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NURS 350 ADULT 1; MODULE 2 EXAM 1 QUESTIONS AND ANSWERS
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NURS 350 ADULT 1; MODULE 2 EXAM 1QUESTIONS AND ANSWERS
Corticosteroid
steroid hormone produced by the adrenal cortex; examples include
androgens, glucocorticoids, and mineralocorticoids
Corticosteroid Meds
Exogenous corticosteroids, or glucocorticoids, are administered to treat
disorders of the adrenal cortex or endocrine system. The administration of
corticosteroids decreases the inflammatory symptoms and alters the immune
response produced by nonendocrine disorders. People once viewed
hydrocortisone, a short-acting corticosteroid and an exogenous equivalent of
endogenous cortisol, as the prototype corticosteroid drug.
Now, they consider prednisone, an intermediate-acting corticosteroid, to be the
prototype corticosteroid.
Corticosteroid Meds: Prototype
prednisone
use
Corticosteroids are administered to control symptoms but do not cure
underlying disease processes. They are extensively used to treat many different
disorders. Except for replace-ment therapy in deficiency states, the use of
corticosteroids is largely empiric. Because the drugs 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.
Corticosteroid Meds: Prototype
prednisone
General Indications
,The corticosteroids discussed in this chapter are used to treat potentially serious
or disabling disorders, including the following:
●● Allergic or hypersensitivity disorders, such as allergic reac-tions to drugs,
serum and blood transfusions, and dermato-ses with an allergic component
●● Collagen disorders, such as systemic lupus erythematosus, scleroderma, and
periarteritis nodosa. Collagen is the basic structural protein of connective tissue,
tendons, cartilage, and bone, and it is therefore present in almost all body tissues
and organ systems. The collagen disorders are characterized by inflammation of
various body tissues. Signs and symptoms depend on which body tissues or
organs are affected and the severity of the inflammatory process.
●● Dermatologic disorders that may be treated with systemic corticosteroids
include acute contact dermatitis, erythema multiforme, herpes zoster
(prophylaxis of postherpetic neu-ralgia), lichen planus, pemphigus, skin rashes
caused by drugs, and toxic epidermal necrolysis. Corticosteroid prepa-rations
that are applied topically in dermatologic disorders are discussed in Chapter 61.
●● Endocrine disorders, such as adrenocortical insufficiency and congenital
adrenal hyperplasia. Corticosteroids are given to replace or substitute for the
natural hormones (both glucocorticoids and mineralocorticoids) in cases of
insufficiency and to suppress corticotropin when excess secretion causes
adrenal hyperplasia. These conditions are rare and account for a small
percentage of corticosteroid use.
●● GI disorders, such as ulcerative colitis and regional enteritis (Crohn’s
disease)
●● Hematologic (blood) disorders, such as idiopathic thrombocytopenic
purpura or acquired hemolytic anemia
●● Hepatic (liver) disorders characterized by edema, such as cirrhosis and
ascites
●● Neoplastic disease, such as acute and chronic leukemias, Hodgkin’s disease,
other lymphomas, and multiple myeloma (see later discussion)
●● Neurologic conditions, such as cerebral edema, brain tumor, acute spinal
cord injury (see later discussion), and myasthe-nia gravis
,●● Ophthalmic disorders, such as optic neuritis, sympathetic ophthalmia, and
chorioretinitis. Corticosteroid preparations that are applied topically in
ophthalmologic disorders are dis-cussed in Chapter 59.
●● Organ or tissue transplants and grafts (e.g., kidney, heart, bone marrow).
Corticosteroids suppress cellular and humoral immune responses (see Chap. 13)
and help prevent rejection of transplanted tissue. Drug therapy is usually
continued as long as the transplanted tissue is in place.
●● Renal disorders characterized by edema, such as the nephrotic syndrome
●● Respiratory disorders, such as asthma, status asthmaticus, chronic
obstructive pulmonary disease (COPD), and inflam-matory disorders of nasal
mucosa (rhinitis)
●● Rheumatic disorders, such as ankylosing spondylitis, acute and chronic
bursitis, acute gouty arthritis, rheumatoid arthri-tis, and osteoarthritis
●● Shock. Corticosteroids are clearly indicated only for shock resulting
from addisonian crisis (also known as adrenal or adrenocortical insufficiency),
which may mimic hypovolemic or septic shock. The use of corticosteroids in
septic shock has been highly controversial, and randomized studies and meta-
analyses have indicated that corticosteroids are not beneficial in treating septic
shock. However, more recent small studies indicate possible clinical usefulness
in septic shock, because this form of shock may be associated with relative
adrenal insufficiency. In anaphylactic shock resulting from an allergic reaction,
corticosteroids may increase or restore cardiovascu-lar responsiveness to
adrenergic drugs.
Corticosteroid Meds: Prototype
prednisone
Specific Uses
Allergic rhitinis
Arthritis
Asthma
Cancer
, Chronic Induced Emesis
Inflammatory Bowel disease
spinal Cord Injury
Prevention of Acute Adrenocortical Insufficiency
Corticosteroid Meds: Prototype
prednisone
Asthma
Corticosteroids are commonly used in the treatment of asthma 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-adren-ergic
bronchodilating drugs. Research indicates that responsive-ness to beta-
adrenergic bronchodilators increases within 2 hours and that numbers of beta
receptors increase within 4 hours.
In acute asthma or status asthmaticus unrelieved by inhaled beta-adrenergic
bronchodilators, high doses of systemic cortico-steroids are given orally or
intravenously along with bronchodi-lators for approximately 5 to 10
days. Although these high doses suppress the HPA axis, the suppression lasts
for only 1 to 3 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. People who regularly use inhaled corticosteroids also
require high doses of systemic drugs dur-ing acute attacks because aerosols are
not effective. As soon as acute symptoms subside, it is necessary to taper the
dose; people should take the lowest effective maintenance dose or discon-tinue
the drug. In chronic asthma, inhaled corticosteroids are the drugs of first choice.
This recommendation evolved from increased knowledge about the importance
of inflammation in the pathophysiology of asthma and the development of
aerosol corticosteroids that are effective with minimal adverse effects.
Inhaled drugs may be given alone or with systemic drugs. In general, inhaled
corticosteroids can replace oral drugs when daily dosage of the oral drug has
been tapered to 10 to 15 mg of prednisone or the equivalent. When a patient is
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