Glucocorticoids 3-5

Question 1

Glucocorticoids aka Corticosteroids
(-sone)

Answer 1

-nearly identical to steroids
for:
-inhibit synthesis of chemical mediators & immune component of inflammation –> reduce swelling, warmth, redness, pain
-cancer treatment
-suppress immune responses in organ transplant
(risk for adverse when high doses for long time)

Question 2

therapeutic uses for glucocorticoids

Answer 2

-Rheumatoid Arthritis
-Systemic Lupus Erythematosus
-IBD
-other inflammatory disorders and allergic conditions
-asthma
-neoplasms: suppress immune system (more risk infx)
-suppress organ rejection post-transplant: take lifelong

Question 3

pharmacokinetics

Answer 3

-metab by liver
-excreted by kidney
-absorption depennds on route and dose
+large dose: for severe, acute attacks

Question 4

adverse effects

Answer 4

-adrenal insufficiency: cushing s/s (hyperglycemia, glycosuria, moon face, skin thinning)
-osteoporosis: affect long bone growth esp in children
+older adults also susceptible
+obtain bone mineral density baseline –> Ca and vit D supplement
-infection: bc suppress immune system
-muscle weakness (myopathy): body aches/sore
-glucose intolerance
-F/E imbalances: hyperNa and hypervolemia and hypoK (bc too much aldosterone)
-psych disturbances (ex: mood changes): dont give at bedtime
-cataracts and glaucoma: eye exam q6months
-PUD: block prostaglandin production (not enough HCO3 and mucus to protect gastric lining) –> pain wont be as present bc glucocorticoids are blocking inflammatory response
-iatrogenic cushings disease: caution use in children, preg, lactating

Question 5

contraindications

Answer 5

-fungal infx: can feed and overgrow fungus
-vaccines (esp live): feed weakened virus
-caution in children, pregnant, lactating

Question 6

interactions

Answer 6

-digoxin and diuretics: worry abt hypoK
-NSAIDS: renal impair and increase risk for gastric ulcers
-insulin and oral hypoglycemics: monitor BG and increase insulin doses

-eat lots of citrus to minimize complications

Question 7

adrenal suppression

Answer 7

-after long term use: adrenal will be unable to produce glucocorticoids
–> use alternate day dosing to minimize suppression
-want to treat bc we worry abt pt risk of trauma and infection

Question 8

glucocorticoid withdrawal

Answer 8

-taper, withdraw slowly: NEVER withdraw suddenly
-switch from multiple daily dosing to single doses
-monitor for bodys production of cortisol
-give at dinner/meal time AND dont give at bedtime
-give before 9AM: most ideal if single dose before 9am –> doesnt keep pt up, before breakfast (protect GI), and matches normal time adrenal gland naturally secretes
-s/s withdrawal: hypotension, hyperglycemia, myalgia, athralgia, fatigue