corticosteroids Flashcards Preview

Pharm2 S.Horvath > corticosteroids > Flashcards

Flashcards in corticosteroids Deck (28)
Loading flashcards...
1
Q

name the hormones:
hypothalamus releases _____
anterior pituitary releases _____
adrenal cortex releases ____

A

hypothalamus releases corticotropin releasing hormone
(CRH)

ant pit releases adrenocorticotropic hormone (ACTH)

adrenal cortex releases cortisol

2
Q

the negative feed back loop mechanism works at which two spots on the HPA Axis?

A

hypothalamus and anterior Pituitary

3
Q

GFR —> ___ ____ ____

zona Glomerulosa
zona Fascicula
zona Reticularis

A

salt, sugar, sex

4
Q

why does it take so long for cortisol to take effect?

A

it binds to the MRNA in the cell and changes the way that proteins are made within the cell.

also why you have a long DOA

5
Q

what is the primary mineralcorticold

in the Outer layer, Zona glomerulosa

A

aldosterone

6
Q

aldosterone’s effects on:

K
Na
water

A

increases K excretion
(LOSE K)

increases Na retention
(KEEP Na)

increases water retention, inc blood volume.

aldosterone makes you hang on to salt and water at the expense of K.

7
Q

If you have first degree adrenocortical insufficiency, you need to replace with…..?

why

A

glucocorticoid AND mineralcorticold.

like florinef: fludrocortisone + prednisone

because the adrenals do not secrete cortisol or aldosterone

8
Q

if you have second degree adrenocortical insufficiency (cushings) you need to replace with…..?

why

A

only glucocorticoid

because aldosterone secretion is maintained.

9
Q

what causes second degree adrenocortical insufficiency?

A

chronic steroid use and suppression of the HPA axis.

because if youre taking a lot of steroids, the negative feedback loop will tell your body that youre good and dont need to make any more.

10
Q

what happens if you d/c steroids someone on long term use

A

send them into adrenal crisis

release of cortisol in response to stress could be blunted or absent and lead to hypotensive shock

11
Q

T/F long term steriod use causes increased CO, increased RR, increased gluconeogenesis

A

TRUE

12
Q

glucocorticoids are used for their ____ response

A

anti-inflammatory

13
Q

which synthetic corticosteroids do not have sodium retaining effects?

A

beta dex tria

betamethasone
dexmethasone
trimincalone

14
Q

which synthetic corticosteroids steroid is a true mineralocorticoid and has 125x potenty for retaining sodium and water

A

fludrocortisone

15
Q

if youre supplementing someone with addisons disease, should be giving something like ___ or ___ because they have both anti-infalmmaroy and sodium retaining effects

A

cortisol

prednisone

16
Q

T/F Steriods are approved for a wide list of clinical uses like anti-emetic, asthma, sepsis, post intubation edema….

A

FALSE. There is no true approval for all those things.

Only approved for: replacement therapy for deficiency states.

17
Q

what is the acid base disturbance associated with steroids

A

hypokalemic metabolic alkalosis

mineralocorticoid effect of cortisol on distal renal tubules leading to enhanced absorption of Na and loss of K

18
Q

steroids have catabolic effects.

peripherally, corticosteroids mobilize amino acids from tissues, so this causes..

A

dec skeletal muscle mass

osteoporosis

thinning of skin

negative nitrogen balance

19
Q

long term use of corticosteroids increases which two lab values?

A

hematocrit and leukocytes

20
Q

what do hyperthyroidism and chronic steroid use have in common

A

put people in a hyperdynamic state

21
Q

T/F Aldosterone secretion remains intact in 2nd degree adrenal insufficiency

A

true

22
Q

T/F Prednison or Dex (even physiologic doses) given as a single daily dose at bedtime is associated more commonly with HPA Axis suppression

A

TRUE

23
Q

in which 2 instances do you assume a patient is HPA suppressed

A

pred 20mg/day for >3w within the previous year

patient with clinical signs of cushings from any steroid use

24
Q

T/F After cessation of steroid therapy, recovery of the HPA axis happens fairly quickly.

A

FALSE - can take 12mo or longer

25
Q

why are addisons patients more susceptible to CV collapse

A

because they cannot release additional endogenous cortisol in response to stress

26
Q

T/F Endogenous cortisol production during stress is >150mg/day

A

FALSE

Endogenous cortisol production during stress is NOT >150mg/day

27
Q

T/F Burn and sepsis patients have an exaggerated need for exogenous corticosteroid supplementation

A

TRUE

28
Q

s/s of acute adrenal crisis

\_\_\_\_glycemia
\_\_\_kalemia
\_\_\_\_natremia
\_\_\_\_volemia 
metabolic \_\_\_\_
A
hypoglycemia 
hyperkalemia
hyponatremia
hypovolemia 
metabolic acidosis