Exam 3- Corticosteroids Flashcards
Corticosteroids
Also called glucocorticoids or steroids
•Hormones produced by adrenal cortex
•Affect almost all body organs in maintaining homeostasis
Corticosteroids mechanism of action
Inhibits arachidonic acid metabolism •Inhibits the production of interleukin-1, and other cytokines •Impairs phagocytosis •Impairs lymphocytes •Inhibits tissue repair
Endogenous corticosteroids
Divided into glucocorticoids, mineral corticoids, and adrenal sex hormones.
Corticosteroids indications for use
Allergy or hypersensitivity •Collagen •Dermatology •Endocrine •Gastrointestinal •Hematology •Hepatic •Neoplastic •Neurology •Opthamology •Organ or tissue transplants or grafts •Renal •Respiratory •Rheumatology •Shock
Corticosteroid withdrawal Syndrome
Malaise, myalgia, nausea, headache, low grade fever, relapse of symptoms (for example; inflammation, pain, asthma) and hypotension
Hydrocortisone
Prototype
Exogenous equivalent of endogenous cortisol
•Anti-inflammatory
•Mechanism of action: Bind to glucocorticoid receptors in target tissues; multiple mechanism of action
Corticosteroid scheduling guidelines
Important to adhere to the schedule
•Short term use: (<1 week) Large divided doses for 48-72 hours, then tapered until discontinued
•Replacement therapy: Daily administration administered between 6 a.m. – 9 a.m.
•Alternate-day therapy (ADT): Double dose taken every other day in the morning; used only for maintenance therapy
Prevention of acute adrenalcortical insufficiency
Do not abruptly withdraw corticosteroids
•Administer corticosteroids during stress
•Administer short courses of steroid therapy for acute disorders, then taper
•Use local over systemic steroid therapy when possible
•Use alternate-day therapy when possible
Indications for prednisone use
- Replacement therapy for adrenal cortical insufficiency
- Severe allergic reactions and anaphylactic reactions
- Collagen Diseases
- Acute exacerbation of chronic diseases (asthma, COPD)
- Rheumatoid arthritis
- Hematologic disorders (thrombocytopenia purpura)
- Ulcerative colitis and Crohn’s Disease
Prednisone
A glucocorticoid
Administered one daily or every other day
•Administered in the morning (6 a.m. - 9 a.m.)
•Never stop suddenly
•Observe for infection (normal signs suppressed)
Contraindications for prednisone use
Contraindications
–Allergy
–Infection
Adverse effects of prednisone
Suppression of physiologic response to infection
exacerbation of gastric ulcers delayed wound healing Increased risk of fracture Sodium and fluid retention Hyperglycemia
Differentiate between low dose and high dose colchicine.
low-dose colchicine has a better treatment response at 24 hours than the high dose with fewer adverse effects such as diarrhea.
What lab values should be monitored with gout?
serum uric acid level.
What patient education should you provide when prescribing colchicine?
Take skipped dose asap without doubling. It should not be discontinued without first consulting the health-care provider. Uric acid levels rise when the drug is stopped. Risk of myopathy and neuropathy. Stopping the drug usually reverses the symptoms within 3 to 4 weeks. To reduce available urates, an alkaline diet may be prescribed that includes reductions in sodium, refined sugars, oxalate-rich foods (e.g., liver, kidney, anchovies, sardines, herring, mussels, bacon, codfish, scallops, trout, haddock, veal, venison, turkey), and excessive calcium intake, as well as increases in oral fluids and dietary fiber.
