer 9

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.

Question 10

what happens if you d/c steroids someone on long term use

Answer 10

send them into adrenal crisis

release of cortisol in response to stress could be blunted or absent and lead to hypotensive shock

Question 11

T/F long term steriod use causes increased CO, increased RR, increased gluconeogenesis

Answer 11

TRUE

Question 12

glucocorticoids are used for their ____ response

Answer 12

anti-inflammatory

Question 13

which synthetic corticosteroids do not have sodium retaining effects?

Answer 13

beta dex tria

betamethasone
dexmethasone
trimincalone

Question 14

which synthetic corticosteroids steroid is a true mineralocorticoid and has 125x potenty for retaining sodium and water

Answer 14

fludrocortisone

Question 15

if youre supplementing someone with addisons disease, should be giving something like ___ or ___ because they have both anti-infalmmaroy and sodium retaining effects

Answer 15

cortisol

prednisone

Question 16

T/F Steriods are approved for a wide list of clinical uses like anti-emetic, asthma, sepsis, post intubation edema….

Answer 16

FALSE. There is no true approval for all those things.

Only approved for: replacement therapy for deficiency states.

Question 17

what is the acid base disturbance associated with steroids

Answer 17

hypokalemic metabolic alkalosis

mineralocorticoid effect of cortisol on distal renal tubules leading to enhanced absorption of Na and loss of K

Question 18

steroids have catabolic effects.

peripherally, corticosteroids mobilize amino acids from tissues, so this causes..

Answer 18

dec skeletal muscle mass

osteoporosis

thinning of skin

negative nitrogen balance

Question 19

long term use of corticosteroids increases which two lab values?

Answer 19

hematocrit and leukocytes

Question 20

what do hyperthyroidism and chronic steroid use have in common

Answer 20

put people in a hyperdynamic state

Question 21

T/F Aldosterone secretion remains intact in 2nd degree adrenal insufficiency

Answer 21

true

Question 22

T/F Prednison or Dex (even physiologic doses) given as a single daily dose at bedtime is associated more commonly with HPA Axis suppression

Answer 22

TRUE

Question 23

in which 2 instances do you assume a patient is HPA suppressed

Answer 23

pred 20mg/day for >3w within the previous year

patient with clinical signs of cushings from any steroid use

Question 24

T/F After cessation of steroid therapy, recovery of the HPA axis happens fairly quickly.

Answer 24

FALSE - can take 12mo or longer

Question 25

why are addisons patients more susceptible to CV collapse

Answer 25

because they cannot release additional endogenous cortisol in response to stress

Question 26

T/F Endogenous cortisol production during stress is >150mg/day

Answer 26

FALSE

Endogenous cortisol production during stress is NOT >150mg/day

Question 27

T/F Burn and sepsis patients have an exaggerated need for exogenous corticosteroid supplementation

Answer 27

TRUE

Question 28

s/s of acute adrenal crisis

\_\_\_\_glycemia
\_\_\_kalemia
\_\_\_\_natremia
\_\_\_\_volemia 
metabolic \_\_\_\_

Answer 28

hypoglycemia 
hyperkalemia
hyponatremia
hypovolemia 
metabolic acidosis