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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
Suffix of all synthetic corticosteroids
-one
26
Divide the synthetic corticosteroids into short-acting, intermediate-acting, and long-acting
``` SHORT: hydrocortisone cortisone prednisone prednisolone methylprednisone ``` INTERMEDIATE: trimacinolone LONG: betamethasone dexamethasone
27
What is the DOC for patients with hepatitis and why?
prednisolone (not metabolized by the liver)
28
What do corticosteroids have to do with vaccinations?
decrease the immune response | do not give the vaccination until the person is on less than 20mg/day
29
What happens to the mood/sleep of patients on corticosteroids?
can't sleep | "all revved up"
30
Why do we use a taper with steroids?
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
What happens to skin and bone in patients on steroids for more than 2 weeks?
bone demineralization acne avascular necrosis
32
What do steroids do to wound healing?
delay it
33
What causes Iatrogenic Cushing's?
lots of steroids for a long time | typically 100mg/day for > 2 weeks
34
Symptoms of Iatrogenic Cushing's?
face rounding puffiness truncal obesity thin extremities
35
Describe adrenal suppression with steroids
when patients are on steroids, their adrenals won't make their own steroids
36
What is stress dosing for trauma/surgery?
double the dose for 24-72h to help maintain BP and nutrition for surgery
37
Name some inhibitors of adrenocorticoid synthesis
metyraprone | aminoglutethimide
38
What are metyraprone and aminiglutethimide used to treat?
Cushing's (adrenal excess)
39
What typically causes Cushing's syndrome?
ACTH or cortisol producing tumor
40
What effects does aldosterone have?
promotes reabsorption of Na+ and therefore water | promotes K+ and H- excretion
41
What is fludrocortisone?
pharmaceutical version of aldosterone
42
What is fludrocortisone used for?
adrenal insufficiency associated with mineralocorticoid deficiency POTS/fainting
43
Name some aldosterone antagonists
spironolactone eplerenone drospirenone
44
For what is spironolactone used?
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
For what is eplerenone used?
HTN/CHF
46
What is Carospir?
liquid version of spironolactone taken by children
47
main side effect of spironolactone?
hyperkalemia
48
What is Addison's disease?
chronic primary adrenal insufficiency
49
Symptoms of Addison's Disease
``` myalgia arthralgia articular cartilage calcification weakness hypotension weight loss salt cravings brown hyperpigmentation of sun exposed skin manic episodes anemia hyponatremia hypokalemia ```
50
Treatment of Addison's disease
hydrocortisone/dexamethasone fludrocortisone --> to maintain BP/fluid balance other hormone replacement
51
medications contraindicated in Addison's Disease
spironolactone | diuretics

NURS 804: Pharmacology (42 decks)

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