1
Q
What are corticosteroids?
A
hormones secreted from either the adrenal cortex or adrenal medulla (both in the adrenal gland)
2
Q
What is aldosterone? What does it do?
A
A mineralcorticoid, it mainly maintains normal Na levels by causing Na reabsorption from the urine in exchange for K and H ions. This increase blood volume and pressure
3
Q
Hypersecretion of aldosterone
A
primary aldosteronism, increased Na and water retention, muscle weakness d/t K loss
4
Q
Addison’s disease
A
Hyposecretion of adrenocortical hormones, decrease blood Na, glucose, increase K, dehydration, weight loss
5
Q
What are glucocorticoids?
A
- usually referred to as corticosteroids
- for glucose metabolism
- maintain adequat “fuel”
6
Q
Chronic illness causes…
A
- long-term stress and cortisol
7
Q
Cortisol causes…
A
- glycogen to glucose
- tryglycerides into fatty acids & glycerol
- muscle proteins into amino acids
- synthesis of more glucose and ketones for body fuel
- results in muscle weakness & atrophy
- poor healing
- immunosuppresion
8
Q
dexamethasone indications
A
- contains glucocorticoids
- relieves inflammation
- treats some arthritis
- skin disorders
- blood disorders
- kidney disorders
- eye disorders
- thyroid disorders
- intestinal disorders (colitis)
- severe allergies
- asthma
9
Q
acute, short-term stress causes…
A
- release of epi and norepi from adrenal medulla
10
Q
catecholamines
A
- epi
- norepi
- dopamine
11
Q
epi and norepi
A
- increase HR & BP
- fight or flight
- dilate airways to raise O2
- vasodilation to important organs
- vasoconstriction to less important
- may cause dry mouth, anorexia, pupil dilation, loss of peripheral vision
12
Q
Prednisone
A
most common adrenal drug
13
Q
Methylprednisone
A
most common injectable glucocorticoid, followed by hydrocortisone and dexamethasone
14
Q
Betamethasone
A
for premature labor, accelerate fetal lung maturation
15
Q
Glucocorticoid contraindications
A
- cataracts
- glaucoma
- PUD
- mental health problems
- DM
- serious infections (because of immunosuppression)
- septicemia
- fungal infx
- varicella
16
Q
Glucocorticoid AE
A
- moon facies (extra fluid volume)
- hyperglycemia
- psychosis (roid rage)
17
Q
Glucocorticoid caution
A
- HF (fluid retention forces heart to work harder)
- can cross placenta barrier
- can be secreted in breast milk
- cause fetal/infant abnormalities
18
Q
Steroid psychosis
A
- confusion
- perplexity
- agitation
- within 5 days of initial treatment
- may develop hallucinations, delucsions, cognitive impairment
- exacerbated mental health problems
19
Q
conditions exacerbated by glucocorticoids and what to look for in a health history
A
- diabetes
- dyslipidemia
- CVD
- GI disorders
- affective (mood) disorders
- osteoporosis
- sx of/exposure to infx
20
Q
baseline measures to take before glucoccorticoids
A
- weight
- height
- bone mineral density
- BP
- CBC
- blood glucose
- lipid profile
21
Q
glucocorticoids nursing implications
A
- don’t stop taking abruptly, taper off
- may need concurrent treatment for osteoporosis or high blood glucose
- monitor for adrenal suppression
22
Q
Type 1 DM
A
- beta cells don’t produce insulin
- or if pancreas is removed
- synthetic insulin is needed
23
Q
Type 2 DM
A
- 95% of all DM
- d/t lifestyle
- pancreas is worn out
- insulin resistence
- may need insulin if BG or A1C is high
24
Q
Normal blood glucose
A
- fasting: 80-130 mg/dL
- but SHOULD be < 100 mg/dL
25
A1C
- glycosylated hemoglobin
- assess long-term BG over 3mo
- varies by age, healt
- generally < 7%
26
Insulin
- most type 1 treated with multiple prandial and basal insuloin or continuous infusion
27
Basal insulin
- long-axcting (glargine or detemir)
- or intermediate-acting (NPH)
28
Prandial insulins
- w/ meals
- rapid acting (lispro, aspart, glulisine)
- or short acting (regular)
29
Lon-acting insulin
- basal
- Detemir
- Glargine (lantus is one, which goes in by itself)
- steady release
- no peak action
- onset varies
- 1x or 2x a day
- do not dilute
30
IDDM
insulin dependent DM
31
Rapid-acting insulin
- bolus
- mimic natural insulins response to meals
- aspart
- glulisine
- lispro
- within 15 min of meal
32
Short-acting insulin
- bolus
- 30-60 min onset
- 30-45 min before meal
- more likely to cause hypoglycemia
33
Oral & Noninsulin injectable agents
- improve the mechanism of insulin and glucose production
- type 2 DM
- for insulin resistance
- for increase glucose production
- biguanides like metformin (the only one in the US)
- Sulfonylureas (glipizide)
- DPP-IV inhibitors (sitaglipin)
34
Biguanides
- metformin (glucophage)
- most effective
- immediate, extended release
- liquid forms
- reduce glucose production by liver
- enhance insulin sensitivity
- improve glucose transport
- may cause weight loss
- type 2 DM
35
Metformin drug alert
- withold for surgery
- withold for radiologic procedure with contrast medium (iodine) which could cause lactic acidosis and AKI
- 1-2 day before, 2 day after when creatinine is within normal limits
36
Metformin contraindications
- renal, liver, cardiac dz
- lactic acidosis
- iodine based contrast medium (will cause lactic acidosis and AKI)
- excessive alcohol
- prednisone (interfere w/ blood glucose control, decrease effectiveness of diabetic meds)
- take with food
37
Sulfonylureas
- stim receptor beta cells to make more insulin and decrease glucagon secretions
- glipizide
- glyburide
- glimepeiride
38
Sulfonylureas contraindications
- advanced DM (pancreas function is needed)
- insulin
- sulfa drug allergy
- NPO
- ETOH
- old age
39
Glucagon
- for hypoglycemia (type 1 and 2 DM)
- can be IM, SC, or IV
40
Hypoglycemia
- too much insulin
- change in mood or mental status
- check BG immediately
41
Rule of 15
- for hypoglycemia
- pt consume 15g of carbs
- check BG after 15min
- is BG is still low, another 15g
- repreat until BG >70mg/dL
42
thyroid replacement drugs
- for hormone imbalances,
- for thyroid disease, cancer, or removal
- inhibit hormone synthesis (levothyroxine-T4, Liothyonine-T3, Liotrix-T3/T4)
43
Levothyroxine (Synthroid)
- used for sx of hypothyroidism
- 30-60min before breakfast
- may cause tachy, angina, temors, intensify warfarin (monitor INR)
- adjust dose in pregnancy
44
Hyperthyroidism
- thyroid makes too much thyroid hormone
- graves disease (autoimmued d/t antibodies
- give thyroid synthesis inhibitoras
- d/t thyroiditis d/t infx, postpartum, meds, injury, liver failure, others
45
thyroid synthesis inhibitors
(antithyroid drugs)
Propylthiouracil
Methimazole
46
Propylthiouracil (PTU) vs
Methimazole
- PTU may cause liver injury (Methimazole doesn't)
- PTU shorter halflife than Methimazole (90 min vs 6-13H)
- PTU crosses placenta less and less concentration in breast milk than Methimazole
- PTU blocks T4-T3 in periphery (Methimazole doesn't)
47
hormones secreted from either the adrenal cortex or adrenal medulla (both in the adrenal gland)
What are corticosteroids?
48
A mineralcorticoid, it mainly maintains normal Na levels by causing Na reabsorption from the urine in exchange for K and H ions. This increase blood volume and pressure
What is aldosterone? What does it do?
49
primary aldosteronism, increased Na and water retention, muscle weakness d/t K loss
Hypersecretion of aldosterone
50
Hyposecretion of adrenocortical hormones, decrease blood Na, glucose, increase K, dehydration, weight loss
Addison's disease
51
- glycogen to glucose
- tryglycerides into fatty acids & glycerol
- muscle proteins into amino acids
- synthesis of more glucose and ketones for body fuel
- results in muscle weakness & atrophy
- poor healing
- immunosuppresion
Cortisol causes...
52
- contains glucocorticoids
- relieves inflammation
- treats some arthritis
- skin disorders
- blood disorders
- kidney disorders
- eye disorders
- thyroid disorders
- intestinal disorders (colitis)
- severe allergies
- asthma
dexamethasone
53
- increase HR & BP
- fight or flight
- dilate airways to raise O2
- vasodilation to important organs
- vasoconstriction to less important
- may cause dry mouth, anorexia, pupil dilation, loss of peripheral vision
epi and norepi
54
most common adrenal drug
Prednisone
55
most common injectable glucocorticoid, followed by hydrocortisone and dexamethasone
Methylprednisone
56
for premature labor, accelerate fetal lung maturation
Betamethasone
57
- cataracts
- glaucoma
- PUD
- mental health problems
- DM
- serious infections (because of immunosuppression)
- septicemia
- fungal infx
- varicella
Glucocorticoid contraindications
58
- moon facies (extra fluid volume)
- hyperglycemia
- psychosis (roid rage)
Glucocorticoid AE
59
- HF (fluid retention forces heart to work harder)
- can cross placenta barrier
- can be secreted in breast milk
- cause fetal/infant abnormalities
Glucocorticoid caution
60
- confusion
- perplexity
- agitation
- within 5 days of initial treatment
- may develop hallucinations, delucsions, cognitive impairment
- exacerbated mental health problems
Steroid psychosis
61
- diabetes
- dyslipidemia
- CVD
- GI disorders
- affective (mood) disorders
- osteoporosis
- sx of/exposure to infx
conditions exacerbated by glucocorticoids and what to look for in a health history
62
- weight
- height
- bone mineral density
- BP
- CBC
- blood glucose
- lipid profile
baseline measures to take before glucoccorticoids
63
- don't stop taking abruptly, taper off
- may need concurrent treatment for osteoporosis or high blood glucose
- monitor for adrenal suppression
glucocorticoids nursing implications
64
- beta cells don't produce insulin
- or if pancreas is removed
- synthetic insulin is needed
Type 1 DM
65
- 95% of all DM
- d/t lifestyle
- pancreas is worn out
- insulin resistence
- may need insulin if BG or A1C is high
Type 2 DM
66
- long-axcting (glargine or detemir)
- or intermediate-acting (NPH)
Basal insulin
67
- w/ meals
- rapid acting (lispro, aspart, glulisine)
- or short acting (regular)
Prandial insulins
68
- basal
- Detemir
- Glargine (lantus is one, which goes in by itself)
- steady release
- no peak action
- onset varies
- 1x or 2x a day
- do not dilute
Lon-acting insulin
69
- bolus
- mimic natural insulins response to meals
- aspart
- glulisine
- lispro
- within 15 min of meal
Rapid-acting insulin
70
- bolus
- 30-60 min onset
- 30-45 min before meal
- more likely to cause hypoglycemia
Short-acting insulin
71
- metformin (glucophage)
- most effective
- immediate, extended release
- liquid forms
- reduce glucose production by liver
- enhance insulin sensitivity
- improve glucose transport
- may cause weight loss
- type 2 DM
Biguanides
72
- withold for surgery
- withold for radiologic procedure with contrast medium (iodine) which could cause lactic acidosis and AKI
- 1-2 day before, 2 day after when creatinine is within normal limits
Metformin drug alert
73
- renal, liver, cardiac dz
- lactic acidosis
- iodine based contrast medium (will cause lactic acidosis and AKI)
- excessive alcohol
- prednisone (interfere w/ blood glucose control, decrease effectiveness of diabetic meds)
- take with food
Metformin contraindications
74
- stim receptor beta cells to make more insulin and decrease glucagon secretions
- glipizide
- glyburide
- glimepeiride
Sulfonylureas
75
- advanced DM (pancreas function is needed)
- insulin
- sulfa drug allergy
- NPO
- ETOH
- old age
Sulfonylureas contraindications
76
- for hypoglycemia (type 1 and 2 DM)
- can be IM, SC, or IV
Glucagon
77
- too much insulin
- change in mood or mental status
- check BG immediately
Hypoglycemia
78
- Levothyroxine
- Propythiouracil (PTU)
- Calcitonin
- Alendronate
thyroid drugs
79
- for hormone imbalances,
- for thyroid disease, cancer, or removal
- inhibit hormone synthesis (levothyroxine-T4, Liothyonine-T3, Liotrix-T3/T4)
thyroid replacement drugs
80
- used for sx of hypothyroidism
- 30-60min before breakfast
- may cause tachy, angina, temors, intensify warfarin (monitor INR)
- adjust dose in pregnancy
Levothyroxine (Synthroid)
81
- thyroid makes too much thyroid hormone
- graves disease (autoimmued d/t antibodies
- give thyroid synthesis inhibitoras
- d/t thyroiditis d/t infx, postpartum, meds, injury, liver failure, others
Hyperthyroidism
82
Propylthiouracil
Methimazole
thyroid synthesis inhibitors
Pharm 4
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