Exam 3 Flashcards
another name for corticosteroids?
glucocorticoids
hormones produced by adrenal cortex?
corticosteroids
where are glucocorticoids produced?
adrenal cortex
inadequate or excess secretion of corticosteroids results in what?
disease
how many steroid hormones does adrenal cortex produce?
30
what are the three classes of adrenal cortex hormones?
glucocorticoids, mineralocorticoids, adrenal sex hormones
effect of GCs on arachidonic acid metabolism?
inhibit
effect of GCs on biologic membranes?
strengthens or stabilizes
effect of GCs on interleukin-1 production?
inhibit
effect of GCs on tumor necrosis factor production?
inhibit
effect of GCs on other cytokines?
inhibit
effect of GCs on phagocytosis?
impairs
effect of GCs on lymphocytes?
impairs
effect of GC on tissue repair?
inhibits
symptoms of what? Malaise, myalgia, nausea, headache, low grade fever, relapse of symptoms, hypotension
GC withdrawal
prototype GC?
hydrocortisone
what is the exogenous equivalent of endogenous cortisol?
hydrocortisone
drug? Bind to glucocorticoid receptors in target tissues
hydrocortisone
when are short term GCs indicated?
self-limiting conditions
when are long term GCs indicated?
life-threatening conditions or severe disabling symptoms
how long is ‘short-term’ gc USE?
<1 WEEK
dosing of short term GCs?
large divided doses for 48-72 hours, then tapered until discontinued
during what hours should GC replacement therapy be admin?
6-9 am daily
describe alternate-day GC therapy?
double dose taken every other day in the morning
when is alternate-day GC therapy used?
only for maintenance therapy
can corticosteroids be stopped suddenly?
no
what should be used over systemic steroid therapy if possible?
local
what GC is used for replacement therapy for adrenal cortical insufficiency?
prednisone
what GC may be used for severe allergic and anaphylactic reactions?
prednisone
what GC may be used for acute exacerbation of chronic diseases? (asthma, COPD)
prednisone
what GC may be used for RA?
prednisone
what GC may be used for hematologic disorders?
prednisone
what GC may be used for thrombocytopenia purpura?
prednisone
what GC may be used in neoplastic disease?
prednisone
what GC may be used for ulcerative colitis?
prednisone
what GC may be used for Cronhn’s disease?
prednisone
during what hours should prednisone be taken?
6-9 am
normal signs of WHAT may be suppressed by prednisone?
infection
what are two medication options to help avoid prednisone GI irritation?
ranitidine or omeprazole
what should we do to steroid dose with increased stress? (surgery)
increase dosage
careful assessment of WHAT with prednisone?
wound healing
prednisone suppresses physiologic response to WHAT?
infection
what medication may lead to increased susceptibility to TB?
prednisone
what medication may lead to increased susceptibility to herpes virus?
prednisone
what medication may lead to increased susceptibility to varicella virus?
prednisone
what medication may cause acne?
prednisone
what medication may delay would healing?
prednisone
how does prednisone cause osteoporosis?
calcium loss from the bone
increased risk of fracture- what endocrine med?
prednisone
effect of prednisone on sodium?
sodium retention
effect of prednisone on fluid?
fluid retention
effect of prednisone on blood glucose?
increased
anxiety and insomnia are associated with what medication?
prednisone
what medication may exacerbate gastric ulcers?
prednisone
two GI complaints with prednisone?
nausea and vomiting
diabetics on prednisone, need more what?
insulin
non-diabetics are also susceptible to WHAT on prednisone?
increased blood sugar
non-diabetics may also need what while on prednisone?
short term sliding scale insulin
two contraindications to prednisone?
allergy and infection
what GC is given for poison ivy?
methylprednisolone dose pack
what drug? Given IV short term management of acute problems such as asthma
methylprednisolone sodium succinate (solumedrol)
what drug? Short term use requiring maximum anti-inflammatory activity?
dexamethasone
specific indication example for dexamethasone?
cerebral edema
what medication class can be used for joint injection for pain control?
glucorticoids (tissue can become damaged if given too often)
what medication have been used in the treatment of patients who are moderately to severely ill with COVID19?
systemic glucocorticoids
what two GCs can be used in moderately-severely ill patients with Covid 19?
methylprednisolone and dexamethasone
when is insulin used in T1DM?
always
what is the one circumstance where insulin is not used in T1DM?
pancreatic transplant
when do type 2 DM need insulin?
most patients over time as beta cell function decreases
do not wait too long to start what in T2DM?
insulin
in what electrolyte imbalance can insulin be used?
hyperkalemia
what is the role of insulin to treat hyperkalemia?
insulin + glucose pushes potassium into cells (resolving the hyperkalemia)
what two conditions is insulin used for in hospital inpatients?
DKA or hyperosmolar hyperglycemic state
WHAT type of insulin therapy is used to maintain normoglycemia when the patient is fasting?
basal
what type of insulin therapy is used to cover food ingested before a meal?
bolus
what type of insulin therapy is used to decrease elevation of blood glucose after food intake?
bolus
basal insulin therapy is used in what type(s) of diabetes?
used in both type1 and type2 (not always initially in type 2)
when is bolus insulin therapy used in type 1 DM?
always
when is bolus insulin therapy used in type 2 DM?
add when beta cell function is not adequate to respond to food intake
basal insulin therapy suppresses what?
any liver gluconeogenesis
what are the 6 types of insulin?
rapid-acting, short-acting, intermediate-acting, long-acting, ultra long acting, inhaled
insulin lispro is what type of insulin?
rapid-acting
insulin aspart is whhat type of insulin?
rapid-acting
insulin glulisine- what type of insulin?
rapid-acting
name the three rapid-acting insulin analogues?
insulin lispro, insulin aspart, insulin glulisine
what is the onset of action of rapid-acting insulin?
15 minutes
rapid-acting insulin has a faster onset than what?
endogenous insulin
what type of insulins have a faster onset than endogenous insulin?
rapid-acting
when are rapid-acting insulins used? (types)
types 1 and 2 DM
what is the indication for rapid-acting insulin?
used as bolus therapy to treat hyperglycemia or blood sugar due to food eaten
what type of insulin is regular insulin?
short-acting
example of short-acting insulin?
regular insulin
what is the onset of action of regular insulin?
30 minutes
what is the duration of action for short-acting insulin?
4 hours (up to 12 hours)
what is the clinically relevant peak of action of regular insulin?
1-2 hours
what type of insulin is NPH?
intermediate-acting
example of intermediate-acting insulin?
NPH/isophane
what types of DM use short-acting insulin?
type 1 and type 2
indication of short-acting insulin?
used as bolus therapy to treat hyperglycemia or blood sugar due to food eaten in types 1 and 2 DM
onset of action of NPH?
1-1.5 hours
duration of action of NPH?
12-24 hohurs
what is the usual duration of action of NPH re: clinical efficacy?
16 hours
what is the indication for NPH?
used as basal insulin in types 1 and 2 DM
examples of long acting insulin?
insulin glargine
is insulin glargine an insulin analogue?
yes
can long-acting insulin be given IV?
no
can you mix insulin glargine with other insulins?
no
can you mix insulin detemir with other insulins?
no
can you give insulin glargine IV?
no
can you give insulin detemir IV?
no
how is insulin glargine uniqu?
no pronounced peak of action
what are the benefits of insulin glargine re: no peak?
less hypoglycemia and better glycemic control
