okay i want to pause
right here because this is a critically
important point
to your patient's safety anyone who's
taking corticosteroid therapy
has a risk for adrenal gland suppression
now we'll talk about some real specific
risks in that but i want you to stop
for just a moment because this is the
most
important point that we're going to talk
about in dealing with corticosteroids
see i've got a silly name up there but
this is really very serious
because when i give extra
corticosteroids to the patient
like i give them a medication we
radically change what's going on in
their body
remember when we talked about how things
went from the hypothalamus
to the anterior pituitary to the adrenal
gland right
you've got the coach the quarterback and
the receiver
now if i start giving you extra
corticosteroids
that hypothalamus is not going to feel
the need to send crh
to the anterior pituitary right so then
the anterior pituitary
since it not it's not receiving crh is
not going to have the stimulus to send
acth to the adrenal cortex
so what's the adrenal cortex doing the
answer
nothing and the higher the level
of the corticosteroids are the longer
the patient is on those doses
the more likely the gland is to become
suppressed
because he's just not being stimulated
the coach sees no reason to send in crh
hypothalamus doesn't send in acth the
adrenal gland is not stimulated to put
out its hormones
so it just becomes really sleepy
or suppressed this is the point
that you cannot go on until you have
this solid
in your mind anytime we add steroids to
a patient
we put them at a small risk or even a
significant risk
of adrenal gland suppression so
these changes can start happening just
within the first
week of high-dose steroids now stop i
don't
want to freak you out if someone sends
you home with a solu medrol dose back i
don't want you to think like oh my
goodness
i don't want to take those no no these
are high dose steroids for greater than
a week
we'll start to see some small changes
remember it takes time for the adrenal
gland to really become suppressed
but you will start seeing those changes
the beginning of that
in just about a little over a week if
it's high enough
steroids so you'll have less crh
in acth right those are suppressed
because
hypothalamus doesn't see any reason to
send crh down
so then the anterior pituitary won't see
any reason to send acth
out that's why crh and acth
are suppressed now the longer
that adrenal gland is suppressed the
longer it doesn't receive that acth
the gland almost becomes atrophied right
it
it might come to the point where we
can't bring it back
now most often if the patient is on
corticosteroids for a period of time and
it's high enough dose that they
experience adrenal gland suppression
their adrenal gland will come back but
it's not overnight
it could even take up to months keep in
mind
i'm giving you the worst case scenarios
this doesn't happen to everyone but we
always want you to be aware of what the
worst case scenario is
so you can be alert and catch the early
signs
now the problem when my adrenal gland is
suppressed
and i go under stress i need more of
those
hormones so if you have a client
who's taking corticosteroids the dosage
may need to be adjusted if they're
experiencing
significant stress so
silly name serious problem because you
know
sugar daddy you don't have to do
anything but just
be available that's why i call it the
sugar daddy syndrome
when we give you medications all the
responsibilities of the adrenal gland
are removed right
they don't have to put anything out
because i've replaced it with a
medication
that's why they're at risk for adrenal
gland suppression
so takeaway point here after
all of that is that you have to write
very clear and specific instructions for
a patient
when they're going to be weaning off
steroids you don't want to abruptly stop
them
you want to make sure that you wean them
gradually off
and we make sure that we give the
patient very specific instructions
on how they'll do that either they'll
decrease the dosage or the number of
pills or
however that works we will need to
communicate a
very clear plan on how your patient will
walk through that process
okay now that's been a lot of
information let's see where you are
we're going to study as you go
see if you can answer these questions i
want you to match the hormone
with the endocrine player just draw a
line from the player
to the hormone
okay now here's nurse natalie to help
you kind of have a pre-test question
you're gonna have to pause the video and
really think about this
but how would you help keep a patient
safe
by teaching them about not stopping
corticosteroids abruptly
so use language that would be
appropriate for a patient
to communicate how would you teach them
why this is
so important okay so let's
wrap up what we've discussed about
corticosteroids
first of all corticosteroids are
produced in the adrenal
cortex now when we give patients
corticosteroids as medications
they have higher levels than normal and
their adrenal gland
might start to be suppressed the higher
the dose
the longer the therapy the greater the
risk of adrenal gland suppression
and remember oral corticosteroids or iv
corticosteroids have an even greater
risk than a topical corticosteroid or an
inhaled corticosteroid
now critically important that you
understand
why we don't abruptly stop
corticosteroid therapy
and how you teach your patients why we
don't abruptly stop
corticosteroid therapy now when we say
wean
we gave you a quick question on how
would you teach a patient
here's how i want you to kind of
remember some important points
think about it being a weekend you know
that feeling when you're all asleep and
you're warm and snug and you don't have
to do
anything how do you like to be woke up
i like to wake up when i'm ready right
when i feel like it when i just kind of
roll over and stretch
that's how i like to start the day so
does your adrenal gland
nobody likes to wake up like this
nobody likes that so when we talk about
weaning
that's what you want to do with your
patients you want to wake up like this
nice slow and gentle
that's why we start slowly reducing the
amount of medication that we're giving
the patient
so you kind of just nudge that little
adrenal gland
you kind of let it know hey we need you
to wake up gently
and start working again not the
of an alarm clock so when you're weaning
medications it's important as we slowly
decrease the medication
give that adrenal gland time to gently
wake up
and start doing what it normally needs
to do
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you