Lecture 06_Spring

Question 1

Your body typically secretes about ___ mg of cortisol per day

Answer 1

20 mg/day

Question 2

What is the action of glucocorticoids?

Answer 2

anti-inflammatory

Question 3

What is the main concern in patients who are on or have recently been on medications with steroids in them?

Answer 3

Suppression of the HPA (hypothalamic-pituitary-adrenal) axis

Adrenal gland no longer able to secrete cortisol in response to stress (illness, surgery)

Risk of cardiovascular collapse (acute adrenal insufficiency) with stress

Question 4

Suppression of the HPA axis can occur after only __ days of taking prednisone __mg /day and can take months to fully recover

Answer 4

5days of taking prednisone 20mg /day

9-12 months to fully recover

Question 5

What is the anti-emetic dose of decadron? What dose prevents cerebral edema?

Answer 5

4mg; 10-20mg

Question 6

The “stress-dose” of hydrocortisone that is necessary can vary dose based on magnitude (stress) of the surgical procedure as well
as the perceived risk of this patient developing acute adrenal insufficiency.

What is the typical stress dose suggested for a procedure with minor surgical stress such as a colonoscopy?

Answer 6

25mg bolus

Question 7

The “stress-dose” of hydrocortisone that is necessary can vary dose based on magnitude (stress) of the surgical procedure as well
as the perceived risk of this patient developing acute adrenal insufficiency.

What is the typical stress dose suggested for a moderate surgical stress procedures such as a hysterectomy ?

Answer 7

50-75mg bolus

Question 8

The “stress-dose” of hydrocortisone that is necessary can vary dose based on magnitude (stress) of the surgical procedure as well
as the perceived risk of this patient developing acute adrenal insufficiency.

What is the typical stress dose suggested for a major surgical stress procedure such as a AAA repair?

Answer 8

100-150mg bolus

Question 9

__ mg of decadron is equivalent to ___ mg of cortisol.

Answer 9

0.75mg decadron = 25mg cortisol

Question 10

OCX enzymes convert ___ to ___.

Answer 10

convert Arachidonic Acid → Prostaglandins

Question 11

___ is a constitutive enzyme - it has a constant level of activity and 3 important things for our body: ___, ___, and ___.

Answer 11

COX-1: Constitutive = constant level of activity

1. Maintenance and protection of gastric mucosa
2. Platelet aggregation (depends on generation of thromboxane A2)
3. Maintenance of renal blood flow

Question 12

____ is an inducible = expressed at sites of injury - it is not a friend to our body. Usually when levels are high, something bad is happening. 3 major effects on our body are ___, ____, and ___.

Answer 12

COX-2: Inducible = expressed at sites of injury

1. Fever
2. Pain
3. inflammation

Pain and inflammation: mediated by PGE2
• Up-regulates sensitivity of peripheral nociceptors
• Cross blood-brain barrier to facilitate spinal nociception

Question 13

What are the desirable feature of NSAIDS?

Answer 13

1. Deactivate/desensitize nociceptors
2. Attenuate inflammatory response
3. No addiction or dependence
4. Synergistic with opioids
5. Pre-emptive analgesia?
6. No respiratory depression
7. Minimal nausea/vomiting
8. Long duration of action
9. No cognitive side effects

Question 14

What are the 3 functions/side effects of aspirin?

Answer 14

1. analgesia
2. antipyretic
3. antiplatelet (irreversible)

Question 15

What are the 3 functions/side effects of ibuprofen (Motrin, Advil)?

Answer 15

1. analgesia
2. antipyretic
3. anti-inflammatory

Question 16

T o F. Torodol is used for post-op analgesia but can cause increased bleeding due to its reversible inhibition of platelet aggregation.

Answer 16

True

Question 17

30 mg IM Torodol = mg morphine__

Answer 17

10 mg morphine

Question 18

Peak effect for Torodol is____

Answer 18

45-60 min

Question 19

NSAIDs are not recommended during pregnancy, especially during 3rd trimester b/c they may cause premature closure of ___ ____ ___ and limit renal blood flow. They have also been linked to premature birth and miscarriage.

Answer 19

fetal ductus arteriosus

Question 20

Celebrex is ______ inhibitor.

Answer 20

COX-2 specific inhibitor

Question 21

____ is not a true NSAID b/c it is not a/an ____. It is however a/an _____ and ______.

Answer 21

Not anti-inflammatory

Is an antipyretic and analgesic

Question 22

Tylenol is metabolized in the liver and the inactive metabolite/toxins are scavenged by ____. More than ___ g/day of tylenol can cause hepatic necrosis. Chronic alcohol used increases the risk because increased ____ activity leads to decreased ____ stores.

Answer 22

Scavenged by glutathione

More than 4g/day

increased P-450 activity leads to decreased glutathione stores.

Question 23

_____ can be given to prevent hepatic damage from tylenol overdose if it is given within ___ hrs

Answer 23

Acetylcysteine, 8 hrs