Steroids Flashcards
HPA Axis Stimulation
increased CTRH decreased cortisol transition to awake hypoglycemia trauma/stress alpha & beta agonists
HPA Axis Inhibition
increased ACTH
increased cortisol
general anesthesia
etomidate
adrenal gland - where is cortisol made
zona fasciculata - middle layer
potency, Na retention, duration – Corticol
1
1
8-12 hours
potency, Na retention, duration - prednisone
4
0.8
18-36 hours
potency, Na retention, duration - dexamethasone
25
0
36-54 hours
mechanism of steroid hormones
acute - occurs in seconds, rapidly increases cortisol production by increasing cholesterol substrate
chronic - genetic changes that increase steroidogenic enzymes
Cortisol Binding
90% bound
10% free
Cortisol Metabolism
liver - phase 1 oxidation
kidney - conjugated and excreted
Acute Adrenal Crisis
s/s
hypoglycemia hypovolemia hyponatremia hyperkalemia metabolic acidosis??
Acute Adrenal Crisis treatment
hydrocortisone 100 mg IV hydrocortisone infusion fluid replacement glucose replacement a-line placement pressers and inotropes
Epidural glucocorticoid injections
neurologic events - vision loss, CVA, paralysis, death
associated with particulate steroid preparation
patients who have received supra physiologic doses of steroids (__mg) for a period of _____ should be considered to have some degree of HPA axis impairment during acute stress.
5
3 weeks within 1 year
HPA axis dysfunction is dependent on the _____ and ____ of steroid therapy
dose and duration
Cortisol secretion
Normal daily output: 20 mg day
highest in morning, lowest around midnight
maximum daily output of cortisol: 200 mg
