Long-term Corticosteroid Treatment and Effects
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Questions and Answers

What is the primary action of loop diuretics in the body?

  • Blocking Na+ reabsorption at the loop of Henle (correct)
  • Decreasing the excretion of potassium
  • Increasing blood pressure
  • Enhancing Na+ reabsorption at the loop of Henle

Which of the following is a key consideration when administering loop diuretics?

  • Limit access to toilet facilities to reduce falls
  • Monitor potassium levels closely (correct)
  • Administer in the evening to avoid nocturia
  • Encourage intake of caffeinated beverages to promote diuresis

Which diuretic medication is noted for not causing allergic reactions in patients with sulfonamide allergies?

  • Torsemide (Demadex)
  • Furosemide (Lasix)
  • Ethacrynic Acid (Edecrin) (correct)
  • Bumetanide (Bumex)

What potential side effect arises from the use of potassium-sparing diuretics with potassium supplements?

<p>Hyperkalemia (D)</p> Signup and view all the answers

What should be done before initiating thiazide diuretic therapy?

<p>Baseline measurement of serum electrolytes (C)</p> Signup and view all the answers

What is a significant risk of long-term corticosteroid therapy related to the adrenal glands?

<p>Adrenal atrophy from lack of stimulation (C)</p> Signup and view all the answers

Which of the following should be avoided in patients on long-term corticosteroids?

<p>LIVE vaccines (D)</p> Signup and view all the answers

What is the preferred lab value for diagnosing thyroid disorders?

<p>TSH levels (D)</p> Signup and view all the answers

What adverse effect can result from chronic corticosteroid use?

<p>Suppression of the immune system (D)</p> Signup and view all the answers

Which substance is known to accelerate the metabolism of levothyroxine?

<p>Phenytoin (C)</p> Signup and view all the answers

What can result from the use of high doses of corticosteroids over a short period?

<p>Adrenal atrophy in 2-4 weeks (B)</p> Signup and view all the answers

Which of the following food items can interfere with the pharmacotherapy of hypothyroid disorders?

<p>Cabbage (A)</p> Signup and view all the answers

Patients on anticoagulants should be cautious about using which natural supplement due to potential dangers?

<p>Gingko Biloba (B)</p> Signup and view all the answers

What is a potential effect of Ginkgo-biloba when taken with tricyclic antidepressants?

<p>Risk of Serotonin Syndrome (C)</p> Signup and view all the answers

What effect does Ginseng have on blood sugar levels?

<p>Decreases blood sugar levels (A)</p> Signup and view all the answers

Which herb is known to increase appetite?

<p>St John's Wort (A)</p> Signup and view all the answers

What is a potential risk of consuming large amounts of black licorice over an extended period?

<p>Severe headaches (A)</p> Signup and view all the answers

Which herb is recognized for its ability to decrease anxiety and improve sleep?

<p>Kava Kava (D)</p> Signup and view all the answers

What effect does turmeric have on anticoagulant medications?

<p>Enhances their effectiveness (C)</p> Signup and view all the answers

What hormone does the kidney produce that helps to regulate blood pressure?

<p>Renin (A)</p> Signup and view all the answers

Vitamin C is effective in enhancing which of the following?

<p>Iron absorption (B)</p> Signup and view all the answers

Which herb is known to have a hormone-like effect and should be avoided during pregnancy?

<p>Saw Palmetto (C)</p> Signup and view all the answers

What is the role of Vitamin K in the body?

<p>Synthesizes clotting factors (D)</p> Signup and view all the answers

What is the most common cause of hyperkalemia?

<p>Renal pathology (A)</p> Signup and view all the answers

Which electrolyte is primarily involved in neuromuscular function?

<p>Magnesium (C)</p> Signup and view all the answers

What is the serum level defining hypomagnesemia?

<p>Below 1.7 mmol/L (B)</p> Signup and view all the answers

Which of the following is NOT a common adverse effect of magnesium therapy?

<p>Muscle rigidity (A)</p> Signup and view all the answers

What causes hypocalcemia?

<p>Lack of calcium or vitamin D (C)</p> Signup and view all the answers

What is a key consideration for administering Levodopa?

<p>Take on an empty stomach (C)</p> Signup and view all the answers

Which medication class is most effective in treating Alzheimer's disease symptoms?

<p>Cholinesterase inhibitors (A)</p> Signup and view all the answers

What is a common adverse effect of Donepezil?

<p>Nausea and vomiting (D)</p> Signup and view all the answers

What condition is characterized by symptoms exacerbating and remitting?

<p>Multiple Sclerosis (D)</p> Signup and view all the answers

Which electrolyte's excess can lead to serious cardiac complications?

<p>Calcium (A)</p> Signup and view all the answers

What is a primary goal in treating Parkinson disease?

<p>Restore balance between dopamine and acetylcholine (A)</p> Signup and view all the answers

Which statement is true regarding hypokalemia treatment?

<p>Potassium supplementation may be needed (C)</p> Signup and view all the answers

Which adverse effect is associated with Benztropine?

<p>Sedation (B)</p> Signup and view all the answers

What could be a serious complication of excessive magnesium levels?

<p>Neuromuscular blockade (A)</p> Signup and view all the answers

Flashcards

Loop Diuretics

Powerful medications that block sodium reabsorption in the loop of Henle, increasing urine output and reducing fluid buildup.

Loop Diuretic Considerations

Before giving loop diuretics, assess the patient's health history, monitor vital signs like heart rate and blood pressure, and ensure bathroom accessibility. Monitor for low potassium levels.

Common Loop Diuretics

Bumetanide (Bumex) treats ascites and edema, Ethacrynic Acid (Edecrin) is used when sulfonamide allergy exists, and Torsemide (Demadex) is twice as potent as furosemide.

Thiazide Diuretic Considerations

Encourage water intake instead of alcohol or caffeine. Monitor electrolytes, blood pressure, and fluid balance.

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Potassium-Sparing Diuretics: Interactions

These diuretics can interact negatively with other medications like potassium supplements, ACE inhibitors, and some pain relievers. Monitor for high potassium levels.

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Long-term Steroid Therapy: Adrenal Atrophy

Prolonged corticosteroid use can lead to adrenal gland atrophy due to the lack of stimulation.

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Long-term Steroid Therapy: Live Vaccines

Patients on long-term steroid therapy should avoid live vaccines (attenuated) due to an increased risk of infection.

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Long-term Steroid Therapy: Weight Gain

Patients on long-term steroid therapy need to report any sudden weight gain exceeding 2 pounds in a single day.

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Adverse Effects: Chronic Corticosteroids

Chronic corticosteroid use can lead to various side effects including immune suppression, decreased inflammatory response, GI bleeds, osteoporosis, behavioral changes, and metabolic changes.

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Thyroid Gland Physiology: Feedback Loop

Low blood thyroid hormone levels trigger a negative feedback loop, stimulating the hypothalamus to release TRH (thyrotropin-releasing hormone), which in turn stimulates the pituitary to release TSH (thyroid-stimulating hormone) and finally thyroid hormones (T3 and T4) from the thyroid gland.

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Hypothyroid Diagnosis: TSH Levels

TSH (thyroid-stimulating hormone) is the preferred lab measure for diagnosing thyroid disorders. Low TSH levels indicate normal thyroid function.

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Hypothyroidism Drug Interactions: Phenytoin

Phenytoin can accelerate the metabolism of levothyroxine, potentially decreasing its effectiveness.

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Natural Products: Safety vs Effectiveness

Natural products are not always safer than synthetic drugs. Some active ingredients in natural products can be as potent as prescription or over-the-counter medications and may trigger allergic reactions.

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Ginseng Effects

Ginseng can decrease blood sugar, stress, blood pressure, and sexual dysfunction. It can also increase energy levels.

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Ginkgo Biloba Effects

Ginkgo biloba acts as an antioxidant, increases blood flow and memory, and can lower blood pressure.

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Black Licorice Interactions

Large amounts of black licorice (4 weeks or more) can be dangerous and lead to headaches, increased blood pressure, and low potassium.

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Ginger Effects

Ginger can reduce nausea, IBS symptoms, stomach issues, and inflammation. It can also increase the effects of anticoagulants.

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Feverfew Effects

Feverfew can decrease fever, inflammation, migraines, nausea, vomiting, tinnitus, and blood pressure. It can also increase the effects of anticoagulants and NSAIDs.

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Garlic Effects

Garlic thins blood, increases immunity, and enhances anticoagulants. It can also reduce cholesterol levels.

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Valerian Effects

Valerian is used for sleep disorders, anxiety, and can lower blood pressure. It can also increase the effects of CNS depressants.

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Kava Kava Effects

Kava Kava is used for sleeping problems, stress, anxiety, and can relax muscles. It can also increase the effects of CNS depressants.

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St. John's Wort Effects

St. John's Wort can decrease depression and anxiety, and improve sleep. It can also increase appetite and the effects of CNS depressants.

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Melatonin Effects

Melatonin can decrease insomnia and enhance antidepressant effects of certain medications. Calcium channel blockers can decrease melatonin production.

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Fluid Imbalance

An imbalance between fluid intake and output that can lead to disorders such as shock and dehydration.

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Electrolytes

Charged substances (positive or negative) essential for maintaining body functions.

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Hypernatremia

High sodium levels in the blood, often caused by dehydration or excessive sodium intake.

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Hypokalemia

Low potassium levels in the blood, frequently caused by diuretics or insufficient potassium intake.

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Hyperkalemia

High potassium levels in the blood, often caused by kidney problems or excessive potassium intake.

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Hypomagnesemia

Low magnesium levels in the blood, often caused by kidney issues or diuretics.

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Hypermagnesemia

High magnesium levels in the blood, typically caused by kidney failure.

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Hypercalcemia

High calcium levels in the blood, often caused by overactive parathyroid glands.

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Hypocalcemia

Low calcium levels in the blood, often caused by lack of calcium or vitamin D, hypothyroidism, or certain medications.

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Neurodegenerative Diseases

Progressive, irreversible loss of neurons affecting various brain functions. Examples include Alzheimer's disease and Parkinson's disease.

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Pharmacotherapy of Parkinson's Disease

Treatment aiming to balance dopamine and acetylcholine in the brain. There's no cure, but medications can help manage symptoms.

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Dopamine Agonists

Medications that increase dopamine levels in the brain by replacing dopamine, decreasing its breakdown, or enhancing its release and effects.

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Anticholinergic Drugs

Medications that block the action of acetylcholine in the brain to reduce involuntary muscle movements.

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Muscle Spasms

Sudden, involuntary muscle contractions that can be painful and debilitating.

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Muscle Spasticity

A sustained, involuntary muscle contraction resulting in stiffness and rigidity. It is often caused by neuromuscular disorders.

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Study Notes

Long-term Corticosteroid Treatment

  • Corticosteroids suppress inflammation and the immune response.
  • Long-term use can lead to adrenal atrophy.
  • Patients should avoid live vaccines.
  • Weight gain of more than 2 pounds in one day is a potential adverse effect.
  • Oral route is generally preferred for chronic conditions.
  • High doses lead to faster adrenal atrophy (2-4 weeks).

Adverse Effects of Chronic Corticosteroids

  • Weakened immune system.
  • Reduced inflammatory responses.
  • Increased risk of stomach ulcers and bleeding.
  • Osteoporosis.
  • Behavioral changes.
  • Metabolic changes and fluid retention.

Replacement Therapy with Glucocorticoids - Drug Interactions

  • Interactions with potassium-wasting drugs and anticholinesterase agents.
  • Avoid live vaccines.
  • Toxoids should be used with caution.
  • Insulin and oral medications like senna, cascara, and buckthorn may have increased effects while certain medications (e.g., salicylates, barbiturates, phenytoin, rifampim) have decreased effectiveness.

Physiology of the Thyroid Gland

  • Low blood levels trigger a negative feedback loop.
  • Hypothalamus releases TRH (thyrotropin-releasing hormone).
  • Anterior Pituitary releases TSH (thyroid stimulating hormone).
  • Thyroid releases T3 and T4 hormones.

Diagnosis of Thyroid Disorders

  • TSH is the preferred lab value.
  • Low TSH is generally considered good.
  • Primary hypothyroidism is associated with low serum T4 and elevated TSH levels.
  • Hashimoto's thyroiditis is indicated by abnormal levels of antithyroid antibodies.

Pharmacotherapy of Hypothyroid Disorders - Drug Interactions

  • Phenytoin accelerates the metabolism of levothyroxine.

Pharmacotherapy of Hypothyroid Disorders - Food Interactions

  • Soy flour, walnuts, and fiber-rich foods may interact with levothyroxine.
  • Foods containing calcium and iron should also be considered.

Natural Remedies and Drug Interactions

  • Certain natural products may have similar effects as some prescription medications, potentially leading to allergic reactions.
  • Natural products should not be assumed to have fewer side effects.
  • Consideration should be given for possible drug interactions with prescription medications.
  • Natural remedies may decrease or increase the effectiveness of specific prescription drugs.

Ginkgo Biloba and Anticoagulants

  • Ginkgo Biloba can pose risks for patients taking anticoagulants due to its flavonoid content.

Herb-Drug Interactions (General)

  • Many herbs interact with various medications.
  • Information regarding specific interactions needs to be referenced as they vary based on the herb and medication.
  • Potential for interactions with blood thinners, blood pressure medications, and others exists.

Principles of Fluid Imbalance

  • Fluid continuously circulates between intracellular and extracellular spaces.
  • Balance between fluid intake and output is essential for homeostasis.
  • Electrolytes (mineral ions) are crucial for body functions.
  • Imbalances in electrolytes or fluid levels can indicate underlying health conditions.

Electrolyte Imbalances (K+, Ca2+, Mag2+)

  • Excessive or insufficient levels of potassium, calcium, or magnesium can cause various health issues.
  • Medications and medical conditions influence these electrolyte levels.
  • Monitoring electrolyte levels is essential for preventing complications.

Pharmacotherapy of Electrolyte Imbalances

  • Treatment addresses the underlying cause and restores balance.
  • Adverse effects of medications should be reviewed for potential complications.

Hypomagnesemia and Hypermagnesemia

  • Low or high magnesium levels have various causes and potential complications.

Hypercalcemia and Hypocalcemia

  • High or low calcium levels have several causes and various complications
  • Medications and pathophysiology should be considered

Pharmacotherapy of Parkinson's Disease

  • Drugs aim to balance dopamine and acetylcholine.
  • Treatment may take several weeks to show benefits.
  • Dopamine agonists increase available dopamine.

Benztropine - Adverse Effects, Contraindications, and Interactions

  • Common effects like sedation and constipation should be considered.
  • Possible risks of conditions, such as closed-angle glaucoma or GI obstructions

Multiple Sclerosis

  • Demyelination is the central factor characterized by inflammatory responses.
  • Characterized by periods of exacerbation and remission.
  • Muscle spasms are commonly treated with NSAIDs and muscle relaxants.
  • Spasticity, characterized by continuous muscle contraction.

Cholinesterase Inhibitors (e.g., Donepezil)

  • Donepezil aims to raise acetylcholine levels in the brain.
  • Side effects often involve the GI system, such as nausea, vomiting, and diarrhoea.
  • Potential for muscle cramps, syncope, and other adverse affects also exist

Liver Function Tests and Non-Pharmacologic Therapies

  • Liver function tests are conducted for individuals under treatment.
  • Non-pharmacologic therapies such as physical therapy, herbal supplements (with caution), and B-complex vitamins (specifically B6) are considered adjuncts.

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This quiz covers the essential aspects of long-term corticosteroid treatment, including its mechanisms, adverse effects, and critical interactions with other drugs. It highlights the importance of monitoring and managing side effects associated with chronic use. Test your knowledge on the implications of glucocorticoid replacement therapy.

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