L5: Corticosteroids & Analgesics Flashcards
What are the two distinct parts of the adrenal gland?
The adrenal gland consists of the adrenal cortex and the adrenal medulla.
What hormones are secreted by the adrenal medulla?
The adrenal medulla secretes catecholamines, specifically epinephrine and norepinephrine.
What is the primary function of the adrenal cortex?
The adrenal cortex secretes corticosteroids, which are steroid hormones.
What hormones are secreted by the adrenal cortex?
The adrenal cortex secretes corticosteroids, specifically glucocorticoids.
What are glucocorticoids?
Glucocorticoids are a type of corticosteroid produced by the adrenal cortex.
How are corticosteroids stored?
Corticosteroids are synthesized as needed and are not stored in the body.
What regulates the levels of corticosteroids?
The levels of corticosteroids are regulated by the hypothalamic-pituitary-adrenal axis.
What is Cushing’s Syndrome?
Cushing’s Syndrome is caused by the oversecretion of adrenocortical hormones, leading to redistribution of body fat.
What are the symptoms of Cushing’s Syndrome?
Symptoms include the redistribution of body fat from the arms and legs to the face, shoulders, trunk and abdomen, called ‘moon face’. Increased retention of water and sodium (caused by ACTH secreting
tumor or by excess use of steroids.)
What is Addison’s disease?
Addison’s disease is caused by the under secretion of adrenocortical hormones, leading to decreased blood sodium and glucose levels, increased potassium levels, dehydration and weight loss.
What is the mechanism of action of most corticosteroids?
Most corticosteroids exert their effects by modifying enzyme activity.
What are some indications for glucocorticoids?
Indications include bacterial meningitis, cerebral edema, collagen diseases, and organ transplantation.
How can glucocorticoids be administered?
Glucocorticoids can be administered by inhalation, nasally, or topically.
What are some contraindications for corticosteroids?
Contraindications include drug allergies, serious infections, and cautious use in patients with gastritis or diabetes.
What are some common adverse effects of corticosteroids?
Common adverse effects include hyperglycemia, hypertension, and mood swings.
What interactions can occur with corticosteroids?
Corticosteroids can interact with non-potassium-sparing diuretics and NSAIDs, increasing the risk of adverse effects.
What is prednisone used for?
Prednisone is commonly used for anti-inflammatory or immunosuppressant purposes.
What is methylprednisolone (Solumedrol)?
Methylprednisolone is the most commonly used injectable glucocorticoid, primarily for anti-inflammatory purposes.
What is dexamethasone (Decadron)?
Dexamethasone is a synthetic corticosteroid used to treat inflammation and allergic conditions.
How are corticosteroids regulated in the body?
Corticosteroids are regulated by the hypothalamic-pituitary-adrenal axis.
What triggers the release of adrenocorticotropic hormone (ACTH)?
Corticotropin-releasing hormone is released from the hypothalamus when corticosteroid levels are low.
What are the effects of Addison’s disease?
It causes decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss.
Adrenal cortex is made up of
endocrine tissue (hormone
driven)
Adrenal medulla is made up of
neurosecretory endocrine
tisue (hormone and peripheral
autonomic nerve impulses)
What happens when the level of a particular corticoid steroid is low?
Corticotropin-releasing hormone is released from the hypothalamus into the bloodstream and travels to the
anterior pituitary gland.
What does corticotropin-releasing hormone trigger?
It triggers the release of adrenocorticotropic hormone (ACTH).
Where is ACTH transported & What does it stimulate?
ACTH is transported in the blood to the adrenal cortex where stimulates the production of corticosteroids.
Name a type of glucocorticoid.
Methylprednisolone (Solumedrol)
Dexamethasone (Decadron)
Prednisone (Deltasone)
What do glucocorticoids affect?
metabolism of carbohydrates, fats, and proteins.
What is one of the functions of glucocorticoids?
Glucocorticoids inhibit or help control inflammatory and immune responses.
Glucocorticoids are administered by which routes
By inhalation for control of steroid-responsive bronchospastic states
Nasally for rhinitis and to prevent the recurrence of polyps after surgical removal
Topically for inflammations of the eye, ear, and skin
What interactions do corticosteroids have with non–potassium-sparing diuretics?
Corticosteroids can lead to severe hypocalcemia and hypokalemia when used with non–potassium-sparing diuretics (e.g., thiazides like Hydrochlorothiazide, loop diuretics like Lasix).
How do corticosteroids interact with NSAIDs and ulcerogenic drugs?
Corticosteroids produce additive gastrointestinal effects with aspirin, NSAIDs, and other ulcerogenic drugs, increasing the chance of gastric ulcer development.
What is the effect of corticosteroids on immunizing biologics?
Corticosteroids can inhibit the immune response when given in combination with immunizing biologics, increasing the risk for infection.
How do corticosteroids affect antidiabetic drugs?
Corticosteroids can reduce the hypoglycemic effect of antidiabetic drugs, resulting in elevated blood glucose levels.
CORTICOSTEROIDS INTERACT with
Non–potassium-sparing diuretics (e.g., thiazides
-Hydrochlorothiazide, loop diuretics -Lasix)
Aspirin, other nonsteroidal antinflammatory drugs (NSAIDs),
and other ulcerogenic drugs
Immunizing iologics
Antidiabetic drugs
PREDNISONE (Deltasone)
route, uses, peak, onset, half-life
Most commonly used oral glucocorticoid for antinflammatory or immunosuppressant purposes
Used to treat exacerbations of chronic respiratory illnesses
Adult Oral-5-60 mg/day, onset of action-unknown, peak-1-2 hr. Half-life-18-36 hr., duration of action-36
hr.
METHYLPREDNISOLONE (SOLU-MEDROL)
route, uses, peak, onset, half-life
Most commonly used injectable glucocorticoid drug
Primary use: antinflammatory or immunosuppressant drug
Usually administered intravenously
Available in a long-acting (depot) formulation
Most injectable formulations contain a preservative
(benzyl alcohol) that cannot be given to children younger than 28 days of age.
Adult-IV-10-40 mg every4 hr.
Onset-immediate, Peak-30 min, Half-life-3-4 hr.
Duration of action-24-36 hr.
DEXAMETHASONE (DECADRON)
route, uses, peak, onset, half-life
Synthetic corticosteroid available in many systemic and ophthalmic formulations
Used to treat inflammation
including allergic conditions, burns
Can be used for the eye, eyelids, conjunctiva and cornea
Adult route ocular- onset of action variable, peak- immediate, Half-life-unknown,
Oral Dosage 0.75-9mg daily
Duration of action-long
Which of the following should the nurse include when
teaching a patient about glucocorticoid therapy?
A. Do not abruptly stop taking the drug.
B. Take the medication on an empty stomach.
C. Avoid use of antiulcer medications when taking glucocorticoids.
D. When used long term, alternate-day dosing of glucocorticoids will help minimize thyroid suppression.
Correct answer: A
Rationale: Abrupt withdrawal of adrenal drugs (e.g., prednisone, methylprednisolone) may lead to a sudden decrease in, or no production of, endogenous glucocorticoids, resulting in adrenal insufficiency. In long-term therapy, alternate-day dosing of glucocorticoids, if possible, will help minimize the adrenal suppression.
Analgesics
Medications that relieve pain
without causing loss of consciousness. ie Opioid analgesics,
Adjuvant analgesic drugs
Adjuvant analgesic
medications that are primarily used for other purposes but can also help to control pain. Examples are neuropathic pain-Neurontin (anti-seizure medication) and Cymbalta (an
antidepressant).
WHO 3-STEP ANALGESIC LADDER
Step 1: Nonopioid (with or without adjuvant medications) after the pain has been identified and assessed. If pain persists or increases, treatment moves to
Step 2: opioids with or without Nonopioid and with or without adjuvants. If pain persists or
increases, management then rises to
Step 3: opioids indicated for moderate to severe pain, administered with or without
Nonopioid or adjuvant medications
A patient with a history of heavy alcohol use needs a medication for pain. The recommended maximum daily dose of acetaminophen for this patient would be
A. 1000 mg.
B. 2000 mg.
C. 3000 mg.
D. 4000 mg.
Answer B.
Maximum daily dose for healthy
adults is being lowered to 3000
mg/day.
2000 mg for older adults and
those with liver disease
SALICYLATE (ASPIRIN) USES
➢ Inhibits platelet aggregation
Antithrombotic effect: used in the treatment of MI and other
thromboembolic disorders
Systemic lupus erythematosus autoimmune disease (body’s tissue attacked by its own immune system): antirheumatic effects
Antipyretic action (life saving)
Examples of pain treated by SALICYLATE (ASPIRIN)
Headache, neuralgia (nerve pain), myalgia (muscle pain), and
arthralgia (joint pain)
Pain syndromes resulting from inflammation: arthritis, pleurisy, and
pericarditis
SALICYLATE (ASPIRIN) & heart attacks
Antithrombotic effect: used in the treatment of MI and other
thromboembolic disorders
Antipyretic action (life saving)
Shown to reduce cardiac death after myocardial infarction (MI)
● Should be administered at the first sign of MI
● If not given before arriving in the emergency department, aspirin is one of the first drugs given if there are no contraindications
ASPIRIN DOSAGE for MI
Daily tablet (81 mg or 325 mg): prophylactic therapy for adults who have strong risk factors for developing coronary artery disease or cardiovascular accident
Effective after MI
The 81- and 325-mg strengths appear to be equally beneficial for the prevention of thrombotic events.
SALICYLATE (ASPIRIN) SIDE EFFECTS
Salicylism: salicylate poisoning
Reye’s Syndrome,
Increased heart rate, Tinnitus (hearing loss), dimness of vision, headache, dizziness, mental confusion, drowsiness, Nausea, vomiting, diarrhea, Sweating, thirst, hyperventilation, hypoglycemia or hyperglycemia
What is Reye’s Syndrome (Aspirin) ?
Acute and potentially life-
threatening condition involving
progressive neurologic deficits that
can lead to coma and may also
involve liver damage.
Triggered by viral illnesses such as
influenza as well as by salicylate
therapy itself in the presence of a
viral illness.
May or may not lead to permanent
neurologic damage.
What are OPIOID DRUGS
Pain-relieving drugs known as opioid
analgesics from the opium poppy
Examples of Opioid drugs
Morphine and Codeine are from the poppy
ReSynthetic drugs that bind to the opiate receptors to relieve pain
Strong agonists: morphine, hydromorphone (Dilaudid), oxycodone, oxymorphone
Mild agonists: codeine, hydrocodone
