Lecture 06_Spring Flashcards
Your body typically secretes about ___ mg of cortisol per day
20 mg/day
What is the action of glucocorticoids?
anti-inflammatory
What is the main concern in patients who are on or have recently been on medications with steroids in them?
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
Suppression of the HPA axis can occur after only __ days of taking prednisone __mg /day and can take months to fully recover
5days of taking prednisone 20mg /day
9-12 months to fully recover
What is the anti-emetic dose of decadron? What dose prevents cerebral edema?
4mg; 10-20mg
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?
25mg bolus
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 ?
50-75mg bolus
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?
100-150mg bolus
__ mg of decadron is equivalent to ___ mg of cortisol.
0.75mg decadron = 25mg cortisol
OCX enzymes convert ___ to ___.
convert Arachidonic Acid → Prostaglandins
___ is a constitutive enzyme - it has a constant level of activity and 3 important things for our body: ___, ___, and ___.
COX-1: Constitutive = constant level of activity
- Maintenance and protection of gastric mucosa
- Platelet aggregation (depends on generation of thromboxane A2)
- Maintenance of renal blood flow
____ 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 ___.
COX-2: Inducible = expressed at sites of injury
- Fever
- Pain
- Inflammation
Pain and inflammation: mediated by PGE2
• Up-regulates sensitivity of peripheral nociceptors
• Cross blood-brain barrier to facilitate spinal nociception
What are the desirable feature of NSAIDS?
- Deactivate/desensitize nociceptors
- Attenuate inflammatory response
- No addiction or dependence
- Synergistic with opioids
- Pre-emptive analgesia
- No respiratory depression
- Minimal nausea/vomiting
- Long duration of action
- No cognitive side effects
What are the 3 functions/side effects of aspirin?
- analgesia
- antipyretic
- antiplatelet (irreversible)
What are the 3 functions/side effects of ibuprofen (Motrin, Advil)?
- analgesia
- antipyretic
- anti-inflammatory
T or F. Torodol is used for post-op analgesia but can cause increased bleeding due to its reversible inhibition of platelet aggregation.
TRUE
30 mg IM Torodol = mg morphine__
10 mg morphine
Peak effect for Torodol is____
45-60 min
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.
fetal ductus arteriosus
Celebrex is ______ inhibitor.
COX-2 specific inhibitor
____ is not a true NSAID b/c it is not a/an ____. It is however a/an _____ and ______.
Not anti-inflammatoryIs an antipyretic and analgesic
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.
Scavenged by glutathione
More than 4g/day
increased P-450 activity leads to decreased glutathione stores.
_____ can be given to prevent hepatic damage from tylenol overdose if it is given within ___ hrs
Acetylcysteine, 8 hrs
