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104 Cards in this Set
- Front
- Back
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what is the major endogenous glucocorticoid
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cortisol
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how is cortisol synthesized and what influences it
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synth. from cholesterol in the adrenal cortex
synth and release into circulation is controlled by ACTH or adrenocorticotropin (ant. pituitary hormone) |
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what is the major endogenous mineralocorticoid and what does it do
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aldosterone
salt retaining activity (promotes reabsorption of Na and excretion of K) |
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what is the major androgen
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DHEA but a small amount of testosterone is also secreted by the adrenals
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small doses of natural/synthetic corticosteroids are used for____. large doses?
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small- dx and tx of disorders of adrenal fxn
large- tx of inflamm and immune disorders |
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hydrocortisone is the same thing as...
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cortisol
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t/f secretion of cortisol is affected by the time of day and light
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T
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amount of cortisol secreted per day by a non-stressed adult
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10-20 mg
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when does cortisol peak
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early morning
after meals |
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what does cortisol bind to in the blood and what can affect it
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75% to CBG
5% albumin 20% free saturation at 20-30 mcg/dl leads to inc. free fraction inc. CBG in preggos and hyperthyroid and estrogen admin. lead to inc. free levels |
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albumin has .... capacity and ... affinity for cortisol
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large
low |
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half life of cortisol and what affects it
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60-90 mins
inc. w/ hydrocortisone in large doses, stress, hypothyroidism, liver dz |
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cortisol MOA
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mediated by glucocorticoid receptors
free hormone enters cell, then binds receptor. transported to target genes in nucleus affects RNA transcription and protein synth |
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t/f effects of corticosteroids are dose-related and magnify w/ inc. in dose
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t
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glucocorticoids influence fxn of ____ cells in the body by _____ of hormones on cell
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most
direct action |
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t/f normal reactions are further stimulated when inc. amounts of roids are present
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false
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metabolic effects of cortisol
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dose-related
carbs protein fat metab |
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t/f inc. in appetite is rarely seen in pts on roids
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F
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cortisol's metabolic effects on carbs
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needed for gluconeogenesis
inc. gluconeo. enzymes inc. in serum glucose stimulates insulin release |
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cortisol's metabolic effects on fat
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inhibits glucose uptake by fat cells which inc. lipolysis
inc. insulin stimulates lipogenesis net increase in fat deposition characteristic fat deposition |
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cortisol's metabolic effects on protein
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inc. amino acid uptake by liver and kidney
AAs released thru muscle catabolism-->dec. muscle mass and weakness |
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steroids cause what catabolic effects
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dec. muscle mass
weakness osteoporosis |
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anti-inflamm fx of steroids
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cuts off arach. acid metab.
reduce symptoms of inflamm reduce PG and LT synth via cox 2 (by inhib. IL-1 and TNF) |
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when are anti-inflamm changes from steroids seen
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maximal at 6 hrs
dissipated in 24 hrsg |
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t/f long-term steroid use inc. vulnerability to infxn
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t
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immunosuppressive fx of roids
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change conc., dist., and fxn of peripheral WBCs -->false picture of infxn
inhibit fxn of leukocytes and macrophages |
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glucocorticoids cause vaso____ when applied directly to vessels
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constriction
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roids ___ capillary permeability by...
this dec. inflamm how? |
reduce
inhibiting kinins and bact. endotoxins and reducing amount of histamine released by basophils by dec. capillary leak |
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complement activation is _____ by roids and its effects are _____
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unaltered
inhibited |
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Ab prodution is ___ by _____ doses of roids
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reduced
large (mod. doses have no effect) |
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how do roids help avoid hypersens. rxns
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inhibit IL-2
block migration inhibition factor block macrophage inhibtion factor |
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CNS ADRs of roids
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-lower seizure threshold (more likely to get seizure)
anxiety insomnia depression euphoria mood changes |
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steroid psychosis can be seen w/ what dosage of what drug
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>40mg of prednisone
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Derm ADRs of roids
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subQ fat redist.
skin thinning (atrophic straie) acneiform eruptions urticaria (hives) impaired wound healing *predispose to skin fungal infxn |
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GI ADR of roids
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inc. acid and pepsin
inc. fat absorption dec. Ca absorption thru vit. D (supplement pt) inc. Ca excretion w/ long term use |
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renal ADR of roids
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dec. GFR (dec. renal fxn)
can't excrete water load -->edema caution in CHF |
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roids inc./dec. ACTH, TSH, FSH
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DEC.
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roid inc./dec number of platelets and RBCs
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inc
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roids inc./dec surfactant production in unborn babies
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inc.
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what dz is seen in adrenocortical insufficiency
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addisons
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what dz is seen in adrenocortical hyperfxn
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cushings
aldosteronism congenital adrenal hyperplasia |
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t/f giving a mother large doses of glucocorticoids before birth reduces resp. distress in premies
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T
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how do you minimize ADRs w/ roids
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use short-acting glucocorticoids
keep dose as low as possible don't dec. or stop therapy suddenly |
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how to minimize nutritional ADRs from roids
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inc. K and Na intake
watch calories inc. protein inc. Ca and Vit D intake bisphosphonates if needed Antacids 3-4/day for dyspepsia |
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t/f if GCs are used for less than 1 week, serious ADRs are rare
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T
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behavioral changes and acute peptic ulcers can be seen in as few as ___ days
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a few days
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t/f nutritional ADRs for roids are generally restricted to older pts
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F
happen to all ages |
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what kind of symptoms are seen w/ long term use of GCs
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cushing like symptoms
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dose dependent metabolic toxicities of roids
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protein or fat redist
insulin resistance inc. fine hair growth acne insomnia inc. appetite |
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late manifestations of metabolic toxicity
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osteoporosis
impaired wound healing diabetes aseptic necrosis of hip |
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myopathy is seen w/ greater freq. w/ what drug
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triamcinolone
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t/f roids can cause:
masking of infxn myopathy benign intracranial htn cataracts, inc. intraocular pressure growth retardation priapism |
T
except for priapism which is caused by living at the playboy mansion |
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what happens when you give corticosteroids for more than a few days? what do you need to give to pt for therapy that lasts weeks to months
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adrenal suppression
supplementary therapy |
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how long should supplementary therapy for adrenal suppression last
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up to 1 year after d/c steroid
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t/f pts must be weaned off of steroids otherwise they could get withdrawal symptoms
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T
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symptoms of steroid withdrawal
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anorexia
N/V weight loss lethargy HA fever joint or muscle pain postural hypotension |
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t/f ACTH is no help for adrenal suppression
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t
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how long does it take for the pituitary to return to normal after steroids?
Adrenals? |
2-3 mos for pituitary
6-9 mos. for adrenals |
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t/f maintenance dosing and dosing to get the initial effect are usually the same
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F
maintenance is less |
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how do you determine the lowest possible dosage for needed effect
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lower dose until inc. in signs/symptoms is noted
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why use alternate day dosing
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when large doses are req'd for a long time
once dz is under control maintenance therapy |
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t/f alternate day dosing is only for maintenance therapy, not to control dz first line
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T
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t/f to start alternate day dosing, just cut out every other day
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F
should be done gradually |
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benefits of intra-articular injxn are greater for rheumatoid dz or OA
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rheumatoid
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t/f benefits of intra-art. injxns can be inc. by resting and not moving joint
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t
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how often can you repeat intra-art. injxns
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every 3 mos. at most
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what is the most popular roid for intra-art. injxns
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methylprednisone
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risks of intra-art injxns include...
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discomfort
joint deterioration arthropathy osteonecrosis HTN, hyperglycemia tissue atrophy nerve damage raraly septic Arth. |
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t/f epidural roids are not first line therapy
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t
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epidural roids are used for... and can be combo'd w/....
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back and leg pain
local anesthetics |
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why are dose packs good
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automatically wean the pt off of the roids
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how do you inc. absorption of topical roids
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inc. skin temp and hydration
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t/f systemic absorption of opthalmic roids is common
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F
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t/f the first pass effect dec. any systemic effect of inhaled roids
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T
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name the short to medium-acting GCs
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hydrocortisone
prednisone methylprednisone |
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name the intermediate to long acting GCs
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triamcinolone
betamethasone dexamethasone |
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what do pts on long term oral GCs need to do
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notify all healthcare providers
not d/c therapy abruptly consider medicalert bracelet avoid chicken pox and measles-->CNS infxn and death |
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t/f thicker application of topical roids will inc. effectiveness
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F
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what to avoid doing w/ topical roids
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avoid eyes
don't extend duration of therapy don't use for other cond'ns don't bandage or cover area (inc. systemic absorption) |
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how many times a day should topical roids be applied
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2-4
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what areas are more prone to ADRs from topicals
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occluded areas
i.e. armpit |
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what pts are at risk for systemic toxicity from topicals
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pts on highest potency preps for >2 weeks
children liver dz |
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t/f there's no need to gradually d/c topicals
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f
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how should topicals be applied
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rubbed in thoroughly
applied to moist skin when possible |
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thin _____ results in easier penetration of topicals
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stratum corneum
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name the mineralocorticoids
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aldosterone
desoxycorticosterone fludrocortisone |
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what is the principal mineralocorticoid in the body
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aldosterone
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MOA of MCs
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bind MC receptor in cytoplasm of target cells
esp. collecting tubule cells |
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what does aldosterone do
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promote reabsorption of Na from urine, and everywhere else
inc. excretion of K inc circulating blood volume |
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t/f aldosterone is not used clinically
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T
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where is aldosterone synthesized
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zona glomerulosa of adrenal cortex
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half life of aldosterone
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15-20 mins
no good clinically |
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what is desoxycorticosterone
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precursor to aldosterone
half life 70 min secretion primarily due to ACTH |
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t/f aldosterone secretion is due to ACTH
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F
some of it is but other factors play a role |
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what is fludrocortisone used for
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primary adrenal insufficiency
aldosterone insuff. salt losing congenital adrenal hypeplasia idiopathic orthostatic hypotension |
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what is metyrapone
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inhibitor of steroid synth
may be used to manage severe cortisol excess |
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ADRs of metyrapone
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salt and water retention
hirsutism from diversion of DOC to androgen synth |
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testosterone causes what effects
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-develop/maintain male sex organs/characteristics
-systemic anabolic effects inc. N, Ca, Na, K, Cl, P with inc. water retention and inc. bone growth skin is less fatty, more vascular erythropoiesis is inc. |
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clinical uses of anabolic roids
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prevent breakdown of tissue from debilitiation dz
androgen replacement therapy for hypogonadal men protein anabolic agents gynecologic disorders |
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what schedule drug is testosterone
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schedule 2
need a signed, original Rx |
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gynecologic uses of testosterone
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dec. breast engorgement post partum
stop endometrial bleeding from post menopausal estrogen therapy chemo of breast tumors in pre-menopausal women |
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testosterone is no longer used for...
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aplastic anemia
sickle cell hemolytic anemia osteoporosis |
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t/f testosterone is used to replace failing androgen production that occurs w/ age
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F
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the gold standard androgen is...
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testosterone
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