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Emily: Pharm 2 > Quiz 7: Corticosteriods > Flashcards

Quiz 7: Corticosteriods Flashcards

1
Q

What is the outer layer of the adrenal Cortex and what does it produce:

A
  • Zona glomerulosa (layer)

- Mineralocorticoids (production)

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2
Q

What is the middle layer of the adrenal Cortex and what does it produce:

A
  • Zona Fascicula (layer)

- Glucocorticoids (production)

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3
Q

What is the inner layer of the adrenal cortex and what does it produce:

A
  • Zona reticularis (layer)

- Weak androgens (producation)

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4
Q

Where is cortisol (hydrocortisone) produced and how is it released:

A
  • Zona fascicula

- HPA axis due to stress

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5
Q

Where is aldosterone produced and how is it released:

A
  • Zona glomerulosa

- Chain of action starting at Renin:AG1:AG2:aldosterone

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6
Q

What type of electrolytes changes will be seen with aldosterone?

A
  • K+ excretion
  • Na retention
  • Water retention (blood volume)
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7
Q

Due to a normal circadian rhythm when will CRH, ACTH, and cortisol be high and low:

A

HIGH - morning

LOW - evening

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8
Q

What disease is associated with 1 degree adrenocortical insuffiency:

A

-addison’s disease

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9
Q

T/F: Addison disease is when the adrenals do not produce any cortisol or aldosterone.

A

TRUE

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10
Q

What replacement therapy is needed for addison disease:

A
  • glucocorticoid

- mineralocorticoid

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11
Q

What is 2 degree adrenocortical insufficiency:

A

-Occurs due to chronic steroid use and suppression of the HPA axis

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12
Q

What replacement therapy is needed for 2 degree adrenocortical insufficiency:

A

-glucocorticoid

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13
Q

Another name for a glucocorticoid is:

A

-hydrocortisone (cortisol)

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14
Q

Another name for a mineralocorticoid is:

A

-aldosterone

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15
Q

Glucocorticoid effect has an ______ respone.

A

-anti-inflammatory

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16
Q

Mineralocorticoid effect evokes a ____ renal tubular reabsorption of __ in exchange for a __.

A

-distal
-Na+
K+

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17
Q

List the natural occurring Corticosteroids:

A
  • Cortisol
  • Cortisone
  • Corticosterone
  • Desoxycorticosterone
  • Aldosterone
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18
Q

List the synthetic corticosteroids:

A 
-GLUCOCORTICOIDS
=prednisolone
=prednisone
=methylprednisolone
=betamethasone
=dexamethasone
=triamcinolone

-MINERALOCORTICOIDS
=fludrocortisone

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19
Q

Water soluble forms (steroids) can be administered I.V. as:

A

-Cortisol succinate

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20
Q

Steroids with prolong effects are administered as:

A

-Cortisone acetate

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21
Q

T/F: Corticosteroids are able to cross the placenta.

A

TRUE

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22
Q

Corticosteroids side effects to the endocrine:

A
  • adrenal atrophy
  • HPA axis suppression
  • Cushing’s syndrome
  • Diabetes/hyperglycemia
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23
Q

Corticosteroids side effects to the cardio:

A
  • dyslipidemia
  • HTN
  • Thrombosis
  • Vasculitis
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24
Q

Corticosteroids side effects to the CNS:

A
  • Cataracts
  • glaucoma
  • Changes in behavior/mood/memory/HA/cerebral atrophy
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25
Q

Corticosteroids side effects to the immune:

A
  • Immunosuppression
  • increased infection risk
  • Latent viral activation
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26
Q

Corticosteroids side effects to the renal:

A
  • Increase sodium
  • Water retention
  • increase potassium
  • increase hydrogen ion
  • edema
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27
Q

Corticosteroids side effects to the GI:

A
  • PUD
  • GI bleed
  • pancreatitis
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28
Q

Corticosteroids side effects to the musculoskeletal:

A

-OP
-osteonecrosis
atrophy
myopathy
retardation of normal bone growth

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29
Q

Corticosteroids side effects to the skin:

A
  • atrophy
  • acne
  • dermatitis
  • delayed wound healing
  • erythema
  • ecchymosis
  • hirsutism
  • hyperpigmentation
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30
Q

Corticosteroids side effects to the GU:

A
  • delayed puberty
  • hypogonadism
  • fetal growth inhibition
  • menstual disorder
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31
Q

Corticosteroids ____ glucose use in peripheral tissues and ______ hepatic gluconeogenesis.

A
  • inhibit

- promote

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32
Q

What changes to oral hypoglycemics may need to take place when corticosteroids are administered to type II diabetes.

A

Hypoglycemic dose may need to be increased.

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33
Q

Redistribution of body fat may go where:

A
  • back (buffalo hump)
  • supraclavicular
  • face (moon face)
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34
Q

What type of catabolic effects will be seen with corticosteroids:

A
  • Decreased skeletal muscle mass
  • osteoporosis
  • thinning of the skin
  • negative nitrogen balance
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35
Q

How long until cataracts can develop with corticosteroids:

A

4 year

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36
Q

What type of behavioral changes may occur with corticosteroid use:

A
  • manic depression

- suicidal tendencies

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37
Q

Peripheral blood changes in the long term corticosteroids tend to increase:

A
  • hematocrit

- leukocytes

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38
Q

Peripheral blood changes in a single dose of corticosteroids will decrease:

A
  • 70% of lemphocytes
  • 90% of monocytes
  • cells are sequestered rather than destroyed
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39
Q

Can arrest growth result from the administration of relatively small doses of glucocorticoids to children.

A

YES

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40
Q

Corticosteroids with inhibit ___ synthesis and ___ division.

A
  • DNA

- Cell

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41
Q

What are the contraindication for corticosteroid use:

A
  • Actice systemic infection
  • immunosuppression
  • acute psychosis
  • primary glaucome
  • hypokalemia
  • CHF
  • Cushing’s syndrome
  • Diabetes
  • hypertension
  • osteoporosis
  • hyperthyroidism
42
Q

Acute adrenal insufficiency (stress dose steroids) would depend on:

A
  • dose of previous steroid therapy
  • duration of previous steroid therapy
  • time since previous steroid therapy
  • electrolyte and fluid replacement
43
Q

Replacement therapy for chronic adrenal insufficiency (addison’s disease) would be admistered how:

A

-Cortisol 25 - 37.5 mg P.O. (25 mg A.M. and 12.5 mg P.M.)

AND/OR

Oral mineralocorticoid (fludrocortisone 0.1 mg - 0.3 mg DAILY)

44
Q

What would be the drug of choice to treat lumbar disc disease:

A
  • tramcinolone 25-50 mg

- methylpredniolone 40-80 mg

45
Q

What would be the drug of choice to treat arthritis:

A

-prednisolone 10 mg

46
Q

T/F: painless destruction of the joint is a risk in intra articular injection for episodic acute joint inflammation associated with osteoarthritis.

A

True

47
Q

T/F: Dexamethasone 8 mg IV with HT3 blocker is superior to HT3 blocker alone in preventing PONV.

A

TRUE

48
Q

Which is better at preventing PONV; giving dexamethasone at induction of anesthesia or at the end of anesthesia.

A

Beginning of anesthesia (4 mg IV)

49
Q

Steroid are currently NOT recommended to be used with in cerebral edem:

A
  • ischemic or hemorrhagic stroke

- SAH

50
Q

Which drug is of choice to decrease cerebral edema:

A

-dexamethasone without meneralocorticoid

51
Q

(ASTHMA) __ - __ % of inhaled dose form of MDI is deposited in the oropharynx and swallowed.

A

80

90

52
Q

Inhaled doses of less than _____mcg in adults and less than ____mcg in children have little or no effect on pituitary adrenal function.

A
  • 1500

- 400

53
Q

What are the side effect of inhaled steroids:

A
  • dysphonia (1/3 of patients)

- oral candidiasis

54
Q

What is the length of time needed for dose of PARENTAL steroid to work appropriately prior to surgery:

A

1 to 2 hours

55
Q

Topical steroids that are full strength (SUPER POTENT):

A
  • Clobetasol
  • Betamethasone
  • Mometasone
  • Fluocinonide
  • Desoximethasone
56
Q

Topical steroids that are mid-strength:

A
  • Fluticasone

- Hydrocorticose

57
Q

Topical steroids that are least potent:

A

-hydrocortisone

58
Q

Postintubation laryngeal edema can be decreased using steroids.

A

TRUE

59
Q

What is the drug of choice for postintubation laryngeal edema and the proper administration:

A

-methylprednisolone 20-40mg every 4-6 hours for a length of 12 to 24 hours

60
Q

Which patient are high risk for postintubation laryngeal edema:

A

-6 days

61
Q

T/F: Steroid use in Respiratory distress syndrome (RDS) should be used as a last resort.

A

TRUE

62
Q

Long term use of steroid greater than _______ increases mortality in the respiratory distress syndrome ADULT patient.

A

2 weeks.

63
Q

Steroid help ______ the incidence and severity of RDS in neonates born between __ and __ weeks of estimated gestational age.

A
  • decrease
  • 24
  • 36
64
Q

Administration of dexamethasone to low birth weight infants for a period of 42 days helps:

A
  • decrease the risk of bronchopulmonary dysplasia

- improve neurodevelopmental outcome

65
Q

What three health problem is steroids no longer recommended in:

A
  • Septic shock
  • cardiac arrest
  • aspiration pneumonitis
66
Q

What may result due to blunted/absent cortisol due to corticosteroid administration:

A

hypotension

67
Q

_________ secretion reamins intact in 2 degree adrenal insufficiency.

A

-aldosterone

68
Q

T/F: Prednisone or dexamethasone given as a single daily dose at bedtime is associated more commonly with HPA axis suppression.

A

TRUE

69
Q

Glucocorticoids of any dose less than __ weeks does not clinically suppress the HPA axis

A

3

70
Q

T/F: Prednisolone 5 mg/day or less is unlikely to suppress HPA axis.

A

TRUE

71
Q

Therapies assumed to suppress HPA axis are:

A
  • prednisone 20 mg/day (or equivalent for >3 weeks within the previous year
  • Patient with clinical signs of cushing syndrome from any steroid dose
  • No need to test the HPA axis in these patient, just supplement with stress doese steroids
72
Q

Which returns to normal first the H-P function or the adrenal function.

A

H-P function

73
Q

How long after cessation of steroid therapy can it take before HPA axis returns to normal.

A

12 months

74
Q

Endogenous cortisol production during stress is NOT > _ mg/day

A

150

75
Q

What are the S/S of acute adrenal crisis:

A
  • Hypotension unresponsive to vasopressors
  • Hyperdynamic circulation
  • hypoglycemia
  • hyperkalemia
  • hyponatremia
  • hypovolemia
  • metabolic acidosis
  • decreased level of consciousness
76
Q

What are the surgeons concerns about the intraoperative use of corticosteroids:

A
  • masking infection or further complicating surgery intended to treat infection
  • altering glucose control in diabetics
  • aseptic nerosis of the femoral head
  • failure of bone fusion
77
Q

What is the route for thyroid hormones:

A 
HYPOTHALAMUC
\+trh
PITUITARY
\+tsh
THYROID
78
Q

The negative feed back comes from the _____ in the form of T3 and T4 and goes to the ______ and _____.

A
  • thyroid
  • pituitary
  • hypothalamus
79
Q

What is the disease name when to little thyroid hormone is produced.

A

-Hashimoto Desease

80
Q

What is the disease name when to much thyroid hormone is produced:

A

-Graves disease

81
Q

What is the clinical presentation of Hashimoto Disease (hypothyroid):

A
  • Cold intolerance
  • dry skin
  • gatigue
  • Weight gain
  • bradycardia
  • slow reflexes
  • coarse skin and hair
  • periorbital swelling
  • painful/heavy menstruation
  • myxedema coma
82
Q

What is the clinical presentation of Graves Disease (hyperthyroid):

A
  • weight loss
  • heat intolerance
  • goiter
  • fine hair
  • tachycardia
  • nervous, anxiety/insomnia
  • lighter periods/smenorrhea
  • sweating/warm/moist skin
  • exophthalmos
  • thyroid storm
83
Q

What is the usual ratio of T3:T4 in the body:

A

1:4

84
Q

Due to its long elimination half life (7 days), patients unable to take Levothyroxine (T4) do not require immediate replacement to I.V. Form.

A

TRUE

85
Q

After 7 days of no synthroid administration administer ____ the dose IV.

A

Half

86
Q

Liothyronine has a higher incidence of ___ side effects.

A

Cardio

87
Q

Liothyronine is a good for long term therapy for thyroid therapy.

A

FALSE

88
Q

Hypothyroidism causes increases in anesthetic in what way:

A
  • increase sensitivity to depressant drugs

- increase in PaCO2

89
Q

Hypothyroidism causes decreases in anesthetic in what way:

A
  • Decrease CO due to decreased HR and SV
  • Slowed metabolism of drugs (Opioids especially)
  • Unresponsive baroreceptor reflexes
  • Decrease in intravascular fluid volume
  • Impaired ventilator response to low PaO2
  • Delay in gastric emptying
  • hyponatremic
  • hypothermic
  • anemic
  • hypoglycemic
  • primary adrenal insufficiency
90
Q

What medications will be used in HYPERthyroidism:

A
  • propylthiouracil(PTU)

- Methimazole (Tapazole)

91
Q

What is the method of action for propylthiouracil or methimazole:

A

-inhibits the formation of thyroid hormone by interfering with the incorporation of iodine into tyrosine residues of thyroglobin.

92
Q

How long until surgery can take place on a hyperthyoidism patient who is taking propylthiouracil and or methimazole.

A

7 days

93
Q

What are some adverse effects of antithyroid medications:

A
  • transient leucopenia
  • rash
  • Arthralgias
  • lupus like symptoms
  • fever
  • granulocytosis early in therapy
94
Q

Lugol’s solution and saturated KI solution are the oldest effective treatments for hyperthyroidism.

A

TRUE

95
Q

Lugol’s solution and/or saturated KI solution with the combination of propranolol is used for the treatment of hyperthyroidism before a ________.

A

Thyroidectomy

96
Q

If chronic use of lugol’s solution and or saturated KI solution it can cause suppressed excessive thyroid gland activity.

A

TRUE

97
Q

What are the S/S of thyroid storm:

A
  • hyperthermia
  • tachycardia
  • CHF
  • dehydration
  • Shock
98
Q

What is the time frame when thyroid storm is most likely to occur:

A

First 6 to 19 hours postop

99
Q

Will thyroid storm be slow or fast onset:

A

Fast onset (Abrupt)

100
Q

What is the treatment of thyroid storm:

A
  • infusion of cold crystalloid solutions
  • sodium iodide
  • Cortisol IV
  • Propranolol IV
  • Propylthiouracil P.O.
  • Avoid ASA
101
Q

Why avoid ASA during a thyroid storm:

A

-it may displace thyroxine from carrier proteins

Emily: Pharm 2 (11 decks)

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