Pharm Exam 2 Part 1

glucocorticoids all end in:

\-sone

Corticosteroids are homornes produced by the _____.

adrenal cortex and affect almost all body organs

Corticosteroids are extremely important in maintaining _____.

homeostasis

Corticosteroids used as medications are referred to as _____.

exogenous corticosteroids

Diseases related to corticosteroids results from…

inadequate or excessive secretion

Endogenous corticosteroid secretion into the bloodstrem is controlled by:

\-hypothalamus; anterior pituitary

\-adrenal cortex

What are the types of endogenous corticosteroids?

\-glucocorticoids​

\-mineralocorticoids​

\-adrenal sex hormones

The types of endogenous corticosteroids are all derived from _____.

cholesterol

The types of endogenous corticosteroids all have similar _____.

chemical structures

Slight differences of the endogenous corticosteroids facilitate _____.

different functions

What is glucocorticoids important for?

metabolic, inflammatory, and immune processes

What does glucocorticoids include?

cortisol, corticosterone, and cortisone

Glucocorticoids are secreted _____.

cyclically (largest amount upon awakening; smallest amount before sleep)

_____ account for most of the characteristics and physiologic effects of corticosteroids.

glucocorticoids

Glucocorticoids _____ the glucose level.

increase

Cortisol _____ blood sugar.

raises

What do mineralcorticoids have a vital role on?

maintenance of fluid–electrolyte balance (influences salt and water metabolism)

What is the main mineralocorticoid?

aldosterone

What does aldosterone help with?

sodium and hangs onto water

How is adrenal sex hormones secreted?

secreted continuously in small amounts by both genders​

What is the adrenal sex hormone in men?

androgens

What does androgens do?

\-increases protein synthesis, which increases mass and strength of muscle and bone tissue

\-increases hair growth and libido in women

\-excessive secretions in women cause masculinizing effect

_____ affect development of secondary male characteristics.

androgen

_____ helps with protein synthesis.

adrenal sex hormones

What is the adrenal sex hormone in women?

estrogen and progesterone

What does estrogen and progesterone do?

normally exert few physiologic effects

What are the mechanisms of action of exogenous corticosteroids?

\-bind to glucocorticoid receptors in target tissues at the cellular level​

\-increase or decrease transcription of many genes to alter protein synthesis regulating physiologic effects​

\-variety in genes produces varying effects

What are the indications of use of exogenous corticosteroids?

\-Allergic/hypersensitivity disorders​

\-Collagen disorders​

\-Dermatologic disorders​

\-Endocrine and gastrointestinal disorders​

\-Hematologic and hepatic disorders​

\-Neoplastic and neurologic conditions​

\-Ophthalmic disorders​

\-Organ/tissue transplants and grafts​

\-Renal disorders​

\-Respiratory disorders​

\-Rheumatic disorders​

\-Shock

_____ are extensively used and used largely based on experienced effects.

exogenous corticosteroids

What are the contraindications for use of exogenous corticosteroids?

\-systemic fungal infections

\-used with caution in patients: risk for infection, with infections, with diabetes, with peptic ulcer disease, with inflammatory bowel disorders, with hypertension, with cogestive heart failure, and with renal insufficiency

Why shouldn’t you give a exogenous corticosteroid to a patient you suspect has a fungel infection?

it suppresses the inflammatory response and will overproduce​

How do you know if someone has a systemic fungal infection?

blood cultures will identify yeast or fungus in the blood

What are exogenous corticosteroids given mainly for?

replacement or therapeutic purposes​

What is replacement dosing?

small doses to correct a deficiency state and store normal function (physiologic effects)

What is therapeutic dosing?

relatively large doses to exert new effects not experienced with physiologic dose (pharmacologic effects)

What are the desired effects of glucocorticoids?

\-Anti-inflammatory​

\-Immunosuppressive​

\-Antiallergic​

\-Antistress

What is the goal of corticosteroid therapy?

\-Reduce symptoms to a tolerable level​ (palliative, not curative​)

\-Avoid serious adverse reactions​ (monitor renals; large dose and taper down; small doeses)​

Low dose for _____.

chronic (as low doses as possible to keep them functioning)

High dose for _____.

acute (taper down)

What are the drug selection factors of corticosteroid therapy?

\-Purpose of use​

\-Specific medication characteristics​

\-Desired route of administration​

\-Individual characteristics of the patient​

\-Expected adverse effects​

What are the drug dosage factors for corticosteroid therapy?

\-Specific medication characteristics​

\-Reason for use​

\-Desired route of administration​

\-Expected adverse effects​

\-Characteristics of the patient

What are the drug administration routes of corticosteroid therapy?

\-Desired effects: local or systemic​ (local administration prevents/decreases systemic toxicity​)

\-Oral route (preferred)​

\-Parenteral (IM, IV)​

What is the frequency of administration for corticosteroid therapy?

\-Scheduling is more important than with most other medications​

\-Most adverse effects occur​ (long-term administration of high doses​)

\-Major adverse reaction​ (loss of adrenocortical function)​

What would you do in acute situation for corticosteroid therapy?

\-Large, divided doses for \~48 to 72 hours​

\-Remaining dosage tapered​

\-Allergic reactions; contact dermatitis​

\-Chronic condition exacerbation​

\-Surgery

What would you do in chronic situation for corticosteroid therapy?

smallest effective dose for shortest effective time​

What is alternate-day corticosteroid therapy?

medication taken god

What is double dose taken god do?

\-Allows rest period from medication​

\-Decreased adverse effects​

\-Anti-inflammatory effects continue​

\-Used for maintenance therapy

Double dose taken god is effective with:

\-Bronchial asthma​

\-Ulcerative colitis​

\-Started after symptoms subside and stabilize

What are other advantages of alternate-day therapy?

\-Decreases infection susceptibility​

\-Does not retard growth in children

What kinds of special populations is corticosteroid therapy used in?

\-Children, older adults​

\-Renal or hepatic impairment​

\-Critical illness​

\-Adrenal insufficiency​

\-Acute respiratory failure in COPD, ARDS​

\-Sepsis, AIDS​

\-Home care

What specific disorders does corticosteroids treat?

\-allergic rhinitis, arthritis, asthma

\-cancer, primary CNS lymphomas, CNS tumors

\-chemotherapy induced emesis

\-COPD, inflammatory bowel disease

\-spinal cord injury

\-prevention of acute adrenocortical insufficiency

Immunizations involve the administration of:

\-antigen to induce antibody formation (active immunity)

\-serum from immune people (passive immunity)

Immunizations are prepared by _____.

pharmaceutical companies (regulated by U.S. Food and Drug Administration)

What are antigens?

microorganisms that cause infectious diseases

What do antigens do?

activate the immune response to produce antibodies that protect the body from specific disease

What are vaccines?

suspensions of microbes (killed/attenuated antigenic products) intended to induce antibody formation for the prevention of disease​

Many vaccines produce _____ immunity.

long lasting

_____ risk of developing disease with live vaccines (especially ommunocompromised).

small

What is toxoids?

bacterial toxins or products modified to destroy toxicity but retain antigenic properties

Toxoids are not permanent and require _____.

boosters

_____ immunity is produced using vaccines and toxoids.

active

Immune serums (globulins) are used for _____ immunity.

passive

Immune serums (globulins) act _____.

rapidly

What is the therapeutic goal of passive immunity?

to prevent or modify disease process

Immune globulins increase risk for _____.

thrombosis

What are the contraindications for immunization use?

\-During febrile illnesses (check the temperature)​

\-During immunosuppressive drug therapy (glucocorticoids and mineralocorticoid)​

\-During immunodeficient states​

\-Leukemia​

\-Lymphoma​

\-Generalized malignancy (cancer throughout)​

\-Pregnancy (no immunizations during first trimester)

What are the special populations for immunizations?

\-healthy adolescents and young/middle-aged adults

\-older adults

\-immunosuppression

\-cancer

Where are most vaccines given?

by IM; 3 fingers down from the acromion process

What are immunosupressnat drugs?

\-Interfere with production/function of immune cells​ (to decrease undesirable immune response​)

\-Prevent immune system from targeting own body tissues for elimination​ (allergic reactions, autoimmune disorders​; posttissue/organ transplant​)

Immunosuppressant drugs are given to decrease...

undesirable immune responses

When do autoimmune disorders occur?

when the patient’s immune system does not distinguish between domestic (self) and foreign (nonself) cells​

Autoimmune disorders is when the immune or inflammatory response is in _____.

overdrive

Inflammatory disorders that may be treated with _____ medications.

immunosuppressant

What is a tissue/organ transplant?

replacing dead host tissue with healthy donor tissue

What are the tissues/organs transplanted?

\-Skin grafts, renal grafts​

\-Heart, liver, lung, pancreas​

\-Bone marrow/stem cell

Drug-induced immunosuppression is a major part of _____ protocols.

transplantation

Inadequate immunosuppression can result in:

\-Graft rejection reaction​ (solid organ transplantation​)

\-Graft versus host disease (GVHD)​ (bone marrow/stem cell transplantation​)

Excessive immunosuppression can result in:

serious infection, adverse effects

What is acute reactions of organ rejection?

occur from 10 days to a few months posttransplant​

What are the characteristics of acute organ rejection?

\-Signs of organ failure​

\-Vasculitis lesions, which often lead to arterial narrowing/obliteration​

What is chronic reactions of organ rejection?

occur after months or years of normal function​

What are the characteristics of chronic organ rejection?

\-Progressive failure of transplanted organ​

\-Fibrosis of blood vessels (clots itself off)

What are the immunosuppressent drugs?

\-Cytotoxic immunosuppressant agents​

\-Conventional antirejection agents​

\-Janus Associated Kinase Inhibitor​

\-Adjuvant medications​

What is the cytotoxic immunosupressent agents?

Mycophenolate mofetil​

What is mycophenolate mofetil​?

\-Blocks production of DNA and RNA of cellular reproduction, growth and development​

\-Used w corticosteroids

What is the conventional antirejection agents​?

cyclosporine ​

What is cyclosporine?

\-Inhibits both cellular and humoral immunity affect t lymphocytes more than b lymphocytes​

\-Nephrotoxic, hirsutism, hypertension and hyperlipidemia​

\-Malignancies: skin, lymphomas, and solid organ​

\-Avoid grapefruit juice and St. John’s wart (not good)

What is the Janus Associated Kinase Inhibitor​?

ruxolitinib

What is ruxolitinib?

inhibits Janus ass kinases which signal the cytokine and growth factors of hematopoiesis and immune function​

What are the adjuvant medications?

\-corticosteroids (suppresses systemic immune response)

\-antibody preparations

\-cytokine inhibitors

\-fusion protein inhibitors

What are antibody preparations?

\-Monoclonal (-mab)– isolation and cloning of B lymphocytes which suppresses specific components of the immune system that causes tissue damage in particular disorders/block cellular growth receptors to inhibit proinflammatory​

\-Polyclonal – mixtures of IgA, IgD, IgE, IgG, and IgM

What are cytokine inhibitors?

\-TNF-alpha​

\-IL-1

What is the nursing care for tissue/organ transplant?

\-Preventing interactions​

\-Administering the medication​

\-Assessing for therapeutic effects​

\-Assessing for adverse effects​

\-Patient teaching – preventing infection​

A nurse is explaining to a parent how vaccines work. Vaccines provide which of the following?

A) active immunity

B) passive immunity

C) innate immunity

D) nonspecific immunity

active immunity

A nurse is caring for a patient with severe immunosupression. This condition is a contraindiction to which of the following?

A) all injectable immunizations

B) the use of live bacterial or viral vaccines

C) the use of immune globulins for passive immunity

D) annual influenza vaccine

the use of live bacterial or viral vaccines

A child is receiving an immunization. The nurse should inform the parents that common aftereddects may include which of the following?

A) skin rash and itching

B) redness and soreness at the injection site

C) muscle weakness and difficulty in walking

D) nausea, vomiting, and diarrhea

redness and soreness at the injection site

A nurse is caring for a 74-year-old man. The nurse recognizes that he would most likely to have a decreased immune response to the influenza vaccine if he is taking which of the following medications?

A) levothyroxine

B) prednisone

C) metoprolol

D) lovastatin

prednisone

After organ transplant, immunosuppressants are given to prevent which of the following?

A) nephrotoxicity

B) hepatotoxicity

C) rejection reaction

D) bleeding disorders

rejection reaction

The most common cancers that develop with long-term immunosuppression after organ transplant are

A) skin cancers and lymphomas

B) cancers of the gastrointestinal tract

C) renal and liver cancers

D) brain and spinal cord cancers

skin cancers and lymphomas

The nurse should instruct the patient taking cyclosporine or tacrolimus that toxic levels of the drug may be reached if taken with which of the following beverages that inhibit metabolism of the drugs?

A) orange juice

B) coffee

C) grapefruit juice

D) milk

grapefruit juice