N212 Lecture 5 Flashcards
adrenal cortex is the outer or inner layer
outer layer
corticosteroid are stored true or false
false, corticosteroids are synthesizes as needed
When the level of a corticoid steroid is low what gets released from the hypothalamus
Corticotropin releasing hormone which then travels to the anterior pituitary gland, it triggers the release of ACTH
once ACTH is released where does it go
to the adrenal cortex to stimulate production of corticosteroids
Cushing’s syndrome is caused by
the over secretion of adrenocortical hormone redistribution of body fat from the arms and legs to the face, shoulders, trunk and abdomen
2 reasons of Cushings syndrome
ACTH secreting tumor or by excess use of steroids which leads to retention of water and sodium
cause of Addisons disease
undersecretion of the adrenocortical hormone
effects of Addisons disease
decreased blood sodium and glucose levels, increased K levels, dehydration and weight loss
how do corticosteroids exert their effects
modifying enzyme activity
what does glucocorticoids affect
metabolism of carbs, fats, and proteins
How do glucocorticoids differ
in their potency, durations of action and extent to their salt and fluid retention
glucocorticoids do what
inhibit or help control inflammatory and immune responses
how are glucocorticoids administered
inhalation
( for control of steroid responsive bronchospastic states), nasally( for rhinitis and to prevent the recurrence of polyps after removal), topically( for inflammation of eye, ear and skin)
corticosteroid contraindications
septicemia, systemic fungal infection, varicella, patients with gastritis, reflux disease, ulcer disease, diabetes, …cardiac, renal or liver dysfunction
adverse effects for corticosteroids
hear failure, cardiac edema, hypotension ( caused by electrolyte imbalance) hypokalemia, hypernatremia, convulsions, headache, vertigo, insomnia, cushings syndrome, carb intolerance, hyperglycemia, peptic ulcers, pancreatitis, fragile skin, muscle weakness, hyperglycemia and psychosis
what are some corticosteroid interactions
non potassium sparing diuretics ( thiazides, loop diuretics-lasix) which lead to hypocalcemia and hypokalemia
what are some other corticosteroid interactions
aspirin, NSAIDs, ulcerogenic drugs
corticosteroids inhibit?
immune response when given in combination with immunizing biologics
corticosteroids reduce what?
the hypoglycemic effect of antidiabetic drugs and result in elevated blood glucose levels
most common oral glucocorticoid for antiinflammatory or immunosuppressant
prednisone
prednisone also treats
exacerbations of chronic respiratory illnesses
prednisone peak life, half life and duration of action
1-2 hrs, 18-36hr, 36 hrs`
most common injectable glucocorticoid drug
methylprednisolone(solu-medrol)
main use of methylprednisolone
anti inflammatory or immunosuppressant drug
methylprednisolone administered usually by
IV
methylprednisolone available in
long acting formulation
what is the preservative contained in most injectable formulations that cannot be given to children of 28 days or younger
benzyl alcohol
methylprednisolone dose, onset, peak, half life, duration of action
10-40mg q4h, immediate, 30min, 3-4hr,24-36hr
dexamethasone is a synthetic corticosteroid available in
systemic and ophthalmic formulations
dexamethasone is used to treat
inflammation, allergic conditions, burns
dexamethasone can be used on
eye, eyelids, conjunctiva and cornea
dexamethasone route, onset of action, peak, duration of action
ocular, variable, immediate, long
an abrupt withdrawal of adrenal drugs can cause
decrease in or no production of endogenous glucocorticoids which results in adrenal insufficiency
why would an H2 receptor or PPI order be given with glucocorticoids
minimize GI upset and minimize ulcer formation ( these drugs are ulcerogenic)
in long term therapy for glucocorticoids, what is preferred
alternate dosing to help with minimizing adrenal suppresion
analgesics are given for
relieve pain without causing loss of consciousness, painkillers, opioid analgesics, adjuvant analgesic drugs
adjuvant analgesic drugs are
not primarily designed to control pain
pain is
unpleasant sensory and emotional experience associated with actual or potential tissue damage
WHO 1st step analgesic ladder is
nonopioid (with or without adjuvant medication) after the pain has been identified or assessed, if pain continues step 2
WHO 2nd step analgesic ladder
opiods with or without nonopioid and with or without adjuvants. if pain continues step 3
WHO 3rd step analgesic ladder
opiods indicated for moderate to severe pain, administered with or without nonopioid or adjuvant medications
example of nonopioid analgesics
tylenol
tylenol is similar to
aspirin which is a salicylates
mechanism of action for tylenol
blocks pain impulses peripherally by inhibiting prostaglandin synthesis
tylenol uses
analgesic and antipyretic effects
indications for tylenol
mild to moderate pain, fever and alternative for those who cannot take aspirin
contraindications for tylenol
liver dysfunction, possible liver failure
taking tylenol is dangerous if taken with
other drugs that are hepatotoxic
prostaglandin synthesis is
cellular damage cause by thermal, mechanical or chemical stimuli which results in release of excitatory neurotransmitters ( prostaglandins, bradykinin, substance P and histamine)
max dosage for a healthy adult
3000mg/day, 2000mg for older adults and those with liver disease
ovedose of tylenol cause
hepatic necrosis, hepatotoxicity( liver damdge)
antidote for overdose of tylenol
acetylcysteine regimen ( used to prevent liver damage)
NSAIDS MOA
inhibitions of the leukotriene pathway ( one of the groups that cause inflammation)
- the prostaglandin pathway (inflammation)
aspirin(salicylate) uses are
inhibits platelet aggregation and antithrombotic effect ( treatment of MI and other thromboembolic disorders)
salicylate (aspirin) used for
headache, neuralgia ( nerve pain) myalgia ( muscle pain) and arthralgia ( joint paint)
side effects for salicylate ( aspirin)
increased heart rate, hypoglycemia, hyperglycemia, nausea, vomiting, diarrhea
Reyes syndrome is
acute and potential life threatening condition of neurological deficits that can lead to coma and liver damage.
opiod drugs used for
pain relieving drugs known as opioid analgesics
morphine and codeine are from
opium poppy
opioid drugs are
resynthetic drugs that bind to opiate receptors for pain
strong agonists are
morphine, hydromorphone(dilaudid) oxycodone, oxymorphone
