1. Negative feedback
    why important because we have enough cortisol (either body is making it or we are given it) the negative feedback tells the body u have enough cortisol

    a pt who stops taking cortisol or d/c abruptly wont have it in their system for days.
  2. AP reveiw
    • Physiologival effects
    • low doses
    • there effects mimics the body's normal function. the effects involves water balance (aldosterone), CV stability, metabolism
    • usually doses to treat endocrine disorder

    • Pharmacological effects
    • - High dose
    • -acute care setting
    • - treat inflammation and suppress the immune system.
  3. Effects of Glucociticoids
    what it does in the body
    • Metabolic effects
    • Carbs metabolism
    • - elev glucose level
    • - makes glucose more available
    • - gluconeogenesis- making glucose out of protein and fat
    • - raises BS level- monitor blood sugars 

    • Protein Metabolism
    • - inhibits protein synthesis
    • - protein gets broken down faster
    • - glucose synthesis
    • - thinning of skin, poor wound healing, poor tugor, more at risk for breakdown, lack muscle

    • Fat metabolism
    • - stimulates lipolysis- break down of fat
    • - moon face, buffalo hump disposit between the shoulder blades, trunk obesity (big in the middle), tend to have skinny arms and legs (bc loss of protein)

  4. Other effects (what is does in the body)
    CV, Stress
    • CV
    • - helps to maintain the vascular system
    • - vasoconstriction
    • - increase the # of circulating RBC, neutrophils, lymphocytes monocytes

    • Stress response
    • - adrenal cortex release cortisol which then releases glucose (to bring down stress). stimulates adrenal medulla which secretes NE and epinephrine- which causes ur BP and HR to go to meet the stress
    • adrenal cortex/medulla- works together during time of stress
  5. Other effects
    H2O and lytes
    Anti inflammatory
    • H2O and Lytes balance
    • - all glucorcoids have a mineralcorticoid action- aldosterone reabsorp. H2O and Na
    • - excrete K
    • - loses Ca

    • CNS
    • - cross into the brain blood barrier
    • - affect neuronal activity
    • - mood changes 
    • - irrability

    • anti inflammatory
    • - reverses steps of inflammation
    • - high doses
  6. Anti Inflammatory
    • interferes with biosynthesis, storafe and release of substance the relation to inflammation (histamine, prostagladins, leuktrine)
    • - stabalizes lysosmal membrane to keep the substance from coming out.
    • - suspension of leukocytes migration and phagocytosis (decreases edema and swollen
    • - decrease antibody formation
    • - inhibits fibroblast and collegan deposit- decre wound healing
    • - inhibits capillary dilation and permeability- vasoconstricts (does allow cell contents to leak out)

    • S.s of inflammation- red, swollen hot, we reverse this
    • -
  7. Why do use CI
    • - replacement therapy for adrenal deficiency- addison disease
    • - anti inflammatory effects- inflammation of bowel, bronchitis, COPD, ashma, 
    • - immunosuppressive agents- to help with not rejecting organ transplant
    • - control symptoms of allergic reaction- does not stop the allergy but stops the symptoms related to it.
  8. Dosage guidelines
    the objective for most pts is relieve symptoms to acceptable level, complete relief may not be goal. 

    high dose

    control the level so pt can be comfy but may not be a cure. 

    usually start low and titrate up and slowly titrate down- allows the body to say i don't have enough cortisol...

    at times of stress may need to be increased. 

    admin at scheduled time- follow body arcardian level- follow body secretion of cortisol- peaks in the am 6-8am (best time before 9am)

    • Day therapy used primarily for children
    • - decrease adrenal insufficiency- bc it allows body time to make cortisol
    • - decreas the risk of growth retardation (effects long bones and muscles, alters protein synthesis)- impact wt/h
    • - decrease risk of toxicity
    • -
  9. abrupt withdrawl
    • can result in adrenal insufficiency (no cortisol in the body)
    • - hypoglycemia 
    • - hypotension
    • - myalgia, arthralgia - muscle/joint pain
  10. Adverse Effects
    • Adrenal insufficiency 
    • infection- poor healing. lower immune system (no s.s of infection- monitor closely, maybe on antibiotic) (bc anti inflammation)- thrush
    • PUD- decre prostagla
    • osteoporosis- long term- decre absorption of Ca. fracture of vertebrae, ribs- give Ca supplements and Vit D.
    • Growth retardation- alternate day therapy
  11. Adverse effect more
    Glucose intolerance- incre BS (on R insulin)

    myopathy- muscle weakness- breakdown protein

    Cartaracts- long term use- cloudiness in the lens

    Psychological changes mood changes

    Cutaneous changes- poor wound healing, skin thinning
  12. Other adverse effect 3
    `Negative nitrogen balance- breaking down protein faster

    Iatrogenic Cushing Syndrome- increase cortisol (moon face etc, edema in feet, poor wound healthing)

    Fluid and Lytes imbalance- Na and H2O retension- edema, decre Ca- at risk for osteoporosis

    Hyperlipdemia- incre lipids , HTN (antihypertesion and anti lipid)
  13. NI
    • Comprehensiove pt assessent
    • pt teaching- esp step dosing/guidelines
    • drug interactions
    • contraindication
    • safety needs and assessments
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