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NURS 804: Pharmacology > Unit 10: Corticosteroids > Flashcards

Unit 10: Corticosteroids Flashcards

1
Q

What stimulates the adrenals to release cortisol?

A

ACTH

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2
Q

What releases ACTH?

A

The anterior pituitary

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3
Q

What stimulates the kidneys to retain sodium and therefore water?

A

ADH

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4
Q

What releases ADH?

A

The posterior pituitary

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5
Q

What kind of steroid is cortisol?

A

GLUCOcorticoid

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6
Q

What kind of steroid is aldosterone?

A

MINERALOcorticoid

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7
Q

What do the glucocorticoids do?

A

metabolism function

immune function

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8
Q

What do the mineralocorticoids do?

A

regulate fluids, electroltytes

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9
Q

What is another name for cortisol?

A

hydrocortisone

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10
Q

What is CBG?

A

cortisol binding globulin

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11
Q

When are levels of CBG higher?

A

pregnancy
increased estrogen
hyperthyroidism

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12
Q

What happens to cortisol when CBG levels go up?

A

less cortisol available

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13
Q

When are levels of CBG lower?

A

protein deficiency
hypothyroidism
genetic defect in synthesis of CBG

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14
Q

What happens to cortisol when CBG levels go down?

A

more cortisol available

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15
Q

What intracellular effects do corticosteroids have?

A 
growth
pro-inflammatory cytokines
immune activity
insulin amount and action
glucagon
catecholamine response
ACTH
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16
Q

What does cortisol do?

A

FASTING: stimulates gluconeogenesis and glycogen synthesis
muscle catabolism
increases serum glucose –> provides continuous supply of glucose to the brain
increases insulin secretion
changes in fat metabolism
increased fatty acids in serum

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17
Q

Why does a person on prednisone have higher WBC counts but decreased response to infection?

A

prednisone increases # of neutrophils by releasing more from bone marrow, but keeps them in the serum and does not allow them to go to the area of inflammation

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18
Q

What effect does cortisol have on macrophages?

A

macrophages are cells that eat bacteria

steroids inhibit them

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19
Q

What effect does cortisol have on prostaglandins?

A

reduces prostaglandins synthesis –> reason steroids can be helpful in arthritis

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20
Q

What effect does cortisol have on mood?

A

depression

insomnia

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21
Q

What effect does cortisol have on the head?

A

increases intracranial pressure (psuedotumor cerebri)

22
Q

What effect does cortisol have on other hormones from the pituitary?

A 
increases 
ACTH
GH
TSH
LH
23
Q

What happens if cortisol is given in pregnancy?

A

mood disorders in the child

24
Q

What effect does cortisol have on the GI tract?

A

reduced prostaglandin synthesis –> decrease in mucous production

25
Q

Suffix of all synthetic corticosteroids

A

-one

26
Q

Divide the synthetic corticosteroids into short-acting, intermediate-acting, and long-acting

A 
SHORT:
hydrocortisone
cortisone
prednisone
prednisolone
methylprednisone

INTERMEDIATE:
trimacinolone

LONG:
betamethasone
dexamethasone

27
Q

What is the DOC for patients with hepatitis and why?

A

prednisolone (not metabolized by the liver)

28
Q

What do corticosteroids have to do with vaccinations?

A

decrease the immune response

do not give the vaccination until the person is on less than 20mg/day

29
Q

What happens to the mood/sleep of patients on corticosteroids?

A

can’t sleep

“all revved up”

30
Q

Why do we use a taper with steroids?

A
  1. steroids help maintain BP; decreasing the dose too quickly can cause hypotension
  2. sometimes, steroids need to be continued for the duration of the illness (e.g. poison ivy)
31
Q

What happens to skin and bone in patients on steroids for more than 2 weeks?

A

bone demineralization
acne
avascular necrosis

32
Q

What do steroids do to wound healing?

A

delay it

33
Q

What causes Iatrogenic Cushing’s?

A

lots of steroids for a long time

typically 100mg/day for > 2 weeks

34
Q

Symptoms of Iatrogenic Cushing’s?

A

face rounding
puffiness
truncal obesity
thin extremities

35
Q

Describe adrenal suppression with steroids

A

when patients are on steroids, their adrenals won’t make their own steroids

36
Q

What is stress dosing for trauma/surgery?

A

double the dose for 24-72h to help maintain BP and nutrition for surgery

37
Q

Name some inhibitors of adrenocorticoid synthesis

A

metyraprone

aminoglutethimide

38
Q

What are metyraprone and aminiglutethimide used to treat?

A

Cushing’s (adrenal excess)

39
Q

What typically causes Cushing’s syndrome?

A

ACTH or cortisol producing tumor

40
Q

What effects does aldosterone have?

A

promotes reabsorption of Na+ and therefore water

promotes K+ and H- excretion

41
Q

What is fludrocortisone?

A

pharmaceutical version of aldosterone

42
Q

What is fludrocortisone used for?

A

adrenal insufficiency associated with mineralocorticoid deficiency

POTS/fainting

43
Q

Name some aldosterone antagonists

A

spironolactone
eplerenone
drospirenone

44
Q

For what is spironolactone used?

A

a potassium-sparing diuretic with several indications: primary aldosteronism (Cushing’s)
heart failure
edema from liver cirrhosis with ascites and nephrotic syndrome
Hirsutism/PCOS
Acne

45
Q

For what is eplerenone used?

A

HTN/CHF

46
Q

What is Carospir?

A

liquid version of spironolactone taken by children

47
Q

main side effect of spironolactone?

A

hyperkalemia

48
Q

What is Addison’s disease?

A

chronic primary adrenal insufficiency

49
Q

Symptoms of Addison’s Disease

A 
myalgia
arthralgia
articular cartilage calcification
weakness
hypotension
weight loss
salt cravings
brown hyperpigmentation of sun exposed skin
manic episodes
anemia
hyponatremia
hypokalemia
50
Q

Treatment of Addison’s disease

A

hydrocortisone/dexamethasone
fludrocortisone –> to maintain BP/fluid balance
other hormone replacement

51
Q

medications contraindicated in Addison’s Disease

A

spironolactone

diuretics

NURS 804: Pharmacology (42 decks)

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