Glucocorticoids/Corticosteriods Flashcards
the adrenal cortex produces
produces glucose-regulating steroids; these drugs very similar.
Corticosteriods do what to glucose **
raise blood glucose
Corticosteriods do what to sodium/water *****
causes retention of sodium and water
Corticosteriods do what to fat **
fat deposits are mobilized
Corticosteriods do what to the immune system *****
suppress immune response and inflammation (why we take them)
Corticosteriods do what to neonates
mature their lungs at birth
process of inflammation:
Release of chemical mediators (prostaglandins, histamine, leukotrienes):
the immune response causes
vasodilation and increased capillary permeability
the immune response initiates
characteristic symptoms of pain, swelling, redness, & warmth
the immune response amplifys
action of lymphocytes & phagocytic cells (neutrophils & macrophages)
Indications for the Glucocorticoids function**
Anti-inflammatory and immunosuppressant effects
Therapeutic uses in nonendocrine disorders
asthma; Rheumatoid arthritis; Systemic lupus erythematosus; Inflammatory bowel disease; Miscellaneous inflammatory disorders
Indications for the Glucocorticoids
Allergic conditions; Asthma; Dermatologic disorders; Neoplasms; Suppression of allograft rejection; Prevention of respiratory distress syndrome
when use Glucocorticoids for Suppression of allograft rejection for what pts **
transplant pts
adverse effects
Adrenal insufficiency; Osteoporosis; Infection; Glucose intolerance; Fluid and electrolyte disturbance; Cataracts and glaucoma; Peptic ulcer disease; Myopathy; Growth retardation; Psychologic disturbances
adrenal insufficiency
pharmacologic doses of glucocorticoids can SUPPRESS production of body’s glucocorticoids
Glucocorticoid withdrawal should be done
SLOWLY; example, taper the dosage over 7 days, or switch from multiple doses to single doses or taper the dosage to 50% of physiologic values over a month’s time (Consider NSAIDs during withdrawal to minimize symptoms)
Monitor for signs of adrenal insufficiency:
↓BP, ↓glucose levels, myalgia, arthralgia, & fatigue
Osteoporosis**
glucocorticoids suppress bone formation
All patients should receive**
calcium and vitamin D supplements
Na+ restriction + thiazide diuretic can
enhance intestinal absorption of calcium
a biophosphonate (alendronate/ Fosamax) inhibits
bone resorption
Infection:
by suppresing the immune response, glucocorticoids increase susceptibility to infection AND reactivating a latent infection
signs and symptoms of infection may
not be evident, even though infection is present
Patients should avoid
close contact with people who have a communicable disease
Glucose intolerance:
glucocorticoids increase blood glucose levels
Diabetics may need to
reduce caloric intake or increase dosage of hypoglycemic agents/insulin
Patients on long term steroid use should have
periodic blood glucose levels checked
Fluid and electrolyte disturbance:
Iatrogenic Cushing’s Syndrome
Iatrogenic Cushing’s Syndrome symptoms
- hypertension
- fluid retention/ overload/ weight gain/edema
- Na+ retention (may need to restrict Na+ intake)
- K+ loss (watch for dysrhythmias/signs of hypokalemia; take K+ supplements/high K+ foods
peptic ulcer disease
by ↓ prostaglandin production, gastric acid ↑
Use in pregnancy and lactation:
glucocorticoids can cross placenta- prolonged use/high doses can cause fetal adrenal suppression; crosses to breast milk
Drug interactions
Interactions related to potassium loss; Nonsteroidal anti-inflammatory drugs (NSAIDs & gastric ulcers); Insulin and oral hypoglycemics; Vaccines ( a live virus vaccine with glucocorticoid increases chance of developing virus-Avoid vaccines while on glucocorticoids
Glucocorticoids/ Corticosteroids *****
(cortisone, prednisone, betamethasone, dexamethasone, hydrocortisone, methylprednisolone) (all end in sone)
