Endocrine: Adrenal Flashcards
Define Anabolic.
Constructive phase of Metabolism. Amino Acids form Proteins, “Muscle”
Define Catabolic.
Destructive phase of Metabolism. Complex substances are broken down into simpler substances, with a release of energy
What are some characteristics of steroids?
anti-inflammatory + vasoconstrictive
What are some examples of steroids?
- Topical steroids = Hydrocortisone
- Inhaled steroids= fluticasone, beclomethasone
- Oral steroids= prednisone
- Natural steroids= testosterone, aldosterone, progesterone, etc.
(-sone)
prob don’t need to know
What are the two types of Catabolic Corticosteroids and some examples of each?
Glucocorticoids:
- dexamethasone
- prednisone
- methylprednisolone
- hydrocortisone
Mineralocorticoids:
- fludrocortisone
What are Corticosteroids (“Cortisol”)?
- Cortisol “stress hormone”
- Increases blood glucose during stress for survival- “fuel for brain”
Periphery metabolic effects of Corticosteroid (“Cortisol”)?
Reduced glucose uptake (antagonizes insulin to ensure more blood glucose for brain, other vital organs) STOPS INSULIN SECRETION
Long-term metabolic effects of Corticosteroid (“Cortisol”)?
CATABOLIC- Decreased muscle mass, thinning of skin, hyperglycemia, moon face and buffalo hump, and osteoporosis!
Inflammation effects of Corticosteroid (“Cortisol”)?
- Reduces gene expression of pro-inflammatory markers (prostaglandins, etc.)
- Reduction in neutrophil infiltration in vasculature, and CLINICALLY you will see a rise in WBC!
Describe Mineralocorticoids (“Aldosterone”).
- Primary mineralocorticoid is aldosterone
- Part of RAAS (Renin-Angiotensin-Aldosterone)
- Regulates plasma volume by SODIUM reabsorption and POTASSIUM excretion in the kidneys
Primary and Secondary causes of Adrenal Insufficiency?
- Primary causes- adrenal glands don’t produce corticoids
- Addison’s Disease
- Secondary causes- Pituitary gland unable to produce ACTH
S/S of Adrenal Insufficiency?
- Hypoglycemia
- Fatigue
- Hypotension
- Anorexia
- N/V/D
- LAB WORK: Low cortisol levels
What are the two categories of Corticosteroids used for?
- Glucocorticoids (mimic cortisol)
- Typically used for INFLAMMATION
- Mineralocorticoids (mimic Aldosterone)
- Typically used for Addisons’ Disease
What are low and high dose Glucocorticoids used to treat?
- LOW dose: adrenal insufficiency (CHRONIC)
- HIGH dose: inflammation (ACUTE)
What are some common uses of Glucocorticoids?
- IBS, Crohn’s
- Asthma, COPD
- Poison Ivy, Atopic Dermatitis
- Adrenal Insufficiency
- Rheumatoid Arthritis
- Leukemia/Lymphomas
What are some routes that Glucocorticoids be administered through?
- Topical
- Oral
- IV
- Inhaled
Corticosteroids adverse effects?
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
What are some long-term therapy risks of Corticosteroids?
- TOPICAL: Patients may develop Topical Steroid Withdrawal Syndrome (TSWS)
- SYSTEMIC: Patient’s Adrenal gland may stop producing Steroids= ADRENAL CRISIS
Corticosteroids nursing considerations?
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!
What are some other names for Topical Steroid Withdrawal Syndrome (TSWS)?
- Topical Steroid Addiction
- Red Skin Syndrome (RSS)
Topical Steroid Withdrawal Syndrome (TSWS) S/S?
- Erythema
- burning/itching
Describe Adrenal Crisis.
- 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
What does High Dose Systemic Steroids cause?
IMMMUNOSUPPRESSION
1) AVOID other people/crowds who may be SICK
2) NO LIVE VACCINES
Who is immunosuppressed?
- Patients on chemotherapy
- Patients on transplant/immunosuppressant drugs
- Patients who are pregnant
- Patients who are on high dose, systemic steroids
