Pharm (Test 3)
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| Where are steroids produced and released? | adrenal cortex
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| What controls secretion of steroids? | pituitary release of corticotropin (ACTH)
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| What are the 2 main classes of steroids? | mineralocorticoids and glucocorticoids
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| Where are mineralocorticoids secreted from? | zona glomerulosa
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| Where are glucocorticoids secreted from? | zona fasiculata
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| What is the precursor to all steroids? | cholesterol
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| What steroid accounts of 95% of all mineralcorticoid activity? | aldosterone
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| What is the function of aldosterone? | maintain status quo re: extracellular fluid vol; maintain plasma cntn of Na+ and K+ ions
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| What 4 things stimulate the secretion of aldosterone? | inc. in serum K+ cntn, hyponatremia, ACTH, angiotensinII
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| What steroid accounts for 95% of glucocorticoid activity? | cortisol
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| True or False: Cortisol is essential for life. | True
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| 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)
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| True or False: Glucocorticoids have anti-inflammatory effects. | True
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| 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
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| Deposits of fatty acids caused by increased cortisol can result in what 2 physical characteristics? | buffalo hump, moon face
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| How does cortisol decrease inflammation? | 1)dec. capillary permeability, 2)stabilize lysosomal membranes
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| 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
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| How does cortisol inc. the number and sensitivity of beta-adrenergic receptors. | dec. myocardial and vascular reponse to catecholamines
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| True or False: Cortisol affects the antigen-antibody reaction and the histamine release w/ allergic reactions. | False
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| How much cortisol do we secrete daily? | 20mg
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| Do we secrete more cortisol during the day or at night? | during the day
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| How much cortisol would be released per day after a minor surgery? | 50mg/day
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| How much cortisol would be released per day after major surgery? | 75-150mg/day
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| Where is cortisol stored? | Not stored anywhere
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| What is the elimination 1/2 life of cortisol? | 70min
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| 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
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| What does a stress increase in cortisol do? | anti-inflammatory and protective effects: prevents stress-induced hypotension and shock
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| What are some examples of endogenous corticosteroids? | cortisol/hydrocortisone/solu-cortef, cortisone, corticosterone, desoxycorticosterone, aldosterone
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| What are some examples of synthetic corticosteroids? | prednisolone, prednisone, methylprednisolone-acetate/depo-medrol, methylprednisolone-sodium-succinate/solu-medrol, betamethasone, dexamethasone/decadron, triamcinolone
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| 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
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| 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
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| 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)
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| Define CIRCI. | critical-illness-related corticosteroid insufficiency; the adrenal response to stress is inadequate
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| What are s/s of CIRCI? | unexplained vasopressor-dependent refractory hypotension; hypovolemic shock w/ myocardial and vascular unresponsiveness to catecholamines
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| 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
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| What are some benefits of steroid coverage? | prevention of life-threatening secondary adrenal insufficiency--CV collapse, perioperative hypotension
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| What are some risks of steroid coverage? | altered wound healing, altered glucose metabolism
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| What are 2 recommendations for steroid coverage for minor surgery? (hernia repair) | 1)usual morning dose, 2)morning dose + hydrocortisone 25mg or equiv
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| 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
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| 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
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| What 3 anesthetics can suppress stress release of cortisol to some extent? | etomidate (suppresses adrenal synthesis), opioids, volatiles (to a lesser degree)
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| 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
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| 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
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