Term
| What are the clinical uses of steroids? |
|
Definition
Asthma/COPD
Immunosuppression
Autoimmune diseases
Inflammatory bowels
Dermatology |
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|
Term
| What induces the hypothalamus in the HPA axis? |
|
Definition
Surgery/trauma
Stress
Infection
Hypoglycemia
Sleep
Hemorrhage/Pain/Fear |
|
|
Term
|
Definition
| Hypothalamus releases CRH --> anterior pituitary releases ACTH --> Adrenal cortex releases cortisol |
|
|
Term
| What are normal cortisol levels? |
|
Definition
| 8-15 mg/day w/ a half life of 30-90 minutes. Released on a circadian rhythm |
|
|
Term
| What are the short term side effects of steroids? |
|
Definition
Insomnia
Psychosis
Hyperglycemia - concern for diabetes
Hypokalemia
leukocytosis
infection risk increases |
|
|
Term
| What is HPA axis suppression? |
|
Definition
exogenous steroid use causes adrenal gland - stopped production of cortisol
May need steroids or IV steroids in case of shock.
Suspect if on steroids >3 weeks |
|
|
Term
| How is HPA suppression diagnosed? |
|
Definition
ACTH stimulation test
Check morning cortisol level, if >15 ok. If not, test adrenal gland by giving ACTH analog - cosyntropin 250 mg IV/IM --> plasma cortisol should increase by 5-7
S/S of withdrawal - an addison's crisis. |
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|
Term
| What are the rules for a steroid taper? |
|
Definition
- If dose > physiological, decrease dose by half every 5-7 days
- Once physiological doses reached, decrease by 1 mg per week
- If in doubt, do an ACTH test |
|
|
Term
| What patient education should be given with steroids? |
|
Definition
Possible weight gain
Increased appetite
Take in the morning with food to avoid insomnia and GI upset
Compliance - do not discontinue abruptly |
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