Corticosteroids – NCLEX Review (Nursing)

00:00 So, corticosteroids are a class of steroid hormones that are produced in the cortex.

00:05 You already underlined that so you know it.

00:07 We've gotta hear both cort and pink in the top and in the bottom, to remind you.

00:12 Now, here's another list. Wait a minute. Haven't we talked about these? Absolutely. But here's your chance on this slide to start looking at other ways that you want to group or chunk this information.

00:25 You are the expert in your brain, and what makes things stick.

00:30 And I don't recommend trying to go up with a long sentence with the first letter of each one.

00:34 There's only so many of those that can be effective.

00:37 You want to be careful what you choose to use those for.

00:40 But in this case, just pause for a minute, play around with what you see here, and see if you wanna group some things together in the way that's most effective for you to remember.

00:49 Now, we know that we're talking about the hypothalamus to the anterior pituitary to the adrenal glands.

00:56 Why does she keep saying that? Because I know that repetition with intention is really important in helping you retain and recall information.

01:07 So, now, we're gonna line things up side to side.

01:09 Hypothalamus releases CRH. Why? Because it sensed that we need extra corticosteroids.

01:17 Your body doesn't have enough corticosteroids.

01:20 Because it's taking up information all the time.

01:23 It's responding to input that it receives and it knows we need more corticosteroids.

01:28 So, it sends out CRH that stands for corticotropin-releasing hormone.

01:35 Now, what is the target of CRH? It's the quarter back or the anterior pituitary.

01:42 When CRH hits the anterior pituitary, the anterior pituitary will send out adrenocorticotropic hormone.

01:51 Write that word down, adreno, that's adreno gland; cortico, cortex, hormone.

01:58 That means it's a chemical messenger.

02:01 So, adreno gland is a target; specifically, the adrenal cortex.

02:06 Tropic just means, hey, make some, put it out.

02:09 So, we've gone from CRH to ACTH.

02:12 You've got the target organ being the anterior pituitary.

02:16 Now, the anterior pituitary being the quarterback is gonna throw the ball down the field.

02:21 So, its target organ is going to be, right, the receiver in this case is the adrenal gland.

02:28 Specifically, the adrenal cortex, and then it will release cortisol and aldosterone. You got it? Okay, so, you know how that goes through. Pause for just a minute. Make sure you're very clear.

02:42 See, it's one thing to follow along with me, but it's more important that you can do it when we are not together.

02:49 Okay, now, there's two types of corticosteroids, right? We know we have the mineralocorticoids and the glucocorticoids.

02:59 Both have C-O-R-T in the middle, that's a great reminder that they come from the adrenal cortex.

03:06 So, if I have a healthy and functioning adrenal cortex, I've got -- hypothalamus is doing well, anterior pituitary is doing well, everything should flow smoothly.

03:17 But there's problems, so sometimes those glands are struggling or I'm adding additional corticosteroids to a patient's body by giving them corticosteroids as a medication.

03:28 So, let's look at what these two types are.

03:31 Mineralocorticoids, an example is aldosterone, well, aldosterone's job is to tell your body, your kidneys, hang on to sodium.

03:40 Where sodium goes, what follows? Right, water.

03:45 Now, looking at glucocorticoids, like cortisol.

03:49 That's a different type of function.

03:51 So, have in your mind, we've got two parts to the adrenal gland, and then we have two types of corticosteroids that come from the cortex, mineralocorticoids and glucocorticoids.

04:03 Now, the adrenal cortex releases mainly cortisol. Pause.

04:09 So, the adrenal cortex releases mainly what? Right. Cortisol.

04:14 But it also does have aldosterone. Obviously that we need that to keep it.

04:19 Now, aldosterone might sound familiar to you from the rest.

04:22 Right, the renin angiontensin aldosterone syndrome -- Yes, that's one of the substances when you end up with angiontensin II that is stimulated to be released.

04:33 That's when you also increase volume and raise your blood pressure.

04:37 So, file that away and you see how these systems kind of interact but this comes from the corticosteroids.

04:44 Now, aldosterone promotes sodium and retention so I have increased volume.

04:50 But cortisol, this is the one that usually comes out in a higher grouping then from the adrenal cortex.

04:56 And when we're going for medications, we're definitely shooting for these effects.

05:01 Now, it impacts carb, fat, and protein metabolism. That's not what we're going for.

05:06 What we're going for is its anti-inflammatory processes.

05:10 So, we want to give cortisol mainly because we're trying to slow down or suppress inflammation in your patient's body.

05:19 But all this other stuff comes with it.

05:22 It also prevents phospholipid release and it decreases eosinophil activity.

05:26 Well, I wanna stop, I don't wanna be as inflamed but it takes some things to make that happen.

05:32 Decreasing eosinophil action, that's another word for white blood cells, right? That's a kind of white blood cell.

05:40 So, when I give cortisol, I'm gonna decrease the action of the eosinophils meaning I'm suppressing inflammation but I'm also making it harder for patients to fight off infection. Right.

05:52 So, have clear in your mind, corticosteroids, two types: we're thinking of examples are aldosterone and cortisol.

06:02 So, usually, we're giving it for the cortisol effect, we want the anti-inflammatory but those other three things come with it.

06:11 Now, when we start talking about side effect from head to toe, it's gonna make sense glucose goes up. Look at one of the four.

06:19 Right, it's gonna make sense why someone has a hard time fighting off infection.

06:25 It's gonna make sense how these other processes are impacted because this is what cortisol does in the body when everything's imbalanced.

06:33 But when we give corticosteroids as a medication, it's not that same balance.

06:39 Now, I like to call this the sugar daddy syndrome and this is a really important thing.

06:43 Kind of a silly name, I know.

06:45 Cuz when you have a sugar daddy, you don't really have to work, right? Everything is taken care of for you. Same thing happens to the adrenal gland.

06:54 If your patient has been on the high-dose steroids for just even over a week, they'll start to experience some level of adrenal gland suppression.

07:03 Now, based on what we've already talked about, you know that when the hypothalamus senses a need for corticosteroids, it'll send out CRH which then sends out ACTH from the pituitary down to the adrenal glands.

07:15 But see, when we're giving the patient a medication, when we're giving them corticosteroids, there's no reason for the hypothalamus to recognize that we need more corticosteroids because we don't.

07:28 We're artificially elevating that level by giving the patient medications.

07:32 So, the hypothalamus doesn't send out CRH that means the anterior pituitary is not sending ACTH, so the adrenal gland isn't getting stimulated. And it becomes kind of lazier, suppressed.

07:44 So, that's why it's really important that you help patients understand that that their adrenal gland can start to become suppressed.

07:52 Now, with an oral dose or an IV dose, the impact is gonna be much more significant than say in an inhaled route.

08:00 If you had an asthmatic patient who's taking an inhaler that had a corticosteroid in it, that's gonna go directly to the lungs and you're not gonna see a severe of the systemic side effects as you would with an oral or IV dose.

08:14 That's across the board for any medication.

08:17 I mean for giving oral or IV doses of medication, you're more risk for systemic side effects.

08:22 So, back to the sugar daddy syndrome.

08:25 We've got high dose steroids for greater than a week, you can start to see a little bit of this.

08:29 The adrenal glands are suppressed, because they're not being stimulated.

08:32 So, you don't have the CRH and the ACTH to stimulate them.

08:36 If this goes on for a long period of time, then the adrenal gland is gonna be atrophy.

08:42 So is gonna be so suppressed, it can't work anymore.

08:46 So, even with a small amount of adrenal gland suppression, it can take a while for that adrenal gland to recover.

08:53 So, this patient would be at risk for adrenal insufficiency in stress because my adrenal gland is part of the process that responds to stress.

09:02 So, if it's gotten lazy, because it hasn't been stimulated, it's not gonna be able to respond if the body needs something in a period of stress.

09:11 So, how do we keep a patient safe with this information? Well, I want you to think about it and we'll talk about it a little later.

09:20 But what are the things you would want to teach a patient? How would you recognize the importance of this information in keeping your patient safe? Okay, we're ready to try a quick quiz now.

09:32 So, without looking at your notes, see if you can do the following.

09:35 Match the hormone with the endocrine player.

09:38 Just draw a line from the player to the hormone.

09:46 Okay, now's your chance to really step up and test yourself.

09:49 How would you use the information when you're teaching a patient how would you can keep them safe by teaching them about not stopping corticosteroids abruptly? Now, you've had a moment to think about it. Let's talk through the answer.

10:11 We've talked about adrenal gland suppression.

10:14 What happens is if the patient has been on the higher doses for a longer period of time, that adrenal gland gets lazy, right? There's no stimulation for it to put out the steroids.

10:24 So, it becomes lazy. There's a process we call weaning and this is why you don't just abruptly stop corticosteroids, you wean them.

10:33 So, we'll have doses be less and less; we start giving them on alternate days.

10:38 So, a healthcare provider will make a very specific plan on how to wean the medications but it's important that you help the patient understand why this matters.

10:49 If the adrenal gland has been suppressed for a long period of time and the patient just stops taking corticosteroids; either the adrenal gland can't respond fast enough or can't respond at all, they're gonna find themselves in an Addisonian crisis.

11:05 Their body will act like someone whose adrenal gland has just been trashed and can't respond.

11:11 So, it's vitally important your patient understands that they don't just abruptly stop taking this medication, they need to consult their healthcare provider.

11:20 And if the healthcare provider's already written out orders, you really need to work with the patient to make sure they understand.

11:26 I get a piece of fresh clean paper, and I'll write out a calendar, and I'll let them know on this day you take this dose, and on this day, and how it weans down from there.

11:38 Every other day medications, don't assume that it makes sense to your patient.

11:42 We deal with physicians all the time, they don't necessarily.

11:46 So, you wanna make sure it's very clear for them, the safest way of following their healthcare provider's orders.