Patients on steroids Flashcards
1
Q
Describe the HPA axis
A
Hypothalamic-pituitary-adrenal-axis
- stress
- hypothalamus releases CRH
- CRH has a positive effect on the anterior pituitary
- anterior pituitary releases ACTH
- ACTH has a positive effect on the adrenal cortex
- adrenal cortex releases cortisol
Cortisol and ACTH have a negative effect on the hypothalamus
2
Q
What effects do steriods have on the HPA axis?
A
Cause suppression via negative feedback
3
Q
What happens to serum ACTH after surgery?
A
Increases
- stimulates adrenal cortex
- increases cortisol
4
Q
What effects does cortisol have?
A
Catabolic effects
- increases protein breakdown
- increases lipolysis
- increases gluconeogenesis
Anti-inflammatory effects
5
Q
What may happen to patients who suddenly stop their steroids?
A
Addisonian crisis
- renal sodium loss + potassium reabsorption
- decreased intravascular volume + CO
Symptoms
- nausea
- hypotension
- pyrexia
- confusion
6
Q
What dose of steroids is given peri-operatively?
A
25mg hydrocortisone IV QDS
