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320 Pharmacology > Endocrine: Adrenal > Flashcards

Endocrine: Adrenal Flashcards

1
Q

Define Anabolic.

A

Constructive phase of Metabolism. Amino Acids form Proteins, “Muscle”

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2
Q

Define Catabolic.

A

Destructive phase of Metabolism. Complex substances are broken down into simpler substances, with a release of energy

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3
Q

What are some characteristics of steroids?

A

anti-inflammatory + vasoconstrictive

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4
Q

What are some examples of steroids?

A
  • Topical steroids = Hydrocortisone
  • Inhaled steroids= fluticasone, beclomethasone
  • Oral steroids= prednisone
  • Natural steroids= testosterone, aldosterone, progesterone, etc.

(-sone)
prob don’t need to know

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5
Q

What are the two types of Catabolic Corticosteroids and some examples of each?

A

Glucocorticoids:

  • dexamethasone
  • prednisone
  • methylprednisolone
  • hydrocortisone

Mineralocorticoids:

  • fludrocortisone
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6
Q

What are Corticosteroids (“Cortisol”)?

A
  • Cortisol “stress hormone”
  • Increases blood glucose during stress for survival- “fuel for brain”
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7
Q

Periphery metabolic effects of Corticosteroid (“Cortisol”)?

A

Reduced glucose uptake (antagonizes insulin to ensure more blood glucose for brain, other vital organs) STOPS INSULIN SECRETION

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8
Q

Long-term metabolic effects of Corticosteroid (“Cortisol”)?

A

CATABOLIC- Decreased muscle mass, thinning of skin, hyperglycemia, moon face and buffalo hump, and osteoporosis!

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9
Q

Inflammation effects of Corticosteroid (“Cortisol”)?

A
  • Reduces gene expression of pro-inflammatory markers (prostaglandins, etc.)
  • Reduction in neutrophil infiltration in vasculature, and CLINICALLY you will see a rise in WBC!
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10
Q

Describe Mineralocorticoids (“Aldosterone”).

A
  • Primary mineralocorticoid is aldosterone
  • Part of RAAS (Renin-Angiotensin-Aldosterone)
  • Regulates plasma volume by SODIUM reabsorption and POTASSIUM excretion in the kidneys
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11
Q

Primary and Secondary causes of Adrenal Insufficiency?

A
  • Primary causes- adrenal glands don’t produce corticoids
    • Addison’s Disease
  • Secondary causes- Pituitary gland unable to produce ACTH
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12
Q

S/S of Adrenal Insufficiency?

A
  • Hypoglycemia
  • Fatigue
  • Hypotension
  • Anorexia
  • N/V/D
  • LAB WORK: Low cortisol levels
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13
Q

What are the two categories of Corticosteroids used for?

A
  • Glucocorticoids (mimic cortisol)
    • Typically used for INFLAMMATION
  • Mineralocorticoids (mimic Aldosterone)
    • Typically used for Addisons’ Disease
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14
Q

What are low and high dose Glucocorticoids used to treat?

A
  • LOW dose: adrenal insufficiency (CHRONIC)
  • HIGH dose: inflammation (ACUTE)
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15
Q

What are some common uses of Glucocorticoids?

A
  • IBS, Crohn’s
  • Asthma, COPD
  • Poison Ivy, Atopic Dermatitis
  • Adrenal Insufficiency
  • Rheumatoid Arthritis
  • Leukemia/Lymphomas
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16
Q

What are some routes that Glucocorticoids be administered through?

A
  • Topical
  • Oral
  • IV
  • Inhaled
17
Q

Corticosteroids adverse effects?

A

C – Cataracts
U – Ulcers (peptic ulcer disease)
S –Skin thinning/Striae, Salt retention
H – Hypertension, Hirsutism
I – Immunosuppression, Infections
N – Necrosis of femoral heads
G – Glucose elevation/Glaucoma
O – Osteoporosis, Obesity
I – Impaired wound healing
D – Depression/mood changes

18
Q

What are some long-term therapy risks of Corticosteroids?

A
  • TOPICAL: Patients may develop Topical Steroid Withdrawal Syndrome (TSWS)
  • SYSTEMIC: Patient’s Adrenal gland may stop producing Steroids= ADRENAL CRISIS
19
Q

Corticosteroids nursing considerations?

A

LONG TERM THERAPY= TAPER OFF (NEVER Stop Suddenly)

  • Steroids should always be used for shortest duration possible
  • MUST TAPER to prevent adrenal atrophy/crisis
  • Never stop suddenly, even if symptoms improve or if patients develop severe adverse effects!
20
Q

What are some other names for Topical Steroid Withdrawal Syndrome (TSWS)?

A
  • Topical Steroid Addiction
  • Red Skin Syndrome (RSS)
21
Q

Topical Steroid Withdrawal Syndrome (TSWS) S/S?

A
  • Erythema
  • burning/itching
22
Q

Describe Adrenal Crisis.

A
  • OCCURS DUE to lack of corticosteroids in the system
  • Can lead to SHOCK (steroids help in Stress + Blood pressure/volume)
  • Populations impacted:
    • Addison’s Disease
    • Patients on long term steroids who suddenly stopped therapy
23
Q

What does High Dose Systemic Steroids cause?

A

IMMMUNOSUPPRESSION

1) AVOID other people/crowds who may be SICK
2) NO LIVE VACCINES

24
Q

Who is immunosuppressed?

A
  • Patients on chemotherapy
  • Patients on transplant/immunosuppressant drugs
  • Patients who are pregnant
  • Patients who are on high dose, systemic steroids
25
Q

What are some non-systemic routes to administer Corticosteroids and what are they used for?

A
  • Topical creams/lotions= Atopic dermatitis/ skin
  • Nasal Spray= season allergies
  • Inhaler= Asthma/COPD
26
Q

How should you administer Systemic (Oral, IV) Corticosteroids?

A

TIMING:

  • Take in mornings (mimic natural endogenous release)
  • If multiple times per day, space out appropriately

ADMINISTRATION:

  • Take with Food to reduce GI irritation
  • If on long term therapy, can encourage diet high in Vit D and Calcium
27
Q

How should you administer Corticoisteroid inhaler?

A
  • Wash mouth out after usage
  • Can use spacer to improve absorption and reduce risk of thrush
28
Q

What patient populations do we need to monitor carefully when taking Corticosteroids?

A
  • Children
  • Diabetes or Pre-Diabetes
  • Addison’s Disease
29
Q

Why do we need to monitor Children taking Corticosteroids?

A
  • May delay growth! (Catabolic in nature)
  • Measure weight + height
30
Q

Why do we need to monitor Diabetes or Pre-Diabetic Patients taking Corticosteroids?

A
  • Steroids will increase glucose levels
  • Pre-Diabetic patients may need insulin while on steroids
31
Q

Why do we need to monitor Patients with Addison’s Disease taking Corticosteroids?

A
  • They are dependent upon exogenous steroids
  • Will need doses of steroids prior to stressful events
    • Such as SURGERY or ILLNESS
    • Giving supplemental doses called “STRESS DOSES” can prevent ADRENAL CRISIS
32
Q

Corticosteroids drug interactions?

A
  • NSAIDS- can increase GI issues, peptic ulcer disease
  • NO GRAPEFRUIT JUICE with methylprednisolone (Random, I know)
  • Other drugs that can cause hyperglycemia
  • Other drugs that can cause hypokalemia
  • NO LIVE VACCINES!
33
Q

What are Mineralocorticoids (fludrocortisone) used to treat?

A
  • Addison’s Disease
  • Orthostatic Hypotension
34
Q

Fludrocortisone mechanism of action?

A

Mimic aldosterone (hold onto salt and water)

35
Q

Fludrocortisone adverse effects?

A
  • Fluid retention
  • Hypertension
  • HYPOKALEMIA

320 Pharmacology (36 decks)

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