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pathopharm exam 3
chapter 72
| Question | Answer |
|---|---|
| Glucocorticoid Drugs | corticosteroids and nearly identical to steroids produced by the adrenal cortex I.E STEROID/ PREDNISONE |
| Physiologic effects (low doses) FUNCTION OF STEROID IN BODY | Modulation of glucose metabolism in adrenocortical insufficiency INEFECTIVE ADRENAL GLAND, SUPPLEMENT WITH CORTICOID |
| Pharmacologic effects (high doses) | Suppression of inflammation GIVE A HIGHER DOES THAN THE BODY PROVIDES |
| Glucocorticoids in Nonendocrine Disorders Glucocorticoid physiology | Metabolic effects• Elevates BG=NEED MORE INSULIN Promotes storage of glucose AS glycogen Reduces muscle mass •Decreases the protein matrix of bone=OSTEOSPORIS |
| GLUCOCORTICOID, PHYSIOLOGY BODY RELEASE LOTS OF GLUST, DUE TO STRESS | Causes thinning of the skin-ONION SKIN •Negative nitrogen balance •Lipolysis •Redistribution of fat: “Potbelly,” “moon face,” and “buffalo hump” |
| Cardiovascular effects polymorphonuclear leukocytes, and decrease lymphocytes, eosinophils, basophils, and monocytes | Low levels of endogenous glucocorticoids: Capillaries become more permeable, vasoconstriction is suppressed, blood pressure falls •Glucocorticoids increase circulating red blood cells |
| EFFECT OF STRESS? | Physiologic stress (eg, surgery, infection, trauma, hypovolemia): Adrenal glands secrete large quantities of glucocorticoids and epinephrine •Result: Hormones help maintain blood pressure and blood glucose levels |
| WHAT IS THE STRESS EFFECT? •Insufficient release of glucocorticoids: | Hypotension and hypoglycemia occur •Very severe stress: Glucocorticoid insufficiency can result in circulatory failure and death |
| EFFECT ON H20 AND ELECTROLYTES? ACE INHIBITOR PROCESS-INCREASE BP=RENIN(KIDNEY) ANGIOTENSIN(LIVER) ALDOSTERONE | AS aldosterone •Can act on the kidney to promote retention of sodium and H2O while increasing urinary excretion of potassium •= hypernatremia, hypokalemia, and edema •Most glucocorticoids used as drugs have very low mineralocorticoid activity |
| Respiratory system in neonates? | During labor and delivery: Adrenal glands of full-term infant release a burst of glucocorticoids •Effect: Maturation of the lungs •Preterm infant: Production of glucocorticoids is low •Preterm infant: High incidence of respiratory distress syndrome |
| Pharmacology of Glucocorticoids Molecular mechanisms of action are different from those of other drugs? | Glucocorticoid receptors are inside the cell Glucocorticoids modulate the production of regulatory proteins rather than signaling pathways |
| Effects on metabolism and electrolytes? | Anti-inflammatory and immunosuppressant (attackg self) Major clinical applications of the glucocorticoids stem from their ability to suppress immune responses and inflammation |
| Therapeutic uses in nonendocrine disorders | Rheumatoid arthritisSystemic lupus erythematosusInflammatory bowel diseaseMiscellaneous inflammatory disorders |
| ALLERGIC REACTION | Allergic conditions Asthma-flares Dermatologic disorder-hives Neoplasms Suppression of allograft rejection Prevention of respiratory distress syndrome in preterm infants |
| Adverse effects? | Adrenal insufficiency with prolonged administration Osteoporosis with prolonged systemic therapyInfection: PCP (Pneumocystis pneumonia)Glucose intolerance: Hyperglycemia and glycosuriaMyopathy: Proximal muscles of the arms and legs are affected most |
| Fluid and electrolyte disturbances: Sodium and water retention and potassium loss Growth retardation: Can suppress growth in childrenPsychologic disturbances OLDER PT BECOME PSYCHOSIS-SUPPRESS GROTH IN CHILDREN-ASK PATIENT BASELINE | |
| Cataracts and glaucoma: Long-term glucocorticoid therapyPeptic ulcer disease: Inhibit prostaglandin synthesis, augment secretion of gastric acid and pepsin, inhibit production of cytoprotective mucus, and reduce gastric mucosal blood flow | |
| Iatrogenic Cushing’s syndrome: Use in pregnancy and lactation | Hyperglycemia, glycosuria, fluid and electrolyte disturbances, osteoporosis, muscle weakness, cutaneous striations, lowered resistance to infection; redistribution of fat produces a “potbelly,” “moon face,” and “buffalo hump” |
| WHAT ARE THE DRUG INTERACTION? | Interactions related to potassium loss Nonsteroidal anti-inflammatory drugs Insulin and oral hypoglycemicsVaccines |
| CONTRAINDICATION AND PRECAUTION | Patients with systemic fungal infections-INCR SUGAR-PROMOTE VIRULENCE PROLONG INFECTION-LOVES SUGAR Those receiving live virus vaccines- GET ACTUAL VIRUS Use with caution in pediatric patients and in pregnancy/breast-feeding |
| ADRENAL SUPPRESION WITHDRAWAL=HYPOTENSION, HYPERGLYCEMIA, | Why it can developAdrenal suppression and physiologic stressGlucocorticoid withdrawal•Taper dosage over 7 days•Switch from multiple doses to single doses•Taper dosage to 50% of physiologic values•Monitor for signs of insufficiency |
| ADMINISTRATION? | Oral, parenteral (IV, IM, subQ), and topical |
| Glucocorticoid Dosage | Highly individualizedDetermined empirically (trial and error)No immediate threat: Start low and slowImmediate threat: Start high; decrease as possibleLong-time use: Smallest effective amount |
| Prolonged treatment with high doses is used only if disorder is life-threatening or has potential to cause permanent disabilityIncreased in times of stressGradual weaningAlternate-day therapyAdminister before 0900 | |
| A patient with systemic lupus erythematosus is prescribed prednisone. It is most important for the nurse to monitor the patient for what? | Neck and back pain from a vertebral compression fracture may occur because of the development of osteoporosis as a result of glucocorticoid therapy. Other possible adverse effects of prednisone include hypertension, hypokalemia, and hyperglycemia. |
| A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? | Abrupt withdrawal of glucocorticoids may cause adrenal insufficiency or an adrenal crisis. Infection should be prevented, W/ KNOW CAUSE NA intake should be restricted while the patient is taking glucocorticoids. Eye exam~ 6 mONTHS for PT on therapy. |
| A PT has been receiving long-term prednisone therapy for treatment of rheumatoid arthritis. Chart indicates that the PT has developed Cushing’s syndROME. When performing a physical assessment, the nurse anticipates finding all but which manifestation ? | Hyperglycemia, glycosuria, fluid and electrolyte disturbances, osteoporosis, muscle weakness, cutaneous striations, and lowered resistance to infection. Redistribution of fat produces a “potbelly,” “moon face,” and “buffalo hump.” |
| PRE-ADMISSION ASSESSMENT | THERAPEUTIC-SUPPRESS ASSESESSEMENT OF DISORDER TO DETERMINE INITIAL DOSAGE AND ADJUSTMENT CONTRAINDICATED IN PT W/ FUNGAL INFECTION-LIVE VIRUS-HBP-SUGAR PILLS-NSAID |
| ADMINISTRATION-IMPLEMENTTION | REDUCE AMOUNT FOR PROLONGED THERAPY ERY DOSE FOR INDIVIDUAL PT TAKE GLUCOCORTICOID QOD B4 9:00AM |
| MINIMIZING ADVERSE EFFECTS - | DRUG LOW AS POSSIBLE MINIMIZE HYPERGLYCEMIA, GLUCOSURIA-ADRENAL INSUFFICIENT-TAKE INSULIN MED USE RISEDRONATE, THIAZIDE TO DECUE OSTEOPOROSIS REDUCE BONE LOSS IN POSTMENOPAUSAL STAY AWAY FROM COMMUNICABLE DISEASE |
| MINIMIZING INTERACTION | LOSS OF K-W/ DIURETIC MONITOR DIGOXIN W/ IT INCREASE RISK OF OF GASTRIC ULCERATION W/NSAIDS INCREASE DOSAGE OF INSULIN NO IMMUNIZATINCREASE ION W/ THIS=DECREASE ANTIBODIES= INFECTION |
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Seka_nurse
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