Endocrine- Corticosteroids

Question 1

What are the Natural and Synthetic steroids?

Answer 1

Natural –Cortisol (hydrocortisone), cortisone, aldosterone Synthetic –Prednisone, Prednisolone, Methylprednisone, Dexamethasone

Question 2

Effects of Mineralcorticoids

Answer 2

Aldosterone –Reabsorption of Na and excretion of K in the distal tubule

Question 3

Effects of Glucocorticoids

Answer 3

• Anti-inflammatory effects
• Augmentation of sustained SNS activity during periods of emotional and physical stress

Question 4

Where are mineralcorticoid and glucocorticoid receptors found?

Answer 4

Mineralcorticoid– Organs of excretion –Colon, salivary glands, kidney, sweat glands, hippocampus

Corticosteroids -Wide Spread

Question 5

MOA of corticosteroids

Answer 5

1. Enter cells and bind to steroid receptors in cytoplasm 2. This complex moves into the nucleus 3. It influences DNA transcription and protien synthesis

Question 6

MOA of steroids, Metabolic effects (and long term effects)

Answer 6

1. Increase blood glucose (can cause Diabetes) 2. Break down Proteins (muscle wasting) 3. Increase Triglycerides (Maldistribution, athrosclerosis)

Question 7

MOA of steroids, Inflammation

Answer 7

1. Phospholipase A2 (produces Arachidonic acid) is inhibited by a steroid generated protein = less arachidonic acid 2. Cytokine and chemokine release decreased OVERALL -Increase in anti-inflammatory protein transcription -Decreased in pro-inflammatory protein transcription

Question 8

How much endogenous cortisol do we produce daily?

Answer 8

10-20 mg/ day on average 50-150 mg/ day during the week before orals (or other stressors)

Question 9

Cortisol pharmakokinetics (the prototype in this class) (PB, formulations, metabolism, e1/2

Answer 9

• Many Routes -IV formulation Solu-cortef -90 PB -70% metabolized in liver -30% unchanged in urine -e1/2 1.5-3.0 hours (clinical effects last for much longer)

Question 10

Relative potencies for Anti-inflammatory and Sodium retaining potency between meds (Chart)

Answer 10

Maggie!!!!!! insert this chart here slide 27

Question 11

Highlights of Synthetic Corticosteroids

Answer 11

1. Methylprednisone IV- intense glucocorticoid effects
2. Betamethasone PO/IV- lacks mineralcorticoid effects
3. Dexamethasone PO/IV- used for cerebral edema, antiemetic, and airway edema, no mineralcorticoid effects
4. Triamcinolone (intraarticularly, IV/PO)- often used for epidural injectiosn
5. Prednisolone PO/IV- mineral and gluco effects —–Prednisone is converted to prednisolone in body

Question 12

Reasons to Give Steroids

Answer 12

Replacement for deficient adrenal or pituitary, Anti-inflammatory

Question 13

When should you give a stress dose of steroids?

Answer 13

If they have taken a steroid for 1 month in the last 6-12 months, Give it! You can always draw it up and have it ready but more than likely you’ll give it

Question 14

Example of dosing in acute and chronic adrenal insufficiency

Answer 14

Acute- Cortisol 100 mg q8 hrs Chronic- PO 25 mg q am and 12.5 mg in afternoon

Question 15

Asthma Uses Acute and Chronic

Answer 15

• Acute
  
  • <1hr see Beta agonist enhancement
  • 4-6 hrs anti-inflammatory effects
• Chronic
  
  • 1st line therapy for bronchospasm in asthmatics
  • 80-90% swallowed and at risk for dysphonia
  • Usually do not see HPA axis disterbance until daily doses >1500 mcg adults, >400 mcg peds

Question 16

Steroids as an Antiemetic

Answer 16

Decadron - 8-10mg IV - Must be given shortly after induction for best effects -synergistic with zofran -e1/2 3 hrs —antiemetic effects last for up to 24 hrs

Question 17

Other uses of Steroids

Answer 17

-Intracranial Tumors- ICP and edema control -Immunosuppression- Transplants and autoimmune -Lumbar disk herniation- epidural injections –Triamcinolone 25-50 mg –or 40-80 mg methyprednisolone with lido –HPA axis suppressed 1-3 months after

Question 18

Side Effects

Answer 18

1. HPA axis suppression - CV COLLAPSE INTRA-OP 2. FLuid and electrolyte imbalances 3. Osteoporosis 4. Infectiosn 5. PUD 6. Skelatal Muscle Weakness 7. Psych disorders 8. Growth retardation in children 9. decrease anticoagulant effectiveness

Question 19

Do you want to give decadron while pt is awake?

Answer 19

Nope, Fire crotch

Question 20

how large of a stress dose should you give? (chart)

Answer 20