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24 Cards in this Set
- Front
- Back
excess adrenal hormones?
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cushings
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adrenal hormone deficient
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addisons
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mineralocorticoids?
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stim Na+ absorption, K/H secretion, regulation of renin angiotensin system
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Fludrocortisone
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used for autoimmune insufficiency and orthostatic hypotension.
can lead to overload of Na and fluids |
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TYpes of glucocorticoids***
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????
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purpose of adrenal steroids?
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maintains BP and ability to vasoconstrict, supports function of skeletal muscle, mood, excitability,"", response to stress, lung development
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Major effects of adrenal steroids?
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Carb metabolism: promotes glucose availability
Protein metabolism: mobilization of AA fat metabolism: accumulates and moves centrally mineral metabolism: na retention and k excretion |
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Replacement therapy for addisons?
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hydrocortisone (DOC), cortisone)
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why does secondary adrenal insufficiency only glucocorticoids?
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the primary problem is not in the adrenal gland so the renin/angiotensin system is preserved
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what do you tx cushings with?
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ketoconazole, aminoglutethamide
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Effects of glucocorticoids?
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sequesters lymphcytes and monocytes which decreases inflammation
inhibits adhesion of neutrophilsto endothelium inhibits macrophage processing antigens (low b/t cell) inhibits lymphokins and arachodonic acid metabolism |
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indications for steroids?
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croup, pneumocytis carinii pneumonia, hyperthyroidism, pain management, bacterial meningitis, rheumatiod arthritis, asthma, neoplasm,
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adverse effects of steroids?
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depression, mania, euphoria
cataracts, myopathy, decreased uptake of glucose, osteoporosis, HTN, CHF, ulcers, pancreatitis, inhibits prostaglandins, adrenal insufficiency, suppresses host defense |
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T/F creams/lotions are more potent than ointments/gels?
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False
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what can increase the absorption of topical steroids?
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high skin temp, hydration, high body surface to weight ratio (baby), occlusive dressing
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what is potecy of steroids determined by?
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the affinity for nuclear receptors
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adverse effects of topical steroids?
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atrophy, bruising, irritation, masks signs of infx, cataracts, glaucoma, worsening of dz
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when should you take steroids?
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morning
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drug interactions of glucocorticoids?
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thiazide and loops can cause hypokalemia
NSAID combo can increase gastric ulceration blunts the effect of insulin and oral agents may decrease the immune system (vaccines, live) |
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do you need to taper supraphysiological doses?
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not if they are given for a short period. if chronically used taper over greater than or equal to 2 mo to allow pit/adrenal gland to respond
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how much do you taper?
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2.5 -5 mg prednisone eq weekly until 5 mg dose reached
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what can happen with rapid withdrawal?
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headache dizzy, lethargic, fever, hypoglycemia
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How to avoid HPA suppression?
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use short acting lose (prednisone/hydrocort), use topical, inhaled, intra-articular, intra-ocular, give entire dose in morning, switch alt day dosing, limit the length of therapy,
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T/F you chould switch to another class before up'n the dose of steroids?
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True
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