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pathopharm exam 3

chapter 72

QuestionAnswer
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 arthritisSystemic lupus erythematosusInflammatory bowel diseaseMiscellaneous 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 therapyInfection: PCP (Pneumocystis pneumonia)Glucose intolerance: Hyperglycemia and glycosuriaMyopathy: 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 childrenPsychologic disturbances OLDER PT BECOME PSYCHOSIS-SUPPRESS GROTH IN CHILDREN-ASK PATIENT BASELINE
Cataracts and glaucoma: Long-term glucocorticoid therapyPeptic 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 hypoglycemicsVaccines
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 developAdrenal suppression and physiologic stressGlucocorticoid 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 individualizedDetermined empirically (trial and error)No immediate threat: Start low and slowImmediate threat: Start high; decrease as possibleLong-time use: Smallest effective amount
Prolonged treatment with high doses is used only if disorder is life-threatening or has potential to cause permanent disabilityIncreased in times of stressGradual weaningAlternate-day therapyAdminister 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
Created by: Seka_nurse
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