Quiz 7: Corticosteriods Flashcards
What is the outer layer of the adrenal Cortex and what does it produce:
- Zona glomerulosa (layer)
- Mineralocorticoids (production)
What is the middle layer of the adrenal Cortex and what does it produce:
- Zona Fascicula (layer)
- Glucocorticoids (production)
What is the inner layer of the adrenal cortex and what does it produce:
- Zona reticularis (layer)
- Weak androgens (producation)
Where is cortisol (hydrocortisone) produced and how is it released:
- Zona fascicula
- HPA axis due to stress
Where is aldosterone produced and how is it released:
- Zona glomerulosa
- Chain of action starting at Renin:AG1:AG2:aldosterone
What type of electrolytes changes will be seen with aldosterone?
- K+ excretion
- Na retention
- Water retention (blood volume)
Due to a normal circadian rhythm when will CRH, ACTH, and cortisol be high and low:
HIGH - morning
LOW - evening
What disease is associated with 1 degree adrenocortical insuffiency:
-addison’s disease
T/F: Addison disease is when the adrenals do not produce any cortisol or aldosterone.
TRUE
What replacement therapy is needed for addison disease:
- glucocorticoid
- mineralocorticoid
What is 2 degree adrenocortical insufficiency:
-Occurs due to chronic steroid use and suppression of the HPA axis
What replacement therapy is needed for 2 degree adrenocortical insufficiency:
-glucocorticoid
Another name for a glucocorticoid is:
-hydrocortisone (cortisol)
Another name for a mineralocorticoid is:
-aldosterone
Glucocorticoid effect has an ______ respone.
-anti-inflammatory
Mineralocorticoid effect evokes a ____ renal tubular reabsorption of __ in exchange for a __.
-distal
-Na+
K+
List the natural occurring Corticosteroids:
- Cortisol
- Cortisone
- Corticosterone
- Desoxycorticosterone
- Aldosterone
List the synthetic corticosteroids:
-GLUCOCORTICOIDS =prednisolone =prednisone =methylprednisolone =betamethasone =dexamethasone =triamcinolone
-MINERALOCORTICOIDS
=fludrocortisone
Water soluble forms (steroids) can be administered I.V. as:
-Cortisol succinate
Steroids with prolong effects are administered as:
-Cortisone acetate
T/F: Corticosteroids are able to cross the placenta.
TRUE
Corticosteroids side effects to the endocrine:
- adrenal atrophy
- HPA axis suppression
- Cushing’s syndrome
- Diabetes/hyperglycemia
Corticosteroids side effects to the cardio:
- dyslipidemia
- HTN
- Thrombosis
- Vasculitis
Corticosteroids side effects to the CNS:
- Cataracts
- glaucoma
- Changes in behavior/mood/memory/HA/cerebral atrophy
Corticosteroids side effects to the immune:
- Immunosuppression
- increased infection risk
- Latent viral activation
Corticosteroids side effects to the renal:
- Increase sodium
- Water retention
- increase potassium
- increase hydrogen ion
- edema
Corticosteroids side effects to the GI:
- PUD
- GI bleed
- pancreatitis
Corticosteroids side effects to the musculoskeletal:
-OP
-osteonecrosis
atrophy
myopathy
retardation of normal bone growth
Corticosteroids side effects to the skin:
- atrophy
- acne
- dermatitis
- delayed wound healing
- erythema
- ecchymosis
- hirsutism
- hyperpigmentation
Corticosteroids side effects to the GU:
- delayed puberty
- hypogonadism
- fetal growth inhibition
- menstual disorder
Corticosteroids ____ glucose use in peripheral tissues and ______ hepatic gluconeogenesis.
- inhibit
- promote
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.
Redistribution of body fat may go where:
- back (buffalo hump)
- supraclavicular
- face (moon face)
What type of catabolic effects will be seen with corticosteroids:
- Decreased skeletal muscle mass
- osteoporosis
- thinning of the skin
- negative nitrogen balance
How long until cataracts can develop with corticosteroids:
4 year
What type of behavioral changes may occur with corticosteroid use:
- manic depression
- suicidal tendencies
Peripheral blood changes in the long term corticosteroids tend to increase:
- hematocrit
- leukocytes
Peripheral blood changes in a single dose of corticosteroids will decrease:
- 70% of lemphocytes
- 90% of monocytes
- cells are sequestered rather than destroyed
Can arrest growth result from the administration of relatively small doses of glucocorticoids to children.
YES
Corticosteroids with inhibit ___ synthesis and ___ division.
- DNA
- Cell
What are the contraindication for corticosteroid use:
- Actice systemic infection
- immunosuppression
- acute psychosis
- primary glaucome
- hypokalemia
- CHF
- Cushing’s syndrome
- Diabetes
- hypertension
- osteoporosis
- hyperthyroidism
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
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)
What would be the drug of choice to treat lumbar disc disease:
- tramcinolone 25-50 mg
- methylpredniolone 40-80 mg
What would be the drug of choice to treat arthritis:
-prednisolone 10 mg
T/F: painless destruction of the joint is a risk in intra articular injection for episodic acute joint inflammation associated with osteoarthritis.
True
T/F: Dexamethasone 8 mg IV with HT3 blocker is superior to HT3 blocker alone in preventing PONV.
TRUE
Which is better at preventing PONV; giving dexamethasone at induction of anesthesia or at the end of anesthesia.
Beginning of anesthesia (4 mg IV)
Steroid are currently NOT recommended to be used with in cerebral edem:
- ischemic or hemorrhagic stroke
- SAH
Which drug is of choice to decrease cerebral edema:
-dexamethasone without meneralocorticoid
(ASTHMA) __ - __ % of inhaled dose form of MDI is deposited in the oropharynx and swallowed.
80
90
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
What are the side effect of inhaled steroids:
- dysphonia (1/3 of patients)
- oral candidiasis
What is the length of time needed for dose of PARENTAL steroid to work appropriately prior to surgery:
1 to 2 hours
Topical steroids that are full strength (SUPER POTENT):
- Clobetasol
- Betamethasone
- Mometasone
- Fluocinonide
- Desoximethasone
Topical steroids that are mid-strength:
- Fluticasone
- Hydrocorticose
Topical steroids that are least potent:
-hydrocortisone
Postintubation laryngeal edema can be decreased using steroids.
TRUE
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
Which patient are high risk for postintubation laryngeal edema:
-6 days
T/F: Steroid use in Respiratory distress syndrome (RDS) should be used as a last resort.
TRUE
Long term use of steroid greater than _______ increases mortality in the respiratory distress syndrome ADULT patient.
2 weeks.
Steroid help ______ the incidence and severity of RDS in neonates born between __ and __ weeks of estimated gestational age.
- decrease
- 24
- 36
Administration of dexamethasone to low birth weight infants for a period of 42 days helps:
- decrease the risk of bronchopulmonary dysplasia
- improve neurodevelopmental outcome
What three health problem is steroids no longer recommended in:
- Septic shock
- cardiac arrest
- aspiration pneumonitis
What may result due to blunted/absent cortisol due to corticosteroid administration:
hypotension
_________ secretion reamins intact in 2 degree adrenal insufficiency.
-aldosterone
T/F: Prednisone or dexamethasone given as a single daily dose at bedtime is associated more commonly with HPA axis suppression.
TRUE
Glucocorticoids of any dose less than __ weeks does not clinically suppress the HPA axis
3
T/F: Prednisolone 5 mg/day or less is unlikely to suppress HPA axis.
TRUE
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
Which returns to normal first the H-P function or the adrenal function.
H-P function
How long after cessation of steroid therapy can it take before HPA axis returns to normal.
12 months
Endogenous cortisol production during stress is NOT > _ mg/day
150
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
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
What is the route for thyroid hormones:
HYPOTHALAMUC \+trh PITUITARY \+tsh THYROID
The negative feed back comes from the _____ in the form of T3 and T4 and goes to the ______ and _____.
- thyroid
- pituitary
- hypothalamus
What is the disease name when to little thyroid hormone is produced.
-Hashimoto Desease
What is the disease name when to much thyroid hormone is produced:
-Graves disease
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
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
What is the usual ratio of T3:T4 in the body:
1:4
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
After 7 days of no synthroid administration administer ____ the dose IV.
Half
Liothyronine has a higher incidence of ___ side effects.
Cardio
Liothyronine is a good for long term therapy for thyroid therapy.
FALSE
Hypothyroidism causes increases in anesthetic in what way:
- increase sensitivity to depressant drugs
- increase in PaCO2
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
What medications will be used in HYPERthyroidism:
- propylthiouracil(PTU)
- Methimazole (Tapazole)
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.
How long until surgery can take place on a hyperthyoidism patient who is taking propylthiouracil and or methimazole.
7 days
What are some adverse effects of antithyroid medications:
- transient leucopenia
- rash
- Arthralgias
- lupus like symptoms
- fever
- granulocytosis early in therapy
Lugol’s solution and saturated KI solution are the oldest effective treatments for hyperthyroidism.
TRUE
Lugol’s solution and/or saturated KI solution with the combination of propranolol is used for the treatment of hyperthyroidism before a ________.
Thyroidectomy
If chronic use of lugol’s solution and or saturated KI solution it can cause suppressed excessive thyroid gland activity.
TRUE
What are the S/S of thyroid storm:
- hyperthermia
- tachycardia
- CHF
- dehydration
- Shock
What is the time frame when thyroid storm is most likely to occur:
First 6 to 19 hours postop
Will thyroid storm be slow or fast onset:
Fast onset (Abrupt)
What is the treatment of thyroid storm:
- infusion of cold crystalloid solutions
- sodium iodide
- Cortisol IV
- Propranolol IV
- Propylthiouracil P.O.
- Avoid ASA
Why avoid ASA during a thyroid storm:
-it may displace thyroxine from carrier proteins