Glucocorticoids - Ch. 63 & Ch. 76 Flashcards
Where are glucocorticoids secreted from?
Adrenal gland–> Adrenal cortex
What does the adrenal medulla secrete?
Epinephrine and norepinephrine
What stimulates glucocorticoid release?
Anterior pituitary ACTH
What do glucocorticoids do physiologically?
Promote glucose availability
Protein metabolism
Fat metabolism
Supports SNS activity on blood vessels
Oversecretion of adrenocortical hormones leads to what?
Cushing’s syndrome
Under secretion of adrenocortical hormones leads to what?
Addison’s disease
What are some glucocorticoids drugs?
Prednisone (prodrug)
prednisolone
cortisone
dexamethasone
What is prednisone?
Drug of choice of oral glucocorticoids for anti-inflammatory purposes and hormone replacement
How are glucocorticoids administered?
inhalation
Nasally
Topically
Systemic (IV, PO)
What are inhaled glucocorticoids used for?
Asthma,COPD
What are nasal glucocorticoids used for?
Rhinitis
Prevent the recurrence of polyps after surgical removal
What are topical glucocorticoids used for?
Inflammations of the eye, ear and skin
What are systemic (IV, PO) glucocorticoids used for?
Hormone replacement
Immunosupression
What is the mechanism of action of glucocorticoids?
Alter gene expression of many proteins
-Help control inflammatory and immune responses
What are glucocorticoids used for?
Adreneocortical deficiency (lifelong replacement therapy)
Anti-inflammatory/immune suppression
-Chronic resp. illnesses
-Organ transplant
-Derm. diseases
-GI diseases
Leukemia and lymphoma (kill malignant cells)
Spinal cord injury
Cerebral edema
When is glucocorticoid use contraindicated?
Serious infections
-systemic fungal infections
When are glucocorticoid to be used cautiously?
Gastritis, reflect disease, peptic ulcer disease
Diabetes mellitus (leads to hyperglycemia)
Hypertension, HF, renal impairment
Pregnancy
What adverse effects are associated with glucocorticoid use?
Mimic Cushing’s syndrome
Significant effects on all body systems
What Cushing syndrome symptoms can glucocorticoids mimic?
-moon face
-buffalo hump (fat deposits on neck)
-abdominal fat
-thin arms and legs
-stria (red markings)
What Cardiovascular adverse effects are associated with glucocorticoids?
HF
Cardiac edema
hypertension
What CNS adverse effects are associated with glucocorticoids?
convulsions
headache
vertigo
mood swings
nervousness
insomnia
steroid psychosis
What endocrine adverse effects are associated with glucocorticoids?
Growth supression
Cushing’s
menstrual irregularities
carbohydrate intolerance
hyperglycemia
Why do glucocorticoids cause hyperglycemias?
Increase plasma glucose levels
What GI adverse effects are associated with glucocorticoids?
peptic ulcers with possible perforation
pancreatitis
abdominal distention
What integumentary adverse effects are associated with glucocorticoids?
Fragile skin
Petechiae
Ecchymoses
Facial erythema
Poor wound healing
Hirsutism
Urticaria
What musculoskeletal adverse effects are associated with glucocorticoids?
Muscle weakness
Loss of muscle mass
Osteoporosis
What ocular adverse effects are associated with glucocorticoids?
Increased intraocular pressure
Glaucoma
Usually replacement therapy via glucocorticoids does not cause what adverse effect?
Cushing’s syndrome
During what use of glucorticoids are major adverse effects more common?
Inflammation suppression uses
Immune suppression uses
-depends on dosage
During times of stress what may need to happen with glucocorticoid replacement therapy?
Increase dosage
stressors = infections, surgery, traumas
e.g, 3 by 3 rule for febrile illness
What is the 3 by 3 rule for febrile illness?
take 3 time the usual dose of glucocorticoids for 3 days
What do glucorticoids do during immunosuppressant therapy?
Drug inhibits physiological control of cortisol secretion
-reduces ACTH
Cortex atrophy
-allows adrenal cortex to recover
Sudden discontinuation of glucocorticoids can cause what?
Adrenal crisis
What is adrenal crisis?
Adrenal incapacity to synthesis glucocorticoids
-not enough cortisol
Symptoms of adrenal crisis?
Abdominal pain
Low BP
Dehydration (syncope, dizziness)
Shock, fatal
Nausea, vomiting
Extreme fatigue
Confusion, convulsions
How is Adrenal crisis avoided?
Drug doses are tapered before being discontinued
What should patients taking adrenal medications be taught?
Take all adrenal meds at the same time every day, usually in the morning, with food
What drugs should be taken with caution when the patient is on glucocorticoids?
NSAIDs
-stomach ulcers
What should the patient be taught to do after used inhaled glucocorticoids?
Rinse mouth to prevent oral fungal infections
Who should patients taking glucocorticoids avoid contact with?
People with infections
-report fever, weakness, lethargy, sore throat
