Pharmacology EDAPT - Steroidal Antiinflammatory Drugs

Adverse Effects associated with corticosteroid administration are widespread and can occur in every body system. Based on your knowledge of the actions of corticosteroids, which of these are the most common adverse effects of corticosteroid drugs?

- hyperglycemia - adrenal suppression - Fluid retention - hypertension - gastric ulcers - weight gain - increased ocular pressure - loss of muscle mass - convulsions - hirsutism - petechiae

Corticosteroid imbalance is treated with steroidal anti-inflammatory drugs. The most significant examples of corticosteroid imbalance are Cushing's Syndrome, Primary Aldosteronism, and Addison's Disease. Use the drop-down menus to select the correct word(s) to complete the statements below.

1. fluid and electrolyte balance 2. hyper 3. hypertension 4. hypokalemia 5. the inflammatory response 6. hyper 7. hypertension 8. hypernatremia 9. hypokalemia 10. hypo 11. hyponatremia 12. hyperkalemia 13. dehydration 14. loss

Corticosteroids should be used cautiously in the following situations. Use the drop-down menus to select the correct word(s) to complete these sentences. Use corticosteroids cautiously in patients with diabetes mellitus as they may ___________________ blood glucose levels. Use of corticosteroids is often avoided in the presence of serious infection such as septicemia, systemic fungal infections, and varicella because these drugs have ____________________________ properties. Use corticosteroids cautiously when treating patients with gastritis, reflux disease, or ulcer disease because these drugs can potentially cause gastric ______________________ Use corticosteroids cautiously in patients with cardiac, renal, and/or liver dysfunction because these drugs can potentially cause ____________________________________. Use corticosteroids cautiously in combination with non-potassium-sparing diuretics because this may cause severe ____________________. Use corticosteroids cautiously in combination with nonsteroidal anti-inflammatory drugs (NSAIDs, such as Aspirin) because both create an increased risk of _____________________.

1. increase 2. immunosuppressant 3. perforation 4. fluid retention and alterations in elimination 5. hypocalcemia and hypokalemia 6. gastric ulcers

Corticosteroids are necessary for various bodily functions. Drag each item at the bottom beneath the proper corticosteroids.

Aldosterone: Anti-inflammatory actions Carbohydrate and protein metabolism Fat metabolism Stress effects Cortisol: Maintenance of serum pH levels Sodium and water resorption

Which statements about adrenal suppression are correct? Select all that apply.

Can result when the adrenal glands stop producing endogenous hormone because of long-term corticosteroid supplementation Possible complication of long-term corticosteroid treatment

Systemically administered glucocorticoids have a wide range of indications. How do these medications differ from one another? Select all that apply.

Degree of salt and water retention they cause Potency Duration of action (short-, intermediate-, and long-acting)

Central Nervous​ ​System

convulsions, headache, vertigo, mood swings

The adrenal gland is part of the endocrine system (pituitary and hypothalamus). Hormones secreted by the adrenal cortex are steroidal hormones called _____________________. Cortisol is a type of corticosteroid called a _________________________, mainly used for its __________________ effects. Aldosterone is a type of corticosteroid called _______________________mainly used for its ______________________________ effects.

corticosteroids glucocorticoid anti-inflammatory mineralocorticoid fluid-electrolyte balancing

Considering the actions of glucocorticoids, the hypersecretion secretion of cortisol will lead to a(n) ____________ in blood pressure and stress effects. Considering the actions of mineralocorticoids, the hypersecretion of aldosterone will lead to a(n) ____________ in water & sodium retention along with a(n) ___________ in potassium.

increase increase decrease

Adverse Effects associated with corticosteroid administration are widespread and can occur in every body system. Try this activity to refresh your knowledge on adverse effects associated with corticosteroid in each of the body systems listed below: OCULAR SYSTEM 1

increased intraocular pressure, glaucoma, cataracts​

Adverse Effects associated with corticosteroid administration are widespread and can occur in every body system. Try this activity to refresh your knowledge on adverse effects associated with corticosteroid in each of the body systems listed below: Musculoskeletal​ System

muscle weakness, loss of muscle mass, osteoporosis​

Gastrointestinal ​System

peptic ulcers, pancreatitis, ulcerative esophagitis, abdominal distension​

Mineralocorticoids impact fluid and electrolyte balance indirectly by ___________ sodium resorption from nephrons into the blood, pulling water and fluid with it. This causes fluid and water ___________ leading to edema, ___________ and increased excretion of potassium and hydrogen in the urine. Glucocorticoids ______________ the inflammatory response indirectly by stabilizing inflammatory cell membranes, __________________ capillary permeability to the inflammatory cells, and decreasing white blood cell migration into the inflamed areas.

promoting retention hypertension inhibit decreasing

Which medication is most commonly used oral systemic synthetic corticosteroid?

Prednisone Prednisone is the used most often, followed by dexamethasone and hydrocortisone. Betamethasone is given to accelerate fetal lung development in cases of premature labor.

Based on your knowledge of corticosteroid function, determine if each of the following are or are not indications for use?

The following are indications for use: Adrenocortical deficiency Cerebral edema Chemotherapy-induced nausea and vomiting (CINV) Gastrointestinal (GI) diseases (such as ulcerative colitis) Exacerbations of chronic respiratory illnesses (such as asthma) Decrease immune response following organ transplantation Treatment of proteinuria

____________ other hormones corticosteroids are ____________________________.

Unlike synthesized as needed Unlike other hormones, corticosteroids are not stored but are synthesized as needed.

The adrenal cortex (outer layer) secretes steroids which are responsible for which biological function?

antiinflammatory actions The adrenal cortex (outer layer) secretes steroids which are responsible for these biological functions: Anti-inflammatory actions, Carbohydrate and protein metabolism, Fat metabolism, Maintenance of normal blood pressure, Stress effects The remaining choices for this question are not bodily functions for which the adrenal cortex is responsible: Hypoglycemic actions, Maintenance of body temperature, Increases urinary output

Addison's disease is caused by the ______________ secretion of adrenocortical hormone, causing symptoms such as weight _____________, for which steroidal anti-inflammatory drugs are used for treatment.

under loss Adrenocortical hormone hyposecretion (undersecretion) causes a condition known as Addison's disease, associated with decreased blood sodium and glucose levels, increased potassium levels, dehydration, and weight loss. The combination of a mineralocorticoid (fludrocortisone) and a glucocorticoid (prednisone) is used for treatment.

Which statements about renal suppression are correct? Select all that apply.

adrenal glands stop producing long term corticosteroid use

Adrenal hormones are necessary for various bodily functions. Based on your knowledge of the actions of cortisol (the major glucocorticoid) and aldosterone (the most important mineralocorticoid), match the corticosteroid to its associated bodily function. Some answers may apply to both columns (hint: cortisol and aldosterone both have functions that affect one of the bodily functions).

cortisol: Maintenance of normal blood pressure (not an option - part of rationale) - Anti-inflammatory actions - Carbohydrate and protein metabolism - Fat metabolism - Stress effects Aldosterone: Maintenance of normal blood pressure ((not an option - part of rationale) - Maintenance of serum sodium levels - Maintenance of serum potassium levels - Maintenance of serum pH levels - Sodium and water resorption

Integumentary​​ System

fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism, urticaria

Cardiovascular​ System

heart failure, edema, hypertension​

Adverse effects associated with corticosteroid administration are widespread and can occur in every body system. The most commonly seen adverse effect in hospitalized patients is:

hyperglycemia

Adverse Effects associated with corticosteroid administration are widespread and can occur in every body system. Try this activity to refresh your knowledge on adverse effects associated with corticosteroid in each of the body systems listed below: Endocrine System

hypothalamic-pituitary-adrenal axis suppression (most serious)​ growth suppression

Systemically administered corticosteroids can interact with many drugs. Based on your knowledge of a corticosteroids' mechanism of action, caution should used when a patient is also taking a non-potassium-sparing loop diuretic because both drug classes can result in an _________________ in the excretion of potassium and other electrolytes in the urine and can lead to severe __________ kalemia.

increase hypo