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Pharm (Test 3)

Where are steroids produced and released? adrenal cortex
What controls secretion of steroids? pituitary release of corticotropin (ACTH)
What are the 2 main classes of steroids? mineralocorticoids and glucocorticoids
Where are mineralocorticoids secreted from? zona glomerulosa
Where are glucocorticoids secreted from? zona fasiculata
What is the precursor to all steroids? cholesterol
What steroid accounts of 95% of all mineralcorticoid activity? aldosterone
What is the function of aldosterone? maintain status quo re: extracellular fluid vol; maintain plasma cntn of Na+ and K+ ions
What 4 things stimulate the secretion of aldosterone? inc. in serum K+ cntn, hyponatremia, ACTH, angiotensinII
What steroid accounts for 95% of glucocorticoid activity? cortisol
True or False: Cortisol is essential for life. True
What are 3 physiological effects of cortisol? 1)inc. gluconeogenesis (amino acids to glucose), 2)protein catabolism (less amino acids stored causes muscle weakness if cortisol is excessive), 3)fatty acid metabolism (movement and oxidation of fatty acids in the cells)
True or False: Glucocorticoids have anti-inflammatory effects. True
What 2 effects of glucocorticoids cause an increased serum blood sugar? 1)mvmt of amino acids from outside the liver to the liver to be converted into glucose, 2)dec. the use of glucose
Deposits of fatty acids caused by increased cortisol can result in what 2 physical characteristics? buffalo hump, moon face
How does cortisol decrease inflammation? 1)dec. capillary permeability, 2)stabilize lysosomal membranes
How does cortisol decrease immune response? 1)dec. mvmt of leukocytes into inflamed areas, 2)dec. number of eosinophils and leukocytes, 3)interfere with formation of leukotrienes
How does cortisol inc. the number and sensitivity of beta-adrenergic receptors. dec. myocardial and vascular reponse to catecholamines
True or False: Cortisol affects the antigen-antibody reaction and the histamine release w/ allergic reactions. False
How much cortisol do we secrete daily? 20mg
Do we secrete more cortisol during the day or at night? during the day
How much cortisol would be released per day after a minor surgery? 50mg/day
How much cortisol would be released per day after major surgery? 75-150mg/day
Where is cortisol stored? Not stored anywhere
What is the elimination 1/2 life of cortisol? 70min
After a stressor, such as anesthesia, cortisol levels increase ______________, and return to baseline _____________. increase immediately after induction; return to baseline w/in 24-48 hrs
What does a stress increase in cortisol do? anti-inflammatory and protective effects: prevents stress-induced hypotension and shock
What are some examples of endogenous corticosteroids? cortisol/hydrocortisone/solu-cortef, cortisone, corticosterone, desoxycorticosterone, aldosterone
What are some examples of synthetic corticosteroids? prednisolone, prednisone, methylprednisolone-acetate/depo-medrol, methylprednisolone-sodium-succinate/solu-medrol, betamethasone, dexamethasone/decadron, triamcinolone
What are some effects of corticosteroids? antiinflammatory effect,immune suppression,suppression of HPA(feedback),wt gain,skeletal muscle wasting,delayed wound healing,inc. susceptibility to infection,gastric ulcers, catabolic effect of skin/muscle/bone/connective tissue, e- disturbances
When is steroid coverage needed? the release of cortisol is response to the stress of surgery is dec. or eliminated; HPA axis suppression occurs at different doses in different people--highly variable; the larger the dose of steroids and the longer the therapy, the greater need
Define HPA axis. hypothalamic-pituitary-adrenal axis (the feedback sys of cortisol levels telling the hypothalamus and the pituitary to produce less ACTH and corticotropin-releasing-hormone)
Define CIRCI. critical-illness-related corticosteroid insufficiency; the adrenal response to stress is inadequate
What are s/s of CIRCI? unexplained vasopressor-dependent refractory hypotension; hypovolemic shock w/ myocardial and vascular unresponsiveness to catecholamines
During what circumstances can you assume HPA axis suppression has occurred? when corticosteroid therapy (20mg/day) has been used for more than 2 week within the previous year
What are some benefits of steroid coverage? prevention of life-threatening secondary adrenal insufficiency--CV collapse, perioperative hypotension
What are some risks of steroid coverage? altered wound healing, altered glucose metabolism
What are 2 recommendations for steroid coverage for minor surgery? (hernia repair) 1)usual morning dose, 2)morning dose + hydrocortisone 25mg or equiv
What are 2 recommendations for steroid coverage for moderate surgery? (colon resection, total joint, lower extremity revascularization) 1)hydrocortisone 50mgIV, then 25mg q8h for 24 hrs, then usual daily dose; 2)morning dose + hydrocortisone 50-75mg or equiv
What are 2 recommendations for steroid coverage for major surgery? (CV, thoracic, aortic aneurysm repair) 1)hydrocortisone 100mg IV, then 50mg q8h for 4 doses, then taper to daily dose, 2)morning dose + hydrocortisone 100-150mg q8h for 48-72 hrs
What 3 anesthetics can suppress stress release of cortisol to some extent? etomidate (suppresses adrenal synthesis), opioids, volatiles (to a lesser degree)
What are equivalent doses of cortisol/hydrocortisone/solu-cortef, methylprednisolone/solu-medrol, dexamethasone/decadron, and prednisone/deltasone? cortisol=20mg; methylprednisolone=4mg; decadron=0.75mg; prednisone=5mg
What are some side effects of chronic corticosteroids? suppression of HPA axis, electrolyte changes, osteoporosis, peptic ulcer disease, airway mgmt. implications, positioning implications, skeletal muscle myopathy, CNS dynfxn, cataracts, growth inhibitions (peds), dec. lymphocytes/monocytes