Endocrine (Adrenal)
What is the suffix of all steroids?
"SONE"
What route is used to administer Methylprednisolone in the hospital?
-- Injectable/IV form
What food causes an increase in steroid effects?
-- Licorice increases the effects of corticosteroids--be cautious!
When should a pt plan to take steroids and why?
--6-9 Am on an empty stomach to avoid adrenal insufficiency
What is a disease seen in pts with too many glucocorticoid steroids?
--OVER secretion of adrenal corticoid= CUSHING SYNDROME
What is a disease seen in pts lacking glucocorticoid steroids?
--UNDER secretion= ADDISONS'S DISEASE
-- Indicated for relief of the inflammatory skin disorders and pruirtis
-- USED IN PREGNANT WOMEN IN PREMATURE LABOR TO ACCELERATE FETAL LUNG MATURATION
What happens if you abruptly stop steroids?
--ABRUPT WITHDRAWAL MUST BE AVOIDED. Abrupt withdrawal of adrenal drugs may lead to a sudden decrease in or no production of endogenous glucocorticoids, resulting in adrenal insufficiency. PTS MUST TAPER OFF THESE DRUGS!!
-- any pt with gastritis, reflux disease, or ulcer disease because of the potential of these drugs to cause GASTRIC PERFORATION.
How do steroids affect the inflammatory response?
-- Inflammatory response inhibited (DECREASE ABILITY TO HEAL)
-- INHIBITION OF INFLAMMATORY RESPONSE
How do steroids affect the immune response?
-- Immune response suppressed (SUSCEPTIBLE TO INFECTIONS)
-- INHIBITION OF IMMUNE RESPONSE
How de steroids affect blood glucose?
--Metabolism: create glucose (HYPERGLYCEMIA)
-- INCREASE LEVELS OF BLOOD SUGAR
What do steroids do to bones?
--Musculoskeletal system: muscle atrophy and bone mineralization (OSTEOPOROSIS)
-- STIMULATE BONE DEMINERALIZATION
What are 5 commonly seen AE's of chronic steroid use?
-- MOON FACE AND BUFFALO HUMP
-- HYPERGLYCEMIA
-- ADRENAL INSUFFICIENCY
-- INCREASED RISK FOR INFECTION
-- STEROID PSYCHOSIS
What class of hormones are produced in the adrenal cortex?
--Cortex produces: CORTICOSTEROIDS
--HPA: HYPOTHALAMIC-PITUITARY-ADRENAL AXIS
-- REGULAR ENDOCRINE TISSUE
-- Medulla produces: CATECHOLAMINES (EPINEPHRINE AND NOREPINEPHRINE)
--Neurosecretory endocrine tissue
-- Stimulated by hormones and autonomic system
What are the 3 main effects of Corticoid steroids?
--ANTI-INFLAMMATORY ACTIONS
-- METABOLIC ACTION: CARBOHYDRATE AND PROTEIN
-- IMMUNE ACTION
What pts should not receive steroids?
-- Pts with DM
-- Pts with serous infections
-- Pts with HF-fluid retention
-- Pts w/ immunosuppression
-- Peptic ulcer disease-gastric perforation
-- Many, many drug interactions!!!!
What is a common side effect of Prednisone?
-- Increased appetite
-- Indigestion
-- Nervousness
-- Restlessness
How is adrenal insufficiency related to steroid use?
-- The adrenal gland produces natural steroids in the body between 6-9 am. If one is on steroids (recommended to take in the AM between times listed), the adrenal gland takes a "vacation" when one tapers off the steroids, you want the adrenal gland to "wake up" and begin to make natural steroids again. If the adrenal gland does not wake up, it can lead to Cushing's Disease.
What is the difference between intermediate-acting and long-acting steroids?
-- Intermediate used for exacerbations of chronic respiratory illnesses, long-acting indicated for anti-inflammatory or immunosuppressant.
-- Fludrocortisone is a Mineralocorticoid!!
-- Indicated for partial replacement therapy for Addison's Disease and can be used to help lower BP (Fludrocortisone is a synthetic corticosteroid; hormones of cortisol and aldosterone secreted by the adrenal gland. It does vital functions).
-- Because of the aldosterone effect and retaining water it has other uses.
-- Comes in oral form
-- Often taken concomitantly with glucocorticoid
-- Must store in an airtight, light-protected container
-- Nurse should monitor sodium and potassium levels
-- Monitor weight
What are important pt teaching points for pts taking steroids?
-- You should realize steroids are given to improve symptoms, and not cure
-- When taking oral steroids, you must take the drug as directed
-- These drugs must not be stopped abruptly
-- Be sure to tell all your healthcare team that you are taking steroids
-- Be sure to contact your doctor before starting a new medication
-- Try to avoid exposure to infection. Wash hands frequently. Avoid sick people
-- Be safe and avoid accidents. It will take you longer to heal
-- These drugs increase your appetite. Weigh yourself regularly. You might also retain fluid
-- Report any changes you notice!