Wk 13: Steroids Flashcards
Steroids
Preparations that contain _________ hormones identical to those secreted _________ by endocrine glands may be administered as drugs
synthetic
endogenously
Steroids
Typically used for _________ replacement to elicit a physiologic effect
hormone
The actions of corticosteroids are classified according to the potencies of these compounds to:
-Evoke _______ renal tubular reabsorption of _______ in exchange for ________ ions (_______________ effect)
-Produce an ______-_________ response (____________ effect)
distal
sodium
potassium
Mineralocorticoid
anti-inflammatory
Glucocorticoid
Naturally occurring corticosteroids are: (5)
Cortisol (hydrocortisone)
Cortisone
Corticosterone
Desoxycorticosterone
Aldosterone
Modifications of structure have resulted in synthetic corticosteroids with more potent ____________ effects than the two closely related natural hormones, __________ and __________
Introduction of a double bond in __________ and __________
glucocorticoid
cortisol and cortisone
prednisolone and prednisone
Mineralocorticoid effects and the rate of hepatic metabolism of these synthetic drugs are ______ than those of the natural hormones
less
Mineralcorticoid receptors are present in (4)
Distal renal tubule
Colon
Salivary glands
The hippocampus
Glucocorticoids MOA
Enhance or suppress changes in the transcription of DNA and therefore the synthesis of ________
Inhibit the secretion of ________ via _____________ effects
proteins
cytokines
posttranslational
Glucocorticoid receptors are _____ widely distributed and do not bind __________ making these receptors glucocorticoid-selective
more
aldosterone
__________ and ________ effects of glucocorticoids are critical for the maintenance of homeostasis during severe stress
Permissive and protective
Permissive actions of glucocorticoids occur at ________ physiologic steroid concentrations and serve to prepare the individual for responding to ________
low
stress
Protective actions of glucocorticoids occur when _____ plasma concentrations of steroids exert _____________ and _________ effects
This protective response prevents the host-defense mechanisms that are activated during the stress from ________ and damaging the organism
high
anti-inflammatory
immunosuppressive
overshooting
Synthetic cortisol and its derivatives are effective _______
orally
Water-soluble _________ _______ can be administered intravenously to achieve prompt increases in plasma concentrations
More prolonged effects are possible with __________ injection
cortisol succinate
intramuscular
Cortisone acetate may be given _____ or _____ but cannot be administered _______
The acetate preparation is a slow-release preparation lasting ___ to ___ hours
After release, cortisone is converted to _______ in the liver
orally or IM
IV
8 to 12
cortisol
Corticosteroids are also promptly absorbed after ________ application or _________ administration
topical
aerosol
Prednisolone is an analogue of __________ that is available as an ______ or _______ preparation
cortisol
oral
parenteral
The anti-inflammatory effect of ___ mg of prednisolone is equivalent to that of 20 mg of cortisol
5
_______ and ________ are suitable for sole replacement therapy in adrenocortical insufficiency because of the presence of glucocorticoid and mineralocorticoid effects
Cortisol
Prednisone
Prednisone is rapidly converted to __________ after its absorption from the ____________ tract
Anti-inflammatory effect and clinical uses are similar to those of ____________
prednisolone
gastrointestinal
prednisolone
Methylprednisolone is the methyl derivative of __________
prednisolone
The anti-inflammatory effect of ____ mg of methylprednisolone is equivalent to 20 mg of cortisol
4
The acetate preparation of methylprednisolone is administered __________ has a prolonged effect
intraarticularly
Betamethasone is a _________ derivative of prednisolone
fluorinated
The anti-inflammatory effect of ____ mg of betamethasone is equivalent to that of 20 mg cortisol
0.75
Betamethasone lacks ___________ properties of cortisol
Not acceptable for ____ replacement therapy in adrenocortical insufficiency
mineralocorticoid
sole
Dexamethasone is a __________ derivative of prednisolone and an isomer of _________
fluorinated
betamethasone
The anti-inflammatory effect of ___ mg of dexamethasone is equivalent to that of 20 mg of cortisol
0.75
Dexamethasone is the corticosteroid that is commonly chosen to treat certain types of _________ edema
cerebral
Triamcinolone is a _________ derivative of prednisolone
fluorinated
The anti-inflammatory effect of ___ mg of triamcinolone is equivalent to that of 20 mg of cortisol
4
The hexacetonide preparation of triamcinolone injected _____________ may provide therapeutic effects for ___ months or longer
intraarticularly
3
__________ is often used for epidural injections in the treatment of lumbar disk disease
Triamcinolone
An unusual adverse side effect of _____________ is an increased incidence of skeletal muscle weakness
triamcinolone
________ rather than appetite stimulation, and ______ rather than euphoria may accompany administration of triamcinolone
Anorexia
sedation
The only universally accepted clinical use of corticosteroids and their synthetic derivatives is as _________ _________ for deficiency states
replacement therapy
The safety of corticosteroids is such that it is acceptable to administer a single large dose in a life-threatening situation on the presumption that unrecognized ______ or ______ insufficiency may be present
adrenal
pituitary
Masking of symptoms of _________ may delay diagnosis of life-threatening illness, such as peritonitis due to perforation of a peptic ulcer
inflammation
_____________ or ___________ are recommended when an anti-inflammatory effect is desired
Prednisolone or prednisone
Deficiency states
Acute adrenal insufficiency requires _______ and ______ replacement as well as supplemental __________
electrolyte
fluid
corticosteroids
Deficiency states
Cortisol is administered at a rate of ____ mg IV every __ hours after an initial injection of ____ mg
100
8
100
Deficiency states
Management of chronic adrenal insufficiency in adults is with the daily oral administration of ______, ____ to ____ mg
A typical regimen is ___ mg in the. morning and ___ mg in the late afternoon. Mimics the normal ______ cycle of adrenal secretion
cortisone
25 to 37.5 mg
25
12.5
diurnal
___________ corticosteroids are capable of potent anti-inflammatory effects and are the mainstay of _______ therapy
Topical
allergic
Unlike antihistamines that provide pharmacologic effects within 1 to 2 hours, topical corticosteroids may require ___ to ___ days of treatment to produce a therapeutic effect
3 to 5
Asthma is an inflammatory disease of the lungs and inhaled ________ are often recommended as first-line therapy for controlling symptoms
glucocorticoids
Parental corticosteroids are important in the emergent preoperative preparation of patients with active ________ _______ disease and in the treatment of intraoperative __________
reactive airway
bronchospasm
Reactive airway disease and bronchospasm
Doses equivalent to ___ to ___ mg/kg of cortisol (or the equivalent dose of prednisolone) are commonly used
Preoperative corticosteroid administration ___ to ___ hours before induction of anesthesia since beneficial effects of corticosteroids may not be fully manifest for several hours
1 to 2
1 to 2
Dexamethasone prevents postoperative nausea and vomiting only when administered near the _______ of surgery, probably by reducing surgery-induced inflammation due to inhibition of ________ synthesis
beginning
prostaglandin
Administration of higher doses (___ to ___ mg) of dexamethasone has a similar antiemetic effect to lower doses ( ___ to ___ mg)
8 to 10 mg
4 to 5 mg
Dexamethasone is also effective in suppressing chemotherapy-induced ________ and ___________
nausea and vomiting
Glucocorticoids peripherally inhibit the _________ chain reaction along both the ____________ and __________ pathways
inflammatory
cyclooxygenase
lipoxygenase
Glucocorticoids are effective in decreasing postoperative pain without the side effect profile of __________
NSAIDs
Perioperative IV dexamethasone at doses more than ____ mg/kg decreases acute postoperative pain and reduced opioid use
0.1
Corticosteroids in large doses are useful in the reduction or prevention of ______ _______ and the resulting increases in _____ seen with intracranial tumors, metastatic lesions, and bacterial meningitis
____________, with minimal mineralocorticoid activity, is frequently selected
cerebral edema
ICP
Dexamethasone
The administration of glucocorticoids to patients with severe cerebral _________, and intracranial _________ is not useful
infarction
hemorrhage
Despite no strong confirming evidence, it is not uncommon to include steroid in the treatment of __________ pneumonitis
aspiration
An alternative to surgical treatment for lumbar disk disease is __________ placement of corticosteroids
Corticosteroids may decrease inflammation and edema of the _____ ______ that has resulted from compression
epidural
nerve root
A common regimen for lumbar disk disease is epidural injection of ___ to ___ mg of triamcinolone, or ___ to ____ mg of methylprednisolone, in a solution containing _______ at or near the interspace corresponding to the distribution of pain
25 to 50
40 to 80
lidocaine
During epidural steroid injection for lumbar disk disease, __________ corticosteroid coverage during this potentially vulnerable (< ___ month) period should be considered in patients undergoing major stress
exogenous
1
In organ transplantation, high doses of corticosteroids are often administered at the time of surgery to produce ________ and decrease the risk of _______ of the newly transplanted organ
immunosuppression
rejection
The criterion for initiating corticosteroid therapy in patients with rheumatoid arthritis is rapid control of __________ flares and progressive _______ despite maximal medical therapy
symptomatic
disability
In arthritis, corticosteroids are administered in the ______ dose possible that provides significant but not _______ symptomatic relief
________ destruction of the joint is a risk of this treatment
smallest
complete
Painless
Manifestations of collagen diseases (except for __________) are decreased and longevity is improved by corticosteroid therapy
scleroderma
Corticosteroids are used to suppress ocular inflammation, ______ and _______, to preserve ______
uveitis and iritis
sight
Topical and intraocular corticosteroid therapy often increases ________ _______ and is associate with ___________
intraocular pressure
cataractogenesis
Topical corticosteroids should not be used for treatment of ________ ______ because delayed healing and infections may occur
ocular abrasions
Topical administrations of corticosteroids is frequently effective in treatment of ______ diseases
skin
(available OTX)
Topical administration
___________ absorption is also occasionally enhanced to the degree that suppression of the hypothalamic-pituitary-adrenal (HPA) axis occurs or manifestations of _______ syndrome appear
Systemic
Cushing
Treatment of postintubation laryngeal edema may include administration of corticosteroids, such as __________, ____ to ___mg/kg IV
_________of corticosteroids for treatment of this condition has not been confirmed
0.1 to 0.2
Efficacy
_________, ____ mg/kg orally is an effective treatment for children with mild croup
Dexamethasone
0.6
Corticosteroids are usually reserved for patients with myasthenia gravis who are ________ to medical or surgical therapy
These drugs seem to be most effective after ___________
unresponsive
thymectomy
*Administration of corticosteroids at least ___ hours before delivery decreases the incidence and severity of ________ _______ _______ in neonates born between ____ and ___ weeks’ gestation
24
respiratory distress syyndrome
24 and 36
The side effects of chronic corticosteroid therapy include (8)
Suppression of the HPA axis
Electrolyte and metabolic changes
Osteoporosis
Peptic ulcer disease
Skeletal muscle myopathy
CNS dysfunction
Peripheral blood changes
Inhibition of normal growth
Systemic corticosteroids used for short periods of time (< ___ days) even at high doses are unlikely to cause adverse side effects
7
_______ corticosteroids are unlikely to evoke adverse systemic effects
Inhaled
Perioperative period
Corticosteroid supplementation should be __________whenever the patient being treated for chronic hypoadrenocorticism undergoes a _______ ______
Based on the concern that these patients are susceptible to _________ collapse because they cannot release additional endogenous cortisol in response to the stress of surgery
increased
surgical procedure
cardiovascular
Perioperative period
There is no advantage in __________ glucocorticoid prophylaxis during surgical stress
Doses of cortisol equivalent to the daily ________ cortisol production rate are sufficient
supraphysiologic
unstressed
Patients taking greater than ___ mg per day of prednisone or its equivalent for more than ___ weeks have a suppressed HPA axis
20
3
Patients taking less than ___ mg per day of prednisone or its equivalent can be considered not to have suppression of their HPA axis
5
Patients taking ___ to ___ mg per day of prednisone or its equivalent for more than ___ weeks may or may not have suppression of the HPA axis
5
20
3
________ metabolic ________ reflects mineralocorticoid effects of corticosteroids on distal renal tubules, leading to enhanced absorption of ________ and loss of ________
______ and _______ gain accompany this corticosteroid effect
Hypokalemic
alkalosis
sodium
potassium
Edema
weight
Corticosteroids inhibits the use of _______ in peripheral tissues and promote hepatic __________
________ can usually be managed with diet, insulin, or both
glucose
gluconeogenesis
Hyperglycemia
For minor surgical stress (inguinal hernia repair
glucocorticoid replacement dose of ____ mg of hydrocortisone or ___ mg of methylprednisolone is sufficient
25
5
For moderate surgical stress (nonlaparoscopic cholecystectomy, colon resection, total hip replacement) glucocorticoid requirement is about ___ to ___ mg daily of hydrocortisone for __ to __ days
50
75
1
2
For major surgical stress (pancreatoduodenectomy, esophagectomy, cardiopulmonary bypass) glucocorticoid dose should be ___ to ____ mg of hydrocortisone for ___ to __ days
100
150
2
3
Osteoporosis, ___________ compression fractures, and _____ fractures are common and serious complications of corticosteroid therapy
An indication for ________ of corticosteroid therapy
verterbral
rib
withdrawal
The presence of _________ could predispose patients to fractures during positioning in the operating room
osteoporosis
Skeletal muscle _______ characterized by weakness of the _______ musculature is occasionally observed in patients taking ______ doses of corticosteroids
myopathy
proximal
large
Central nervous system dysfunction
Corticosteroid therapy is associated with an increased incidence of _______ and _______
neuroses and psychoses
Cataracts develop in almost all patients who receive ________, ____ mg daily, or its equivalent for ___ years
prednisone
20
4
A single dose of cortisol decreases by almost ___ %- the number of circulating __________, and by more than ____% the number of circulating ________ in ___ to ___ hours
70%
lymphocytes
90%
monocytes
4 to 6
Acute lymphocytopenia most likely reflects ___________ from the blood rather than destruction of cells
sequestration
________ _______ (___) regulates extracellular calcium concentration, through action on the _______, ______, and ________
Parathyroid hormone (PTH)
PTH secretion is activated by __________ and elevated ________ levels
hypocalcemia
phosphorous
The net effect of PTH is to ___________ extracellular calcium
increase
Hypercalcemia can be categorized as either parathyroid ________ or non-parathyroid _________
dependent
dependent
Hypercalcemia from parathyroid disease is associated with _____ ____ and __________
bones loss
osteoporosis
Management of hypercalcemia includes: (4)
IV fluids
Bisphosphonates
Calcitonin
Glucocorticoids
The most common setting for symptomatic hypocalcemia is within ___ to ___ hours of surgery, particularly after total or subtotal ___________ or four-gland __________ exploration or removal
12 to 24
thyroidectomy
parathyroid
Hypocalcemia can cause ___________ irritability, ____________, decreased ___________ contractility, and _________
neuromuscular
arrhythmias
myocardial
hypotension
Acute, severe hypocalcemia (total serum calcium levels <___mg/dL, normal albumin) is a medical emergency associated with death from largyngeal _______ or _______ _______ _______
____ ________ is indicated for acute symptomatic hypocalcemia
7.5
spasm
grand mal seizures
IV calcium
Perioperative replacement of anterior pituitary hormones may be necessary for patients receiving exogenous hormones because of a prior ___________
hypophysectomy
(surgical removal of pituitary gland)
Anterior pituitary drugs
Cortisol must be provided continuously, whereas _______ hormones have such a long elimination half-time that they can be omitted for several days without adverse effects
thyroid
Anterior pituitary drugs
__________ is a somatostatin analogue that inhibits growth hormone and is an effective treatments for patients with acromegaly
Octreotide
Anterior pituitary drugs
Octreotide inhibits the secretion of ________, therefore decreased glucose tolerance and _________ might be observed
insulin
hyperglycemia
Anterior pituitary drugs
Octreotide can be lifesaving in patients experiencing and _________ _______ _______
Bolus may be accompanied by _________ and _____-and _____-degree heary block
acute carcinoid crisis
second and third
Anterior pituitary drugs
_________ stimulates the secretion of corticosteroids from the _______ ______, principally _________
Adrenocorticotrophic hormone (ACTH)
adrenal cortex
cortisol
Anterior pituitary drugs
An important clinical use of ACTH is as a diagnostic aid in patients with suspected ______ insufficiency
adrenal
Treatment of disease states with ACTH is not physiologically equivalent to administration of a specific hormone because ACTH exposed the tissues to a mixtures of _______, __________, and ________
glucocorticoids
mineralcorticoids
androgens
________ is the principal substance secreted by the pineal gland
Melatonin
The mammalian pineal glad is a __________ transducer
neuroendocrine
In humans, the circadian rhythm for the release of _________ from the pineal gland is closely synchronized with the habitual hours of sleep
melatonin
Arginine _________, also known as antidiuretic hormone, and ________ are the two principal hormones secreted by the posterior pituitary
vasopressin
oxytocin
Arginine ________ is the exogenous preparation of AVP used to treat a variety of clinical conditions
vasopressin
Diabetes insipidus is due to inadequate secretion of vasopressin by the ________ pituitary, excessive _____ ______, and _________ via polyuria
posterior
water loss
hypernatremia
Diabetes insipidus can follow _______ and surgery of the ________ and ________, cerebral _______, or cerebral __________
neurotrama
pituitary
hypothalamus
ischemia
malignancy
Nephrogenic diabetes insipidus resulting from an inability of the _______ _______ to respond to adequate amounts of centrally produced AVP dose not respond to _________ administration of the hormone or its congeners
renal tubules
exogenous
Perioperative administration of angiotensin-converting enzyme inhibitors or angiotensin II receptors blockers inhibit the renin-angiotensin system and can cause _________ ________ after administration of anesthesia
refractory hypotension
_________ may be effective to treat hypotension from ________ and from severe ___________ deficiency after resection of a pheochromocytoma
Vasopressin
anaphylaxis
catecholamine
Excess generation of ______ _____, activation of the ______ - _______ system, and low plasma concentrations of ________ contribute to progressive loss of vascular tone during sepsis
nitric oxide
renin-angiotensin
vasopressin
Vasopressin infusion ( _____ to ____ unit per minute) can reverse systemic hypotension and decrease norepinephrine dosages in catecholamine-resistant septic shock
0.01 to 0.04
Vasopressin may serve as an adjunct in the control of bleeding ________ ________ during abdominal surgery in patients with cirrhosis and portal hypertension
Infusion of ___ units over __ minutes results in marked decreases in hepatic blood flow lasting about __ minutes
esophageal varices
20
5
30
__________ and increased systemic ______ ________ occur only with doses of vasopressin much larger than those administered for the treatment of diabetes insipidus
Vasoconstriction
blood pressure
Vasopressin, even in small doses, may produce selective vasoconstriction of the ________ ________, with decreases in coronary blood flow manifesting as ________ _______, electrocardiographic evidence of _______ _______, and in some instances, _________ ________
coronary arteries
angina pectoris
myocardial ischemia
myocardial infarction
Oxytocin stimulates uterine muscle and is administered to induce labor at term, reduce and prevent uterine ________, and decrease __________ in the postpartum or post abortion period
atony
hemorrhage
All preparations of oxytocin used clinically are __________ and their potency is described in ________
synthetic
units
High and bolus doses of oxytocin are more likely to _________ systolic and diastolic blood pressures via a direct ________ effect on vascular smooth muscles
decrease
relaxant
Estrogens are effective in treating unpleasant side effects of __________
menopause
There is evidence that administration of estrogen to postmenopausal women prevents ______ ______, and _______ and _____ bone fractures
bone loss
vertebral
femoral
An important use of estrogens is in combination with _________ as oral _________
progestins
contraceptives
Androgens are administered to males to stimulate development and maintenance of ________ sexual characteristics
secondary
The most common indication of androgen therapy in females is _______ _______ of ________ ______ _______
palliative management
metastatic breast cancer
Androgens enhance __________ by stimulation of renal production of __________
erythropoiesis
erythropoietin
Certain androgens may be useful in the treatment of hereditary __________
angioedema
