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24 Cards in this Set

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Two therapeutic uses for Glucocorticoids
-Hormone Replacement Therapy
-Non-endocrine disordors
-Must be converted to cortisol
-Mainly acts as a mineralocorticoid
Cortisol
-Must be converted to Pednisolone in liver
-Best for anti-inflammatory effects d/t lack of mineralocorticoid activity
Prednisone
Enzyme that converts Prednisone to Prednisolone in the liver
11-beta-Hydroxysteroid dehydrogenase
More toxic glucocorticoid
Triamcinolone
250x more potent -mineralocorticoid than cortisol
-Only orally available mineralocorticoid
-Not used as a GC d/t salt retention and CV effects
Fludrocortisone Acetate
Physiologic effects of non-endocrine use of glucocorticoids
-Muscle wasting, weakness
-Osteoporosis
-thinning skin
-Inhibition of growth in children
-CNS effects
CNS Effects of GC use in patients with Addisons
Apathy, depression, irritability, frank psychosis

(who's Frank =))
CNS Effects of GC use in Non-addisons patients
Euphoria, insomnia, restlessness, increased motor activity, eeg changes

(anxiety, depression, phsychosis sometimes)
Effects of GC on the bone
-Decreased bone mass due to suppression of catabolic activity of osteoblasts (bone builders)
-Inhibition of Ca++ absorption by the gut and REabsorption by the kidneys
-OSTEOPOROSIS
GC and the Immune system
-Requires high doses of GC
-suppresses all aspects of immune response(humoral and innate)
-Alters concentration, distribution, function of immune cells
-Inhibits Cytokines
Cytokines inhibited by GC
IL-1, 2, 3, 6, 8, 12, IFN-Gamma, GM-CSF, NOS-2, COX-2
Indications for glucocorticoids
-TONS
-Addisons, adrenal hyperplasia, asthma, crohn's, dermatitis, organ transplants (to suppress rejection), rheumatoid arthritis, thyroididtis
Alternate Day dosing of GC in chronic therapy
-Mimics Circadian rhythm of GC
Dietary Changes for patients on long term GC therapy
-High protein/potassium
-Low sodium
-Calorie reduction, overall
Termination of GC therapy
-Must be gradual d/t suppression of Hypothalamus-Pituitary-Adrenal axis
-Patient cannot adequatly respond to stress
-CAN CAUSE FLARE UP OF UNDERLYING DISEASE FOR WHICH GH WAS PRESCRIBED
Flonase
Intranasal GC used for rhinitis
Topical GC
-Used for dermatitis
-Can cause systemic suppresion of HPA axis
Medrysone
Fluorometholone
-Topical GC
-Treat Eye Inflammation
-Cause Increased IO Pressure->glaucoma
(systemic GC do NOT cause glaucoma)
GC withdrawal Syndrome
Fever, myalagias (muscle pain), arthralagias (joint pain), malaise.
Cushings Syndrome
-Adverse effect of GC treatment
-100mg for >2wks can cause it
Metabolic disorders associated with GC use
-Pseudo-NIDDM(non-insulin dep.)->Hyperglycemia, glucosuria
-Negative Nitrogen balance
-increased protein catabalism (breakdown)->decreased wound healing, altered fat distribution
Adverse effects of GC on electrolytes and Vitamins
-Hypokalemia alkalosis
--edema
--muscular weakness
--abn EKG
-Decreased Ca++ abs in gut
-Calciuria->dec repabsorption of Ca++ in tubules
-Inhibition of carotene conversion to vitamin A
Contraindications of prednisolone use
Absolutely no--
Varicella, Chicken Pox, Cushings, Fungal Infection, Measles
-Discontinue IMMEDIATLEY