exam 4 - glucocorticoids

where are corticosteroids produced

adrenal cortex

mineralcorticoids

modulate Na+ and water balance

glucocorticoids

influence carb metabolism/other processes

physiologic/endogenous effects of glucorticoids

treat endocrine disease

replacement, cortisol insufficiency, treatment of addison’s disease

low doses = not toxic bc adrenal gland not producing. lack of cortisol

pharmacologic effects of glucocorticoids

treat other conditions, non-endocrine

suppression of inflammation

high doses = toxic

metabolic effects of glucocorticoid

affect carb metabolism, increases glucose (“steroid diabetes”)

suppress protein synthesis

stimulate fat breakdown, causes redistribution with long term use (Cushing syndrome)

cardiovascular effects of glucocorticoids

capillaries more permeable

increase circulating RBCs, decrease WBCs=higher risk for infection

water and electrolyte effect of glucocorticoids

Na+ and H2O retention

K+ excretion/loss; mindful of heart disease or furosemide

decrease in Ca+ (bone density, osteoporosis)

mineralocorticoid effects

mechanisms of action for glucocorticoids

inhibit synthesis of chemical mediators to reduce inflammation/pain

suppress infiltration of phagocytes, averting damage from lysosomal enzymes (inflammation)

suppress proliferation of lymphocytes (immune component). not toxic at physiologic doses

treatment goals for non-endocrine disorders

pharmacologic dosing, higher doses needed can cause severe toxicity. determined by pattern of drug use, route, dosing

achieve therapeutic effect while keeping side effects to a minimum; produce anti inflammatory and immunosuppressive effects

high dose/pharmacologic treatment of non-endocrine diseases

rheumatoid arthritis, osteoarthritis, tendonitis

lupus, multiple sclerosis

asthma, bronchitis, exacerbations or late stage COPD

IBD, misc. inflammatory disorders

cancer; leukemia, hodgkin’s/non hodgkins lymphoma

skin conditions; allergic rxs/not anaphylaxis

head and spinal cord injury

adverse effects of pharmacologic use of glucocorticoids

iatrogenic Cushing syndrome: buffalo hump, moon face, truncal obesity

thinning skin, striations

hirsutism (female facial hair)

fluid/electrolyte imbalances; fluid and Na+ retention, K+ loss

myopathy, muscle wasting

osteoprosis

increase infection risk

hyperglycemia

adrenal insufficiency

caution use in pts with/taking…

HTN, HF, renal impairment, gastritis/PUD, DM, osteoporosis, open-angle glaucoma, resistant infections

K+ depleting diuretics, digoxin, oral hypoglycemics/insulin, NSAIDs

steroid use masks s/s of infection, lowers WBCs

taper! lower adrenal suppression/crisis

long term use of glucocorticoids with older adults

osteoporosis, adrenal insufficiency, GI ulceration/PUD

cause anemia → dizzy → falls

drug interactions with glucocorticoids

K+ loss/hypokalemia: digoxin increases risk of toxicity/dysrhythmias, thiazide and loop diuretics

NSAIDs: increase risk of GI ulceration/bleeding (PUD), kidney effects

insulin & oral hypoglycemic agents: increase dosage needed to lower BS

vaccines: lower antibody response

contraindication: systemic fungal infections, live virus vaccines=increase risk of acquiring viral disease

route of administration of glucocorticoids

oral/PO: predinsone, cortisone, hydrocortisone, prednisolone

parenteral/IV: dexamethasone, methylprednisolone, hydrocortisone

injection/IM: betamethasone, hydrocortisone, dexamthasone

topical: triamcinolone, hydrocortisone

inhalation: MDI, DPI

general guidelines of dosing

highly individualized therapy, often trial and error, smallest dose

start low, go slow; unless life threatening (head/spinal cord injury)

local use preferred over systemic (PO/IV); fewer side effects

take in am to mimic normal diurnal variation of cortisol

take with food/milk; lower GI effects

must increase dose in times of stress (truame, surgery, infection)

do not discontinue abruptly

alternate day dosing

larger doses every other day

several benefits; lower adrenal suppression and overall toxicity

drawback: longer interval between doses permits s/s flare-up

nursing considerations for glucocorticoids

monitor for therapeutic effects vs risks

monitor glucose

early am administration

K+ supplements

stomach protections

gradual withdraw; taper

encourage to carry med alert bracelet

prevent/monitor infection

teach s/s fluid and electrolyte imbalances

anabolic steroids

only treatment is for male hypogonadism

athletes use to build muscle mass and strength, performance enhancing, increase delivery of oxygen to exercising tissues

signs of abuse: mood swings, obsession with body image, rapid gains in strength/muscle

adverse effects of steriods

shrunken testicles, gynecomastia: malebreasts

virilization in females (facial hair, baldness, voice change)

swollen head, altered facial features, acne

salt and water retention, edema, HTN

aggressiveness, severe depression