Steriods

Question 1

Steroids can be given for 3 reasons

Answer 1

Replacement

Anti-inflammatory

Immunosuppression

Question 2

What scenarios would we give steroids

Answer 2

Allergies
Dose and route depends upon severity

Asthma
Inhaled steroids

COPD exacerbation
IV transitioned to po

Chronic inflammatory bowel disease

Rheumatic disorders

Post-transplant
Frequently weaned off if no rejection episodes

Question 3

goal of steroid replacement

Answer 3

Mimic physiologic levels

MUST increase dose in times of stress

Question 4

Glucocorticoids (non-endocrine disorders)

Answer 4

Alternate-day therapy
Before 9 am
‘Mimics’ glucocorticoid burst by adrenals at dawn
Traditional dosing multiple, small doses

Question 5

Mineralocorticoids

Answer 5

Once per day dosing

Frequently do not need to replace

Question 6

What are the 3 glucocorticoids

Answer 6

Hydrocortisone
Prednisone
Deszmethasone

Question 7

Hydrocortisone

Answer 7

synthetic, identical to cortisol

some Mineral corticoid (MCC) action

Question 8

routes of hydrocortisone

Answer 8

PO
IV

Question 9

hydorcortisone dosing

Answer 9

low dose- minimal to no adverse effects

Large dose- toxic

Question 10

prednisone can be used for

Answer 10

COPD
Chronic disease states

Question 11

dexamethasone can be used to test what

Answer 11

adrenal function

Question 12

Acute Side effects of glucocorticoid replacement

Answer 12

Increased intraocular pressure problem for people with eye diseases like glaucoma
Fluid retention
High blood pressure
Mood swings
Weight gain- fat deposits in abdomen, face, and back of neck (centralized)
Hunger

Question 13

Long-term side effects of corticosteroid use

Answer 13

If a patient takes steroids for long-term (months to years)

Clouded eye lens (cataracts)

High blood sugar worsening
or developing diabetes

Increased risk of infections (remember WBC suppression)

Thinning bones (osteoporosis) & fractures

Suppressed adrenal gland hormone production

Fatigue, loss of appetite, nausea, muscle weakness

Think skin, bruising, slow wound healing

Question 14

Nursing implications for corticosteroid use

Answer 14

DO NOT ABRUPTLY STOP TAKING
Steroid taper
Tell patients to take at the same time throughout the day
Especially with long-term use
Wear a medical-alert bracelet with long-term use
Monitor weight & blood sugar

Question 15

what is the 1 mineral corticoid

Answer 15

Fludrocortisone (Florinef)

Question 16

Characteristics for Fludrocortisone (Florinef)

Answer 16

Only mineralocorticoid replacement
May be needed with GCC replacement
Salt wasting (inability to maintain Na+ levels, K+ levels high despite adequate renal function)