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104 Cards in this Set
- Front
- Back
Addison’s disease |
primary adrenocortical insufficiency with inadequate production of cortisol and aldosterone |
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Addisonian crisis |
condition that mimics hypovolemic and septic shock; also known as adrenocortical insufficiency |
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Aldosterone |
mineralocorticoid hormone secreted by the adrenal cortex to increase sodium reabsorption by the kidneys and indirectly regulate blood levels of potassium, sodium, and bicarbonate; also regulates pH, blood volume, and blood pressure |
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Corticosteroid |
steroid hormones produced by the adrenal cortex; examples include androgens, glucocorticoids, and mineralocorticoids; also known as glucocorticoids or steroids. |
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Cortisol |
the main glucocorticoid secreted as part of the body’s response to stress
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Cushing’s disease |
adrenocortical hyperfunction; may result from excessive corticotropin or primary adrenal tumor |
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Glucocorticoid |
adrenal cortical hormone that protects the body against stress and affects protein and carbohydrate metabolism |
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Immunosuppression
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suppression of the immune system |
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Mineralocorticoid |
steroid hormone released by the adrenal cortex to promote sodium and water retention and potassium excretion |
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Negative feedback mechanism |
when the output of a system affects the stimulus for the system (e.g., hormone secretion produces an effect that shuts off the stimulus for further hormone secretion) |
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steroid |
lipid-soluble hormone produced by the gonadal organs or the adrenal cortex |
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homeostasis
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Corticosteroid hormones affect almost all body organs and are extremely important in maintaining __________ when secreted in normal amounts. |
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hypothalamus, the anterior pituitary, and adrenal cortex |
Corticosteroid secretion is controlled by the ________________, the ____________, and ___________ (the hypothalamic–pituitary–adrenal, or HPA, axis). |
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stimuli that activate the hypothalamic-pituitary-adrenal, or HPA, axis |
low plasma levels of corticosteroids pain anxiety trauma illness anesthesia |
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corticotropin-releasing hormone or factor
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the stimuli cause the hypothalamus of the brain to secrete ______________ (known as CRH or CRF). |
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corticotropin-releasing hormone or factor (known as CRH or CRF)
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___________________________ stimulates the anterior pituitary gland to secrete corticotropin. |
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corticotropin
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__________ then stimulates the adrenal cortex to secrete corticosteroids. |
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sympathetic nervous system (SNS)
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The stress response activates the _______________ to produce more epinephrine and norepinephrine and the adrenal cortex to produce as much as 10 times the normal amount of cortisol.
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synergistic interaction
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The _________ of these hormones (epinephrine, norepinephrine and cortisol) increases the person’s ability to respond to stress. However, the increased SNS activity continues to stimulate cortisol production (the main glucocorticoid secreted as part of the body’s response to stress) and overrules the negative feedback mechanism. Excessive and prolonged corticosteroid secretion damages body tissues. |
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storage area
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In general, protein binding functions as a ____________ from which the hormones are released as needed. This promotes more consistent blood levels and more uniform distribution to the tissues. |
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glucocorticoids, mineralocorticoids, and adrenal sex hormones
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The adrenal cortex produces approximately 30 steroid hormones, which are divided into ______________, _____________, and ______________.
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cholesterol
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Chemically, all corticosteroids are derived from _____________ and have similar chemical structures. However, despite their similarities, slight differences cause them to have different functions. |
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Exogenous corticosteroids |
_________ are used as drugs in a variety of disorders. Their use must be closely monitored, because they have profound therapeutic and adverse effects. |
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endogenous hormones |
To understand the effects of corticosteroids used as drugs (exogenous corticosteroids), it is necessary to understand the physiologic effects and other characteristics of the _________. |
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Corticosteroid secretion |
_____________ is controlled by the hypothalamus, the anterior pituitary, and adrenal cortex (the hypothalamic–pituitary–adrenal, or HPA, axis). |
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adrenal cortex |
The _________ ________ produces approximately 30 steroid hormones, which are divided into glucocorticoids, mineralocorticoids, and adrenal sex hormones. |
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glucocorticoids |
Although the term “corticosteroids” actually refers to all secretions of the adrenal cortex, it is most often used to designate the ____________ , which are important in metabolic, inflammatory, and immune processes. |
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Glucocorticoids |
_________ are secreted cyclically, with the largest amount being produced in the early morning and the smallest amount during the evening hours (in people with a normal day–night schedule). |
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Mineralocorticoids |
a class of steroids that play a vital role in the maintenance of fluid and electrolyte balance through their influence on salt and water metabolism. |
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Aldosterone |
the main mineralocorticoid and is responsible for approximately 90% of mineralocorticoid activity |
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androgens; estrogens and progesterone |
The adrenal cortex secretes male (_________) and female (_______ and _________) sex hormones. |
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Adrenal androgens |
_____________ increase protein synthesis (anabolism), which increases the mass and strength of muscle and bone tissue; they affect development of male secondary sex characteristics; and they increase hair growth and libido in women. |
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Primary adrenocortical insufficiency (Addison’s disease) |
is associated with destruction of the adrenal cortex by disorders such as tuberculosis, cancer, or hemorrhage; with atrophy of the adrenal cortex caused by autoimmune disease or prolonged administration of exogenous corticosteroids; and with surgical excision of the adrenal glands. In this disorder, there is inadequate production of both cortisol and aldosterone. |
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Secondary adrenocortical insufficiency |
produced by inadequate secretion of corticotropin, is most often caused by prolonged administration of corticosteroids. This condition is largely a glucocorticoid deficiency; mineralocorticoid secretion is not significantly impaired. |
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Congenital adrenogenital syndromes and adrenal hyperplasia |
____________ result from deficiencies in one or more enzymes required for cortisol production. Low plasma levels of cortisol lead to excessive corticotropin secretion, which then leads to excessive adrenal secretion of androgens and hyperplasia (abnormal increase in number of cells). |
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Androgen-producing tumors |
__________ of the adrenal cortex, which are usually benign, produce masculinizing effects. |
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Adrenocortical hyperfunction (Cushing’s disease) |
__________ may result from excessive corticotropin or a primary adrenal tumor. Adrenal tumors may be benign or malignant. Benign tumors often produce one corticosteroid normally secreted by the adrenal cortex, but malignant tumors often secrete several corticosteroids. |
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Hyperaldosteronism |
_______________ is a rare disorder caused by adenoma (a benign tissue from glandular tissue) or hyperplasia of the adrenal cortex cells that produce aldosterone. It is characterized by hypokalemia, hypernatremia, hypertension, thirst, and polyuria. |
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glucocorticoids |
Exogenous corticosteroids, or _______________, are administered to treat disorders of the adrenal cortex or endocrine system. |
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corticosteroids |
The administration of ____________ decreases the inflammatory symptoms and alters the immune response produced by nonendocrine disorders. |
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hydrocortisone |
People once viewed _____________, a short-acting corticosteroid and an exogenous equivalent of endogenous cortisol, as the prototype corticosteroid drug. |
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prednisone |
Now they consider _____________, an intermediate acting corticosteroid, to be the prototype corticosteroid. |
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Prednisone (Apo-Prednisone, Deltasone) |
Glucocorticoid prototype |
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Glucocorticoid other drugs in class |
Beclomethasone (QVAR, Beconase AQ) Betamethasone (Celestone) Betamethasone acetate and betamethasone sodium phosphate (Celestone Soluspan) Budesonide (Pulmicort, Rhinocort, Entocort EC) Cortisone Dexamethasone (Decadron) Dexamethasone acetate Dexamethasone sodium phosphate (Decadron Phosphate) Flunisolide (AeroBid, Nasarel) Fluticasone (Flovent, Flonase) Hydrocortisone (Cortaid) Hydrocortisone (Cortef) Hydrocortisone sodium phosphate Hydrocortisone sodium succinate (Solu-Cortef) Hydrocortisone retention enema (Cortenema) Hydrocortisone acetate (Cortifoam) Methylprednisolone (Medrol) Methylprednisolone sodium succinate (Solu-Medrol) Methylprednisolone acetate (Depo-Medrol) Mometasone (Nasonex) Prednisolone (Prelone) Prednisolone acetate (Pred Forte) Triamcinolone Triamcinolone acetonide (Azmacort, Nasacort) Triamcinolone hexacetonide (Aristospan) |
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Fludrocortisone (Florinef) |
Mineralocorticoid prototype |
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HPA axis |
The administration of exogenous corticosteroids suppresses the __________ ________. As a result, secretion of corticotropin decreases, causing atrophy of the adrenal cortex and decreased production of endogenous adrenal corticosteroids. |
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inflammatory |
corticosteroid drugs act to inhibit the release, formation, or activation of various ___________ mediators. |
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Inflammatory process |
Cellular responses to injury include the following: phospholipid in the cell membrane is acted on by phospholipase to release arachidonic acid, metabolism of arachidonic acid produces the inflammatory mediators prostaglandins and leukotrienes, lysosomal membrane breaks down and releases inflammatory chemicals (e.g., histamine, bradykinin, intracellular digestive enzymes), and white blood cells (WBCs) are drawn to the area and release inflammatory cytokines (e.g., interleukin-1 [IL-1] alpha). |
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phospholipase A2 |
Normally, when a body cell is injured or activated by various stimuli, the enzyme _________________ causes the phospholipids in cell membranes to release arachidonic acid. Free arachidonic acid is then metabolized to produce proinflammatory prostaglandins (see Chap. 14) and leukotrienes. At sites of tissue injury or inflammation, corticosteroids induce the synthesis of proteins that suppress the activation of phospholipase A2. This action, in turn, decreases the release of arachidonic acid and the formation of prostaglandins and leukotrienes. |
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edema |
Anti-inflammatory agent of corticosteroid reduces capillary permeability and thus prevents leakage of fluid into the injured area and development of ____________. It also reduces the chemicals that normally cause vasodilation and tissue irritation. |
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corticosteroid drugs |
Because the ___________________ affect virtually every aspect of inflammatory and immune responses, they are used in the treatment of a broad spectrum of diseases with an inflammatory or immunologic component. |
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Allergic rhinitis (also called seasonal rhinitis, hay fever, and perennial rhinitis) |
a common problem for which corticosteroids are given by nasal spray, once or twice daily. The drugs decrease mucus secretion and inflammation. Therapeutic effects usually occur within a few days with regular use. Systemic adverse effects are minimal with recommended doses but may occur with higher doses, including adrenocortical insufficiency from HPA suppression. |
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joint inflammation |
Corticosteroids are the most effective drugs for rapid relief of the pain, edema, and restricted mobility associated with acute episodes of _________ __________. They are usually given on a short-term basis. When inflammation is limited to three or fewer joints, the preferred route of drug administration is by injection directly into the joint. Intraarticular injections relieve symptoms in approximately 2 to 8 weeks, and several formulations are available for this route. However, corticosteroids do not prevent disease progression and joint destruction. As a general rule, a joint should not be injected more often than three times yearly because of risks of infection and damage to intraarticular structures from the injections and from overuse when pain is relieved. |
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asthma |
Corticosteroids are commonly used in the treatment of _____________ because of their anti-inflammatory effects. In addition, corticosteroids increase the effects of adrenergic bronchodilators to prevent or treat bronchoconstriction and bronchospasm. The drugs increase the number of beta-adrenergic receptors and increase or restore responsiveness of beta receptors to beta-adrenergic bronchodilating drugs. Research indicates that responsiveness to beta-adrenergic bronchodilators increases within 2 hours and that numbers of beta receptors increase within 4 hours. |
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5 to 10 days. |
In acute asthma or status asthmaticus unrelieved by inhaled beta-adrenergic bronchodilators, high doses of systemic corticosteroids are given orally or intravenously along with bronchodilators for approximately__________ to _______ days. |
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1 to 3 days |
Although high doses of corticosteroid suppress the HPA axis, the suppression lasts for only _____ to _______ days, and other serious adverse effects are avoided. Thus, systemic corticosteroids are used for short-term therapy, as needed, and not for long-term treatment. |
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flunisolide inhaler |
U.S. Food and Drug Administration (FDA) has issued a BLACK BOX WARNING ♦ for people who are transferred from systemically active corticosteroids to _______ _________ because deaths have occurred from adrenal insufficiency. |
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lymphomas, lymphocytic leukemias, and multiple myeloma. |
Corticosteroids are commonly used in the treatment of __________ , lymphocytic __________ , and multiple __________. |
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lymphocytes |
corticosteroids inhibit cell reproduction and are cytotoxic to __________. In addition to their anticancer effects in hematologic malignancies, corticosteroids are beneficial in treatment of several signs and symptoms that often accompany cancer |
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Corticosteroids |
__________________ are used to treat anorexia, nausea and vomiting, cerebral edema and inflammation associated with brain metastases or radiation of the head, spinal cord compression, pain and edema related to pressure on nerves or bone metastases, graft-versus-host disease after bone marrow transplantation, and other disorders that occur in patients with cancer. |
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COPD |
The authors found if patients with ___________ received systemic corticosteroids during acute exacerbations, the airflow limitations improved, relapses decreased, and length of hospital stays decreased. |
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alternate-day therapy (ADT) |
Strategies to minimize HPA suppression and risks of acute adrenal insufficiency: Using _________________, which involves titrating the daily dose to the lowest effective maintenance level, then giving a double dose every other day. |
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growth |
A concern with children is __________ retardation, which can occur short term with small doses and administration by inhalation. Many children have a growth spurt when the corticosteroid is discontinued. Adult stature does not appear to be affected by inhaled corticosteroid therapy during childhood. |
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older patients |
adverse effects such as mania, depression, psychosis, and delirium are extremely common in _____________ treated with corticosteroids. |
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aggravated by corticosteroids in older adults |
heart failure, hypertension, diabetes mellitus, arthritis, osteoporosis, increased susceptibility to infection, concomitant drug therapy that increases risks of GI ulceration, and bleeding |
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Use in patients with renal impairment |
In these patients, as in others, adverse effects of systemic corticosteroids may include infections, hypertension, glucose intolerance, obesity, cosmetic changes, bone loss, growth retardation in children, cataracts, pancreatitis, peptic ulcerations, and psychiatric disturbances. |
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Use in Patients With Hepatic Impairment |
Metabolism of corticosteroids is slowed by severe hepatic disease, and corticosteroids may accumulate and cause signs and symptoms of hypercorticism. Use of prednisolone is preferred than prednisone |
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Adrenal insufficiency |
__________ is the most clear-cut indication for use of a corticosteroid, and even a slight impairment of the adrenal response during severe illness can be lethal if corticosteroid therapy is not instituted. |
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pneumocystosis |
Corticosteroids improve survival and decrease risks of respiratory failure with _______________ , a common cause of death in patients with AIDS. |
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adrenocortical insufficiency |
corticosteroids adverse effects: fainting, weakness, anorexia, nausea, vomiting, hypotension, shock, and death (if untreated) |
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Cushingoid features: |
“moon face” and buffalo hump due to the redistribution of fat |
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Cardiovascular symptoms |
corticosteroids results in adverse reactions: hypotension, shock, hypertension, heart failure, thromboembolism, thrombophlebitis, fat embolism, and cardiac dysrhythmias |
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diminished immunity |
corticosteroids results in adverse reactions: increased susceptibility to infection |
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Endocrine effects |
corticosteroids results in adverse reactions: diabetes mellitus, hyperglycemia, and hypercholesterolemia; diminished T3 and T4 levels, resulting in hypothyroidism; reduced growth because of altered synthesis of DNA |
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Fluid and electrolyte effects |
corticosteroids results in adverse reactions: fluid retention, hypokalemia, hypocalcemia |
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integumentary effects |
corticosteroids results in adverse reactions: reddened skin, thinner skin, stretch marks, skin tears, delayed wound healing |
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musculoskeletal effects |
corticosteroids results in adverse reactions: hypocalcemia, which places the patient at risk for osteoporosis and fracture development; serum hypocalcemia, which increases the release parathyroid hormone, increasing the loss of calcium from bone |
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Ocular effects |
corticosteroids results in adverse reactions: cataracts and glaucoma |
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Reproductive effetcs |
corticosteroids results in adverse reactions: amenorrhea or irregular menstrual cycles |
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Licorice |
__________ increases the effects of corticosteroids, which may potentiate its effects; cautious use of this with corticosteroids is necessary. |
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locally |
Corticosteroids can be given by several different routes to produce local or systemic effects, depending on the clinical problem. If feasible, these drugs should be given ____________ rather than systemically to prevent or decrease systemic toxicity. |
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oral inhalation |
several formulations have been developed for _________ __________ in the treatment of asthma and for nasal inhalation in the treatment of allergic rhinitis. |
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Parenteral |
______________ administration is indicated only for patients who are seriously ill or unable to take oral medications. |
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sodium phosphate or sodium succinate salts |
For intramuscular or IV injections, sodium ____________ or sodium ___________ salts are used because they are most soluble in water. |
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acetate salts |
For intraarticular or intralesional injections _____________ salts are used because they have low solubility in water and provide prolonged local action. |
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Drugs That Increase the Effects of Corticosteroids |
Estrogens, oral contraceptives, ketoconazole, macrolide antibiotics (e.g., erythromycin) Increase the effects of corticosteroids by inhibiting the enzymes that normally metabolize corticosteroids in the liver. Diuretics (e.g., furosemide and thiazides) Increase hypokalemia |
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Drugs That Decrease the Effects of Corticosteroids |
Antacids and cholestyramine Decrease the absorption of corticosteroids Carbamazepine, phenytoin, rifampin Induce microsomal enzymes in the liver and increase the rate at which corticosteroids are metabolized or deactivated |
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stress or illness |
For people receiving chronic corticosteroid therapy, dosage must be increased during periods of __________ or _________. Some common sources of stress for most people include surgery and anesthesia, infections, anxiety, and extremes of temperature. Note that events that are stressful for one patient may not be stressful for another. |
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hydrocortisone |
During major stress or severe illness, even larger doses are necessary. For example, a patient undergoing abdominal surgery may require 300 to 400 mg of ______________ on the day of surgery. |
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100 mg |
During acute stress situations of short duration, such as traumatic injury or invasive diagnostic tests (e.g., angiography), a single dose of approximately _____________ mg of hydrocortisone immediately after the injury or before the diagnostic test is usually sufficient. |
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Alternate-day therapy |
____________ , in which a double dose is taken every other morning, is usually preferred for other chronic conditions. This schedule allows rest periods so that adverse effects are decreased while anti-inflammatory effects continue. |
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ADT |
_______________ seems to be as effective as more frequent administration in most patients with bronchial asthma, ulcerative colitis, and other conditions for which long-term corticosteroid therapy is prescribed. |
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maintenance |
ADT is used only for ____________ therapy (i.e., clinical signs and symptoms are controlled initially with more frequent drug administration). ADT can be started after symptoms have subsided and stabilized. |
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glucocorticoids |
Intermediate-acting ___________ (e.g., prednisone, prednisolone, methylprednisolone) are the drugs of choice for ADT. |
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ADT |
-decreases susceptibility to infection and does not retard growth in children - not usually indicated in patients who have previously received corticosteroids on a long-term basis |
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Addison’s disease. |
Prescribers order hydrocortisone (Solu-Cortef) for the treatment of ________________ |
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Prednisone
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______________ is the drug of choice for nonendocrine disorders in which anti-inflammatory, antiallergic, antistress, and immunosuppressive effects are desired. |
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dexamethasone |
Health care providers consider________________ (parenteral or oral) the corticosteroid of choice for cerebral edema associated with brain tumors, craniotomy, or head injury, because it is thought to penetrate the blood–brain barrier more readily and achieve higher concentrations in cerebrospinal fluids and tissues. |
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medical alert bracelet |
Wear a special _______________ or tag or carry an identification card stating the drug being taken; the dosage; the prescriber’s name, address, and telephone number; and instructions for emergency treatment. If an accident or emergency situation occurs, health care providers must know about corticosteroid drug therapy to give additional amounts during the stress of the emergency. |
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infection |
Avoid exposure to _____________ when possible. Avoid crowds and people known to have an infection. Also, wash hands frequently and thoroughly. These drugs increase the likelihood of infection, so preventive measures are necessary. Also, if infection does occur, healing is likely to be slow. |
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weigh |
____________ frequently when starting corticosteroid therapy and at least weekly during long-term maintenance. An initial weight gain is likely to occur and is usually attributed to increased appetite. Later weight gains may be caused by fluid retention. |
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oral; nasal |
Commonly used local applications are applied topically for skin disorders; by _________ inhalation for asthma; and by ___________ inhalation for allergic rhinitis. Although long-term use is usually well tolerated, systemic toxicity can occur if excess corticosteroid is inhaled or if occlusive dressings are used over skin lesions. Thus, a corticosteroid for local application must be applied correctly and not overused.
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Self- or Caregiver Administration |
Take an oral corticosteroid with a meal or snack to decrease GI upset. If taking the medication once a day or every other day, take before 9:00 AM if taking multiple doses, take at evenly spaced intervals throughout the day. When applying a corticosteroid to skin lesions, do not apply more often than ordered and do not cover with an occlusive dressing unless specifically instructed to do so. |
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metered-dose inhaler oral-inhalation corticosteroid |
1. Shake canister thoroughly. 2. Place canister between lips (both open and pursed lips have been recommended) or outside lips. 3. Exhale completely. 4. Activate canister while taking a slow, deep breath. 5. Hold breath for 10 seconds or as long as possible. 6. Wait at least 1 minute before taking additional inhalations. 7. Rinse mouth after inhalations to decrease the incidence of oral thrush (a fungal infection). 8. Rinse mouthpiece at least once per day. |