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annie morel
stress response and pharmacology of adrenosorticosteroids
| Question | Answer |
|---|---|
| What is stress? | A response to an environmental demand or situation |
| Stress can be positive or .... | negative. It is all about how we cope with our stress |
| What is a stressor to one can or can't be a.... | stressor to another person |
| How does stress affect our system? | Affects our GI, heart problems, high cholesterol, depression, sleep problems, irritability, diarrhea, type 2 DM, |
| What are 4 factors in our response to stress? | Hardiness, sense of coherence, resilience, attitude |
| What affects hardiness? | clear sense of values and goalsstrong tendency to interactionsense of meaningfulnessinternal focus of control |
| What affects coherence? | See life as ordered, manageable, predictable, and determines health affects from stress |
| What affects resilience? | resourceful, flexible, problemsolver |
| What affects attitude? | glass is half full--positive attitude and your feelings affect how much control you have over your situation |
| What is GAS? | Genera; Adaptation syndrome |
| What three stages are involved in the GAS? | Alarm reaction, stage of resistance, and stage of exhaustion |
| what happens in the alarm reaaction stage? | It is fight of flight and BP^, Hr^ with sweating and snxiety |
| what happens in the stage of resistance? | extra energy expenditure, fitness, resources, coping, mechanical(healthy ones), how well you resist stress is based on your surrent state of health |
| What happens in the stage of exhaustion? | All energy is expended, there is brief alarm--body's last unph, and stress/death--coping is gone |
| What 4 factors are involved with the physiologic response? | limbic system, hypothalamus, endocrine stimulation, immune system |
| What happens when the hypothalamus releases CRH? | There is a release of B endorphins and decrease the sense of pain |
| what happens when the hypothalamus releases ACTH? | Cortisol secretion leading to increase glucose and inhibits inflammation process and increase in epi and norep.You have ^BP and ^HR and vasoconstriction |
| What happens when the mimbis system is involved? | there is an immune response and the immune system has a decrease in cytokines and decrease of phagocytosis. |
| What happens wth endocrine stimulation response? | epi and norep from adrenal medualla |
| What is considered the limbic system? | emotions and behavior |
| In the immune system is it decreased ir increased with cytokines? | decreased--inhibition of inflammation |
| what are cytokines? | neurotransmitters that carry messages between cells |
| With the Limbic, endocrine, hypothalamus, and immune systems, they release the.....? | transmitters and hormones and endorphines |
| What are the effects of stress? | In addition to the GI and heart problems etc, memory, cognitive abilities are impaired, atrophy of hippocampus(atrophy of brain--physical changes b/c of stress, increased risk if autoimmune disease--decrease inflam response and decrease in inflam process |
| How do we respond to stress? | We respond by coping and by relaxation |
| What factors affect our coping? | health status, belief systems, problem solving skill, support systems and resources, social skills, and finances |
| What factors affect our relaxation? | deep breathing, imagery, meditation, muscle relaxation, amd massage |
| What are the three steroids regulated and secreted by the adrenal cortex? | Glucocorticoid--cortisolMineralcorticoid--aldosteroneAndrogen--testosterone |
| Where are the adrenal glands located? | on top of the kidneys |
| What is the purpose of adrenal glands? | to secrete hormones to help regulate chemical balance, metabolism, and supplement other glands |
| What are two adrenal cortex diseases? | Addison's and Cushings |
| What causes Cushing syndrome? | excess corticosteroids, administration of corticosteroids ie: prednisone, ACTH pituitary tumor, adrenal tumor, ectopic ACt from tumors. MAINLY steroid usage from exogenous or outside sources (drugs) |
| What causes Addisons' | decreased corticosteroids, pituitary diease, autoimmune response, polyendocrine def.syndrome, TB, infarction, hemorrhage, fingal infections, AIDS, and metastic cnacer |
| What are the symptoms of Cushings? | decreased wound healing, ^BP, dyspepsia(^HCL acidosis), moonface, hair loss, edema, humpback, purple striae, trinkal obesity, ^BG, bruising, buffalo hump, liver enlargement, weak muscles, atrphy, acne, facial hair, gynecomastia,^appetite, ^NA, decreased K |
| what are some other symptoms of Cushings? | depression, irritability, disturbed body image, disturbed sleep, FVE, osteoporosis, decreased immunity, ^risk of fractures |
| What effects do corticosteroids have on the body? | anti-inflammatroy, immunosupopresion, maintenance of BP, carb, protein, metabolism, and fat metabolism, (glucocoricoids) --moon face, trunkal obesity and buffalo hump |
| What causes NA and K retention? | mineral corticosteroids |
| Why are patients on corticosteroids? | allergic reactions, asthma, COPD, autoimmune disease (lupus, rheumatoid arthritis), inflammatory bowel disease (chron's ulcerative colitis), organ transplant pt, thyroid disorders |
| Why are patients on corticosteroids? continued... | head and spinal cord trauma, cancer treatment, skin disorders (rashes), and hepatitis |
| What are glucocorticoids called? | prednisone, dexamethasone, methylprednisolone |
| What are mineralcorticoids called? | florinef |
| What is prednisone? | an immunosuppressant and anti-inflammatory which is immediate-acting and synthetic |
| Does this have less mineralcorticoid in it than hydrocortisone? | yes--it has srtong glucocorticoid in it and low mineralcorticosteroid |
| Do you gice this with meals? | yes |
| Can you stop is abruptly? | No b/c of adrenal crisis--body goes without making and takes a long time for the body to kick in again |
| Name one reason you give this med? | for asthma |
| What are some things to remeber when taking prednisone? | BP check, F&E, sleep/mood, would healing, wt. gain, BG, masked infection, withdrawal, GI response to vaccines(live virus-do not get immunity b/cprednisone), NO ASPIRIN!!! |
| What is Dexamethasone? | an immunosuppressant and anti-inflammatory, long acting and synthetic |
| Does this have minimal minerlacorticoid activity? | yes--with strong glucocorticoid |
| What is dexamethasone used for? | for anti-emetic in cancer ptients--5 Ht3 antagonizers |
| How is it given? | PO, IV, IM< OPth, Top, INhal, and intranasal. |
| what is it also used for? | for cerebral edema--tramatic brain injuries |
| What are some things to watch for with use? | K loss, cataracts, bowel perforation, vertebral compression fracture, nasal irritaion,(intranasal) |
| What is Hydrocortisone? | Immunosuppresant and anti-inflammatory, short-acting and synthetic, metabolic |
| Is this a mineralcorticoid? | yes...it is a glucocorticoid with a strong mineralcorticoid |
| How is it given? | PO, IM , Top, intrarticular, PR, SC, IV |
| What are some things to consider with this drug? | inspect your skin, decreased Ca, decreased K, increased Na, increased excretion of Ca, electrolyte problems |
| Think of fractures when using Cortef, or Solucortef or Cortaid--what is the most commom place this steroid is used? | on the face--do not use ANY steroids on the face for more than one week!! |
| Why is Hydrocortisone different from the other two--prednisone and Dexamethasone and Methylprednisone and Fludrocortisone? | b/c it is a strong mineralcorticoid |
| What is Methyprednisone? | Immunosuppressant and anti=inflammatory-intermediate acting and synthetic |
| Is it a mineralcorticoid or a glucocorticoid? | a glucocorticoid like Hydrocortisone but less mineralcorticoid |
| How is it given? | PO, IM, IV |
| What is it used for? | spinal cord injuries/asthma |
| What are some examples of Methyprednisolone? | Solumedrol and Medrol (given PO in a week pack) |
| What is the most important thing to remember about Methyprednisolone? | IV incompatibility with D5 1/2 Na Cl--need to be given with NS or something else!!!!!! |
| What is Fudrocortisone? | Lond acing synthetic potent mineralcorticoid!!! |
| Should you use a glucocorticoid with it? | yes |
| What is also key to remember? | you need to have replacement therapy for adrenacortical insufficiency watch for fluds |
| What are the side effects of corticosteroids? | Cushing syndrome and withdrawal |
| The side effects vary on the type of steroid used and .... | how long!!! |
| What are some nursing implications? | check for fever,increase protein for wound healing, skin assess, labs, electr, standard prec, pt. wear mask, little meals during the day helps BG,NA restriction, avoid K rich foods, tell them side effects such as moon face, etc..... |
| what are some K rich foods? | spinach, black licorice, bananas, oranges, canteloupe |
Created by:
anniemorel
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