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)
2
Q
What is the middle layer of the adrenal Cortex and what does it produce:
A
- Zona Fascicula (layer)
- Glucocorticoids (production)
3
Q
What is the inner layer of the adrenal cortex and what does it produce:
A
- Zona reticularis (layer)
- Weak androgens (producation)
4
Q
Where is cortisol (hydrocortisone) produced and how is it released:
A
- Zona fascicula
- HPA axis due to stress
5
Q
Where is aldosterone produced and how is it released:
A
- Zona glomerulosa
- Chain of action starting at Renin:AG1:AG2:aldosterone
6
Q
What type of electrolytes changes will be seen with aldosterone?
A
- K+ excretion
- Na retention
- Water retention (blood volume)
7
Q
Due to a normal circadian rhythm when will CRH, ACTH, and cortisol be high and low:
A
HIGH - morning
LOW - evening
8
Q
What disease is associated with 1 degree adrenocortical insuffiency:
A
-addison’s disease
9
Q
T/F: Addison disease is when the adrenals do not produce any cortisol or aldosterone.
A
TRUE
10
Q
What replacement therapy is needed for addison disease:
A
- glucocorticoid
- mineralocorticoid
11
Q
What is 2 degree adrenocortical insufficiency:
A
-Occurs due to chronic steroid use and suppression of the HPA axis
12
Q
What replacement therapy is needed for 2 degree adrenocortical insufficiency:
A
-glucocorticoid
13
Q
Another name for a glucocorticoid is:
A
-hydrocortisone (cortisol)
14
Q
Another name for a mineralocorticoid is:
A
-aldosterone
15
Q
Glucocorticoid effect has an ______ respone.
A
-anti-inflammatory
16
Q
Mineralocorticoid effect evokes a ____ renal tubular reabsorption of __ in exchange for a __.
A
-distal
-Na+
K+
17
Q
List the natural occurring Corticosteroids:
A
- Cortisol
- Cortisone
- Corticosterone
- Desoxycorticosterone
- Aldosterone
18
Q
List the synthetic corticosteroids:
A
-GLUCOCORTICOIDS =prednisolone =prednisone =methylprednisolone =betamethasone =dexamethasone =triamcinolone
-MINERALOCORTICOIDS
=fludrocortisone
19
Q
Water soluble forms (steroids) can be administered I.V. as:
A
-Cortisol succinate
20
Q
Steroids with prolong effects are administered as:
A
-Cortisone acetate
21
Q
T/F: Corticosteroids are able to cross the placenta.
A
TRUE
22
Q
Corticosteroids side effects to the endocrine:
A
- adrenal atrophy
- HPA axis suppression
- Cushing’s syndrome
- Diabetes/hyperglycemia
23
Q
Corticosteroids side effects to the cardio:
A
- dyslipidemia
- HTN
- Thrombosis
- Vasculitis
24
Q
Corticosteroids side effects to the CNS:
A
- Cataracts
- glaucoma
- Changes in behavior/mood/memory/HA/cerebral atrophy
25
Corticosteroids side effects to the immune:
- Immunosuppression
- increased infection risk
- Latent viral activation
26
Corticosteroids side effects to the renal:
- Increase sodium
- Water retention
- increase potassium
- increase hydrogen ion
- edema
27
Corticosteroids side effects to the GI:
- PUD
- GI bleed
- pancreatitis
28
Corticosteroids side effects to the musculoskeletal:
-OP
-osteonecrosis
atrophy
myopathy
retardation of normal bone growth
29
Corticosteroids side effects to the skin:
- atrophy
- acne
- dermatitis
- delayed wound healing
- erythema
- ecchymosis
- hirsutism
- hyperpigmentation
30
Corticosteroids side effects to the GU:
- delayed puberty
- hypogonadism
- fetal growth inhibition
- menstual disorder
31
Corticosteroids ____ glucose use in peripheral tissues and ______ hepatic gluconeogenesis.
- inhibit
| - promote
32
What changes to oral hypoglycemics may need to take place when corticosteroids are administered to type II diabetes.
Hypoglycemic dose may need to be increased.
33
Redistribution of body fat may go where:
- back (buffalo hump)
- supraclavicular
- face (moon face)
34
What type of catabolic effects will be seen with corticosteroids:
- Decreased skeletal muscle mass
- osteoporosis
- thinning of the skin
- negative nitrogen balance
35
How long until cataracts can develop with corticosteroids:
4 year
36
What type of behavioral changes may occur with corticosteroid use:
- manic depression
| - suicidal tendencies
37
Peripheral blood changes in the long term corticosteroids tend to increase:
- hematocrit
| - leukocytes
38
Peripheral blood changes in a single dose of corticosteroids will decrease:
- 70% of lemphocytes
- 90% of monocytes
- cells are sequestered rather than destroyed
39
Can arrest growth result from the administration of relatively small doses of glucocorticoids to children.
YES
40
Corticosteroids with inhibit ___ synthesis and ___ division.
- DNA
| - Cell
41
What are the contraindication for corticosteroid use:
- Actice systemic infection
- immunosuppression
- acute psychosis
- primary glaucome
- hypokalemia
- CHF
- Cushing's syndrome
- Diabetes
- hypertension
- osteoporosis
- hyperthyroidism
42
Acute adrenal insufficiency (stress dose steroids) would depend on:
- dose of previous steroid therapy
- duration of previous steroid therapy
- time since previous steroid therapy
- electrolyte and fluid replacement
43
Replacement therapy for chronic adrenal insufficiency (addison's disease) would be admistered how:
-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
What would be the drug of choice to treat lumbar disc disease:
- tramcinolone 25-50 mg
| - methylpredniolone 40-80 mg
45
What would be the drug of choice to treat arthritis:
-prednisolone 10 mg
46
T/F: painless destruction of the joint is a risk in intra articular injection for episodic acute joint inflammation associated with osteoarthritis.
True
47
T/F: Dexamethasone 8 mg IV with HT3 blocker is superior to HT3 blocker alone in preventing PONV.
TRUE
48
Which is better at preventing PONV; giving dexamethasone at induction of anesthesia or at the end of anesthesia.
Beginning of anesthesia (4 mg IV)
49
Steroid are currently NOT recommended to be used with in cerebral edem:
- ischemic or hemorrhagic stroke
| - SAH
50
Which drug is of choice to decrease cerebral edema:
-dexamethasone without meneralocorticoid
51
(ASTHMA) __ - __ % of inhaled dose form of MDI is deposited in the oropharynx and swallowed.
80
| 90
52
Inhaled doses of less than _____mcg in adults and less than ____mcg in children have little or no effect on pituitary adrenal function.
- 1500
| - 400
53
What are the side effect of inhaled steroids:
- dysphonia (1/3 of patients)
| - oral candidiasis
54
What is the length of time needed for dose of PARENTAL steroid to work appropriately prior to surgery:
1 to 2 hours
55
Topical steroids that are full strength (SUPER POTENT):
- Clobetasol
- Betamethasone
- Mometasone
- Fluocinonide
- Desoximethasone
56
Topical steroids that are mid-strength:
- Fluticasone
| - Hydrocorticose
57
Topical steroids that are least potent:
-hydrocortisone
58
Postintubation laryngeal edema can be decreased using steroids.
TRUE
59
What is the drug of choice for postintubation laryngeal edema and the proper administration:
-methylprednisolone 20-40mg every 4-6 hours for a length of 12 to 24 hours
60
Which patient are high risk for postintubation laryngeal edema:
-6 days
61
T/F: Steroid use in Respiratory distress syndrome (RDS) should be used as a last resort.
TRUE
62
Long term use of steroid greater than _______ increases mortality in the respiratory distress syndrome ADULT patient.
2 weeks.
63
Steroid help ______ the incidence and severity of RDS in neonates born between __ and __ weeks of estimated gestational age.
- decrease
- 24
- 36
64
Administration of dexamethasone to low birth weight infants for a period of 42 days helps:
- decrease the risk of bronchopulmonary dysplasia
| - improve neurodevelopmental outcome
65
What three health problem is steroids no longer recommended in:
- Septic shock
- cardiac arrest
- aspiration pneumonitis
66
What may result due to blunted/absent cortisol due to corticosteroid administration:
hypotension
67
_________ secretion reamins intact in 2 degree adrenal insufficiency.
-aldosterone
68
T/F: Prednisone or dexamethasone given as a single daily dose at bedtime is associated more commonly with HPA axis suppression.
TRUE
69
Glucocorticoids of any dose less than __ weeks does not clinically suppress the HPA axis
3
70
T/F: Prednisolone 5 mg/day or less is unlikely to suppress HPA axis.
TRUE
71
Therapies assumed to suppress HPA axis are:
- 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
Which returns to normal first the H-P function or the adrenal function.
H-P function
73
How long after cessation of steroid therapy can it take before HPA axis returns to normal.
12 months
74
Endogenous cortisol production during stress is NOT > _ mg/day
150
75
What are the S/S of acute adrenal crisis:
- Hypotension unresponsive to vasopressors
- Hyperdynamic circulation
- hypoglycemia
- hyperkalemia
- hyponatremia
- hypovolemia
- metabolic acidosis
- decreased level of consciousness
76
What are the surgeons concerns about the intraoperative use of corticosteroids:
- 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
What is the route for thyroid hormones:
```
HYPOTHALAMUC
+trh
PITUITARY
+tsh
THYROID
```
78
The negative feed back comes from the _____ in the form of T3 and T4 and goes to the ______ and _____.
- thyroid
- pituitary
- hypothalamus
79
What is the disease name when to little thyroid hormone is produced.
-Hashimoto Desease
80
What is the disease name when to much thyroid hormone is produced:
-Graves disease
81
What is the clinical presentation of Hashimoto Disease (hypothyroid):
- Cold intolerance
- dry skin
- gatigue
- Weight gain
- bradycardia
- slow reflexes
- coarse skin and hair
- periorbital swelling
- painful/heavy menstruation
- myxedema coma
82
What is the clinical presentation of Graves Disease (hyperthyroid):
- weight loss
- heat intolerance
- goiter
- fine hair
- tachycardia
- nervous, anxiety/insomnia
- lighter periods/smenorrhea
- sweating/warm/moist skin
- exophthalmos
- thyroid storm
83
What is the usual ratio of T3:T4 in the body:
1:4
84
Due to its long elimination half life (7 days), patients unable to take Levothyroxine (T4) do not require immediate replacement to I.V. Form.
TRUE
85
After 7 days of no synthroid administration administer ____ the dose IV.
Half
86
Liothyronine has a higher incidence of ___ side effects.
Cardio
87
Liothyronine is a good for long term therapy for thyroid therapy.
FALSE
88
Hypothyroidism causes increases in anesthetic in what way:
- increase sensitivity to depressant drugs
| - increase in PaCO2
89
Hypothyroidism causes decreases in anesthetic in what way:
- 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
What medications will be used in HYPERthyroidism:
- propylthiouracil(PTU)
| - Methimazole (Tapazole)
91
What is the method of action for propylthiouracil or methimazole:
-inhibits the formation of thyroid hormone by interfering with the incorporation of iodine into tyrosine residues of thyroglobin.
92
How long until surgery can take place on a hyperthyoidism patient who is taking propylthiouracil and or methimazole.
7 days
93
What are some adverse effects of antithyroid medications:
- transient leucopenia
- rash
- Arthralgias
- lupus like symptoms
- fever
- granulocytosis early in therapy
94
Lugol's solution and saturated KI solution are the oldest effective treatments for hyperthyroidism.
TRUE
95
Lugol's solution and/or saturated KI solution with the combination of propranolol is used for the treatment of hyperthyroidism before a ________.
Thyroidectomy
96
If chronic use of lugol's solution and or saturated KI solution it can cause suppressed excessive thyroid gland activity.
TRUE
97
What are the S/S of thyroid storm:
- hyperthermia
- tachycardia
- CHF
- dehydration
- Shock
98
What is the time frame when thyroid storm is most likely to occur:
First 6 to 19 hours postop
99
Will thyroid storm be slow or fast onset:
Fast onset (Abrupt)
100
What is the treatment of thyroid storm:
- infusion of cold crystalloid solutions
- sodium iodide
- Cortisol IV
- Propranolol IV
- Propylthiouracil P.O.
- Avoid ASA
101
Why avoid ASA during a thyroid storm:
-it may displace thyroxine from carrier proteins
