Term
| 2 types of effects of corticosteroids |
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Definition
physiologic-low doses
pharmacologic-high doses |
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Term
| Use for low dose corticosteroids |
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Definition
| treat adrenocortical insufficiency |
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Term
| Use for high dose corticosteroid |
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Definition
| treat inflammatory disorders, cancer, & suppress immune system for transplants |
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Term
| Causes of toxicity of glucocorticoids |
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Definition
Determined by pattern of use
Pharmacological doses for extended periods |
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Term
| Metabolic effect of glucocorticoids |
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Definition
CHO-increase bl glucose by promoting synthesis of glucose from amino acids, reducing peripheral glucose use, reduce glucose uptake by target tissues, promotes glucose storage as glycogen.
Protein-supress synthesis from amino acids=decrease muscle mass, decrease bone matrix, thinning of skin, (-)N balance.
Fat-stimulates lipolysis, fat redistribution (belly, buffalo hump) |
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Term
| CV effects of glucocorticoids |
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Definition
| Increase # RBC & polymorphonuclear leukocytes. Decrease lymphocytes, eosinophils, basophils, & monocytes |
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Term
| Glucocorticoids and stress |
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Definition
| increased along with epinepherine to maintain BP and bl glucose |
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Term
| Glucocorticoids and water & electrolytes |
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Definition
| similar to aldosterone: act on kidneys to promote Na/H20 retention and increase K excretion |
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Term
| Glucocorticoids and the neonate |
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Definition
| During L&D of newborns burst is relased to mature lungs (premature infants are deficient) |
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Term
| Control of synthesis and secretion of glucocrticoids |
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Definition
(-) feedback loop: hypothalamus, anterior pituitary, adrenal cortex
Activated by stress or stimulant to CNS |
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Term
| Cortisol released from & effects |
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Definition
adrenal cortex
-stimulates physiologic responses
-supresses further release of CRH & ACTH |
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Term
Pharmacologic Glucocorticoid
molecular MOA |
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Definition
-receptors are inside cells
-modulate the production of regulatory proteins by penetrating cell membrane & bind in cytoplasm to DNA altering activity of target organs |
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Term
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Definition
| pain, swelling, redness, warmth |
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Term
| Cells and mediators of inflammation |
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Definition
-Intiated by prostaglandins, histamine, & leukotrienes.
-Amplified by lymphocytes & phagocytes |
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Term
| Action of prostaglandins & histamine |
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Definition
| Vasodilation, increase capillary permeability & stimulate pain receptors |
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Term
| Action of neutophils & macrophages |
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Definition
| Release lysosomal enzymes that cause tissue injury |
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Term
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Definition
| Intensify inflammation by causing cell injury & promoting antibody formation |
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Term
| Pharmacologic effects of glucocorticods |
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Definition
| increase bl glucose, decrease protein synthesis, fat deposits mobilized, inhibit intestional Ca absorption, some forms cause Na/H20 retention w/K loss, suppress immune responses & inflammation |
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Term
Pharmacologic Glucocorticoids
kinectics |
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Definition
PO-aborp rapid/complete
IM-absorp rapid w/sodium phosphates and succinates but slow w/acetates
duration-dose dependent, route, solubility
hepatic metabolism, renal excretion |
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Term
Therapeutic uses of
Pharmacologic Glucocorticoids |
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Definition
| acute RA exacerbations, SLE, IBS, bursitis, tendinitis, synovitis, osteoarthritis, gouty arthrits, inflammatory disorder of eye, allergic conditions, asthma, dermatologic disorders, neoplasms-leukemia & Hodkins/non-Hodkins, premature infants |
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Term
Adverse effects
Pharmacologic Glucocorticoids |
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Definition
| adrenal insufficiency, osteoporosis (ribs&vertebrae most often), infection (new or activate latent), glucose intolerance, myopathy, fluid/electrolyte imbalances, growth retardation, psychologic disturbances(insomnia, anxiety, agitation,irritability,delerium,hallucinations,depression,euphoria,mania), cataracts & glaucoma, peptic ulcer, iatrogenic Cushings,crosses placenta (cleft palate/lip,abortion,low birth weight)enters breast milk |
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Term
Drug interactions
Pharmacologic Glucocorticoids |
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Definition
| DIgoxin, thiazide, loop diuretics (K loss) NSAIDs-increase ulcer, insulin/oral hypoglycemics, vaccines |
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Term
How to manage/avoid osteoporosis from
Pharmacologic Glucocorticoids |
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Definition
-Before tx bone density of lumbar
-Ca/Vit D supplement
-Na restrict + thiazide
-biophosphonate
-calcitonin
-teriparatide
-estrogen in postmenopausal
-use lowest dose possible
-weight-bearing exercise |
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Term
How to manage/avoid growth suppression
Pharmacologic Glucocorticoids |
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Definition
| Minimize with alternate-day therapy, reserve for older children or severe asthma in younger children |
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Term
Other precautions/tests
Pharmacologic Glucocorticoids |
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Definition
Eye exam q6 months
Check stools for occult blood periodic
PCP prophlaxsis |
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Term
Populations to use w/caution
Pharmacologic Glucocorticoids |
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Definition
| Pediatrics, pregnancy, HTN, HF, esophagitis, gastritis, peptic ulcer dx, MG, DM, osteoporosis, infections resistant to tx (herpes, varicella, TB), concurrent tx w/K depleting diuretics, Digoxin, insulin, oral hypoglysemics, NSAIDs |
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Term
Pharmacologic Glucocorticoids
contraindications |
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Definition
Systemic fungal infections
Live virus vaccines |
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Term
Adrenal suppression
causes |
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Definition
| long term therapy with pharmacologic glucocorticoids cause pituitary gland to lose ability to manufacture ACTH. Adrenals atrophy and no longer synthesize cortisol & other glucocorticosteroids |
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Term
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Definition
| 5 days>year determined by length of tx |
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Term
| Long term therapy plan to avoid adrenal suppression |
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Definition
| Need increased doseages for stressful times, supplement at d/c w/PRN for stress until adrenals recover |
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Term
| Glucocorticoid withdrawl plan |
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Definition
| Taper over 7 days, switch from multiple daily doses to single AM doses, taper dose to 50%, physiologic value over month and monitor for endogenous cortisol. Do not need to taper if used <2-3wks |
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Term
| Pharmacologic Glucocorticoids withdrawl symptoms |
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Definition
| hypotension, hypoglycemia, myalgia, arthralgia, fatigue |
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Term
Determination of duration of action and route
Pharmacologic Glucocorticoids |
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Definition
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Term
| Alternate-day therapy schedule |
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Definition
| Large dose every other day before 9am, avoid long acting |
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Term
| Short acting glucocorticoids |
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Definition
cortisone, hydrocortisone
highest mineralcorticoid potency (Na/H20 retention & K depletion), only short term use |
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Term
| Intermediate acting glucocorticoids |
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Definition
| prednisone, prednisolone, methylprednisone, triamcinolone |
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Term
| Long acting glucocorticoids |
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Definition
betamethasone, dexamethasone
(highest anti-inflammatory potency) |
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Term
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Definition
| Flovent, Qvar, Pulmicort, Alvesco, Aerospan, Asmanex |
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Term
| Combo inhaled glucocorticoids + long acting beta2 agonists |
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Definition
| Advair, symbicort, Dulera |
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Term
| How to manage fluid & electrolyte disturbances in glucocorticoid therapy |
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Definition
| using long-acting/low mineralcorticoid activity, restrict Na intake, take K supplements or consume K rich foods (potato, bananas, citrus fruits), watch for rapid weight gain & swelling |
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Term
| How to manage psychologic disturbances caused by glucocorticoids |
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Definition
| Long-term low dose can cause depression, short-term high dose can cause delerium/psychosis. reverse with withdrawl depression >6wks, delerium days-week. Tx w/mood stabilizer or SSRI |
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